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Biomedical subjects

A Devera-Sales

Publications and source records attributed to A Devera-Sales.

5 recordsLinked to original sources
PubMed1999

What do family medicine patients think about medical students' participation in their health care?

PURPOSE: To find out what patients think about students' involvement in their health care. METHOD: After conducting semistructured interviews with 24 patients, the authors developed a questionnaire addressing patients' concerns about student involvement in health care. The questionnaire was administered to 735 patients in academic and community settings; 575 (78%) patients responded. RESULTS: Most responding patients (90%) were willing to have a student involved in their health care. Those who were unwilling commonly cited privacy concerns. A third of the patients reported that the student did at least part of the physical examination. Three fourths of the patients who saw a student, and half of those who did not, said they appreciated or would appreciate the attention they got from a medical student. Almost half the patients (39%) perceived that student involvement lengthened their visits. CONCLUSION: Most patients in family medicine are willing to allow students to be involved in their care, and most perceive it as beneficial.

Adolescent↗
PubMed1998

Screening for problem drinking: does a single question work?

BACKGROUND: Brief interventions with problem drinkers have been shown to be effective, but physicians often do not ask about alcohol use. If a single question could effectively screen for problem drinking, it might facilitate intervention with problem drinkers. METHODS: A cross-sectional study was undertaken to address the clinical utility of the question, "On any single occasion during the past 3 months, have you had more than 5 drinks containing alcohol?" Placing it between questions about tobacco and seat-belt use, we presented the three questions in writing to 1435 patients; 95.3% answered them. With a systematic sample of 101 patients who answered yes and 99 who answered no, we administered the Alcohol Use Disorders Identification Test in writing followed by two gold-standard interview instruments: (1) a calendar-based review of drinking, with at-risk drinking defined as drinking more than 4 drinks on one occasion or more than 14 drinks per week for men, and more than 3 drinks on one occasion or 7 per week for women; and (2) the alcohol questions in the Composite International Diagnostic Interview, with alcohol-use disorders defined by the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) criteria. We defined problem drinking as either at-risk drinking in the previous month or an alcohol-use disorder in the past 12 months. RESULTS: The single question had a positive predictive value of 74% and negative predictive value of 88% for problem drinking, with a sensitivity of 62% and a specificity of 93%. The question's utility was similar for detecting at-risk drinking and current alcohol-use disorders; it correctly identified all 29 patients who had both. CONCLUSIONS: A single question about alcohol can detect at-risk drinking and current alcohol-use disorders with clinically useful positive and negative predictive values.

Adult↗
PubMed1997

Teaching medical students in community-based practices: a national survey of generalist physicians.

BACKGROUND: This study was undertaken to determine the extent of medical student teaching by community-based generalists, differences between teachers and nonteachers, and physicians' perceptions and attitudes about teaching. METHODS: Two questionnaires were mailed to a random sample of 4974 generalist physicians in community-based practice in the United States including family physicians, general internists, and general pediatricians. The first survey instrument was a postcard with two questions; the second was a 4-page questionnaire sent to postcard responders. These mailings were supplemented by a telephone survey of nonresponders. RESULTS: Forty-two percent responded to the postcard, and, of those, 47% responded to the questionnaire. Adjusted by the results of a telephone survey of postcard nonresponders, 30% of family physicians and general pediatricians and 20% of general internists taught medical students in their offices. The average teaching physician worked with three students per year for approximately 10 days each. Family physicians and general internists who had community-based educational experiences while in medical school were more likely to be teachers. Teachers were somewhat younger than nonteachers (year of medical school graduation 1977 vs 1973), but there were few other differences. Controlling for specialty, teachers did not differ from nonteachers in patient-care volume or payer mix of the practice. Teachers noted a 30-minute (median) lengthening of their workday when a student was present, and 30% saw fewer patients per day when a student was in the practice. Only 9% of the teachers reported being paid for their teaching. More than 90% of both nonteachers and teachers believed that students should receive part of their education in community-based practices. CONCLUSIONS: Depending on specialty, 20% to 30% of community-based generalists teach medical students. Although teachers perceive that teaching lengthens their work day and may decrease productivity, the great majority of both teachers and nonteachers believe that community-based education is important.

Ambulatory Care↗
PubMed1996

Impact of medical student teaching on family physicians' use of time.

BACKGROUND: The purpose of this study was to determine how much and in what ways family physicians' time at work is affected by the presence of a medical student in the practice. METHODS: The study included work sampling of 22 non-academic family physicians, each observed during 1 day with and 1 day without a medical student, and 12 academic family physicians, of whom nine were observed for 8 half-days and three for 2 or 4 half-days of clinical practice. Observations were made on average every 4 minutes at preselected random times during the workday. RESULTS: When a student was present at the practice, the amount of time private physicians actually spent working increased by 52 minutes per day, and their patient-care productivity decreased from 3.9 to 3.3 patients per hour. There was no significant change in time spent at work for academic physicians. With a student present, the physicians in private practice spent 27 fewer minutes per day in patient-care activities, whereas academic physicians spent 47.5 fewer minutes per day in these activities. Private and academic physicians spent 71 and 63 minutes per day, respectively, in student-centered activities. There were few differences between physician groups in how this direct teaching time was used. CONCLUSIONS: When a student is in the practice, private family physicians shift substantial amounts of work time from patient-centered to student-centered activities. They also use their personal time for teaching activities and experience a decrease in patient-care productivity of 0.6 patients per hour.

Ambulatory Care↗