Commentary: Health care reform and primary care: training physicians for tomorrow's challenges.

Although Congress recently passed health insurance reform legislation, the real catalyst for change in the health care delivery system, the author's argue, will be changes to the reimbursement model. To rein in increasing costs, the Centers for Medicare and Medicaid aims to move Medicare from the current fee-for-service model to a reimbursement approach that shifts the risk to providers and encourages greater accountability both for the cost and the quality of care. This level of increased accountability can only be achieved by clinical integration among health care providers.

Image transfer through cirrus clouds. I. Ray trace analysis and wave-front reconstruction.

A new technique for modeling image transfer through cirrus clouds is presented. The technique uses a ray trace to model beam propagation through a three-dimensional volume of polydisperse, hexagonal ice crystals. Beyond the cloud, the technique makes use of standard Huygens-Fresnel propagation methods.

Student involvement on teaching rounds.

Background: Inpatient internal medicine education occurs in a fragile learning environment. The authors hypothesized that when medical students are involved in teaching rounds, residents may perceive a decrease in value of attending teaching.

Method: During two summer periods, trained research assistants shadowed teaching rounds, tracking patient census and team call status, recording basic content of rounds, and delivering a survey instrument to the learners, asking them to rate the quality of the attending's teaching that day.

Do pressure and fatigue influence resident job performance?

Background: Global surveys of residents have consistently identified stress variables as important factors in resident job performance.

Aims: Determine whether an association exists between resident stress and job performance.

Method: Over a three month period, interns on our inpatient ward services were surveyed regarding their current call schedule, whether their prior night's sleep was sufficient, whether they felt pressed by other commitments, whether they spent enough time teaching medical students and whether they had completed all patient care issues on a given day.