Note: Each of the following topics is rated as inadequate with the percentage noted (one if only in 2001, 3 numbers if rated in 1999, 2000, and 2001) bold areas are those where primary care experiences could definitely contribute and the impact is potentially there for other subjects as well. The numbers do not mean a failure on the part of medical schools, the topics are chosen to track areas deemed important by AAMC over time:
Nutrition 66% of senior students in 2001 rated nutrition instruction as inadequate; practice management 72, 66.3, 63.8%; pain management 62.1, 60.5, 56.1%; managed care, law and medicine, alternative medicine all about 55% inadequate; occupational medicine 54.1, 55.1, 52.1%; med record keeping instruction inadequate rating by 52.4, 47.3, 45%; cost effective care 45.6; genetics counseling 40%; role of community health and social service agencies 41.6, 41.6, 36.7 (similar numbers in biostats eval also); patient follow up 46.2%, 46.3%, 34.8%; palliative care, family/domestic violence, end of life care all about 30 - 35% of students rated these as inadequate; culturally appropriate care for diverse populations 33.8, 33.3, cultural differences and health related behaviors, customs 31.5, 32.8, health issues for underserved populations 35.3, 29.2, public health and community medicine 33, 32.3, 27.3%, risk assessment and counseling 40.5, 29.6, 25.4, continuity of care inadequate 24.1%
The outliers are clearly the following,
adequate coverage of medical economics in the first two years (51% disagree or strongly disagree)
adequate coverage of health care systems in the first two years (65% disagree or strongly disagree)
nutrition related experiences (57% D or SD) note: except for that related to heart disease
care of ambulatory patients inadequate listed by 20% 1999, 16.3% in 2000, 10.3% in 2001 (doubt the curricula or emphasis change as much as faculty and national attitudes here
patient follow up inadequate 46.2%, 46.3%, 34.8% - why the sudden decline in ratings for patient follow up - attitude
primary care excessive 13.7%, 14.1%, 14.0 in 2001 - very little change but lots more press
long term health care inadequate 39.5, 39.6, 36
physician to physician communication skills 19.7 % inadequate (new in 2001) (wonder about the choices of these students in the match as compared to the 78.3% who thought the instruction was appropriate)
teamwork with other health professionals inadequate 15.6, 16.3, 14.6
clinical pharmacology inadequate 28, 28.7, 26% a scary statistic
nutrition inadequate 65.7% new in 2001
geriatrics inadequate 43.6, 38.6, 42.3
pain management inadequate 62.1, 60.5, 56.1
continuity of care inadequate 24.1
public health and community medicine inadequate 33, 32.3, 27.3 - similar numbers in epidemiology
role of community health and social service agencies inadequate 41.6, 41.6, 36.7, similar numbers in biostats
health promotion disease prevention inadequate 20.6, 19.2, 16.6
health issues for underserved populations inadequate 35.3, 29.2
risk assessment and counseling inadequate 40.5, 29.6, 25.4
occupational medicine inadequate 54.1, 55.1, 52.1
cultural differences and health related behaviors, customs inadequate 31.5, 32.8 (one of the only such measures to increase despite the fact that it is measured and other similar indicators are falling)
culturally appropriate care for diverse populations inadequate 33.8, 33.3
cost effective 45.6
quality assurance inadequate 56.6, 50.3, 42.8
practice management inadequate 72, 66.3, 63.8
med record keeping instruction inadequate rating by 52.4, 47.3, 45%
managed care, law and medicine, alternative medicine all about 55% inadequate
family dynamics, palliative care, family/domestic violence, end of life care all about 30 - 35% inadequate
- patient followup, long term health, pain management, continuity of care control, family dynamics,
palliative care, family/domestic violence, end of life care all about 30 - 35% inadequate.