BACKGROUND:Rates of blood pressure (BP) control are lower in minority populations compared to whites. OBJECTIVE:As part of a project to decrease healthrelated disparities among ethnic groups, we sought to evaluate the knowledge, attitudes, and management practices of clinicians caring for hypertensive patients in a predominantly minority community. DESIGN/PARTICIPANTS:We developed clinical vignettes of hypertensive patients that varied by comorbidity (type II diabetes mellitus, chronic renal insufficiency, coronary artery disease, or isolated systolic hypertension alone). We randomly assigned patient characteristics, e.g., gender, age, race/ethnicity, to each vignette. We surveyed clinicians in ambulatory clinics of the 4 hospitals in East/ Central Harlem, NY. MEASUREMENTS:The analysis used national guidelines to assess the appropriateness of clinicians' stated target BP levels. We also assessed clinicians' attitudes about the likelihood of each patient to achieve adequate BP control, adhere to medications, and return for follow-up. RESULTS:Clinicians' target BPs were within 2 mm Hg of the recommendations 9% of the time for renal disease patients, 86% for diabetes, 94% for isolated systolic hypertension, and 99% for coronary disease. BP targets did not vary by patient or clinician characteristics. Clinicians rated African-American patients 8.4% (p=.004) less likely and non-English speaking Hispanic patients 8.1% (p=.051) less likely than white patients to achieve/maintain BP control. CONCLUSIONS:Clinicians demonstrated adequate knowledge of recommended BP targets, except for patients with renal disease. Clinicians did not vary management by patients' sociodemographics but thought African-American, non-English-speaking Hispanic and unemployed patients were less likely to achieve BP control than their white counterparts.

A structured debate resulted in residents reporting increased comfort level and willingness to discuss mammography with women in their 40s.

This program, in which internists trained medical residents in pelvic examination, utilized real patients, improved participants self-assessed competency, and may increase the likelihood of residents performing pelvic examination in primary care.

Morning report is a case-based teaching session common to many residency programs with varying purposes and focuses. At our institution, physicians and residents felt our Internal Medicine morning report had lost its educational focus. The purpose of this project was to improve morning report using a well-known curriculum development framework for medical education. We conducted a focus group of residents to develop and implement changes to morning report. Themes from our focus group led us to split morning report with the first 30 minutes for postgraduate year 3 (PGY-3) residents to give handover, to receive feedback on diagnosis and management, and to either discuss an interesting case or receive teaching aimed at their final certification examination. The second 30 minutes involved PGY-3 residents leading PGY-1 residents in case-based discussions with an attending physician providing feedback on the content and process of teaching. We measured success based on a follow-up survey and comments from resident evaluations before and after the change. Overall, the changes were well received by both faculty and residents; however comments revealed that the success of morning report is preceptor dependent. In summary, we have successfully implemented a split morning report model to enhance resident education with positive feedback.