Volume 107, Issue 1

Context : Tens of millions of Americans use herbal products and/or dietary supplements, yet scant data are available regarding the purity, safety, or efficacy of these substances. A better understanding of usage trends and patient attitudes toward self-initiated supplementation is vital to obtaining accurate and complete medical history data. Objective : To survey Americans aged approximately 60 years and older regarding their use of herbal products and dietary supplements and their attitudes and knowledge regarding the safety of these popular substances. Methods : A face-to-face, 35-item survey was administered to 267 men and women residing in the Kansas City, Mo–metropolitan area. Researchers documented usage patterns for, attitudes about, and knowledge of herbal products and dietary supplements in this population. Results : Fifty-six (21%) respondents were currently taking at least one herbal product or dietary supplement, and potential for adverse drug reactions was apparent in 12 (19%). Glucosamine, garlic, Echinacea , and Gingko biloba were the most frequently cited substances used by survey participants. White women with at least some college education were most likely to report taking these products. However, preservation of health was by far the most predictive indicator for use of herbal products and dietary supplements. Subjects were found to be receptive to patient education efforts for these products. Conclusion : Although substantial misconceptions about herbal products and dietary supplements exist among older Americans, most individuals in this population are interested in receiving additional information about these products. Excellent opportunities exist for expanded patient education—and improved patient care.

Objective: To assess the opinions of emergency medicine (EM) residents and program directors about the value of completing a nonrequired 1-year internship before entering an EM residency program accredited by the Accreditation Council for Graduate Medical Education (ACGME). Methods: An eight-question, self-administered online survey was e-mailed to EM residents who had completed a nonrequired internship before entering ACGME-accredited residency programs. A separate, six-question survey was e-mailed to program directors of ACGME-accredited programs that do not require an internship who had ever had a resident who had completed a nonrequired internship. Results: Forty-six (27 [59%] osteopathic, 19 [41%] allopathic) of 113 residents and 40 of 124 program directors responded to the survey questions. Less than 4% of residents completed a separate nonrequired 1-year internship. The most common reason for completing a nonrequired internship was to obtain licensure by the American Osteopathic Association (19 [41%]). Most residents believed that they were more proficient with history-taking and physical examinations (38 [83%]) and procedures (34 [74%]) during the first year of residency than their colleagues who did not complete an internship, but this percentage decreased over time. The program directors had similar opinions. Most osteopathic residents who completed the internship for osteopathic licensure would not have done so if it were not required. Most (39 of 40) program directors would not recommend taking a nonrequired internship. Conclusion: Completing a 1-year internship before entering an EM residency program may better prepare physicians for their first year of residency in terms of basic clinical competancy, but further study is needed in this area.

The authors present a model of an interdisciplinary, longitudinal (lifecycle), generalist “doctoring” course that spans the first 2 years of osteopathic medical education and training. This course is intended to run concurrently with a nongeneralist curriculum and to link this curriculum sequentially. The educational topics and objectives show a unique alignment with anatomy and osteopathic principles. The course encompasses (1) logical sequencing of curricular content; (2) a strong interconnection between the didactic and clinical practice experiences throughout the continuum of education and training; (3) additional exposure to clinical applications during the early and formative stages of medical education; and (4) additional coverage of specific clinical competency areas.