The healthcare marketplace is rapidly changing how we finance medical education, how we train physicians, and the interrelationships within an academic institution. This case study examined the historical development of the Department of Family and Community Medicine and the impact of growing financial constraints on the training of medical students and residents, the clinical practice, faculty workload, and departmental organization. The theoretical frameworks of resource dependence, culture, and professionalization theory were employed to understand how different groups within the context of an academic health center co-exist to meet the core missions of teaching, research, and service. Data collection was conducted over a two-year period and utilized the triangulation of interviews, document analysis, and participant observation methods. The study's findings indicated that the Department of Family and Community Medicine continually faced the challenge of being a primary care department in an academic medical culture that placed more emphasis on specialized care and specialty departments. Over a period of time, the Department went from a profit-center to a cost-center where faculty's ability to teach and conduct research revolved around the success or failure of the clinical care enterprise. Faculty productivity was increasingly emphasized and its definition was dependent on the healthcare marketplace and the availability of resources. The competitive health care market encroached on faculty workload and manifested itself in part through the loss of a major patient care contract, the receivership of the Department, and the splitting of the Department and its resources. During the period of time analyzed, the department was in a no-win situation because the success of the department was determined by more powerful coalitions that had decision making ability and controlled the necessary resources. The department's power lay in the provision of teaching resources and its alignment with the state's goal of training primary care physicians to work in rural and underserved communities. Conflict arose as departments tried to defend and protect their declining resources and jurisdictions. The study findings emphasized the importance of understanding departmental jurisdictions and how resource allocation decisions are made in the context of the academic setting and culture.

Research on belief perseverance--the finding that people cling to initial beliefs to an unwarranted extent--has demonstrated that a belief persists to the extent that there are more explanations available to the believer to support the original belief than to support alternative beliefs. Thus, explanatory evidence that supports an alternative target belief may be more effective in changing prior beliefs than statistical evidence. In an experiment testing this hypothesis, subjects read explanatory (biological) information and/or statistical (epidemiological) information supporting the belief that Acquired Immune Deficiency Syndrome (AIDS) cannot be spread by casual contact. Subjects' beliefs on this issue were assessed before and after reading this information. Subjects also evaluated the evidence they read. Finally, the availability of explanations supporting the target belief was assessed. Results indicated that: (1) explanatory evidence produced significant belief change, whereas statistical evidence did not; (2) evaluations of evidence were biased in accord with subjects' initial beliefs; (3) information polarized attitudes, although attitudes changed in the appropriate direction; (4) final beliefs were more congruent with the target alternative belief after subjects read explanatory information than after they read statistical information. Evidence was mixed regarding whether explanatory evidence was less subject to evaluation bias and subsequent attitude polarization than statistical information. In addition, explanation availability mediated the effectiveness of information in determining final beliefs, and evaluations of the evidence mediated the effect of initial beliefs on attitude polarization. A motivational construct, attitudes toward gay men, was related to initial beliefs and belief change--those with negative attitudes had more inappropriate beliefs and displayed less change in beliefs than those with moderate attitudes. However, evaluations of evidence were better predicted by initial beliefs than by attitudes toward gay men. This study has clear implications for those attempting to change beliefs, including those responsible for AIDS education: explanatory evidence is more effective than statistical evidence in changing beliefs.

Thesis (Ph.D.)--Pacific Graduate School of Psychology, 1994. / Source: Dissertation Abstracts International, Volume: 56-04, Section: B, page: 1921. Chair: Bruce Bongar.

Thesis (M.S.P.H.)--University of Michigan, 1940.

Thesis (M.S.)--University of Michigan, 1983.

Thesis (M.S.)--University of Michigan, 1983.

Thesis (M.S.)--University of Michigan, 1983.

Thesis (M.S.)--University of Michigan, 1982. / "A research report submitted in partial fulfillment of the requirements for the degree ..."

Thesis (M.S.P.H.)--University of Michigan, 1940.

Thesis (doctoral)--Katholieke Universiteit te Nijmegen, 1989?