Implementing clinical practice guidelines: social influence strategies and practitioner behavior change.

Clinical practice guidelines offer potentially valuable tools for rationalizing health care delivery and improving patient outcomes. Currently, major efforts are under way to develop, test, and refine guidelines for a wide variety of medical conditions and procedures. Although methods for producing guidelines are fairly well understood and continue to improve, experience suggests that guidelines rarely translate directly into changes in practice.

Two ways to assess problems of evaluating third- and fourth-year medical students: a case study.

Clinical faculty commonly acknowledge that they have difficulty evaluating third- and fourth-year medical students. The faculty and administration of the Louisiana State University (LSU) School of Medicine in New Orleans conducted pilot tests of two types of materials to assess these problems as part of the Clinical Evaluation Program undertaken by the Association of American Medical Colleges in 1984-1985. The two types of materials--questionnaires and the Problem-Case Analysis--were developed by the staff of the AAMC program and used by the LSU Department of Medicine and the Department of Obstetrics and Gynecology to identify problems in the process of evaluating clerks.

Types of problem students encountered by clinical teachers on clerkships.

The teachers who play the all-important role of enabling students to learn on clinical clerkships must balance the two essential skills of being a good role model and maintaining objectivity in order to identify students with a variety of problems. This study describes the findings of a survey that identifies both the type of the problems that most bother teachers and the relative frequency of those problems. Non-cognitive problems (poor interpersonal skills and non-assertive, shy students) were identified by teachers as being seen at the same relative frequency but posing greater difficulty than cognitive problems (poor integration skills, disorganization, poor fund of knowledge, etc.

An AAMC pilot study by 10 medical schools of clinical evaluation of students.

In 1979 the Association of American Medical Colleges (AAMC) began a Clinical Evaluation Program. In the first phase of the program, AAMC staff members interviewed more than 500 persons in approximately 40 medical schools and solicited responses from clerkship coordinators in six specialties on the problems encountered in evaluating students' clinical performance. These results were published in 1983.