Faculty Bibliography

Using the latest computer tomography (CT) and X-ray (DEXA) technology to measure body fat in 224 Caucasian women, researchers confirmed that abdominal fat, particularly internal fat wrapped around the liver and other internal organs, is linked to heart disease. According to their report in the American Journal of Clinical Nutrition, leg fat was actually associated with better cardiovascular health

The objective of this survey was to demonstrate whether a primary care track internal medicine residency program emphasizing community-based health care of the urban sick poor trains physicians who will continue to practice in general internal medicine or similar fields. Thirty-five primary care residents (100% of graduates) who trained from 1976 through 1993 in the Adult Primary Care Track of the Internal Medicine Residency Program at St. Vincent's Hospital, New York were used as participants.

BACKGROUND: Limited success of efforts to improve residents' critical appraisal skills may be due to poor understanding of their preintervention conceptual framework. DESCRIPTION: To describe internal medicine residents' a priori conceptual approach to critical appraisal of intervention trials, we performed an exploratory content analysis of 41 residents' unprompted descriptions of strengths and weaknesses of a randomized trial of spa therapy for back pain. EVALUATION: Eighty-eight percent of responses were assigned independently by 2 reviewers to 23 categories ( kappa .65). Residents agreed on some important characteristics (e.g., blinding), disagreed on others (e.g., similarity of treatment and control groups), frequently mentioned some irrelevant characteristics (e.g., "objective" vs. "subjective" outcomes), and rarely mentioned some important criteria (e.g., intention to treat). CONCLUSIONS: An open-ended questionnaire reliably revealed both expected and unexpected conceptions and misconceptions among residents who had received minimal or no formal instruction in critical appraisal. We propose a classification model for residents' critical appraisal concepts that can be tested in future studies and used to identify areas for focusing interventions to improve resident physicians' critical appraisal skills.

By 1998, a Medicare prospective payment system for home care is expected to be in place. Physicians must become more involved in home care, because they will be held accountable for the patients they refer and the services they order.