Benefits and barriers among volunteer teaching faculty: comparison between those who precept and those who do not in the core pediatrics clerkship

Background: Community-based outpatient experiences are a core component of the clinical years in medical school. Central to the success of this experience is the recruitment and retention of volunteer faculty from the community. Prior studies have identified reasons why some preceptors volunteer their time however, there is a paucity of data comparing those who volunteer from those who do not. Methods: A survey was developed following a review of previous studies addressing perceptions of community-based preceptors. A non-parametric, Mann–Whitney U test was used to compare active preceptors (APs) and inactive preceptors (IPs) and all data were analyzed in SPSS 20.0. Results: There was a 28% response rate. Preceptors showed similar demographic characteristics, valued intrinsic over extrinsic benefits, and appreciated Continuing Medical Education (CME)/Maintenance of Certification (MOC) opportunities as the highest extrinsic reward. APs were more likely to also precept at the M1/M2 level and value recognition and faculty development opportunities (p<0.05). IPs denoted time as the most significant barrier and, in comparison to APs, rated financial compensation as more important (p<0.05). Conclusions: Community preceptors are motivated by intrinsic benefits of teaching. Efforts to recruit should initially focus on promoting awareness of teaching opportunities and offering CME/MOC opportunities. Increasing the pool of preceptors may require financial compensation

Managed Care, Attitudes, and Career Choices of Internal Medicine Residents

The influence of managed care on internal medicine residents' attitudes and career choices has not yet been determined and could be substantial. In a survey of 1,390 third-year internal medicine residents, 21% believed that managed care was the best model of health care for the United States, and 31% stated they would be satisfied working in a managed care system. Those from high managed care communities (>30% penetration) were only slightly more accepting of managed care, but were more likely to choose general internal medicine as a career (54%, p=.0009) than those from communities with lower managed care penetration

Long-term safety and efficacy of a cholesterol-lowering diet in children with elevated low-density lipoprotein cholesterol:Seven-year results of the Dietary Intervention Study in Children (DISC)

Objective. Diets reduced in fat and cholesterol are recommended for children over 2 years of age, yet long-term safety and efficacy are unknown. This study tests the long-term efficacy and safety of a cholesterol-lowering dietary intervention in children. Methods. Six hundred sixty-three children 8 to 10 years of age with elevated low-density lipoprotein cholesterol (LDL-C) were randomized to a dietary intervention or usual care group, with a mean of 7.4 years' followup. The dietary behavioral intervention promoted adherence to a diet with 28% of energy from total fat, Results. Reductions in dietary total fat, saturated fat, and cholesterol were greater in the intervention than in the usual care group throughout the intervention period. At 1 year, 3 years, and at the last visit, the intervention compared with the usual care group had 4.8 mg/dL (.13 mmol/L), 3.3 mg/dL (.09 mmol/L), and 2.0 mg/dL (.05 mmol/L) lower LDL-C, respectively. There were no differences at any data collection point in height or serum ferritin or any differences in an adverse direction in red blood cell folate, serum retinol and zinc, sexual maturation, or body mass index. Conclusion. Dietary fat modification can be achieved and safely sustained in actively growing children with elevated LDL-C, and elevated LDL-C levels can be improved significantly up to 3 years. Changes in the usual care group's diet suggest that pediatric practices and societal and environmental forces are having positive public health effects on dietary behavior during adolescence

Medical education in pediatrics: attitude assessment in health promotion and preventive care Educação médica na residência de pediatria: avaliação de atitudes em promoção e prevenção de saúde

OBJECTIVES: to evaluate attitudes in childcare and primary care in pediatrics, as well as aspects of training and medical education for residents in pediatrics consistent with the current medical paradigm. METHODS: the subjects were 133 residents of six pediatrics residency services in the city of Porto Alegre, RS. A cross-sectional, descriptive study was performed consisting of a questionnaire and an attitude measurement scale (Likert scale). Thirty propositions related to the issues of child care and primary care in pediatrics were simultaneously submitted to small groups of residents at their residency settings. RESULTS: women outnumbered men in a ratio of three to one in the residency programs. The majority aimed at a specialty in pediatrics, principally the ones involving high-tech procedures. Choices were influenced by prior training and by professors or tutors, although they stated they would like to work in prevention in the future. As for the scale, 87% had the right attitudes, both positive and negative, according to the Golden standard applied. CONCLUSIONS: the result obtained in this study related to attitude was very satisfactory but future professional choices are a concern to the medical educational system. The authors suggest that studies on attitude be further developed and improved to become a source of input for new strategies in the area of pediatrics education.<br>OBJETIVOS: avaliar atitudes sobre puericultura e cuidados primários em pediatria, bem como aspectos de treinamento e educação médica em residentes de pediatria, em consonância com o paradigma médico atual. MÉTODOS: os sujeitos foram 133 residentes de seis serviços de residência em pediatria da cidade de Porto Alegre. É um estudo transversal, descritivo, no qual os residentes responderam a um questionário e uma escala de mensuração de atitudes (escala de Likert) com 30 proposições acerca dos temas acima, aplicados simultaneamente, em pequenos grupos, nos locais de estágio. RESULTADOS: quanto ao sexo, nos estágios predominaram mulheres, na proporção de três para um. A maioria deles pretende especializar-se numa área da pediatria, principalmente aquelas que envolvem tecnologia avançada, sendo as escolhas influenciadas pelos estágios prévios e pelos professores ou tutores, embora informem desejar trabalhar em prevenção no futuro. Quanto à escala, 87% apresentaram atitudes adequadas, tanto positivas como negativas, conforme o padrão ouro utilizado. CONCLUSÕES: o resultado obtido neste estudo, quanto às atitudes, foi bastante satisfatório, porém, as escolhas profissionais futuras preocupam o sistema de educação médica. As autoras sugerem desenvolver e aprimorar estudos de atitudes, os quais poderão tornar-se fonte de subsídios para novas estratégias de educação pediátrica formativa

Rewards and Incentives for Nonsalaried Clinical Faculty Who Teach Medical Students

We surveyed the clerkship administrators of pediatrics, family medicine, and internal medicine at U.S. medical schools, and of pediatrics at Canadian medical schools to determine what rewards and incentives are being offered to nonsalaried faculty for office-based teaching. Monetary payment was offered by 13% to 22% of the programs. Nonmonetary rewards like educational opportunities were offered by 70% to 89%; academic appointments by 90% to 95%; special recognition events by 62% to 79%; and appreciation letters by 74% to 84% of programs. Only 3 of 338 responders offered no rewards or incentives