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This is the third of a three-part series reporting a national survey of general practice residency directors and their evaluation of the medical risk assessment (MRA) instruction curriculum in their programs. The purpose of Part III was to report the program directors' narrative comments in response to six essay-style questions regarding problems, suggestions, and innovations encountered in their efforts. Availability of physician faculty was the most frequently mentioned problem in providing MRA instruction for general practice residents. Defining and communicating goals and objectives were also of major concern. Proposed solutions included attempts to recruit additional physician faculty and improved supervision and management of program activities, especially off-service rotations. There was no consensus as to what future modifications the Commission on Dental Accreditation should make in its approach to teaching MRA as defined in Standard 14. The majority of responses indicated a desire to decrease total experience, especially in physical examination requirements other than head and neck.

Formal and structured training in medical risk assessment (MRA) has been a requirement in general practice residency (GPR) programs since their inception in 1972. Institutions offering GPR programs frequently differ in the levels and types of available resources necessary to implement this training. Program directors have expressed significant concerns that this training is difficult to provide, especially in the area of physical examination. The literature has not yet established how or if programs have organized their curricula to conform to accreditation standards in MRA established by the American Dental Association's Commission on Dental Accreditation. The purpose of this study was to conduct a nationwide survey of all GPR programs to identify program characteristics and resources, didactic and clinical educational methods, and perceived achievement of ADA Standard Fourteen for MRA training. Recommendations for further research are also given. Results will be reported in this paper, the paper following in this issue, and an additional paper to be published in a forthcoming issue.

This is the second part of a three-part series reporting a national survey of general practice residency directors and their evaluation of the medical risk assessment (MRA) instruction curriculum in their programs. The purpose of Part II is to evaluate the degree of success of the implementation of the ADA Commission on Accreditation's standard for MRA programs. Acceptable levels of achievement were attained in most areas of basic and intermediate-level skills. However, approximately one-third to one-half of general practice residency directors report that they are not achieving the standard for some intermediate or advanced assessment skills. When various instructor categories were compared, physicians scored significantly higher than oral and maxillofacial surgeons or other dentists in their ability to achieve acceptable outcomes in MRA instruction. The results of this survey, coupled with available literature concerning medical risk assessment instruction, support that changes in the undergraduate curriculum, a mandatory additional year of training, or modification of defined goals and outcomes should be considered.