Faculty Bibliography

The concern that there are too few generalist physicians and too many specialists is part of the ongoing health care debate. Medical educators have been challenged at the graduate and undergraduate levels to educate more generalists. While some question the actual effect of medical education on the choice of a generalist career, others strongly express the view that a generalist curriculum influences graduates to pursue a career in primary care. Residency training programs are largely based in hospitals, and pediatric practice is largely community based. The terms educational malpractice, educational mismatch, and, most recently, educational dysjunction have been used to describe the difference between the educational and practice experience.

The authors conducted a study of the rate of utilization of psychiatric consultation by various services at two general hospitals. The study found that the rehabilitation and plastic surgery services had the highest ratio of consultations to admissions. Depression was the most frequent reason cited in staff requests for psychiatric consultation. Male patients were overrepresented among the consultees in proportion to their number in the total general hospital census. The authors conclude that appropriate psychiatric consultation can enable the majority of patients with psychiatric problems to be maintained on the wards to which they were admitted, and that psychiatric liaison staff should be trained in a variety of consulting roles.