Background. The population perspective (risk-factor assessment, preven
tion, epidemiology, and the social aspects of illness) is increasingly
important in medical school and residency curricula. The authors desi
gned an observational study to assess the population-perspective conte
nt of internal medicine teaching rounds led by attending physicians at
the Columbia-Presbyterian Medical Center. Method. During eight months
in 1992 a trained research assistant used a structured observation fo
rm in observing attending rounds. Population scores were calculated by
totaling the number of times population-perspective topics were menti
oned during each case presentation (one point was awarded per mention,
with an additional point being added for discussions lasting 30 secon
ds or more). Chi-square tests and unpaired t-tests were used to compar
e scores between teams with one generalist and one subspecialist atten
ding physician and teams with two subspecialists. Results. Fifteen tea
ms and 368 patient presentations were observed. The mean population sc
ores were 24.5 for teams with generalist attending physicians and 17.9
for teams with subspecialists only (p <.0001). The population scores
for individual case presentations ranged from 2 to 55. Conclusion. The
population-perspective topics were raised more frequently on the inte
rnal medicine teaching rounds when a generalist attending physician wa
s present than when there were only subspecialist attending physicians
.