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Biomedical subjects

A S Peters

Publications and source records attributed to A S Peters.

At least 19 recordsLinked to original sources
PubMed2005

The clinical effectiveness of hand held Doppler examination for diagnosis of reflux in patients with varicose veins.

OBJECTIVE: To assess the accuracy of hand held Doppler (HHD) as a rapid screening test for selecting varicose vein patients for duplex imaging. DESIGN: Prospective single blind study of consecutive patients in a randomised trial. MATERIALS: Use of hand held Doppler and duplex ultrasound scanners. METHODS: One thousand two hundred and eighteen legs (943 patients) were examined by HHD and then duplex. HHD examiners recorded whether they would normally have requested duplex. RESULTS: HHD results of one Clinical Assistant (166 limbs) were significantly poorer than all others and his results were excluded from analysis. Duplex would not have been requested in 645 of 1052 (62%) limbs. Among these HHD missed significant reflux in the long saphenous vein in 18 (3%) and the short saphenous in 25 (4%). Reasons for requesting duplex were popliteal fossa reflux (202); recurrent (94) or atypical (86) varicose veins; and possible previous thrombosis (67). Differences were observed between staff and units in requests for duplex; and in thoroughness and style of duplex reporting. CONCLUSIONS: Selective use of HHD can avoid duplex imaging for many patients, with a low failure rate for detecting correctable venous reflux. Observed variations between individuals and units in results of HHD and duplex imaging have implications for the increasing use of duplex by clinicians.

Adolescent↗
PubMed2001

The effect of medical education on primary care orientation: results of two national surveys of students' and residents' perspectives.

PURPOSE: To examine changes among a nationally representative sample of students and residents in their orientations toward primary care as reflected in their attitudes toward the psychosocial and technical aspects of medicine and their perceptions of the academic environment for primary care. METHOD: Confidential telephone interviews of stratified national probability samples of first- and fourth-year medical students and residents were conducted in 1994 and 1997. The 1997 survey included 219 students and 241 residents who had also been interviewed in 1994. Participants were asked about their attitudes toward addressing psychosocial issues in medicine and their perceptions of faculty and peer attitudes toward primary care. Responses were compared over time and across groups. RESULTS: Between the first and fourth years of medical school, there was a decline over time in students' reported orientations to socioemotional aspects of patient care (61.6% versus 42.7%, p =.001) and their perceptions that working with psychosocial issues of patients made primary care more attractive (56.3% versus 43.5%, p =.01). This pattern continued for 1997 residents (PGY-3), who were even less likely to say that addressing psychosocial issues made primary care more attractive (26.9%). For fourth-year students in 1994 who became PGY-3 residents in 1997, there was an increased perception that non-primary-care house officers and specialty faculty had positive attitudes toward primary care (20.8% versus 33.0%, p =.005; 28.3% versus 45.7%, p <.0001; respectively). CONCLUSIONS: Between 1994 and 1997 students and residents perceived a positive shift in the attitudes of peers and faculty toward primary care. During the course of their education and training, however, the students experienced an erosion of their orientations to primary care as they progressed through medical school into residency.

Adult↗
PubMed2001

The longitudinal primary care clerkship at Harvard Medical School.

The primary care clerkship (PCC) at Harvard Medical School was established in 1997. The goals are to provide students with longitudinal experiences with patients and to include modern themes in the curriculum: managing illness and clinical relationships over time; finding the best available answers to clinical questions; preventing illness and promoting health; dealing with clinical uncertainty; getting the best outcomes with available resources; working in a health care team; and sharing decision making with patients. The PCC, a required course in the clinical years, meets one afternoon a week for nine months. Students spend three afternoons per month in primary care practices, where they see three to five patients per session and follow at least one patient ("longitudinal patient") over time. Classroom sessions, in both large- and small-group formats, promote a common educational philosophy and experience, and reinforce habits of problem-based learning established in the preclinical years. The students rated 74% of their preceptors excellent, especially praising their ability to facilitate and support good interpersonal relationships with patients, their ability to encourage students' independent evaluation of patients (as opposed to shadowing), and their enthusiasm for teaching. Students saw their longitudinal patients a mean of 4.8 times; 83% saw their patients at least three times. The PCC complements the curriculum of block clerkships in hospitals, and because the two are offered concurrently, students are required to come to terms with two substantially different cultures within medicine. Other medical schools are beginning to develop longitudinal clerkships to ensure that students have essential educational experiences that are difficult to achieve in block, hospital-based clerkships.

Attitude of Health Personnel↗
PubMed2000

The effect of medical student teaching on patient satisfaction in a managed care setting.

OBJECTIVE: To measure the effect on patient satisfaction of medical student participation in care and the presence of medical student teaching. DESIGN: Prospective cohort study. SETTING: Eight outpatient internal medicine departments of a university-affiliated HMO in Massachusetts. PATIENTS: Two hundred seven patients seen on teaching days (81 patients who saw a medical student-preceptor dyad and 126 patients who saw the preceptor alone), and 360 patients who saw the preceptor on nonteaching days. Five hundred (88%) of 567 eligible patients responded. MEASUREMENTS AND MAIN RESULTS: Thirteen closed-response items on a written questionnaire, measuring satisfaction with specific dimensions of care and with care as a whole. Visit satisfaction was similar among patients on teaching and nonteaching days. Ninety-one percent of patients seeing a medical student, 93% of patients seeing the preceptor alone on teaching days, and 93% of patients on nonteaching days were satisfied or very satisfied with their visit; less than 2% of patients in each group were dissatisfied with their visit. Satisfaction on all measured dimensions of care was similar for patients seeing a medical student, patients seeing the preceptor alone on teaching days, and patients seeing the preceptor on nonteaching days. CONCLUSIONS: Medical student participation and the presence of medical student teaching had little effect on patient satisfaction. Concerns about patient satisfaction should not prevent managed care organizations from participating in primary care education.

Clinical Clerkship↗
PubMed2000

Long-term outcomes of the New Pathway Program at Harvard Medical School: a randomized controlled trial.

PURPOSE: To evaluate the long-term effects of an innovative curriculum, the New Pathway (NP) Program, on behaviors and attitudes related to humanistic medicine, lifelong learning, and social learning. METHOD: Long-term follow-up of Harvard Medical School students who participated in a randomized controlled trial. Descriptive study using 1998 telephone interviews of 100 1989 and 1990 graduates (50 who had studied the NP curriculum, 50 who had studied the traditional curriculum). The NP Program consisted of problem-based learning tutorials, with coordinated lectures, labs, experiences in humanistic medicine, and clinical experiences; the traditional program consisted of basic science lectures and labs. RESULTS: Of 22 measures on the survey, NP and traditional students differed significantly on only five (three humanism; two social learning): 40% of NP students and 18% of traditional students went on to practice primary care or psychiatry. NP students rated their preparation to practice humanistic medicine higher than did traditional students and expressed more confidence in their ability to manage patients with psychosocial problems. NP students were more likely than were traditional students to believe that faculty from the first two years continued to influence their thinking. NP students liked the pedagogic approaches of their program more than traditional students did. There was no difference between the groups on measures of lifelong learning. CONCLUSIONS: Differences between NP and traditional students in the humanism domain first appeared during medical school and residency and remained significant well into practice, suggesting that humanistic medicine can be taught and learned.

Attitude↗
PubMed1999

Views of managed care--a survey of students, residents, faculty, and deans at medical schools in the United States.

BACKGROUND AND METHODS: Views of managed care among academic physicians and medical students in the United States are not well known. In 1997, we conducted a telephone survey of a national sample of medical students (506 respondents), residents (494), faculty members (728), department chairs (186), directors of residency training in internal medicine and pediatrics (143), and deans (105) at U.S. medical schools to determine their experiences in and perspectives on managed care. The overall rate of response was 80.1 percent. RESULTS: Respondents rated their attitudes toward managed care on a 0-to-10 scale, with 0 defined as "as negative as possible" and 10 as "as positive as possible." The expressed attitudes toward managed care were negative, ranging from a low mean (+/-SD) score of 3.9+/-1.7 for residents to a high of 5.0+/-1.3 for deans. When asked about specific aspects of care, fee-for-service medicine was rated better than managed care in terms of access (by 80.2 percent of respondents), minimizing ethical conflicts (74.8 percent), and the quality of the doctor-patient relationship (70.6 percent). With respect to the continuity of care, 52.0 percent of respondents preferred fee-for-service medicine, and 29.3 percent preferred managed care. For care at the end of life, 49.1 percent preferred fee-for-service medicine, and 20.5 percent preferred managed care. With respect to care for patients with chronic illness, 41.8 percent preferred fee-for-service care, and 30.8 percent preferred managed care. Faculty members, residency-training directors, and department chairs responded that managed care had reduced the time they had available for research (63.1 percent agreed) and teaching (58.9 percent) and had reduced their income (55.8 percent). Overall, 46.6 percent of faculty members, 26.7 percent of residency-training directors, and 42.7 percent of department chairs reported that the message they delivered to students about managed care was negative. CONCLUSIONS: Negative views of managed care are widespread among medical students, residents, faculty members, and medical school deans.

Administrative Personnel↗
PubMed1999

Comparison of osteopathic and allopathic medical Schools' support for primary care.

OBJECTIVE: To contrast prevailing behaviors and attitudes relative to prJgiary care education and practice in osteopathic and allopathic medical schools. DESIGN: Descriptive study using confidential telephone interviews conducted in 1993-94. Analyses compared responses of osteopaths and allopaths, controlling for prJgiary care orientation. SETTING: United States academic health centers. PARTICIPANTS: National stratified probability samples of first-year and fourth-year medical students, postgraduate year 2 residents, and clinical faculty in osteopathic and allopathic medical schools, a sample of allopathic deans, and a census of deans of osteopathic schools (n = 457 osteopaths; n = 2,045 allopaths). MEASUREMENTS: Survey items assessed personal characteristics, students' reasons for entering medicine, learners' prJgiary care educational experiences, community support for prJgiary care, and attitudes toward the clinical and academic competence of prJgiary care physicians. MAIN RESULTS: PrJgiary care physicians composed a larger fraction of the faculty in osteopathic schools than in allopathic schools. Members of the osteopathic community were significantly more likely than their allopathic peers to describe themselves as socioemotionally oriented rather than technoscientifically oriented. Osteopathic learners were more likely than allopathic learners to have educational experiences in prJgiary care venues and with prJgiary care faculty, and to receive encouragement from faculty, including specialists, to enter prJgiary care. Attitudes toward the clinical and academic competence of prJgiary care physicians were consistently negative in both communities. Differences between communities were sustained after controlling for prJgiary care orientation. CONCLUSIONS: In comparison with allopathic schools, the cultural practices and educational structures in osteopathic medical schools better support the production of prJgiary care physicians. However, there is a lack of alignment between attitudes and practices in the osteopathic community.

Adult↗
PubMed1999

Intention to practice primary care by pediatric residents: nature or nurture?

Factors associated with the intention to practice primary care were examined in a survey of a national sample of PL-2 residents (n = 98). Socioemotional orientation (nature), faculty and peer encouragement (nurture), and clinical experiences during residency (nurture) were independently associated with a primary care career choice. For residents who changed career intentions to primary care from a nonprimary care preference, gender, encouragement by faculty and peers, and outpatient experiences during residency were associated with the change. Encouragement by both faculty and peers had the strongest influence on primary care career choice for all residents.

Emotions↗
PubMed1997

Hand-held Doppler as a screening test in primary varicose veins.

BACKGROUND: Hand-held Doppler is in common use for evaluating varicose veins, but its accuracy in identifying the exact sites of venous reflux is inferior to that of duplex scanning. It has been suggested that duplex should be used to investigate all varicose veins, but this is currently impractical, and should be unnecessary if hand-held Doppler examination were shown to be an adequate screening test. METHODS: Eighty-five patients (122 legs) with primary varicose veins were evaluated using a hand-held Doppler in the outpatient clinic, according to a protocol. Patients then had venous duplex imaging. RESULTS: Different methods of assessing the long saphenous vein (LSV) (tourniquet and tapping tests, and examination at and below the groin) had similar sensitivities for detecting reflux (75-86 per cent), and together detected 91 per cent of cases. Six of the nine missed had a competent saphenofemoral junction, and five had low-velocity reflux. Hand-held Doppler assessment missed 11 cases of popliteal fossa reflux; only four involved the short saphenous vein (SSV), and most had low-velocity popliteal vein reflux. CONCLUSION: Hand-held Doppler examination missed LSV or SSV incompetence in 11 per cent of legs, but these included cases with short-duration and low-velocity reflux of dubious clinical importance.

Adult↗
PubMed1996

Academia's chilly climate for primary care.

OBJECTIVE: To describe the attitudes toward and perceptions of primary care education and practice among academic health center constituents. DESIGN AND PARTICIPANTS: Descriptive study using confidential telephone interviews (October 1993 to March 1994) of national stratified probability samples of first- and fourth-year medical students, residents, clinical faculty, internal medicine and pediatrics residency training directors and chairs, and deans (N=2293). RESULTS: Five areas were examined: respondents' specialty orientation, attitudes toward the competence of primary care physicians, encouragement and positive regard for primary care, exposure to primary care-related educational experiences, and socioemotional orientation. The response rate was 84%. Respondents generally perceive primary care tasks as not requiring high levels of expertise; nearly half believe that generalists are not the best physicians to manage patients with serious illness and that the quality of primary care research is inferior to that in other fields. Attitudes are more positive toward the quality of primary care teaching. Learners perceive little encouragement for generalist careers and negative attitudes toward generalists among faculty, and view the quality of their primary care training as inferior to that for specialty practice. Those who have progressed further in the academic medicine hierarchy generally report lower levels of socioemotional orientation than individuals at earlier phases of career development. CONCLUSIONS: Despite changes in the health care system and in education, students and residents encounter an atmosphere that is chilly toward primary care. If medical educators seek to optimize enthusiasm and preparation for primary care careers, they must develop approaches to changing the attitudes, values and composition of their faculties.

Academic Medical Centers↗
PubMed1996

The teaching matrix: a tool for organizing teaching and promoting professional growth.

Despite barriers of limited time and lack of formal preparation for teaching, physician-teachers want to do a good job in the classroom. However, without appropriate feedback or self-reflection, physician-teachers have no systematic way to think about their role both in what students learn and in how well they understand important information. With this in mind, the authors developed a model, the Teaching Matrix, designed to encourage clinician-teachers to reflect on their teaching before, during, and after each teaching session. The Matrix helps teachers to address five central questions: Who am I teaching? What am I teaching? How will I teach it? How will I know if the students "got it"? And how will I improve my teaching for the next time? In this paper, the authors describe how the Teaching Matrix may be used as a tool for planning actions, as a "suggestion box" of ideas, advice, and questions, and, most importantly, as a guide to systematic reflection on teaching.

Education, Medical, Undergraduate↗
PubMed1990

The reliability of the proposal review process for a summer research fellowship program.

The authors evaluated the reliability of the proposal review process used by a faculty-student committee to choose medical student researchers for summer fellowships. A total of 82 proposals were reviewed by the committee over a two-year period (43 in 1987 and 39 in 1988); the proposals were assigned ratings in the spring of each year. The 39 students whose proposals received the highest ratings over the two-year period received fellowships and carried out their projects during ten weeks in the summer of each year. In December of both years, the research fellows, along with a total of 12 students whose proposals had been rejected by the program over the two-year period but who had received support from other programs, presented their findings. These research presentations were also judged and rated, and the ratings of all the presentations were compared with the student committee's original ratings of the research proposals. A significant correlation was found between both years' sets of ratings for the proposals and the research presentations. The "accepted" students generally received higher ratings on their presentations than did the "rejected" students; however, the mean of the ratings received by the "accepted" students for their presentations was not significantly higher than that received by the "rejected" students. Even so, the significant correlation between each year's set of ratings for all the students involved demonstrates the soundness of the review process.

Evaluation Studies as Topic↗
PubMed1989

Teaching the informed consent process to residents.

We believe the focus and emphasis of this committee on informed consent is unique, and that the development of an informed consent teaching process for residents will focus on the moral and ethical issues regarding informed consent. Even more important, we believe we will emphasize the patient care aspects of informed consent and also teach residents their responsibilities for long-term patient care with regard to patients' satisfaction and understanding of their disease process.

Informed Consent↗
PubMed1987

Effect of a course in cancer prevention on students' attitudes and clinical behavior.

The long-term effects of a first-year medical school course in disease prevention focusing on cancer were studied. The authors hypothesized that students' increased knowledge of disease prevention principles would result in more positive attitudes toward aggressive treatment and prevention of cancer and a more frequent use of disease prevention techniques in clinical settings. On two occasions one to three years after the course, groups of students who took the course and groups that did not take the course responded to a test of knowledge of cancer, a cancer attitude survey, a clinical practice survey, and an evaluation of the course's relevance. Also, their clinical behavior was observed and coded during videotaped interviews of patients. While the students who took the course were more knowledgeable about cancer than their peers who did not, they did not have significantly more positive attitudes; nor were they significantly more likely to use prevention techniques in clinical settings. However, the more knowledgeable students--both those who took the course and the control students--had more positive attitudes than the less knowledgeable students. Those students who considered the course relevant to their training were more knowledgeable and had more positive attitudes toward cancer prevention than those who did not consider it relevant.

Attitude of Health Personnel↗
PubMed1986

Effect of a cancer education program on student interest and learning in cancer.

In a five-year study of medical students who had participated in a first-year elective course on cancer, the authors found that 47 percent of all participants subsequently became involved in other cancer programs. A sample (n = 40) of the participants was interviewed and studied in depth. Their subsequent expressed and overt interests in cancer were related to their achievement on neoplasm-related test items contained in second-year systemic pathology examinations and to their perception of transfer of learning from the cancer course. Neither expressed nor overt interest in cancer was significantly related to test scores on neoplasm items; but perceived transfer of learning was positively related to scores on neoplasm items, and perceived transfer and overt interest, combined, significantly related to test scores on neoplasm items in systemic pathology.

Career Choice↗