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OBJECTIVES Participants in faculty development workshops often comment that 'those who need faculty development the most attend the least'. The goals of this study were to explore the reasons why some clinical teachers do not participate in centralised faculty development activities and to learn how we can make faculty development programmes more relevant to teachers' needs. METHODS In 2006, we conducted focus groups with 16 clinical teachers, who had not participated in faculty development activities, to ascertain their perceptions of faculty development, reasons for non-participation and perceived barriers to involvement. Content analysis and team consensus guided the data interpretation. RESULTS Focus group participants were aware of faculty development offerings and valued the goals of these activities. Important reasons for non-participation emerged: clinical reality, which included volume of work and lack of (protected) time; logistical issues, such as timing and the central location of organised activities; a perceived lack of financial reward and recognition for teaching, and a perceived lack of direction from, and connection to, the university. CONCLUSIONS Clinical reality and logistical issues appeared to be greater deterrents to participation than faculty development goals, content or strategies. Moreover, when asked to discuss faculty development, teachers referred to their development as faculty members in the broadest sense, which included personal and career development. They also expressed the desire for clear guidance from the university, financial rewards and recognition for teaching, and a sense of 'belonging'. Faculty development programmes should try to address these organisational issues as well as teachers' personal and professional needs. [ABSTRACT FROM AUTHOR]

The Centre for Epidemiological Studies Depression Scale (CES-D) is a widely used self-report scale to assess depressive symptom levels among the general population. The purposes of the study are to explore the factor structure of CES-D in a population-based Canadian sample and to compare focal constructs of CES-D across age and gender. Confirmatory factor analysis supported the four-factor structure of the CES-D across three age categories and both genders. Subscales scores, however, showed important differences primarily based on gender. Attending to these specific symptom dimensions could help explain known gender differences in depression. [ABSTRACT FROM AUTHOR]

AIM: This study was designed to assess medical school teachers' tacit knowledge of basic pedagogic principles and to explore the specific character of the knowledge base. METHODS: We developed a 50-item, multiple-choice question test based on important pedagogic principles, and classified all questions as requiring either declarative or procedural knowledge. A total of 72 medical teachers representing 5 different groups of clinicians and educators agreed to sit the test. RESULTS: Teachers in all 5 groups performed well on the test of tacit pedagogic knowledge but those with advanced education degrees, or local recognition as experts, performed best. All test takers performed best on questions requiring procedural knowledge. CONCLUSION: Medical teachers possess tacit knowledge of basic pedagogic principles. Superior test performance on questions requiring procedural knowledge is consistent with their working in a clinical environment characterised by repeated procedural activities. [ABSTRACT FROM AUTHOR]

Academic faculty members in medical schools rarely receive formal instruction in basic pedagogic principles; nevertheless many develop into competent teachers. Perhaps they acquire tacit knowledge of these principles with teaching experience. This study was designed to assess clinical teachers' tacit knowledge of basic pedagogic principles and concepts. The authors developed a multiple-choice question (MCQ) exam based on 20 pedagogic principles judged by a panel of education experts to be important for clinical teaching. Three groups of clinician-educators sat the test: (1) clinicians with advanced education training and experience; (2) internal medicine specialists; (3) surgical specialists. All four groups of clinicians-educators passed the test, indicating that they possess a reasonable tacit knowledge of basic pedagogic principles. Those with advanced education training performed much better than members of the other two groups while specialists and residents working in teaching hospitals outperformed specialists from non-teaching hospitals. It is possible that converting this tacit knowledge to explicit knowledge may improve individual teaching effectiveness. [ABSTRACT FROM AUTHOR]

Purpose: The objective was to determine whether the year and medical school of graduation, the medical specialty and the sex of the treating physician was associated with prescribing beta-blockers after hospital discharge among survivors of myocardial infarction (MI), after adjusting for patient characteristics.Methods: We carried out a dynamic retrospective cohort study using data from a longitudinal database that contained information on Quebec residents over the age of 65 years sent home from hospital after MI between 1990 and 1993. The outcome was a beta-blocker being dispensed after hospital discharge. Logistic regression was used to estimate the association between training characteristics and beta-blocker dispensation and clustering of patients within physicians was accounted for using Generalized Estimating Equations.Results: The cohort consisted of 14,334 MI survivors who were treated by 3209 physicians, yielding a mean of about 4.5 patients per physician [standard deviation (SD) = 8.2]. Beta-blockers were prescribed to approximately one-third of subjects. After adjusting for patients' demographic characteristics, comorbid medical conditions, and markers of MI severity, physicians who were more likely to prescribe a beta-blocker included cardiologists and the most recent graduates (graduating after 1989). Systematic differences were also observed between graduates of different medical schools.Conclusions: After adjusting for differences between patients', the sex of the physician was largely unrelated to prescribing beta-blockers for secondary prevention of MI. However, prescribing differed by training characteristics such as medical specialty and year and medical school of graduation. [ABSTRACT FROM AUTHOR]

Fall armyworm, Spodoptera frugiperda (J. E. Smith) (Lepidoptera: Noctuidae); corn earworm, Helicoverpa zea Boddie (Lepidoptera: Noctuidae); southwestern corn borer, Diatraea grandiosella Dyar (Lepidoptera: Crambidae); sugarcane borer, Diatraea saccharalis F. (Lepidoptera: Crambidae); and lesser cornstalk borer, Elasmopalpus lignosellus Zeller (Lepidoptera: Pyralidae), are lepidopteran pests of corn, Zea mays L., in the southern United States. Blended refuge for transgenic plants expressing the insecticidal protein derivative from Bacillus thuringiensis (Bt) has recently been approved as an alternative resistance management strategy in the northern United States. We conducted a two-year study with 39 experiments across 12 states in the southern United States to evaluate plant injury from these five species of Lepidoptera to corn expressing Cry1F and Cry1Ab, as both single and pyramided traits, a pyramid of Cry1Ab×Vip3Aa20, and a pyramid of Cry1F×Cry1Ab plus non-Bt in a blended refuge. Leaf injury and kernel damage from corn earworm and fall armyworm, and stalking tunneling by southwestern corn borer, were similar in Cry1F×Cry1Ab plants compared with the Cry1F×Cry1Ab plus non-Bt blended refuge averaged across five-plant clusters. When measured on an individual plant basis, leaf injury, kernel damage, stalk tunneling (southwestern corn borer), and dead or injured plants (lesser cornstalk borer) were greater in the blended non-Bt refuge plants compared to Cry1F×Cry1Ab plants in the non-Bt and pyramided Cry1F×Cry1Ab blended refuge treatment. When non-Bt blended refuge plants were compared to a structured refuge of non-Bt plants, no significant difference was detected in leaf injury, kernel damage, or stalk tunneling (southwestern corn borer). Plant stands in the non-Bt and pyramided Cry1F×Cry1Ab blended refuge treatment had more stalk tunneling from sugarcane borer and plant death from lesser cornstalk borer compared to a pyramided Cry1F×Cry1Ab structured refuge treatment. Hybrid plants containing Cry1F×Cry1Ab within the pyramided Cry1F×Cry1Ab blended refuge treatment had significantly less kernel damage than non-Bt structured refuge treatments. Both single and pyramided Bt traits were effective against southwestern corn borer, sugarcane borer, and lesser cornstalk borer., (© The Authors 2015. Published by Oxford University Press on behalf of Entomological Society of America. All rights reserved. For Permissions, please email: journals.permissions@oup.com.)

The red imported fire ants, Solenopsis invicta (Buren), are generally considered pests. They have also been viewed as beneficial predators feeding on other insect pests of various agroecosystems. This study documents the foraging habits of fire ants in a sweetpotato field in Mississippi. Fire ant foraging trails connecting outside colonies to a sweetpotato field were exposed and foraging ants moving out of the field toward the direction of the colony were collected along with the solid food particles they were carrying. The food material was classified as arthropod or plant in origin. The arthropod particles were identified to orders. Fire ant foragers carried more arthropods than plant material. Coleoptera and Homoptera were the most abundant groups preyed upon. These insect orders contain various economically important pests of sweetpotato. Other major hexapod groups included the orders Hemiptera, Diptera and Collembola. The quantity of foraged material varied over the season. No damage to sweetpotato roots could be attributed to fire ant feeding. Imported fire ant foraging may reduce the number of insect pests in sweetpotato fields., (© 2012 Institute of Zoology, Chinese Academy of Sciences.)

Objectives: The goals of this study were three-fold: to explore the reasons why some clinical teachers regularly attend centralised faculty development activities; to compare their responses with those of colleagues who do not attend, and to learn how we can make faculty development programmes more pertinent to teachers' needs., Methods: In 2008-2009, we conducted focus groups with 23 clinical teachers who had participated in faculty development activities on a regular basis in order to ascertain their perceptions of faculty development, reasons for participation, and perceived barriers against involvement. Thematic analysis and research team consensus guided the data interpretation., Results: Reasons for regular participation included the perceptions that: faculty development enables personal and professional growth; learning and self-improvement are valued; workshop topics are viewed as relevant to teachers' needs; the opportunity to network with colleagues is appreciated, and initial positive experiences promote ongoing involvement. Barriers against participation mirrored those cited by non-attendees in an earlier study (e.g. volume of work, lack of time, logistical factors), but did not prevent participation. Suggestions for increasing participation included introducing a 'buddy system' for junior faculty members, an orientation workshop for new staff, and increased role-modelling and mentorship., Conclusions: The conceptualisation of faculty development as a means to achieve specific objectives and the desire for relevant programming that addresses current needs (i.e., expectancies), together with an appreciation of learning, self-improvement and networking with colleagues (i.e., values), were highlighted as reasons for participation by regular attendees. Medical educators should consider these 'lessons learned' in the design and delivery of faculty development offerings. They should also continue to explore the notion of faculty development as a social practice and the application of motivational theories that include expectancy-value constructs to personal and professional development.

Aim: To determine the current status of university based faculty development at Canadian Medical Schools., Background: The roles and responsibilities of faculty members at Canadian medical schools are changing significantly as a consequence of influences such as the competency dictates outlined in the CanMEDS roles. One result of the changes is an increased need for faculty development to assist faculty members in carrying out their new and expanded roles., Methods: The changing climate in medical schools, and the enhanced performance expectations of academic faculty, led us to conduct a survey of current faculty development practices in Canadian medical schools to determine what is being done to address the new and expanded expectations of faculty members. We used an on-line survey instrument based on surveys of faculty development conducted in 1987 and 1997., Results: We received responses from faculty development directors at all 17 Canadian medical schools. Among the principal findings are a continued emphasis on faculty members' teaching roles, increased funding of faculty development activities at most schools, and a broadened emphasis on faculty roles other than teaching. Among these are research and scholarship, and management and administrative roles. The survey revealed a mismatch between what faculty development directors consider to be effective development practices and which practices are actually used in their schools. Another notable finding is the absence of credible faculty development impact studies., Conclusion: The 2007 survey of faculty development practices in Canadian medical schools indicates that teaching is still the number one priority for faculty members and the main focus of faculty development programs. There are notable efforts to help faculty members deal with their newly identified roles including those outlined in the CanMEDS framework. In looking forward, Canadian faculty development directors should continue their efforts to devise credible program evaluation methods. Furthermore, they should expand their thinking beyond Canada's borders. It is time to aggressively explore and understand the approaches and experiences which have proven successful internationally in the United States and Europe.

Background: Faculty development activities in medical schools regularly target teaching behaviours but rarely address basic pedagogic principles underlying those behaviours. Although many teachers have an intuitive or tacit knowledge of basic pedagogic principles, overt knowledge of fundamental educational principles is rare., Aims: We conducted a short-term pilot study designed to transform teachers' tacit knowledge into explicit knowledge of pedagogic principles. We hypothesized that conscious awareness of these principles will positively influence their teaching effectiveness., Methods: The intervention included a workshop, provision of a workbook on pedagogic principles and free access to educational consultants. For the intervention, we chose a purposive sample of experienced teachers at our medical school., Results and Conclusions: Evaluation of the impact of the intervention using questionnaires and semi-structured interviews revealed three notable findings; 1. Participants were surprised to discover the existence of an extensive body of pedagogic science underlying teaching and learning. 2. They were enthusiastic about the intervention and expressed interest in learning more about basic pedagogic principles. 3. The knowledge acquired had an immediate impact on their teaching.

Background: Although educational innovations in medical education are increasing in number, many educators do not submit their ideas for publication., Aims: The goal of this initiative was to assist faculty members write about their educational innovations., Method: Twenty-four faculty members participated in this intervention, which consisted of a half-day workshop, three peer writing groups, and independent study. We assessed the impact of this intervention through post-workshop evaluations, a one-year follow-up questionnaire, tracking of manuscript submissions, and an analysis of curriculum vitae., Results: The workshop evaluations and one-year follow-up demonstrated that participants valued the workshop small groups, self-instructional workbook, and peer support and feedback provided by the peer writing groups. One year later, nine participants submitted a total of 14 manuscripts, 11 of which were accepted for publication. In addition, 10 participants presented a total of 38 abstracts at educational meetings. Five years later, we reviewed the curriculum vitae of all participants who had published or presented their educational innovation. Although the total number of publications remained the same, the number of educationally-related publications and presentations at scientific meetings increased considerably., Conclusions: A faculty development workshop and peer writing group can facilitate writing productivity and presentations of scholarly work in medical education.

Background: Many educators have had little or no preparation in the design, delivery or evaluation of workshops., Methods: This faculty development intervention consisted of a faculty development workshop on Developing Successful Workshops; a workbook to guide independent study; and peer consultations. Program evaluation included immediate and delayed post-workshop evaluations, tracking of site-specific activities, and assessment of self-perceived efficacy., Results: Participants found the workshop very useful, highlighting the assessment of learner needs, goal-setting, "matching" of objectives to content and methods, and use of a structured framework as most beneficial. Nine months after the intervention, seven of eleven participants had conducted a workshop in their own settings. Self-assessment of skills in workshop design also increased., Conclusion: A workshop on Developing Successful Workshops can help participants to understand the principles of workshop design and delivery.

The Teaching Scholars Program for Educators in the Health Sciences at McGill University, in Montreal, Quebec, was designed to promote the professional development of health science educators by increasing their expertise in developing and implementing educational programs and taking on leadership roles in education. This program, which was initiated in 1997 and is tailored to the individual needs of the participants, consists of participation in: two university courses; a monthly seminar; a research study or an educational project, consisting of curriculum design and evaluation; and faculty-wide faculty development activities. As of 2006, 34 scholars have completed this program. Outcome data indicate that the majority of teaching scholars have taken on new roles and responsibilities in medical education; maintained the changes implemented in their teaching practices; continued to participate in faculty development activities; and presented their work at educational meetings. A number of scholars have also applied successfully for educationally related grants and have published their educational projects. Five of the scholars have pursued advanced studies. This program, which aims to move beyond the improvement of teaching skills by providing a foundation for educational leadership and scholarship, resembles many others in its emphasis on independent study, peer support, and the maintenance of ongoing responsibilities. It is innovative in that scholars participate in university courses and are encouraged to attend an "outside" conference or course. The overall benefits of this program, as noted by the scholars, include increased knowledge and skills, introduction to a "community of practice," and new career paths and opportunities.

Chlorotic and necrotic lesions typical of powdery mildew caused by L. taurica were observed in several tomato (Lycopersicon esculentum) and pepper (Capsicum annuum) fields in Santa Cruz State, Bolivia near the town of Mairana during September 2004. The tomato cultivars affected were Santa Clara, Superman, and Cool 45. Symptoms included bright yellow chlorotic lesions or brown necrotic lesions on different age leaves. Examination of samples collected from several fields revealed sporulation of L. taurica on abaxial leaf surfaces. The fungus had branched conidiophores, a tapered or pyriform apical conidium, with other conidia being more cylindrical (1,2). Conidial size was approximately 60 × 18 μm. Only the Oidiopsis stage was observed. Disease severity was high and caused a significant amount of leaf necrosis and partial defoliation on tomato. Only sporadic lesions were observed on pepper cv. YoloWonder and no significant foliar damage was observed. The growing region receives approximately 75 mm of rainfall annually with most of the rainfall occurring between October and April. Thus, powdery mildew was observed near the end of the normal 5-month dry season. It is likely that the disease has been in the region for some time based on observations from field personnel. Although reported from several other South American countries, to our knowledge, this is the first report of this disease in Bolivia. References: (1) H. J. Boesewinkel. Bot. Rev. 46:167, 1980; (2) J. C. Correll et al. Plant Dis. 71:248, 1987.

Purpose: To estimate the reduction in all-cause mortality conferred by beta-blockers in a population-based cohort of elderly survivors of myocardial infarction during the year following hospital discharge., Methods: A dynamic retrospective cohort was assembled from persons aged 66 years and over surviving myocardial infarction in Quebec between 1990 and 1993. Information on hospitalizations was linked to medication and physician claims, demographic characteristics and vital status. Subjects prescribed beta-blockers at hospital discharge had fewer comorbid medical conditions, less pre-existing cardiovascular disease and less severe infarcts. To control for these differences, analyzes were restricted to subjects receiving at least one beta-blocker and mortality was compared between periods with and without beta-blocker exposure using Cox proportional hazard models., Results: Among 14,547 survivors of myocardial infarction, 41% were dispensed at least one beta-blocker. Among those subjects, the risk of dying during periods of beta-blocker use was reduced 40% (hazard ratio = 0.6; 95% CI: 0.5, 0.7)., Conclusion: Confounding by indication threatens the validity of observational studies of intended effects of medications. For elderly survivors of myocardial infarction, the estimated benefit of beta-blockers from observational studies is greater than the estimate from randomized trials. Greater benefits do not seem to be an artifact arising from systematically prescribing beta-blockers to subjects with better prognosis. Reducing confounding by indication can enhance the validity of observational studies of medications and widen research applications of administrative health databases. While the actual benefits of medications are never truly known these studies can provide a credible range that brackets the truth.

Formal or traditional CME can be criticized because organizers often ignore adult learning principles when designing courses. Critics also suggest that formal CME courses have limited impact on attendees' behaviors and practices. The authors agree that attention must be paid to pedagogic principles to assure success of educational courses, but feel that the extant negative evidence related to the impact of formal CME is narrow in scope and of inadequate strength to seriously damn formal approaches. Survey responses were received from 853 practicing physicians who say they still regularly attend formal CME courses. They are motivated to attend to satisfy specific professional needs and for personal reasons. Formal CME is still popular despite what its critics say. The authors are convinced that attention to physicians' perceived needs, effective use of social marketing strategies, and adherence to adult learning principles can assure successful delivery of CME and that formal CME is a useful complement to physician-driven informal CME.

Background: Clinical teachers rarely receive formal instruction in the basic concepts and principles of education. It is usually assumed that expertise as a practitioner will translate into effectiveness as a teacher., Purpose: To identify the important concepts and pedagogic principles, which, if known and understood by clinical practitioners, might enhance their teaching prowess and success., Method: We developed a long list of potentially important concepts identified in the education literature. We then conducted a 3-round Delphi expert opinion-soliciting process to identify which of the concepts were of most importance to clinical teachers., Results: Thirteen of the 14 panel members successfully completed the process and achieved 94% reliability in rating the potential importance of the concepts on the e-mailed ratings list., Conclusion: We have identified a limited list of core pedagogic concepts, knowledge of which may enhance the success of clinical teachers.

The authors describe a year-long faculty development initiative to develop leaders in medical education. The Teaching Scholars Program for Educators in the Health Sciences at McGill University enables faculty to improve their educational knowledge and skills while maintaining their clinical, teaching, and research responsibilities. The program, tailored to the participant's individual needs, consists of five main components: two university courses; independent study; participation in faculty-wide faculty development workshops and medical education rounds; a monthly seminar; and attendance at a national or international conference or course. Since its inception in 1997, 22 faculty members have completed the program; four are currently participating in it. This report discusses the experience of 15 scholars who completed the program by September 2000. Evaluations indicate that the scholars achieved most of their stated objectives. The university courses provided a foundation in educational principles and methodology; independent study allowed them to work on educational projects relevant to their disciplines; and the monthly seminars, faculty development workshops, and outside courses offered opportunities for skill acquisition and reflection. Participants also appreciated the opportunity to meet others interested in medical education and to become aware of available educational resources. A year after completing the program, many had joined new educational committees, taken on new leadership roles in medical education, and developed new courses for students and residents. Some of their projects had been presented at national meetings and were being prepared for publication. Two scholars had pursued further study at a master's level. Despite the ongoing challenge of protecting time for educational pursuits, this program has been beneficial in helping to develop educational leaders in the Faculty of Medicine.

Objective: Although online discussion groups are being used with increasing frequency in undergraduate and postgraduate education, their usefulness in faculty development has not been explored. The goal of this innovation was to offer an online discussion group following a faculty development workshop in order to reinforce workshop concepts and to allow participants to seek advice related to specific teaching and learning problems. We also wanted to assess the benefits of this educational tool., Description: We originally wanted to implement an online discussion group following a one-day workshop "The "Problem" Resident: Whose Problem Is It?" However, once this proposal was presented to our academic administrators, they asked us not to implement the discussion group because of concerns related to confidentiality and due process. They were worried that an online discussion might replace the faculty's evaluation and promotion guidelines, that teachers might no longer go to the "right" person to discuss a problem, and that we would give teachers a false sense of security. To respect these concerns, we changed the discussion topic and decided to implement an online discussion following a workshop "Promoting Interaction in Small-group Teaching." We chose this venue because it was less "emotionally charged" and because online discussions are seen as a potential adjunct to small-group teaching. We introduced the idea of a facilitated WebCT group discussion at the end of the workshop, and gave faculty members clear instructions on how to access the discussion group. Most of the workshop participants liked the idea of a follow-up to the workshop, but they preferred an e-mail listserv. We therefore decided to offer the WebCT discussion group to half of the participants, and an e-mail listserv to the others. To initiate the discussion, we posted several issues for both groups, and we awaited the participants' responses. To our surprise, only two individuals (8%) responded on the e-mail listserv, after several attempts to stimulate discussion., Discussion: In looking back at our "medical experiment" we were disappointed that our efforts to facilitate an online discussion following a faculty development workshop were not successful. However, based on personal reflections and conversations with a number of the workshop participants, we feel that some important lessons were learned. Time and competing demands clearly pose a major barrier. In addition, the "perceived need" of the initiative is critical. Our faculty members did not see the need for discussing interactive small-group teaching techniques online. Faculty members' comfort with technology must also be considered. Many of our teachers were not familiar with the potential uses of online learning. Moving faculty development beyond workshops also remains a challenge. With these lessons in mind, we plan to initiate another online discussion with faculty members, based on a need that they have defined around a topic that they have identified as critical to their own development as faculty members. We continue to believe that follow-up activities are essential in faculty development and that we need to further assess the potential value of this educational method.

The authors developed a cognitive-theory-based checklist of seven important principles for teaching technical skills. They then used the checklist in a workshop for doctors who teach procedural and technical skills. Participants in the workshop found the principle-based approach to be more effective than the traditional "see one, do one, teach one" approach.

At our university, Internal Medicine clerks are members of a team responsible for the care of patients hospitalized on a teaching ward. Clerks first encounter their patients after the latter have been fully worked up by other physicians who have examined them and initiated investigations and management. Clerks are thus deprived of the opportunity to practice information acquisition, hypothesis generation and problem solving. We therefore undertook a 'blinding' initiative wherein each clerk was required to work up at least one hospitalized patient per week without access to the patient chart and without knowledge of information acquired and hypotheses generated by other physicians. Weekly data collection during the 8-week experiment with 40 clinical clerks revealed that work up of 'blinded' patients was more time-consuming and more difficult than work up of unblinded patients. Clerks were appreciative of the educational value of blinding. Teaching faculty felt clerk 'blinding' to be a practical approach to approximating the true conduct of medical practice and as such was useful for student learning.

The authors planned to study the roles and concerns of senior faculty members at their institutions. To elaborate the aims of their study and to help them design a valid questionnaire, they conducted focus groups with senior faculty. The authors describe how the information gleaned from the focus groups helped them develop their questionnaire.

Objective: To assess the coding accuracy of primary and secondary discharge diagnoses in the Quebec hospital discharge database for elderly persons with myocardial infarction (MI)., Design: Retrospective chart review in a convenience sample of six Montreal hospitals. The diagnoses listed in the medical chart were compared with those listed in the hospital discharge database. For each subject, the Charlson comorbidity index was calculated twice, once based on the medical chart and again based on the hospital discharge database., Patients: Subjects aged 65 years and over who had an MI coded as the primary discharge diagnosis in the hospital discharge database and who were discharged alive., Main Results: For 234 MI survivors, the positive predictive value (ie, probability that a patient with MI reported in the hospital discharge database had an MI diagnosed by the discharging physician) for coding MI was 0.96 (95% CI 0.94, 0.98). Comorbid medical conditions and complications of the MI were under-reported in the hospital discharge database, which meant that the Charlson index based on the hospital discharge database was an average of 0.71 units lower than the Charlson index based on the medical chart., Conclusions: When studying survivors of MI by using hospital discharge databases, the advantages must be weighed against potential drawbacks in the quality of the information. Hospital discharge databases are almost as reliable as medical charts for identifying MI patients, but there is substantial under-reporting of comorbid medical conditions.

Objective: To examine how drug therapy course directors design and deliver drug therapy courses, and whether they employ adult education principles to assure effective education., Design: Analysis of a three-part questionnaire sent to directors of drug therapy courses in Canada., Participants: The questionnaire was sent to all seven directors of drug therapy courses at medical schools that are accredited continuing medical education providers., Results: All directors completed and returned the questionnaires. To decide on course content, most use feedback from previous course attendees, peer consultations, course committee member discussions and their own perceptions of learners' needs. Courses generally use conventional teacher-dominated technology rather than methods that emphasize active learner participation., Conclusion: Directors of Canadian continuing medical education drug therapy courses reasonably employ adult education principles when deciding learner needs and designing teaching vehicles.

Context: As medical costs are increasingly being scrutinized, there is heightened interest in defining variations in physician behavior in clinical settings., Objective: To evaluate if standardized patient (SP) technology is a reliable and feasible method of studying interphysician variations in test ordering, referral requests, prescribing behavior, and visit costs., Design: The study was conducted with blinded SP visits to family medicine and internal medicine residents, university-affiliated family physicians, and community-based family physicians. Resource utilization and visit costs were assessed using test requisitions, consult requests, and prescriptions that were collected by the SPs., Setting: Physicians' offices in ambulatory care, hospital-based clinics and in the community., Participants: Four persons (aged 57-77 years) trained to simulate having osteoarthritis of the hip. In one simulation, the patient had gastropathy due to nonsteroidal anti-inflammatory drug use, and in the other, the patient sought therapy for hip discomfort., Main Outcome Measures: Reliability of cost estimates of physician services, tests, consultations, prescriptions, and total visits and test-ordering behavior for nonsteroidal anti-inflammatory gastropathy., Results: Overall, 112 (63%) of the physicians who were sent invitations to the study agreed to participate. Of 312 total SP visits conducted over a 1-year period, unblinding due to SP detection occurred on 36 occasions (11.5%). Reliable cost estimates of physician services, tests, and consultations, and moderately reliable estimates of total visit costs, were obtained with 4 visits per practicing physician and with 2 visits per resident. There were extreme variations in total visit costs generated by the study physicians. A small number of physicians had a major impact on this variability., Conclusion: Standardized patient technology provides a reliable, feasible method to assess variations in resource utilization between physicians.

Long-acting benzodiazepines (LABZs) are relatively contraindicated for elderly patients because they increase the risk of impaired cognitive function, falls, and hip fractures. The purpose of this study was to identify the characteristics of physicians who frequently prescribe LABZs for elderly patients. The authors examined the prescribing profile of 4,976 physicians who saw at least 20 elderly Quebec medicare registrants in 1990. Physicians who frequently prescribed LABZs for their elderly patients were more likely to have graduated before 1979, to be general practitioners as opposed to specialists, to practice in long-term care settings, and to have graduated from a medical school in Quebec as opposed to other schools in Quebec, in other provinces, or in other countries. The authors have identified several characteristics of physicians who frequently prescribed LABZs for the elderly. Strategies to improve prescribing in this field should target this group of physicians.

Objective: To compare the current status of faculty development practices in Canadian medical schools with the status of such practices in 1986., Design: Mail survey., Setting: All 16 Canadian medical schools., Participants: Faculty development coordinators at the medical schools., Outcome Measures: Existence of faculty development committees, funding for faculty development activities, types of activities and recognition of faculty participation in such activities., Results: Completed responses were received from all schools. They indicated a significant, positive evolution in faculty development since the previous survey, conducted in 1986. Most schools have established a faculty development committee and provide funds for such activities as workshops, sabbatical leaves and conference attendance. Although traditional development practices are prevalent, there is now widespread emphasis on computer technology, information retrieval, management skills and research. Experienced faculty and other experts are more widely used for consultation on teaching. Very little has been done to evaluate the impact of faculty development., Conclusion: Faculty development in Canadian medical schools has undergone a major, positive transition during the last 10 years.

In industrialized countries, gender differences observed in health condition and the use of medical services appear insufficient to explain a greater consumption of psychotropic drugs in women than men. The authors have tested the hypothesis that physician prescribing patterns largely explains this observation. They demonstrate, using data from the Régie de l'assurance maladie du Québec for people aged 65 and over, that physicians' sociodemographic and practice characteristics are significantly associated with the percentage of men and women who receive a psychotropic drug prescription in their practice.

Drug prescribing for the elderly is an important area of medical knowledge since inappropriate prescribing may lead to significant adverse drug events. The objective of this study was to evaluate the association between knowledge of drug use and quality of drug management by general practitioners in practice. A cross-sectional study design was used to evaluate a sample of 37 GPs in practice. A set of common musculoskeletal problems was chosen to evaluate doctors' knowledge of non-steroidal anti-inflammatory drug use, while performance in practice was assessed using elderly standardized patients. The reliability of knowledge test scores was evaluated using measures of internal consistency. The relationship between knowledge of drug use and quality of therapeutic management in practice was evaluated by rank order and linear correlation analysis. Demographic characteristics of participating and non-participating doctors were similar. The reliability of the knowledge test was 0.55. The reliability of performance scores was 0.66. The correlation between overall performance on the standardized patient cases and total knowledge test score was 0.22 (95% confidence interval = 0-0.63). Knowledge test scores were poorly correlated with quality of therapeutic management in office practice. This indicates that knowledge tests alone cannot predict quality of performance with regard to drug prescribing for the elderly in primary care office practice.

Objective: To develop a consensus-based list of inappropriate practices in prescribing for elderly people., Design: Mail survey of a 32-member national panel., Setting: Academic medical centres across Canada., Participants: Thirty-two specialists selected arbitrarily, including 7 clinical pharmacologists, 9 geriatricians, 8 family practitioners and 8 pharmacists., Outcome Measures: Consensus that the practice would introduce a substantial and significant increase in the risk of serious adverse effect and is common enough that its curtailment would decrease morbidity among elderly people, ranking of clinical importance of the risk, and availability of equally or more effective and less risky alternative therapy., Results: The 32-member national panel developed a list of 71 practices in prescribing for elderly people and rated the clinical significance of each on a scale of 1 (not significant) to 4 (highly significant). The practices in prescribing identified fell into 3 categories: drugs generally contraindicated for elderly people, drug-disease interactions and drug-drug interactions. The mean significance rating was greater than 3 for 39 practices. For each practice, alternative therapies were recommended. There was surprising congruence among the specialists on the significance rating and the suggested alternative therapies., Conclusion: The authors have developed a valid, relevant list of inappropriate practices in prescribing for elderly people, to be used in a practice-based intervention study.

We used information statistics to quantify first-order sequential dependencies in the social behavior of two sibling wolf pups (Canis lupus). Sequential dependencies in the behavior of the individual pups increased between the first sample (18-32 days of age) and two later samples taken from 34-53 days and 64-106 days of age. Sequential dependencies between pups were greatest during the second age sampled. We relate these findings to changes in the importance and style of interactions. In the first 32 days, social co-actions primarily involved mutual mouthing and pushing. Between 34 and 53 days, when interactions frequently became aggressive, pups were most responsive to the actions of their partner and tail-raising predicted biting. By 64 days, play-chasing was the mode. By this age pups had formed a relationship, were less attentive to the specific actions of their partner, and biting was no longer predicted by tail-raising. These results illustrate the importance of considering demand characteristics in distinguishing capabilities from performance, and suggest that changing social organization may underlie developmental changes in behavior. We also speculate that during these play-like interactions, pups may gain control over expressive displays.

Laboratory bioassays with green peach aphids, Myzus persicae (Sulzer), were conducted on samples from field grown spinach and mustard greens to determine the persistence of triazamate, dimethoate, and mevinphos. Treatment with each insecticide resulted in similar mortality initially on both crops. Mortality on samples from mevinphos treated plants declined considerably by 1 d after treatment. Dimethoate persisted for > 4 d at a level that would kill at least some aphids during the allotted time. Persistence of triazamate and dimethoate activities were similar on spinach. Triazamate, however, resulted in greater aphid mortality through time on mustard greens than did dimethoate.

I examined developmental changes in associations among components of timber wolf (Canis lupus) postural communication in two hand-reared pups between 15 and 85 days of age. The frequency with which select postural components co-occurred was scored from 180 randomly sampled frames of video records of these pups made during social interactions. I used this index of association as the basis for multidimensional scaling and cluster analyses. Relations among postural components became more structured with age. Two-dimensional models were found to account for associations among postures displayed at 69-85 and 32-67 days of age but not at 15-32 days of age. I interpret these orthogonal dimensions as continua of dominance to submission and seriousness to playfulness. These data suggest the intended messages contained in postural displays may depend on the specific combinations of components used.

Objectives: To determine (a) whether the risk of a potentially inappropriate drug combination (PIDC) increases with the number of physicians involved in the medical management of an elderly patient and (b) whether the risk of a PIDC is reduced if a patient has a single primary care physician or a single dispensing pharmacy, or both., Design: Cross-sectional retrospective provincial database study., Participants: A regionally stratified random sample of 51,587 elderly medicare registrants in Quebec who (a) visited at least one physician in 1990, (b) were not living in a health care institution for the entire year and (c) had been dispensed at least one prescription for a cardiovascular drug, a psychotropic drug or a nonsteroidal anti-inflammatory drug (NSAID)., Outcome Measures: Information on all physician visits and drugs dispensed during 1990. Physician claims were used to identify the number of physicians involved in a patient's management and whether the patient had one primary care physician. Prescription claims were used to identify the number of PIDCs, prescribing physicians and dispensing pharmacies., Results: The prevalence of PIDCs ranged from 4.0% (among those in the NSAID group) to 20.3% (among those in the psychotropic drug group). Of the PIDCs identified, 17.6% to 25.8% resulted from contemporaneous prescribing by different physicians. The number of prescribing physicians was the most important risk factor for a PIDC in all drug groups (odds ratio [OR] 1.44 to 1.71). The presence of a single primary care physician lowered the risk for cardiovascular and psychotropic PIDCs (OR 0.70 and 0.79 respectively) but not for NSAID PIDCs (OR 0.94). The use of a single dispensing pharmacy lowered the risk of a PIDC in all drug groups (OR 0.68 to 0.79)., Conclusion: The greater the number of physicians prescribing medications for an elderly patient, the greater is the risk that the patient will receive a PIDC. A single primary care physician and a single dispensing pharmacy may be "protective" factors in preventing PIDCs.

Objective: To determine whether patient satisfaction ratings can be predicted by faculty ratings or self-ratings of resident humanism., Design: A prospective three-month collection of patient satisfaction ratings in two ambulatory care clinics and simultaneous acquisition of faculty ratings and self-ratings of resident humanism using ABIM questionnaires., Setting: Two teaching hospital ambulatory care internal medicine clinics., Participants: Forty-seven internal medicine residents and 17 faculty internists were sent questionnaires for evaluation of humanism of individual residents. One thousand one hundred ninety-four consecutive outpatients cared for by the residents were eligible for patient satisfaction questionnaires., Measurements and Main Results: Thirty-three residents and 13 faculty completed evaluations of resident humanism while 792 patients completed satisfaction questionnaires, which were used for analysis. The faculty ratings of resident humanism correlated strongly with patient satisfaction ratings, while the resident self-ratings did not., Conclusions: Faculty ratings of resident humanism were highly predictive of patient satisfaction with the care rendered by internal medicine residents in two ambulatory care clinics. This suggests that ambulatory care settings are useful for evaluation of noncognitive behavioral features of resident performance.

Objective: To estimate the prevalence of questionable and rational high-risk prescribing among elderly people of the three drug groups most commonly implicated in drug-related illness: cardiovascular drugs, psychotropic drugs and nonsteroidal anti-inflammatory drugs (NSAIDs)., Design: Retrospective prevalence study; all prescription and billing records for the period Jan. 1 to Dec. 31, 1990, for the study sample were retrieved from the relevant provincial databases of the Régie de l'assurance-maladie du Québec., Setting: Quebec., Participants: Regionally stratified random sample of 63,268 elderly medicare registrants who made at least one visit to physician in 1990 and were not living in a health care institution for the entire year., Main Outcome Measure: Prescription information was examined for three types of high-risk prescribing: rational and questionable drug combinations, excessive treatment duration and drugs relatively contraindicated for use in elderly people., Results: Overall, 52.6% of the patients experienced one or more events of high-risk prescribing, and 45.6% experienced at least one that was questionable. High-risk prescribing was most prevalent for psychotropic drugs, and questionable prescribing was more frequent than rational prescribing in this drug group. An estimated 30.8% of the total elderly population in Quebec received benzodiazepines for more than 30 consecutive days, 12.9% received a long-acting benzodiazepine, and 13.0% received a questionable high-risk psychotropic drug combination. The prevalence of high-risk prescribing was higher among the women than among the men and increased with age until 75 to 84 years. There were significant unexplained differences between regions in the regional prevalence of high-risk prescribing, particularly of psychotropic drugs., Conclusion: The prevalence of questionable high-risk prescribing, especially of psychotropic drugs, is substantial among elderly people. This may be a potentially important and avoidable risk factor for drug-related illness in elderly people.

Purpose: To document the characteristics of the clinical education in internal medicine of undergraduate medical students at Canadian medical schools., Method: A five-part questionnaire was sent in 1991-92 to the individuals responsible for supervising the internal medicine clerkships at all 16 Canadian medical schools. The questions were related to (1) tutors, hospitals, and inpatient clinical experiences of internal medicine clerks; (2) ambulatory care experiences; (3) evaluation methods; (4) "junior clerkships" (i.e., clinical courses that precede the clerkships); and (5) supervisors' opinions about changes needed to improve the clerkships., Results: Responses were received from all schools. There was surprising uniformity in clinical education across Canada. Clinical education methods have changed very little over the past decade. In the opinion of the clerkship supervisors, there were too few committed clinical tutors, little evidence of use of newer evaluation methods, and inadequate ambulatory care instruction., Conclusion: The study results suggest that the clinical education in internal medicine of undergraduate medical students has changed little despite numerous calls for reform.

The authors interviewed faculty members to determine their perceptions of what constitutes effective teaching in the ambulatory setting. They conducted semistructured interviews with experienced clinician-tutors who supervise residents in two internal medicine clinics. Tutors identified similarities as well as important differences between inpatient teaching and outpatient teaching. Questioning, role modeling, and emphasizing general principles and concept comprehension can be used effectively in both settings. On the other hand, the two settings differ strikingly in teaching of problem solving, bedside teaching, and provision of feedback. Many characteristics of the setting influence outpatient teaching, but the tutors offered differing viewpoints about whether these characteristics are beneficial or detrimental.

Objective: To determine the status of ambulatory care training of core internal medicine residents in Canada., Design: Mail survey., Participants: All 16 program directors of internal medicine residency training programs in Canada., Outcome Measures: The nature and amount of ambulatory care training experienced by residents, information about the faculty tutors, and the sources and types of patients seen by the residents. As well, the program directors were asked for their opinions on the ideal ambulatory care program and the kinds of teaching skills required of tutors., Results: All of the directors responded. Fifteen stated that the ambulatory care program is mandatory, and the other stated that it is an elective. Block rotations are more common than continuity-of-care assignments. In 12 of the programs 10% or less of the overall training time is spent in ambulatory care. In 11 the faculty tutors comprise a mixture of generalists and subspecialists. The tutors simultaneously care for patients and teach residents in the ambulatory care setting in 14 of the schools. Most are paid through fee-for-service billing. The respondents felt that the ideal program should contain a mix of general and subspecialty ambulatory care training. There was no consensus on whether it should be a block or continuity-of-care experience, but the directors felt that consultation and communication skills should be emphasized regardless of which type of experience prevails., Conclusions: Although there is a widespread commitment to provide core internal medicine residents with experience in ambulatory care, there is little uniformity in how this is achieved in Canadian training programs.

Medical students on an in-patient service and residents working in an ambulatory care clinic have regularly evaluated their clinical tutors over the 5 years 1985-1989. Both groups of raters reliably and predictably evaluated their tutors and both emphasize between-tutor comparisons more than actual rating values for individual tutors. Tutors active in both contexts regularly receive higher ratings from the medical students than from the residents. Mid-course feedback to tutors in the medical course had no impact on end-of-course ratings. In neither context did tutor ratings improve from one evaluation to the next. Both groups reliably discriminate between the teaching skills and the personality traits of individual tutors.