Biomedical subjects
Anne Walling
Publications and source records attributed to Anne Walling.
Do family physicians fail to provide triptans for patients with migraine?
While continuing to improve recognition of migraine in your patient population, pay particular attention to the adherence rate among those for whom you have prescribed a triptan. Ask patients who discontinue triptan therapy why they made that decision. Besides adverse effects from the agent, reasons may include medication cost, influence of comorbidities, or triptan interaction with medications you may not have known about.
Making Parkinson proud.
Explore the source record for details and available documents.
Web-based orientation for new faculty members.
Explore the source record for details and available documents.
Implementing a systematic course/clerkship peer review process.
OBJECTIVE: A systematic course/clerkship peer-review process was developed to meet several objectives: improvement of quality of course/clerkship, enhancement of understanding of individual course and overall curricular content, improvement of communication and collaboration between basic science and clinical disciplines across campuses, provision of forum to address curricular concerns of students and faculty, facilitation of data collection for LCME reviews and the AAMC CurrMIT project; and monitoring curricular equivalency at multiple clinical sites. DESCRIPTION: Previously each course had carried out an internal review process. These reviews varied considerably in terms of the data collected and how those data were used for quality improvement. Data and outcomes of the internal reviews were seldom shared with colleagues, students, or administrators. This limited communication discouraged collaboration and led to disparity in curricular content between campuses. A collaborative effort between the medical school's Office of Medical Education (OME) and the Education Council, the faculty governance committee composed of faculty from each basic science and clinical department on each campus, has led to the development and implementation of a systematic course/clerkship peer-review process. Two standing committees of the Education Council oversee the systematic review process. One committee is charged with oversight of the first two years of the curriculum and a second committee with oversight of the third and fourth years. A two-tiered course/clerkship review process was designed with all courses undergoing a limited annual review. A comprehensive, "nuts and bolts" review for required courses was to occur every three years. The limited annual review was based on course evaluations completed by students, collected and summarized by the OME, and presented to the Education Council. The comprehensive review of a required course/clerkship occurred over a six-to-eight-month period. Course directors on each campus completed a questionnaire and submitted materials. To facilitate cross-discipline communication and synergy, a subcommittee composed of both basic science and clinical faculty, principally course directors, and at least one medical student who had completed the course at each campus reviewed submitted materials and had a series of meetings with the course directors, support personnel, and department chairs. Final review reports presented to the Education Council identify issues, concerns, and recommendations for action. To date 11 required courses have completed the comprehensive review process. Simple oversights, significant curricular disparity between campuses, and opportunities for multidisciplinary collaboration have been identified and addressed. Student-rated satisfaction has improved for those courses that have been reviewed. DISCUSSION: The systematic course/clerkship peer-review process has been a success, although there was initial resistance to "outside review." We have not yet completed one cycle of comprehensive course reviews but already faculty and administration have a better understanding of individual course and overall curriculum content. Faculty have developed working relationships and are sharing educational strategies across disciplines and campuses, and identifying innovative collaborations. The annual review process is now perceived to lack depth and is under reconsideration.
HRSA goes triad: an update on the training grant review process.
Explore the source record for details and available documents.
Understanding frequent emergency room use by Medicaid-insured children with asthma: a combined quantitative and qualitative study.
BACKGROUND: Medicaid-insured asthmatic children frequently use emergency rooms (ERs). The reasons are unclear and have predominantly been studied in inner-city populations. METHODS: We used billing data and focus groups to clarify reasons for frequent ER use by Medicaid-insured children with asthma living in rural areas and 23 towns in Kansas. RESULTS: High ER utilization was concentrated in a small percentage of provider practices and children with asthma. Parents expressed strong preference for primary care treatment, and identified real or perceived difficulties in using primary care as the principal reasons for ER use. Difficulties included trouble contacting primary care physicians or obtaining urgent appointments, limited continuity of care, practice systems poorly adapted to patient needs, a perception that physicians preferred patients to use emergency services, and difficulties in obtaining medications. Parents were not aware of preventive measures or case management but reported high interest in these. Parents did not recall provider discussion of asthma risk factors/preventive strategies during primary care visits, although all children with high ER utilization had multiple risk factors, including exposure to high levels of household smoking. CONCLUSIONS: Reducing ER utilization by Medicaid-insured asthmatic children depends on overcoming barriers to effective treatment in primary care and in greater attention to preventive services.
"O tell me the truth about love".
Explore the source record for details and available documents.
Which patients are most challenging for second-year medical students?
BACKGROUND AND OBJECTIVES: Fostering appropriate attitudes toward patients begins with recognition of the physician's personal biases and preferences about patients. We sought to assist second-year medical students to identify those patient attributes that may influence their clinical behavior, especially in difficult patient encounters. This study's objectives were (1) to identify the principal patient characteristics reported by students to evoke negative or positive affective reactions sufficient to compromise the quality of patient care and (2) to examine differences between male and female students on these patient characteristics. METHODS: An anonymous survey was made of all second-year medical students attending a seminar on medical errors. Students recorded the three principal patient characteristics that might evoke in them a negative personal reaction sufficient to compromise the quality of clinical care. Students then recorded three principal patient characteristics that might evoke a positive reaction sufficient to compromise the quality of clinical care. The data were analyzed to identify the primary concerns of the entire group of students and any significant differences between male and female students. RESULTS: Information on negative attitudes was provided by 67 of 71 (94%) students and on positive attitudes by 70 of 71 (99%). Content analysis identified four general categories of patient characteristics associated with negative attitudes (patients who are rude, contributed to medical problem, are abusive to others, and other attributes). Five general categories (patients with whom students have personal connection or patients who have physical and/or social attractiveness, vulnerability, power/influence, and other) were associated with positive attitudes by the students. The leading patient attributes reported as likely to influence clinical behavior were the positive attributes of "personal connection" and "attractiveness." These were reported by 60% and 53% of the class, respectively, compared to the leading negative attributes of "rudeness" and "contributed to own condition," each reported by 51% of students. Significant differences between male and female students only occurred in the categories of "rude" and "attractive." CONCLUSIONS: Students are willing to disclose specific, personal attitudes toward patients that they perceive as sufficiently serious to influence the quality of clinical care. More than half of the students anticipated difficulty in providing optimal care to patients who exhibit certain characteristics. More students reported concerns about positive affective reactions to patients than about negative reactions. Medical education should address these issues in strategies to adequately prepare students for practice.
Why do some community physicians NOT teach medical students?
Explore the source record for details and available documents.