Alabama

Feb. 2-4: Certificate in business administration physicians program. Auburn University, Auburn. (15 hrs: P) Sponsor: Southern Medical Association. Contact Joyce Lane: 800-423-4992.

Alaska

Dec. 1-2: Child and adolescent psychiatry. Providence Alaska Medical Center, Anchorage. (7 1/2 hrs: E) Sponsor: Providence Health System Alaska. Contact Mark Agnew, M.D.: 907-261-3011.

Arizona

Dec. 6-7: Dermatologic procedures. Holiday Inn Sunspree Resort, Scottsdale. (16 hrs: P) Sponsor: National Procedures Institute. Contact Chantee DuFort: 517-631-4664.

Dec. 6-7: Sclerotherapy. Holiday Inn Sunspree Resort, Scottsdale. (11 1/4 hrs: P) Sponsor: National Procedures Institute. Contact Chantee DuFort: 517-631-4664.

Dec. 8: Flexible sigmoidoscopy. Holiday Inn Sunspree Resort, Scottsdale. (6 3/4 hrs: P) Sponsor: National Procedures Institute. Contact Chantee DuFort: 517-631-4664.

Dec. 8-9: Orthopedics for the office practice. Holiday Inn Sunspree Resort, Scottsdale. (12 hrs: P) Sponsor: National Procedures Institute. Contact Chantee DuFort: 517-631-4664.

Dec. 14-17: Intensive conversational medical Spanish/culture workshop. Manicopa Medical Center, Phoenix. (36 3/4 hrs: P) Sponsor: Rios Associates. Contact Joanna Rios: 520-907-3318; www.proespanol.com.

Dec. 15: Neurology for the non-neurologist. The Phoenician, Scottsdale. (11 hrs: P) Sponsor: Medical Education Resources. Contact Linda Main: 800-421-3756.

Jan. 26-29: Intensive conversational medical Spanish/culture workshop. University of Arizona, Tucson. (36 3/4 hrs: P) Sponsor: Rios Associates. Contact Joanna Rios: 520-907-3318; www.proespanol.com.

Feb. 16-19: Intensive conversational medical Spanish/culture workshop. University of Arizona Medical School, Phoenix. (36 3/4 hrs: P) Sponsor: Rios Associates. Contact Joanna Rios: 520-907-3318; www.proespanol.com.

Mar. 14-16: Clinical reviews 2001. Ritz-Carlton Hotel, Phoenix. (17 1/2 hrs: P) Sponsor: Mayo Clinic Scottsdale. Contact Sarah Dorste: 480-301-4580.

Mar. 17: Women’s health in primary care 2001 and beyond. Ritz-Carlton Hotel, Phoenix. (4 1/2 hrs: P) Sponsor: Mayo Clinic Scottsdale. Contact Sarah Dorste: 480-301-4580.

Mar. 29-30: Mayo update in liver disease/ transplantation. Embassy Suites, Paradise Valley. (12 hrs: P) Sponsor: Mayo Clinic Scottsdale. Contact Sarah Dorste: 480-301-4580.

Reduced funding, rising student numbers, geographical dispersal, and increased competition in a complex global market have put medical schools under pressure to embrace computer assisted learning

New technologies may have important educational advantages, but without support and training for staff and students they could prove an expensive disaster

Expansion of computer assisted learning requires cultural change as well as careful strategic planning, resource sharing, staff incentives, active promotion of multidisciplinary working, and effective quality control

It is becoming “a truth universally acknowledged” that the education of undergraduate medical students will be enhanced through the use of computer assisted learning. Access to the wide range of online options illustrated in the figure must surely make learning more exciting, effective, and likely to be retained. This assumption is potentially but by no means inevitably correct.

Deans of medical faculties often receive requests for development funding for computer assisted learning projects. Decisions to introduce these projects into the undergraduate curriculum are generally justified by one or more of the arguments listed in box 1.

Box 1: Why fund computer assisted learning?

Computer assisted learning is inevitable–Individual lecturers and departments are already beginning to introduce a wide range of computer based applications, sometimes in a haphazard way. Planned and coordinated development is better than indiscriminate expansion

It is convenient and flexible–Courses supported by computer assisted learning applications may require fewer face to face lectures and seminars and place fewer geographical and temporal constraints on staff and students. Students at peripheral hospitals or primary care centres may benefit in particular

Unique presentational benefits–Computer presentation is particularly suited to subjects that are visually intensive, detail oriented, and difficult to conceptualise, such as complex biochemical processes or microscopic images.[1] Furthermore, “virtual” cases may reduce the need to use animal or human tissue in learning

Personalised learning–Each learner can progress at his or her preferred pace. They can repeat, interrupt, and resume at will, which may have particular advantages for weaker students

(American Academy of Family Physicians) An experimental, four-week clerkship, titled Surgical Oncology for the Generalized Physician, for 24 fourth-year medical students entering family practice or general internal medicine was found to increase the oncology knowledge and retention levels of these students compared with peers who were not enrolled in the clerkship. The students who participated in the clerkship at a regional cancer center were given a pretest, posttest and a six-month follow-up examination. The students’ knowledge rose significantly from pretest to posttest with an improvement of 40 percent compared with only a 10 percent increase of knowledge among peers. Evaluation at six months showed a 90 percent retention rate among the clerkship students and a return to a pretest level of knowledge among the peer group. The four components of the clerkship were: ambulatory multidisciplinary experiences in breast, dermatology, gastrointestinal, thoracic, endoscopy, and soft tissue and melanoma with multidisciplinary conferences; practical skill stations on breast, testicular, skin and prostate examination; supervised objective structured clinical education sessions with physician audit and immediate feedback; and problem-based learning sessions in small group setting. The researchers contend that multidisciplinary education, crossing the traditional barriers of medicine, surgery, pathology, radiology and others, is feasible and effective in student education.–JUDY LYNN SMITH, M.D., Roswell Park Cancer Institute, Buffalo, New York.

Teaching complementary medicine offers a way of making teaching more holistic

Complementary and alternative medicine is no longer an obscure issue in medicine. Our patients are using alternative therapies in addition to conventional care[1 2] and sometimes do not share this information with us. But even if they did would we know how best to advise them about safety issues or about the effectiveness of a particular therapy for their problem? Surveys indicate that doctors and medical students are increasingly interested in complementary and alternative therapy,[3-5] yet lack of knowledge is one of the greatest barriers to its appropriate use. Although many medical schools and training programmes now include teaching on complementary and alternative therapies, the approaches are variable and often superficial.

In this issue Owen et al ask provocative questions about our attitudes and behaviour towards complementary and alternative therapy (p 154),[6] and point out that few of us encountered such therapy as medical students or during later training. Nevertheless, there are signs of change, and Owen et al describe initiatives to include complementary and alternative therapy in medical education in the United Kingdom. Similar changes are occurring in the United States. In 1995 a national conference on complementary and alternative therapy education involving the National Institutes of Health recommended that complementary and alternative therapy should be included in nursing and medical education. Two years later a survey of all 125 US medical schools found that 75 of them offered some form of education on complementary and alternative therapy.[7]

The concept of the indirect cost of graduate medical education was introduced into the hospital payment lexicon in 1980 by the Health Care Financing Administration (HCFA). HCFA stated that, in calculating the Section 223 cost limits, the per diem allowable costs could be adjusted for a number of factors, including indirect cost of graduate medical education. To determine the adjustment, HCFA analysts estimated a cost function in which the dependent variable was the routine costs per day and the independent variables were location (urban versus rural), bed size, and the number of interns and residents per bed (IRB). The adjustment was tied to the estimated coefficient on the IRB.

When the Medicare Prospective Payment System (PPS) was being designed, there was an agreement that the direct costs of graduate medical education would be paid on a cost basis and that the PPS payment rates would be adjusted in order to account for the indirect costs for graduate medical education. There was also agreement that the indirect medical education (IME) adjustment would be based on the empirical estimate of the relationship between Medicare operating costs per case and IRB as measured by the coefficient from a cost regression. Dalton, Norton, and Kilpatrick briefly discuss some of the history of the IME, both from a policy perspective (i.e., how policymakers set the actual adjustment) and from a research perspective (i.e., how the cost model should be specified and what the implications of alternative specification are). As they point out, the current IME adjustment is based on the coefficient from a cost function using 1981 data. Furthermore, the payment adjustment is higher than the empirical es timate as a result of an explicit policy decision. The IME adjustment is a major contributor to the relatively high margins on Medicare inpatient operating costs that teaching hospitals have.

If you blinked lately, you might have missed a new opportunity to earn CME credit online at the AAFP Web site. AFP online CME cases have become a reality and can be found at www.aafp.org/afp/cases/. But just what are these online cases?

AFP’s online cases are designed to provide family physicians with another option for obtaining CME. The cases offer high-quality, peer-reviewed CME on a variety of subjects relevant to family practice. Each case is presented in an interactive format; at important junctions, the user is asked to make a choice that then dictates his or her path through the case. Each case includes a summary and a short CME quiz to reinforce key concepts. Where appropriate, cases make use of the multi-media capabilities of the Web. So, for example, a case on cardiac auscultation allows users to listen to heart murmurs and one on refractory hypertension shows users the results of a funduscopic examination. The cases also provide links to online resources such as clinical guidelines and patient education materials. In addition, an electronic bulletin board is available that offers users a chance to interact with the author, the medical editor and other participants.

The online cases are developed under the direction of one of AFP’s contributing editors, Mark Zamorski, M.D., M.H.S.A., along with staff from the special projects department of the AAFP publications division. Dr. Zamorski is a clinical assistant professor of family medicine in the Department of Family Medicine at the University of Michigan Medical School, Ann Arbor.

Cases may tie in with topics covered in AFP articles. Five cases are currently available:

* “Practical Management of Panic Disorder: Part 1. Using Antidepressants,” by Mark Zamorski, M.D., M.H.S.A.

* “Practical Management of Panic Disorder: Part 2. Benzodiazepines,” by Mark Zamorski, M.D., M.H.S.A.

* “Auscultation of Systolic Murmurs in the Adult Patient,” by Jeffrey M. Weinfeld, M.D.

* “Evaluation and Management of Difficult-to-Control Hypertension: Part 1. Lifestyle Modifications and Patient Adherence,” by Anthony F. Jerant, M.D.

* “Evaluation and Management of Difficult-to-Control Hypertension: Part 2. Evaluation of Secondary Hypertension,” by Anthony F. Jerant, M.D.

Clinical Quiz questions are based on selected articles in this issue. Answers appear in this issue.

American Family Physician has been approved by the American Academy of Family Physicians as having educational content acceptable for Prescribed credit hours. This issue has been approved for up to 4 Prescribed credit hours. Term of approval covers issues published within one year from the beginning distribution date of April 2001. Credit may be claimed for one year from the date of this issue.

The American Academy of Family Physicians is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

The AAFP designates this educational activity for a maximum of 4 hours in Category 1 credit toward the American Medical Association Physician’s Recognition Award. Each physician should claim only those hours of credit that he or she actually spent in the educational activity.

AAFP Credit

Each copy of AFP contains a Clinical Quiz answer card. AAFP members may use this card to obtain the designated number of Prescribed credit hours for the year in which the card is postmarked.

AMA/PRA Category 1 Credit

AAFP members who satisfy the Academy’s continuing medical education requirements are automatically eligible for the AMA/PRA.

Physicians who are not members of the AAFP are eligible to receive the designated number of credit hours in Category 1 of the AMA/PRA on completion and return of the Clinical Quiz answer card. AFP keeps a record of AMA/PRA Category 1 credit hours for nonmember physicians. This record will be provided on request; however, nonmembers are responsible for reporting their own Category 1 CME credits when applying for the AMA/PRA or other certificates or credentials.

For health care professionals who are not physicians and are AFP subscribers, a record of CME credit is kept by AAFP and will be provided to you on written request. You are responsible for reporting CME hours to your professional organization.

NOTE: The full text of AFP is available online (http://www.aafp.org/afp), including each issue’s Clinical Quiz. The table of contents for each online issue will link you to the Clinical Quiz. Just follow the online directions to take the quiz and, if you’re an AAFP member, you can submit your answers for CME credit.

According to the Association of American Medical Colleges, the number of African-American applicants and women of all races has increased in the nation’s 126 accredited medical schools this school year, the San Francisco Chronicle reports.

The number of African-American applicants rose nationwide by almost 5 percent to 2,483, but the number who actually enter medical school in 2003 declined by almost 4 percent to 1,089, the report states.

Overall the number of individuals, men and women, applying to medical school increased nationally by 3.4 percent, from 33,625 for last year’s class to 34,785 for the class of 2003.

The Association of American Medical Colleges states that the rise in applications reverses the negative trend that began after 1996 when the number of applicants to medical school peaked at 47,000.

Dr. Jordan Cohen, president of the Association of American Medical Colleges, attributes the boost to people who are looking for new career paths and says that “opportunities in other areas are not as great,” according to the Chronicle.

Dr. Cohen added that racial and gender diversity are important in medical schools because of the increasingly diverse U.S. population and because it gives other students a multiracial and multicultural perspective and sensitivity.

Dr. Andrewes said: My first and most pleasant duty is to bid a hearty welcome to the newcomers to this school, and I trust that you will gain here not only adequate u’aining in the profession you have chosen which this school is now more than ever fitted to give you, but also a number of firm friendships and pleasant memories which will remain for your whole lives. I have next to say something to you–not new, indeed, but I hope true–about the methods of medical education, and especially about the value of a rational perspective in your studies. The enthusiasm for work, which I have found even keener amongst women students than amongst men, entails the risk that you may spend time over things that matter little, leaving insufficient space fbr more vital matters. It should be the main function of your teachers to direct your energies into the most important channels. No one can in five, or even in fifty, years learn all that one could wish about disease and its prevention and treatment. You have to go on learning all your lives, and, a healthy sense of ignorance is a saving grace. But there are three things which you must learn in your five years of medical study. You have to learn how to learn. Then you have to learn as much as you can of those things which are of immediate and cardinal importance, and which will serve as the groundwork for furore learning after you commence practice. Lastly, you have to learn how to set forth what you have learned in such a manner as to persuade a Board of Examiners that you are fit and proper persons to be let loose on the public as qualified medical practitioners.

On July 31 the Medscape Web site, named the official provider of online coverage for the new International AIDS Society conference which took place July 8-11, 2001 in Buenos Aires, Argentina, released three Continuing Medical Education programs for medical professionals. Anyone can use them for a review of current knowledge in some of the major areas of HIV treatment. These programs will remain online for one year.

The Medscape site requires a one-time registration, but it is cost-free.

Here we list the titles of the programs and the articles required for CME credit in each one. Each program also has several other articles available which are not listed here.

I. Current Patient Management:

* New Light Through Old Windows: Fine-tuning the Use of Approved Antiretrovirals, by Graeme Moyle, M.D., M.B.B.S.

* Pharmacokinetics, Pharmacodynamics, and Pharmacogenomics: The Continuing Evolution of Pharmacologic Issues in HIV Disease, by Stephen Becker, M.D.

* Update on Antiretroviral Drug Resistance, by Daniel R. Kuritzkes, M.D.

* Management of HIV-Infected Women and Mother-to-Child HIV Transmission, by Alexandra M. Levine, M.D.

II. Novel Therapeutic Strategies

* HIV Entry — From Molecular Insights to Specific Inhibitors, by William A. O’Brien, M.D., M.S.

* Investigational Antiretrovirals in Existing Classes, Mike Youle, M.B.B.S.

* Strategies for Immune Reconstitution in HIV Disease, by Ronald T. Mitsuyasu, M.D.

* Insights From Basic Science: Implications for HIV Treatment and Prevention, Mark A. Wainberg, Ph.D.

III. Complications of HIV Disease

* Opportunistic Infections: Still a WorldWide Problem, Even in the HAART Era, by Henry Masur, M.D.

* New Developments in AIDS-Related Hematology and Oncology, by Alexandra M. Levine, M.D.

* Adverse Effects of Antiretroviral Therapy: More Noise, Less Clarity?, by William G. Powderly, M.D.