The Division of General Medicine's faculty completed an exciting and challenging year in patient care, research, and education. Our research program continued to develop with an expanded portfolio which runs the gamut from collaborative work with leading international corporations, to research which will redefine how health care is measured and managed.

The University of Michigan and key members of the Division of General Medicine have continued a very productive relationship with the Ford Motor Company. Dr. James Woolliscroft, Senior Associate Dean of the University of Michigan Medical School and a member of the Division, was awarded a grant to assist in developing competencies for Ford's global physician workforce. In addition, Dr. Jack Billi has continued his work with Ford Motor Company and General Motors in developing new paradigms of health care delivery, partnering with these worldwide corporations to redefine and refine health care delivery in partnership for the 21st Century.

A number of faculty have explored new ways of teaching and evaluating the effectiveness of our teaching, a key goal of the University of Michigan Medical School. First, Dr. Rajesh Mangrulkar is studying the design and evaluation of digital technology in medical education. In a controlled study, he found that performance on a simulated examination improved with the use of such an educational computer program, and that learned skills were sustainable over one year. Building on the principles learned in this study, he and Dr. Richard Judge (Cardiology) received funding to begin to develop a Clinical Skill Builder. The Clinical Skill Builder is a carefully crafted multimedia Web-based textbook of cases designed to effectively simulate the clinical and education environment. In another educational innovation, Dr. Brent Williams, noting an era of decreased resources for education in the academic medical centers, and for the need of accurately measuring clinical teaching performance, developed a Global Rating Scale (GRS), to measure residents' ratings of teaching faculty performance. The University of Michigan GRS matched extremely closely with the results of residents' ratings of faculty teaching along seven dimensions. As a result of this, and previous work demonstrating its reliability and validity, the GRS has been implemented at a number of programs across the country, and similar global measures are gaining increased acceptance as one component of systems to evaluate faculty teaching performance. Finally, Dr. David Stern is leading the Medical School's program on Global Research Education and Collaboration in Health (REACH) and is working with the Institute for International Medical Education to establish international minimal standards for the MD degree.

Dr. Susan Dorr Goold, Associate Professor of Internal Medicine and Director of the Medical School's Bioethics Program, co-designed a unique program to understand better laypersons' health care allocation decisions. This group simulation exercise a "game" called "Choosing Healthplans All Together" (CHAT), allows participants to assist in the design of their own healthplan, individually and as a group. CHAT has been used to study the insurance benefit preferences and values of North Carolina residents, including the uninsured, and was used in the Consumer Health System Study and Reform Proposal in Minnesota. Currently, Dr. Goold and her colleagues are testing an electronic derivative (eCHAT), designing a lightweight, easily portable educational version (EdCHAT), and plan to develop a web version in the near future (WebCHAT). This novel way of engaging individuals, and indeed communities, in understanding the financial and practical trade-offs inherent in creating a viable health plan, will be increasingly necessary as the cost of health care continues to escalate along with patients needs and desires for ever more expensive health care options.

Another group of faculty in the Division have developed leadership nationally in the field of medical errors. Drs. Hayward and Hofer have challenged the overall methodology used in the Institute of Medicine report on patient safety. While recognizing the critical issue of patient safety, they note that the Institute of Medicine report's methodology significantly over states the issue, and their work seeks to put the problem in proper context. Dr. Sanjay Saint has addressed the real issues of patient safety related to catheters used while patients are hospitalized. These catheters, while often beneficial, pose, as do all medical interventions, a definable risk of local and systemic infection. He has shown that in certain high-risk populations there were economic and medical benefits of using special silver alloy urinary catheters to prevent urinary tract infections. He has also gone on to show, along with his colleagues Drs. Steven Bernstein and Timothy Hofer, as well as colleagues in Seattle and San Francisco, that in fully one-third of patients with urinary catheters, their attending physicians were unaware that they were in use. This demonstrates an important issue and the need for ongoing oversight in this useful technology with inherent risk. Drs. Hofer and Saint are directing a nationally funded Development Center for Education and Research in Patient Safety at Michigan.

We would also like to highlight three new research faculty in the Division, whose individual research programs enhance the overall research agenda of the Division and should prove very productive in the coming years. Dr. Catherine Kim, MD, MPH, holds a joint appointment in the Department of Obstetrics and Gynecology. She has focused her research on screening and management of cardiovascular risk factors in women. In addition to this key research agenda, she is also involved in medical education and developed printed materials for the new women's health curriculum for Internal Medicine residents. Dr. Monica Lypson, MD, has a focus in medical education, specifically, on academic leadership and the underrepresentation of minorities in academic medicine. She has recently completed work on an evaluation of medical student career choice in academic medicine stratified by race. Finally, Maria Silveira, MD, MA, MPH, is a health services researchers and medical ethicist examining issues surrounding the end of life. She is interested in exploring not only the personal decisions patients make regarding end-of-life care, but also the laws governing end-of-life decisions, as well as the distribution of resources geographically related to end-of-life care.

The research program in the Division of General Medicine has continued to flourish. In the past fiscal year, the funded research in the division has increased from a yearly average of 5.4 million to 7.8 million dollars per year. In addition, this past fiscal year, faculty applied for over 44 million dollars in total grant funding.

Our education and clinical care program remains a cornerstone, not only of the division, but also to the Department of Internal Medicine. This past year, faculty in the division saw over 212,650 outpatient visits. In addition to providing superb patient care, patients and faculty participate in the educational programs of the Medical School and Department. Every faculty member participates in this educational activity and a number of our faculty have been singled out as providing excellent care and teaching. Dr. Paul Fine won the Medical School Kaiser Permanente Award for clinical teaching, the highest award given yearly by the Medical School in recognition of teaching excellence. Dr. Sanjay Saint received the Galens Medical Society Silver Shovel Award presented by the senior class in recognition of teaching excellence. The Department of Internal Medicine provides teaching awards to recognize members of the department who have contributed in a unique way to the educational program. Three of our faculty received Department of Medicine awards this year. Dr. Robert Ernst received special recognition for contributions to the house officer teaching program, Dr. Sean Kesterson received special recognition for contributions to the medical student teaching program, and Dr. Sanjay Saint received the Richard D. Judge Award for excellence in medical student teaching. This unprecedented recognition by both the Medical School and Department of our faculty's involvement in teaching highlights the dedication and attention paid to teaching by all of our faculty.

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