Search

The authors evaluated the effectiveness of chart audit with written feedback as a tool for encouraging second- and third-year residents to obtain and record occupational information during history-taking. Baseline information was obtained by reviewing the charts of 20 residents of patients who presented for complete history-taking and physical examination and scoring for various aspects of occupational history-taking. Intervention was directed at 10 of the residents; the other 10 served as controls. Between five and 12 charts were reviewed for each of the 10 residents in the intervention group; the scoring sheet, scoring criteria, results, and a brief discussion of potentially relevant occupational concerns for the given patient were returned to the resident, along with copies of the relevant pages of the patient's record. Chart review showed no difference in total scores for occupational history-taking between the two groups before intervention. The postintervention scores improved insignificantly for the intervention group; however, the scores deteriorated significantly for the control group (1.38 to 0.92, .05 greater than p greater than .025).

This study compared reports of appetite and symptoms in 28 obese subjects randomly assigned to either a 500 calorie protein-sparing modified fast (PSMF) or a 1200-kcal balanced diet. During the first comparison month, subjects consuming the PSMF lost significantly more weight and reported significantly less hunger than did subjects consuming the 1200 kcal diet. Similar results were obtained for the second month, but differences in hunger were not statistically significant. There were no significant differences between conditions in subjects' ratings of their preoccupation with eating or in their ratings of the acceptability or disruptiveness of their diets. PSMF subjects reported significantly greater problems with cold intolerance, constipation, dizziness, dry skin, and fatigue. These symptoms remitted completely, however, when PSMF subjects consumed a 1200-kcal balanced diet. There were no significant differences between conditions in subjects' reports of psychological functioning. Results are discussed in terms of the need for further research to identify the characteristics of PSMF which confer anorexia.

The past decade has seen less competition for medical school positions accompanied by the declining interest of medical students in internal medicine. At the same time, the number of first postgraduate-year positions in internal medicine residencies has increased, as has the number of first-year residents who take those positions. The purpose of this study was to examine trends in the medical knowledge of internal medicine residents during the past 6 years. Comparison of performance on the items common to pairs of the certifying examinations of the American Board of Internal Medicine from 1983 to 1988 revealed that the scores of candidates in the reference group have declined, but not dramatically. This trend has occurred among candidates from the top residency programs as well as all other residency programs, and it is present in candidates of all levels of overall clinical competence. Continuing declines in this area could ultimately affect patient care.

The purpose of this paper was to determine if the decline in performance with time since completion of training on the 1980 ABIM Recertification Examination can be explained by a difference in performance on items testing different types of knowledge. Results showed that candidates further out of training performed less well on items testing new or changing knowledge, while performance on items testing stable knowledge was relatively constant across age groups.