Continuing Medical Education: Planning and Goals Conference in Continuing Medical Education—Workshop Recommendations

Following are recommendations drawn up by workshops held as a part of the Planning and Goals Conference in Continuing Medical Education, sponsored by the California Medical Association and directed by its Committee on Continuing Medical Education, San Diego, 11 to 12 March 1967. The general subject was divided among four workshops and the reports of two of them—No. 1, (a) and (b), and No. 2—were printed in the August issue of California Medicine. The Reports herewith are those of the other two workshops.The conference was supported in part by Contract No. PH 108-67-158, Bureau of Health Manpower, Public Health Service, Department of Health, Education and Welfare.     

Histoplasmosis—A Review of Three Cases Studied in San Diego County

Three cases of histoplasmosis, a disease seldom reported in California, were diagnosed clinically by the authors in San Diego County. It is probable that there is a higher incidence of this disease in California than is at present recognized.Travel history, histoplasmin skin testing and serologic studies for mycotic infection are important in the diagnosis. Cultures of secretions and biopsy material are of great value if positive; but negative cultures (at least in non-endemic areas) do not rule out the disease. Travel and migration to and from endemic areas present opportunities for this disease to constitute a diagnostic problem far from the geographic area in which the disease was acquired.Although usually benign, histoplasmosis may be severe in the acute state, may disseminate or may be chronically active and progressive. Amphotericin B is the only effective chemotherapeutic agent and it is usually reserved for these forms of the disease.     

CANCER OF THE THYROID GLAND—Its Occurrence Among Residents of San Francisco and Alameda Counties

The incidence of cancer of the thyroid gland in men was about the same in Alameda and San Francisco counties as in the country at large, but the greater incidence of the disease in women than in men was more pronounced in Alameda and San Francisco counties than elsewhere in the nation.     

Examinations in Higher Education—A Review

Genetic mechanisms in humans are discussed and a different light thrown on some of the more commonly discussed aspects. Attention is drawn to ‘uncertainties’ that are frequently presented as dogma in textbooks.     

Factors Associated with Clinical Research Recruitment in a Pediatric Academic Medical Center—A Web-Based Survey

Background

One of the most difficult aspects of conducting clinical research is the ability to successfully recruit participants. Pediatric clinical research presents unique recruitment challenges that relate to the need for parental consent on behalf of a minor, child assent, and school attendance. Yet, this has been less well studied. We conducted a survey of investigators performing human subjects research in a single large academic pediatric hospital to better understand characteristics of studies with successful recruitment.

Methods

We conducted a web-based survey from September 2011 to December 2011 of all principal investigators with an Institutional Review Board approved human subjects protocol at Boston Children’s Hospital, a pediatric Academic Medical Center. The survey captured various characteristics of the protocols including study design, staffing, resources, and investigator experience and training as well as respondents’ perceived barriers and facilitators to recruitment. We used chi square tests and Mantel-Haenszel test for linear trend to examine the relationship between selected predictor variables and the binary outcome of successful vs. unsuccessful recruitment and multivariable logistic regression analyses to examine the simultaneous influence of potential predictors on each outcome.

Results

Among the 349 eligible investigators, 52% responded to the survey, and 181 with valid data were included in the analyses. Two-thirds of the 87 protocols closed to enrollment reached 80% or more of their target enrollment, whereas, only one-third of the 94 protocols actively recruiting were meeting 80% of their target. Recruitment method appeared to be the only significant and independent factor associated with achieving 80% or more of target enrollment in closed to enrollment protocols. Closed to enrollment protocols that used recruitment in person were 4.55 times (95% CI 1.30 to 15.93; p = 0.02) more likely to achieve 80% or more of their target enrollment when compared to those that used other recruitment methods. Other potentially modifiable factors such as number of study visits, study duration and investigator experience were suggestive of being meaningfully related to recruitment.

Conclusion

Recruiting in person may promote reaching an acceptable target enrollment in pediatric as well as adult clinical research. Future research is needed on larger and more diverse samples to gain a better understanding of how the characteristics and qualifications of the individuals who conduct recruitment influence participant enrollment as well as how best to approach patient and families for their participation.     

A Survey to Assess Family Physicians’ Motivation to Teach Undergraduates in Their Practices

Background

In Germany, family physicians (FPs) are increasingly needed to participate in undergraduate medical education. Knowledge of FPs’ motivation to teach medical students in their practices is lacking.

Purpose

To describe a novel questionnaire that assesses the motivation of FPs to teach undergraduates in their practices and to show the results of a subsequent survey using this instrument.

Methods

The questionnaire was developed based on a review of the literature. Previously used empirical instruments assessing occupational values and motivation were included. A preliminary version was pretested in a pilot study. The resulting 68-item questionnaire was sent to 691 FPs involved in undergraduate medical education. Reliability was assessed and subgroups were analyzed with regard to differences in motivation.

Results

A total of 523 physicians in n = 458 teaching practices participated (response rate 75.7%). ‘Helping others’ and ‘interest’ were revealed as the predominant motives. Responses showed a predominantly intrinsic motivation of the participating FPs. Their main incentives were an ambition to work as a medical preceptor, to generally improve undergraduate education and to share knowledge. Material compensation was of minor importance. Time restraints were indicated as a barrier by some FPs, but were not a general concern.

Conclusion

German FPs involved in medical education have altruistic attitudes towards teaching medical students in their practices. Motivational features give an important insight for the recruitment of FP preceptors as well as for their training in instructional methods.     

What Do Physicians Know About Normal Pressure Hydrocephalus and When Did They Know It? A Survey of 284 Physicians

Normal pressure hydrocephalus (NPH) is a relatively new neurologic disorder first described by Salamon Hakim of Bogotá, Colombia, in 1965. NPH is characterized by three symptoms — impaired gait, incontinence and dementia — and an anatomic abnormality, i.e., enlargement of the cerebral ventricles, which can be seen on computerized tomographic or magnetic resonance imaging. Surprisingly, the intracranial pressure is normal.     

CHILDHOOD ACCIDENT PREVENTION—Program and Statistical Survey by a County Medical Society

A study of childhood accidents was begun by the Alameda-Contra Costa Medical Association to determine the incidence of various kinds of accidents, the causes and possible means of prevention. Hospitals, the State Department of Public Health and county and city health departments gave willing assistance when their aid was sought.Data gathered thus far have served to better identify the problems and can be used to set priorities for various phases of future study.