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Biomedical subjects

C L Gjerde

Publications and source records attributed to C L Gjerde.

16 recordsLinked to original sources
PubMed1995

Patients with dementia and their caregivers 3 years after diagnosis. A longitudinal study.

OBJECTIVES: To document caregivers' perceptions of the deterioration in functional ability of persons with dementia over time, to identify the most problematic behavior for caregivers at two stages of dementing illness, and to compare the perceived informational needs of caregivers at diagnosis and 3 years later. DESIGN: Single cohort. Surveys were mailed at time 1 and respondents were followed up after 3 years (time 2). SETTING: Midwestern hospital dementia assessment clinic with a family physician director. Continuing care was by community physicians. SUBJECTS: Thirty elderly patients with dementia who were evaluated at the dementia clinic. Data were provided by their caregivers. RESULTS: Patients' scores on the Activities of Daily Living section of the questionnaire declined (bathe self, P = .03; transfer from bed or chair, P = .03; and groom self, P = .06). Significant deterioration in behaviors over time was found in incontinence (P = .04). Fewer patients were depressed at time 2 (P = .02). The patient behaviors found most troublesome at time 1 were worrying about memory loss, losing or hiding things, feeling blue, experiencing restlessness, having difficulty calculating, experiencing a lack of interest, and having false ideas. At time 2, the greatest problems were having a short attention span, failing to recognize persons or things, experiencing a lack of interest, experiencing restlessness, repeating himself or herself, forgetting where he or she is, speaking incoherently, and being incontinent. Questions caregivers most wanted answered at time 1 concerned possible treatment, the future course of illness, and the cause of the symptoms. At time 2, the concerns were the future course of illness, possible treatment, and disease inheritance. There was significantly more interest in family agreement about care (P = .004) and the need for legal guardianship (P = .001) at time 2. CONCLUSIONS: Caregivers' perceptions of the most frequent and troublesome behaviors of patients with dementia were documented at different stages of the disease. The importance caregivers attached to their requests for information reflected changing but continuing needs for reassurance about the patient's diagnosis and treatment and for help with the psychosocial consequences of dementia. Physicians must be aware of caregivers' needs at different stages of the disease process and be equipped to help them appropriately.

Activities of Daily Living↗
PubMed1995

Ambulatory medical education: teachers' activities, teaching cost, and residents' satisfaction.

PURPOSE: To assess faculty activities and costs in supervising ambulatory patient care at a family practice clinic, and to assess resident satisfaction with access to ambulatory care teaching. METHOD: This time-and-motion study was conducted in 1993 over two three-week periods (at the end of one academic year and at the beginning of another) in a family practice clinic affiliated with the University of Iowa College of Medicine. Observers recorded time spent by 14 faculty on teaching and non-teaching activities. Thirty-two residents were surveyed about their satisfaction with access to teaching. RESULTS: Over 59 half-days, 2,644 faculty service events were recorded; 47% were teaching events (supervising care delivered by residents) and 53% were non-teaching events (providing care for other clinic patients). Mean teaching time was greater for first-year residents; they consulted faculty more frequently and required more teaching time per consultation. The most common non-teaching activities were telephone calls out, telephone calls in, and inquiries from nurses and office staff. Ten percent of non-teaching activities interrupted teaching, and 17% of the residents reported their teaching had been interrupted. Eighty percent of the residents were satisfied with their access to teaching, but 12% reported they had had to postpone discussing pressing patient problems. Resident dissatisfaction correlated with longer perceived waiting time, interruption of teaching, and faculty inaccessibility. CONCLUSION: Faculty should plan to spend two to three times longer to teach lower-level residents than upper-level residents. By delegating some non-teaching activities to other personnel, faculty can reduce teaching costs and increase resident satisfaction.

Ambulatory Care↗
PubMed1992

Expectations and satisfaction of runners with injury treatments.

Seventy-eight runners competing in three Iowa races were surveyed concerning their most recent running injury for which they sought medical care from a family physician, an orthopedic surgeon, or a podiatrist. Their reasons for choosing a doctor, expectations of care, and satisfaction with treatment received were assessed. Most patients selected the orthopedic (50%) or podiatric (42%) physicians upon the recommendation of other runners; only 13% of the family physicians were selected from recommendations. Orthopedic and podiatric patients were more likely than family physician patients to expect x-rays. There was no difference in overall patient satisfaction with treatment received from the three groups of physicians. The runners felt that all physician groups treated their running injuries equally well.

Athletic Injuries↗
PubMed1985

Office procedural skills in family medicine.

In a study of 131 residents, 34 faculty members, and 236 graduates at nine family practice residency programs in Iowa, 29 office and outpatient procedural skills (for example, repair of lacerations) were identified as representing the ideal core content for family practice residency training, and another 11 procedures (for example, endometrial biopsy) were identified as elective procedures. The faculty members' responses that residents were taught these 40 procedures by direct supervision were much higher than third-year residents' reports of having been supervised while performing them. There was a positive relationship between the percentage of residents who reported having been supervised and the percentage who felt competent to perform the procedures. There was strong agreement among faculty members, residency graduates, and the residents that residents should be evaluated by direct observation of their performance of both core and noncore procedures. Therefore, the view that evaluation by direct observation would be resisted by residents is not supported by this study. As a result of these findings, the authors encourage programs to establish processes for assessing and documenting residents' performances of office and outpatient procedures.

Clinical Competence↗
PubMed1985

A comparison of four empathy instruments in simulated patient-medical student interactions.

Prior investigations of empathy in medicine have used several available instruments for assessment, including a scale developed by Hornblow, Hogan's empathy scale, the Carkhuff-Truax empathic understanding scale, and the Barrett-Lennard relationship inventory. The purpose of the study reported in this article was to investigate the intercorrelations of the scores on these four instruments when used in a medical student-simulated patient interaction. The results showed that measures of empathy based on observed behavior of the students were highly intercorrelated but that empathy self-assessed by the students themselves as having that trait did not correlate significantly with any of the behavior-based measures. No significant effect on these findings was attributable to the timing of the instrument administration, to the students' interpersonal skills training or experience in taking histories and performing physical examinations, or to the sex of the students and the observers.

Clinical Competence↗
PubMed1983

The visiting lectureship in radiology: an evaluation.

This study was designed to assess the effectiveness of didactic lectures in radiology by visiting faculty. Residents attending a lecture given by a visiting professor of radiology were subjected to a pre- and postlecture test on the contents of the lecture. Results indicated substantial gain in base knowledge of the subject material. Other studies indicate that increasing medical knowledge through lectures is of debatable effectiveness. This study indicates significant information transfer when short-term retention was tested. The level of retention was independent of the two sites of training and independent of level of training.

Analysis of Variance↗
PubMed1982

Resident and faculty perceptions of effective clinical teaching in family practice.

Increasing interest in clinical teaching has led to the realization that the unique subset of skills which characterizes effective clinical teaching needs to be identified. Such identification will lead to development of these skills and improvement in the quality of clinical teaching. Family practice faculty are vitally concerned with improving their clinical teaching skills, since clinical teaching is the core of education in family medicine and since many family physicians who become preceptors have had no formal training as teachers. In this investigation of effective clinical teaching behaviors, faculty and residents generally agree in their perceptions of the helpfulness of 58 clinical teaching behaviors. Neither group felt that emphasis on references and research is as important a factor in effective clinical teaching as are residents' active participation in the learning situation and positive preceptor attitudes toward teaching and residents. It was perceived that the ineffective clinical teacher has a negative attitude toward residents, is inaccessible, and lacks skills in providing feedback, while the effective clinical teacher has skills in two-way communication, creates an educational environment that facilitates learning, and provides constructive feedback to residents.

Attitude of Health Personnel↗
PubMed1982

Promotion criteria: perceptions of faculty members and departmental chairmen.

Medical school promotions committees tend to depend heavily on departmental evaluations of candidates for promotion. Unfortunately, departments often lack clear promotion guidelines; this results in confused perceptions of promotion criteria. Faculty members and department chairman do not always see eye to eye. When asked to indicate which activities contributed the most toward achieving promotion to higher academic rank, faculty members in a large midwestern medical school perceived research to be the single most important activity. Departmental chairmen had a broader perception, however, and included research, teaching patient care and administration/service in their list of desirable and essential activities. Faculty members and chairman differed significantly (p less than .01) in their mean ratings of 12 of 69 activities. Such perceptual discrepancies can lead to conflict and disagreement that can be avoided by straightforward explanations of promotion criteria and more clearly defined job descriptions and time allocations.

Clinical Competence↗
PubMed1981

'Curriculum mapping': objectives, instruction, and evaluation.

The objectives, instruction, and evaluation in a health professions course were studied by an evaluation approach which the author calls "curriculum mapping" to determine the degree of congruence among the three components. During the three years studied there were shifts in course content emphasis and yearly variations in the content tested. By the third year the objectives were no longer congruent with the instruction and test items used in evaluation. In addition, the test items were typically at lower cognitive levels than the related objectives. The application of this evaluation model may be useful to faculties in improving their courses.

Connecticut↗
PubMed1978

Another look at learning style inventory and medical career choice.

It has been suggested that learning style, as measured by the Learning Style Inventory, can be associated with choice of a particular medical field and that individuals with certain learning styles in making career choices are influenced more than other students by particular learning experiences. In the replication study reported here the Learning Style Inventory was administered to over 200 practicing physicians and medical students. Contrary to the previous findings, the results of this study suggest that there is no association between learning style and career choice in medicine and no association between learning style and the kind of influences which were most important in making a career choice.

Career Choice↗
PubMedDate not supplied

Using an optical scanner and data base program to manage a family medicine teaching program.

This article describes the value of optically scannable forms and off-the-shelf software in improving administration of a required multi-site, third-year family medicine preceptorship. Formerly, a small preceptorship administrative staff manually handled nearly 1,000 evaluation forms per year. The process was slow, cumbersome, expensive, and inflexible. Optically scannable forms are now used and data bases are created, from which a series of administrative reports are easily generated. This system has reduced management time and cost, eliminated errors, and allowed staff to create both standardized and specialized reports as needed.

Database Management Systems↗
PubMedDate not supplied

Medical student evaluation of self-selected learning modules.

BACKGROUND: The purposes of this study were to determine the self-directed learning needs of second-year medical students, the resources they selected to address their learning needs, and the effectiveness of those resources. METHODS: Students in an Introduction to Clinical Medicine course were required to devote 24 hours to the study of self-directed learning activities. Although options were provided, students could create their own study modules. Students evaluated each module used. RESULTS: Major needs identified were history and physical examination skills, diagnosis, emergency procedures, psychosocial issues in medicine, and issues concerning physicians as people. The most selected module types were videotapes (52%), computer-aided instruction, labs, and seminars. Overall ratings (5 = high) indicated four clusters of modules: self-directed learning, 4.3; labs, 4.0; seminars, slide-tapes, and computers, 3.65; and videotapes and books, 3.25. Videotapes, the most frequently used module, received low overall ratings. CONCLUSIONS: Self-directed learning allowed students to use a great array of educational opportunities. Students appeared to recognize needs, identify resources, and use those resources to address their learning needs.

Computer-Assisted Instruction↗