A new measure of the cognitive, metacognitive, and experiential aspects of residents' learning.

Purpose: Psychometric data are presented for the Cognitive Behavior Survey: Residency Level (rCBS), a survey that profiles cognitive, metacognitive, and experiential aspects of residents' learning.

Method: The authors asked 963 residents from seven medicine residencies of large academic medical centers to participate in their study and gathered data from the respondents during a three-year period, 2000-2002. A factor analysis cross-validation design guided the development of rCBS's seven scales: memorization, conceptualization, reflection, independent learning, critical thinking, meaningful learning experience, and attitude toward educational experience.

Chronic condition self-management support: proposed competencies for medical students.

Objective: Governments and the medical profession are concerned that there continues to be less than optimal health outcomes despite escalating expenditure on health services from the effect of the ageing population with chronic illnesses. In this context, doctors will need to have knowledge and skills in effective chronic condition management (CCM) and chronic condition self-management (CCSM).

Method: A national workshop of representatives of eight medical schools from the CCSM special interest group (SIG) of the Australian and New Zealand Association on Medical Education met in September 2004, to consider curriculum content in CCM and CCSM.

Residency education, preventive medicine, and population health care improvement: the Dartmouth-Hitchcock Leadership Preventive Medicine approach.

In 2003, Dartmouth-Hitchcock Medical Center (DHMC) inaugurated its Leadership Preventive Medicine residency (DHLPMR), which combines two years of leadership preventive medicine (LPM) training with another DHMC residency. The aim of DHLPMR is to attract and develop physicians who seek to become capable of leading change and improvement of the systems where people and health care meet. The capabilities learned by residents are (1) leadership -- including design and redesign -- of small systems in health care, (2) measurement of illness burden in individuals and populations, (3) measurement of the outcomes of health service interventions, (4) leadership of change for improvement of quality, value, and safety of health care of individuals and populations, and (5) reflection on personal professional practice enabling personal and professional development.

Direct observation of faculty with feedback: an effective means of improving patient-centered and learner-centered teaching skills.

Background: In 2002 Lehigh Valley Hospital and Health Network Internal Medicine residency program sought to establish a faculty development program for their teaching faculty that emphasized learner-centered teaching of patient-centered care.

Description: Medical educators trained in observational research practices shadowed teaching teams for 24 months and observed 24 General Internal Medicine faculty teach on inpatient rounds and provided timely written feedback to faculty. Within 48 hr, faculty received a completed Observation Feedback Sheet and summary comments.

Teaching focused histories and physical exams in ambulatory care: a multi-institutional randomized trial.

Purpose: We needed specific strategies for students in diverse outpatient settings to more uniformly learn focused history and physical exam skills.

Methods: We conducted a randomized control trial to test the use of focused history and physical exam scripts in enhancing 3rd-year medical students' clinical skills at two medical schools. The article based scripts outlined focused outpatient encounters.

Exploring and embracing complexity in a distance-learning curriculum for physicians.

The recent pressures on clinical medicine such as the attention to medical error and the challenges of interdisciplinary care have also exerted pressure on health professions education. Educators must now gauge how to redesign education systems to adapt quickly to these disruptions. Sometimes disruptions can be self-inflicted, such as the VA National Quality Scholars Fellowship's decision to use interactive video (IV) as its primary medium for delivering the curriculum to its six sites around the nation.

An efficient and effective teaching model for ambulatory education.

Teaching and learning in the ambulatory setting have been described as inefficient, variable, and unpredictable. A model of ambulatory teaching that was piloted in three settings (1973-1981 in a university-affiliated outpatient clinic in Portland, Oregon, 1996-2000 in a community outpatient clinic, and 2000-2001 in an outpatient clinic serving Dartmouth Medical School's teaching hospital) that combines a system of education and a system of patient care is presented. Fully integrating learners into the office practice using creative scheduling, pre-rotation learning, and learner competence certification enabled the learners to provide care in roles traditionally fulfilled by physicians and nurses.