Reframing Professionalism: The Virtuous Professional.

This article was migrated. The article was marked as recommended. In response to prevalent unprofessional behaviors during the 1990s, the medical school administration at Michigan State University's College of Human Medicine developed a student curriculum for professional development, called "The Virtuous Student Physician.

Patient Factors Influencing Respiratory-Related Clinician Actions in Chronic Obstructive Pulmonary Disease Screening.

Introduction: The purpose of this study was to identify patient-related factors that may explain the increased likelihood of receiving a respiratory-related clinician action in patients identified to be at risk for chronic obstructive pulmonary disease in a U.S.-based pragmatic study of chronic obstructive pulmonary disease screening.

The impact of screening tools on diagnosis of chronic obstructive pulmonary disease in primary care.

Background: Chronic obstructive pulmonary disease (COPD) is frequently misdiagnosed or undiagnosed, which can delay disease management interventions.

Purpose: The Screening, Evaluating and Assessing Rate CHanges of diagnosing respiratory conditions in primary care 1 (SEARCH1) study assessed whether screening using the COPD Population Screener (COPD-PS) questionnaire to detect COPD risk factors and symptoms, with or without a handheld spirometer (copd-6) to detect airflow limitation, can increase yields of COPD diagnosis and respiratory-related clinician actions in primary care.

Design: A prospective, multi-center, pragmatic, comparative-effectiveness, cluster-randomized study conducted from September 2010 to October 2011 (data analyzed from December 2011 to January 2013).

Advancing geriatrics fellowship programs through a community-based residency network.

Background And Objectives: Our nation faces unprecedented challenges in caring for older adults. Geriatricians who provide care and teach geriatrics are underrepresented in the workforce, especially in non-metropolitan communities. In Michigan, geriatricians and geriatrics fellowship (GF) programs are clustered in the Southeast, suggesting that training site demographics may influence fellows' career location decisions.

Evolution of faculty affairs and faculty development offices in U.S. medical schools: a 10-year follow-up survey.

Purpose: To determine how U.S. MD-granting medical schools manage, fund, and evaluate faculty affairs/development functions and to determine the evolution of these offices between 2000 and 2010.

Student performance on smoking cessation counseling with standardized patients.

Background And Objectives: Gaps in medical school education exist for the leading preventable cause of morbidity and mortality in the United States--cigarette smoking. This report is on an innovative medical student curriculum of smoking cessation with a high-stakes required performance assessment during a third-year clerkship in family medicine addressing the following questions: (1) Can medical students consistently achieve high levels of performance providing smoking cessation advice with standardized patients and (2) Is the performance on standardized patients associated with other concurrent cognitive test performance on comprehensive topics relevant to family medicine?

Methods: From 1997--2002 (Cohort 1), 470 students completed a focused assessment with standardized patients on smoking cessation counseling. From 2003--2007, 277 students completed a revised, complex shared decision making assessment on smoking cessation with standardized patients.

Nonpharmacological management of agitation in hospitalized patients: a pilot study.

This article reports on the use of Simple Pleasures interventions to minimize agitation in hospitalized patients with late-stage dementia. The pilot project was not able to demonstrate statistical significance; however, the positive response to the education and provision of interventions has led to a hospital-wide dissemination of the interventions in the form of an activity box. No adverse effects of the interventions were found, and some patients experienced a significant decrease in agitation and use of sedative medications after exposure to the interventions.

Clinician perceptions of factors influencing referrals to a smoking cessation program.

Background: Referral of patients to smoking cessation telephone counseling (i.e., quitline) is an underutilized resource by primary care physicians.

Practice-based referrals to a tobacco cessation quit line: assessing the impact of comparative feedback vs general reminders.

Purpose: We undertook a study to assess the impact of comparative feedback vs general reminders on practice-based referrals to a tobacco cessation quit line and estimated costs for projected quit responses.

Methods: We conducted a group-randomized clinical trial comparing the impact of 6 quarterly (18 months) feedback reports (intervention) with that of general reminders (control) on practice-based clinician referrals to a quit-line service. Feedback reports were based on an Achievable Benchmark of Care approach using baseline practice, clinician, and patient survey responses, and referrals per quarter.

Recruiting health plan members receiving pharmacotherapy into smoking cessation counseling.

Background: Smokers receiving pharmacotherapy and individualized smoking cessation counseling through telephone quitlines have been found to have higher quit rates than smokers receiving pharmacotherapy alone. Health plans are often positioned to encourage their members to use quitline services in addition to pharmacotherapy.

Objective: To determine if healthcare members who were receiving pharmacotherapy increased their participation in smoking quitline services after receiving proactive telephone calls or postcards.

Increasing generic prescribing: a resident educational intervention.

Background And Objectives: Future physicians are urged to balance effectiveness and cost in their prescribing of medications. This study determined whether educational sessions for residents together with a "Resident Report Card" changed residents' prescribing of generic medications in both commercial and Medicaid patient panels, compared with regional performance of physicians in practice in the community.

Methods: Twenty-four family medicine residents providing care for 1,038 (600 Medicaid and 438 commercial) members (or 31,140 total member months) received biannual profiles of their prescribing patterns and participated in four training sessions related to prescription profiling within a regional health plan.

Medical comorbidity in addictive disorders.

Greater risks exist for medical comorbidities in persons with addictive disorders. Clinicians should screen for early comorbidities such as hepatitis C and HIV. During acute intoxications and overdoses, patients are at greater risk for major respiratory and cardiac events.

An examination of the process of relapse prevention therapy designed to aid smoking cessation.

The process of relapse prevention (RP) therapy is examined. Patients' responses were recorded primarily during telephonic, RP counseling designed to facilitate smoking cessation. A computer program that prompted counselor initiatives and provided a framework for the recording of patient responses guided counselor interaction with patients.

The development of resident "report cards" in the context of managed care education.

This article describes the development of residents' report cards as one component of a curriculum on physician profiling for primary care residents. Thirty-two first-year residents matriculating into family practice, internal medicine, pediatrics, and obstetrics-gynecology residency programs in 1998 were profiled. The patient information in the report cards was limited to data on a panel of Medicaid patients initially seen in the resident ambulatory care clinics.

Enhancing smoking cessation of low-income smokers in managed care.

Background: Although office-based and telephone support services enhance the rate of smoking cessation in managed care systems, it is not clear whether such services are effective for very low-income smokers. We evaluated the comparative effectiveness of usual care (physician-delivered advice and follow-up) and usual care enhanced by 6 computer-assisted telephonic-counseling sessions by office nurses and telephone counselors for smoking cessation in very low-income smokers in Medicaid managed care.

Methods: A randomized clinical trial comparing the 2 approaches was conducted in 3 Michigan community health centers.

Are higher doses of nicotine replacement more effective for smoking cessation?

This study determined whether higher dose nicotine patches are more efficacious than lower dose patches among heavy smokers. A randomized double-blind study compared 0, 21, 35, and 42 mg/day of a 24-h patch in 1039 smokers (> or = 30 cigarettes/day) at 12 clinical sites in the USA and one in Australia. Daily patches were used for 6 weeks followed by tapering over the next 10 weeks.

Training tomorrow's clinicians today--managed care essentials: a process for curriculum development.

Objective: To develop a managed care curriculum for primary care residents.

Design: This article outlines a 4-stage curriculum development process focusing on concepts of managed care organization and finance. The stages consist of: (1) identifying the curriculum development work group and framing the scope of the curriculum, (2) identifying stakeholder buy-in and expectations, (3) choosing curricular topics and delivery mechanisms, and (4) outlining the evaluation process.