Academic medicine : journal of the Association of American Medical Colleges
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Randomized Controlled Trial Clinical Trial
Determining the effectiveness of a clinical-practice intervention in improving the control of pain in outpatients with cancer.
To determine the effectiveness of a clinical-practice intervention in improving the control of pain in outpatients with cancer. ⋯ Although analgesic regimens were altered significantly when the physicians understood more about the patient's pain, cancer pain management remains a complex problem. Future studies should focus on the long-term systematic incorporation of simple pain-assessment tools into daily outpatient oncology practices as well as on innovative ways to address other aspects of managing cancer pain.
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The authors examined the operational meaning of the 48 items that state the accreditation standards for teaching, learning, and evaluation in medical school, and determined the extent to which these standards were applied by schools and by on-site evaluators for 59 programs surveyed by the Liaison Committee on Medical Education (LCME) in 1994-1996. In this study, "application" meant that evidence was offered, not necessarily that it proved compliance with the standard. The data sources employed were the medical education databases and self-studies prepared by schools undergoing accreditation surveys, and the reports prepared by ad hoc teams of surveyors. ⋯ The authors argue that many of the standards given scant attention on surveys are important to educational program development and quality control. The LCME will need to consider whether more prominent definition and highlighting should be given to neglected standards, or whether some of the requirements are at the margin as quality indicators. A planned survey of communities of interest-educators, practitioners, students, graduates, and residency program directors, among others-may help confirm
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The Generalist Physician Initiative (GPI) was created by The Robert Wood Johnson Foundation to help medical schools increase the number of predoctoral and residency graduates entering generalist careers. The underlying assumption of the GPI is that more medical graduates will become generalists if schools select candidates whose personal characteristics are compatible with generalist careers and if schools provide for them an educational environment that values generalist careers in the same manner it has valued specialist careers. In essence, the GPI is helping schools modify the culture in which medical education occurs so that they may increase their production of generalists. ⋯ Most schools have developed external partners (e.g., state legislatures, managed care organizations, area health education centers) to assist in achieving their goals. The project is now (1997) at its halfway mark. This article describes the conceptual bases for the program (e.g., changes in admission criteria to favor applicants oriented to generalism), identifies common approaches to intervention chosen by the participating schools (e.g., establishing longitudinal, generalist-oriented clinical experiences throughout the four years of medical school), and explores issues being faced by the schools as they implement change (e.g., difficulties in decentralizing clinical education to include community physicians as teachers and role models).