A promotion ladder for teachers at Harvard Medical School: experience and challenges

The authors describe the development, implementation, and institutionalization at Harvard Medical School of a promotion ladder that recognizes the teaching and scholarly contributions of full-time clinical faculty. They also discuss the challenges that arose during this process, for example, how to make the new track creditable and attractive to both the appointed faculty and the faculty at large. The criteria developed for promotion focus on a candidate's skills and accomplishments in teaching, scholarship, clinical work, and departmental service. The authors present the elements of these criteria for the three professional levels of the ladder and outline the appointment process, including the steps for consideration of a given promotion. The development of this teacher-clinician ladder has had a positive influence on faculty who are committed to teaching by allowing recognition of their contributions in a track held to be the equal of the other full-time tracks in a medical faculty traditionally committed to research and patient care. Data are given for the 70 faculty who were promoted over the five years from 1989 to 1994. The true success of this promotion ladder will be measured only over time through its impact on the educational enterprise within the medical school and its hospitals, and its capacity to both successfully advance the careers of qualified medical educators and further the development of the field of medical education.     

Dartmouth Medical School bicentennial

To investigate the regulation of cell-to-cell coupling in myocardial ischaemia, the three-dimensional expression of connexin43 (Cx43) during experimental ischaemia was examined using a confocal laser scanning microscope. After induction of myocardial infarction in rats, serial optical sections were obtained from the left ventricular myocardium at various times (3 h to 60 days after ligation). The expression of Cx43 was detected immunohistochemically with FITC-labelled anti-rat Cx43 antibody. Fluorescent dots of Cx43 remained along the intercalated disc and decreased in number around the infarct up to 12 h after ligation. Cx43-expression disappeared completely within 48 h after ligation. After day 4, and especially on days 8 and 15 after ligation, the edges of the cardiomyocytes bordering the infarcted area manifested numerous sarcoplasmic tentacles that reacted positively to anti-desmin antibody. Distinct expression of Cx43 was observed extensively on the tentacles, although no cardiomyocytes remained viable around them. By day 60 after ligation, atypical expression of Cx43 had disappeared. These findings suggest that ischaemia induces temporally abnormal expression of Cx43, which might be responsible for abnormal conduction around the infarct.     

Physical activity and stroke incidence: the Harvard Alumni Health Study

BACKGROUND and PURPOSE: Physiologically, it appears plausible for physical activity to decrease stroke risk; however, epidemiological studies have produced mixed findings. Furthermore, few studies have examined specific kinds and intensities of activities. The purpose of this study was to examine the association between physical activity, including its various components (walking, climbing stairs, participation in sports and recreational activities), and stroke risk. METHODS: This was a prospective cohort study of 11 130 Harvard University alumni (mean age, 58 years) without cardiovascular disease and cancer at baseline. Men reported their walking, stair climbing, and participation in sports or recreation on baseline questionnaires in 1977. Stroke occurrence was assessed with another questionnaire in 1988. Death certificates were obtained for decedents through 1990 to determine strokes not previously reported (total strokes=378). We used Cox proportional hazards regression to estimate the relative risks and 95% CIs for stroke occurrence associated with physical activity. RESULTS: After adjustment for age, smoking, alcohol intake, and early parental death, the relative risks of stroke associated with <1000, 1000 to 1999, 2000 to 2999, 3000 to 3999, and >/=4000 kcal/wk of energy expenditure at baseline were 1.00 (referent), 0.76 (95% CI, 0.59 to 0.98), 0.54 (0.38 to 0. 76), 0.78 (0.53 to 1.15), and 0.82 (0.58 to 1.14), respectively; P=0. 05 for linear trend. Walking >/=20 km/wk was associated with significantly lower risk, independent of other physical activity components. Climbing stairs and activities of at least moderate intensity (>/=4.5 METs, or multiples of resting metabolic rate) each showed U-shaped relations to stroke risk, with the risk being significantly lower at the nadir of the curve. Light intensity activities (<4.5 METs), however, were unrelated to stroke risk. CONCLUSIONS: Physical activity is associated with decreased stroke risk in men. A decreased risk was observed at energy expenditures of 1000 to 1999 kcal/wk, with further risk decrement seen at 2000 to 2999 kcal/wk but not beyond. Confirmation of the U-shaped relation observed in these data requires similar observations in other populations.     

Coping Style as a Predictor of Health and Well-Being Across the First Year of Medical School.

Medical students in their 1st year (N=71) were assessed prior to starting training and at year's end. Coping styles reported at baseline were strongly related to coping styles at the end of the year. Students' physical health and psychological well-being declined over the course of the year. The greater the students' use of both problem-focused coping and approach emotion-focused coping, the less their physical health deteriorated. Psychological well-being at year's end was more strongly related to baseline functioning, and coping style did not predict change. This study demonstrated the utility of measuring coping style and the predictive ability of coping on physical health in a healthy sample. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Medical ethics teaching. Report of a National Medical School Survey

Medical ethics teaching was surveyed at American medical schools. Of 107 schools that responded, 97 indicated some kind of medical ethics teaching. This included, however, 19 schools where teaching was only by discussion of ethical issues in courses not primarily identified as ethics courses. Fifty-six institutions (up from 17 in 1972) reported that they conducted special conferences, lectures, or seminars on issues in medical ethics. Specific medical ethics electives were offered in 47 schools; some kind of required course existed at six institutions. The number of faculties with major commitments to medical ethics teaching increased approximately 50% (from 19 to 31). Several schools now have departments or interdepartmental teaching programs with formal structure and permanent staff.     

Letter from North America. Medical practice and criminal law

Aboriginal communities and their health services should prepare together and in advance for caring for an HIV-infected person. Good social support will be the keystone to successful clinical management. Health care workers must look to Aboriginal people for the lead in developing appropriate responses.     

Medical Records for Building Health Management

Medical records provide essential information for evaluating a patient’s health. Without them, it would be difficult for doctors to make accurate diagnoses. Similar to diagnoses in medical science, building health management also requires building medical records for making accurate diagnoses. At later stages of a building’s life cycle, when the budget is limited, organizations responsible for building repairs and maintenance are unable to digitalize building health diagnoses and keep complete medical records of buildings; as a result, maintenance crews usually cannot fully understand buildings’ overall health conditions and their medical histories, which may result in erroneous diagnoses directly or public safety dangers indirectly. Using the problem-oriented medical record adopted for the medical diagnosis of human diseases, this paper designs a building medical record (BMR), which allows simple electronic archiving, and evaluates its practicability with a case study of school buildings. The purpose of a BMR is to enable maintenance engineers (building doctors), building managers, and contractors of school buildings to have low-cost access to required information for making complete evaluations and maintenance suggestions for buildings.     

More Harvard humbug.

Replies to J. Sonnenfeld's (1982) critique of D. Bramel and R. Friend's (see record 1982-08638-001) article on the studies performed at the Hawthorne plant of Western Electric. Sonnenfeld fails to recognize the unique aspects of Bramel and Friend's reinterpretation of what happened at Hawthorne. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Medical School Characteristics Associated With the Employment of Psychologists.

The purpose of this communication is to present results from analyses correlating the number of psychologists employed in the 115 U.S. medical schools in 1977 with some of the schools' demographic characteristics, as well as the schools' perceived reputations. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Isolation of penicillin-resistant Streptococcus pneumoniae in Saga Medical School Hospital

A recent nationwide increase in beta-lactams-resistant Streptococcus pneumoniae has attracted a great deal of attention. We studied the drug sensitivity of S. pneumoniae isolated from various clinical specimens in Saga Medical School Hospital between April 1988 and December 1991. To determine the drug sensitivity of the strains, we used a micro-dilution method and determined the MIC. Drug resistance was evaluated using MIC of ampicillin (ABPC) as a reference MIC, and the results were roughly classified into the following three groups: sensitive (< or = 0.1 microgram/ml), moderately resistant (0.2-3.13 micrograms/ml) and highly resistant (> or = 6.25 micrograms/ml). The isolation frequency was calculated on the basis of one strain from one patient. No strain of S. pneumoniae with high resistance against ABPC was found in 1988 (94 strains of S. pneumoniae were isolated) and 1990 (115 strains isolated), but one such strain (0.8%) was found among 129 strains isolated in 1989, and 2 such strains (2.4%) among 84 strains isolated in 1991. Moderately resistant strains were isolated at the frequencies of 12.8%, 15.5%, 22.6%, and 21.4% respectively, in 1988, 1989, 1990, and 1991. A sum of the frequencies of "moderately resistant" and "highly resistant" (2.4%) strains was 23.8% in 1991. The frequency of resistant strains is increasing and the intensity of resistance is also being elevated.     

Unwinding, Recuperation, and Health Among Compulsory School and High School Teachers in Sweden.

The aim of this study was to investigate unwinding and recuperation among teachers. Six items were used and combined to identify level of activation and recuperation during the 24 hr of each day. Cluster analysis was used to detect groups of individuals with similar activation-recuperation profiles. The study group comprised 472 teachers from 12 schools. Three clusters of teachers were identified: alert, in-between, and nonrecuperated. About 20% of the teachers fell into the nonrecuperated group. This group showed more (a) symptoms of ill health, (b) illness-related absences that were due to sickness, and (c) poorer attendance when sick than the other two groups. Failure to recuperate was related to aspects of the classroom, but not to teachers' perceptions of more general organizational circumstances. (PsycINFO Database Record (c) 2010 APA, all rights reserved)