This study examined whether the clinical environment could be used to increase internal medicinehouse officers' adoption of care recommendations taught in a didactic conference. Subjects were11 ...internal medicine house officers who served 6‐week rheumatology elective rotations. At the start of each of four rotation periods, house officers attended a 1‐hour conference in which periarticular rheumatic disorders associated with knee pain (anserine bursitis, pseudothrombo‐phlebitis) and shoulder pain (bicipital tendinitis) were discussed. All house officers also practiced physical examination techniques on anatomic models simulating the disorders. During alternate rotation periods, reminder sheets were appended to the records of arthritis patients with histories of chronic knee or shoulder pain. The frequency with which house officers followed conference recommendationswas documented by direct observation (6 house officers in 17 encounters with reminders, 5 house officers in 30 encounters without reminders). Specific questioning about a recent history of knee or shoulder pain and the performance of four of five recommended physical examination maneuvers were increased significantly by reminder sheets in patients' charts (P < 0.05 for all). Although rheumatology faculty often have limited options available to increase the number of house officer trainees or to intensify clinical activity, qualitative improvements within existing logistic parameters are feasible by assuring that the clinical environment (e.g., patient records) contains salient cues that will prompt desired actions.
In this study, we evaluated an inservice training program for public health nurses. The training program concerned arthritis screening and management of the disease in elderly subjects. Twenty-nine ...nurses were assigned randomly to experimental (training) or control conditions. Evaluation data from 158 interviews with patients showed that screening for arthritis was done twice as frequently by nurses in the experimental group, compared with that done by nurses who were not in the experimental group (P less than 0.01). Recommended management of arthritis was not correspondingly improved. Stronger inservice programs are discussed in light of the need to anticipate seasonal conflicts between arthritis care and preventive care for the elderly, to change habitual practice patterns, and to increase access to arthritis health professionals.
The evolution of clinical knowledge about the management of a common chronic disease was determined by applying analysis of variance and multiple discriminant analysis to responses on two patient ...management problems by groups of junior medical students and internal medicine residents. Differences between junior and resident groups were found on both problems for management decisions and therapeutic actions and on one problem for information-gathering. Discriminant analyses of original responses clearly identified patterns of choices contributing to group differences. The utility of patient management problems when analyzed under these two empirical models is discussed.
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