A general model for preventive intervention in clinical practice.

A five-stage collaborative project to develop curriculum and associated instructional materials in preventive medicine has been initiated by the Association of Teachers of Preventive Medicine in cooperation with the Center for Educational Development in Health at Boston University. As part of the first stage, a general model delineating physician responsibilities in the preventive dimension of clinical practice was developed and analyzed in terms of requisite attitudes, knowledge, and skills. The model is based on a theoretical matrix modified by consideration of optimal physician performance in three tracer conditions (lung cancer, gonorrhea, and hypertension) and the results of a Delphi survey among a sample of 50 primary care practitioners. Competency in planning a practice-based program of prevention and the ability to assist patients in modifying patterns of behavior emerged as significant determinants of physician effectiveness in preventive intervention.