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Biomedical subjects

D S Greer

Publications and source records attributed to D S Greer.

At least 19 recordsLinked to original sources
PubMed2001

Social marketing: application to medical education.

Medical education is often a frustrating endeavor, particularly when it attempts to change practice behavior. Traditional lecture-based educational methods are limited in their ability to sustain concentration and interest and to promote learner adherence to best-practice guidelines. Marketing techniques have been very effective in changing consumer behavior and physician behavior. However, the techniques of social marketing-goal identification, audience segmentation, and market research-have not been harnessed and applied to medical education. Social marketing can be applied to medical education in the effort to go beyond inoculation of learners with information and actually change behaviors. The tremendous potential of social marketing for medical education should be pilot-tested and systematically evaluated.

Behavior Therapy↗
PubMed1995

Changing career patterns of deans of medicine, 1940-1992.

This study examined the occupational experiences of deans of medicine during five decades, 1940-1992, to explore whether changes in their prior career paths could explain the increasing turnover of deans that occurred during this period. The results indicate that deans are now more likely to have had previous administrative experience, as either chairs or lower-level administrators, than they were in earlier decades; in most cases, this administrative experience has occurred in the same institutions in which they were appointed to the deanship ("inside hires"). However, the greater number of deans with prior administrative experience cannot explain the increasing turnover of deans because administrative experience was associated with longer tenures. The kinds of positions the deans took upon leaving office did not change during the study period, particularly among those who had short tenures of four years or less. During the five decades, inside hires leaving during their first five years in office most often moved into faculty, chair, or lower-level administrative positions. Outside hires leaving during their first five years most often went on to higher-level administrative positions. The study results do not support the hypothesis that the shorter tenures of deans in recent decades are related to their previous professional experiences or to increasing opportunities for deans to move to better positions. In conclusion, the authors emphasize that organizational and environmental factors rather than deans' individual characteristics must have played the dominant role in the increasing turnover of deans of medicine in recent years.

Adult↗
PubMed1994

Turnover of deans of medicine during the last five decades.

This report uses published information on the tenures of the 862 U.S. medical school deans who served from 1940-41 through 1990-91 to ascertain whether the turnover of deans has increased historically. The data confirm the wide-spread impression that there has been increasing instability of medical school leadership in recent decades. The proportion of deans who survive to a specific tenure in office has diminished, and the proportion of schools with new deans has increased, although with marked yearly fluctuations. Furthermore, the frequency of deans' turnover has not been evenly distributed among medical schools. Some schools have had large numbers of short-tenured deans, while other schools have had only a few deans over the five decades studied. The authors speculate that the rise in the turnover of deans may be related to the criteria used for their selection and/or because American academic medical centers have grown in size and are increasing in organizational complexity. The authors urge that future research that explores the causes of recent deans' turnover should incorporate modern management and statistical techniques and consider organizational variables as well as the personal and professional characteristics of deans.

Faculty, Medical↗
PubMed1994

Comments on the AAMC policy statement recommending strategies for increasing the production of generalist physicians.

The United States has a physician specialty imbalance, primarily a shortage of generalists (defined as family physicians, general internists, and general pediatricians) relative to other specialists. In recent years, the rising costs of health care, the expansion of managed care, and problems of access to care have accentuated the critical role that generalists must play in a cost-effective, accessible health care system. Despite numerous public and private initiatives designed to address the supply of generalist physicians, the ratio of generalists to specialists has been decreasing. Although the factors contributing to the shrinking proportion of generalists are many and are often outside the control of educators, there is evidence that medical schools can play a major role in influencing specialty choice. Recognizing the need to address the specialty imbalance in this country, the Association of American Medical Colleges (AAMC) appointed the Generalist Physician Task Force to develop a statement suggesting actions that the AAMC and its constituents could take to foster a greater representation of generalist physicians in the United States. The task force produced an Executive Summary, published as an AAMC policy statement in early 1993, that contained recommended strategies for medical schools, graduate medical education, and the practice environment. The authors of the present article critique these recommendations, provide a background and rationale for each of them, and give suggestions about how some of the recommendations might be implemented. While they are in general agreement with the AAMC policy statement, they feel the recommended strategies fall short of the need. They maintain that the AAMC statement represents an admirable but cautious approach to a daunting problem, and that the time is past when cautious approaches will suffice. The authors conclude with the hope that bolder initiatives will emerge from the new AAMC Office of Generalist Physician Programs.

Academic Medical Centers↗
PubMed1990

Charting the winds of change: evaluating innovative medical curricula.

The increased interest, in North America and around the world, in problem-based and community-oriented medical curricula has sparked interest in the evaluation of these innovative programs. In January 1989, the Josiah Macy Jr. Foundation sponsored a conference to consider designs for evaluation studies and the potential distinctive outcomes of the innovative curricula that might be foci of these studies. After defining an "innovative curriculum," the participants identified seven characteristics of "important evaluation studies," particularly endorsing studies that compare curricula as whole entities. The participants then identified 26 areas where differences between graduates of innovative and traditional curricula might be expected, and five equally important areas where differences are not expected. Distinctive outcomes of innovative curricula were anticipated in areas such as interpersonal skills, continuing learning, and professional satisfaction. Overall, these recommendations are offered to stimulate creative evaluations of the growing number of innovative programs in medical education.

Clinical Clerkship↗
PubMed1987

Human neuroelectric patterns predict performance accuracy.

In seven right-handed adults, the brain electrical patterns before accurate performance differed from the patterns before inaccurate performance. Activity overlying the left frontal cortex and the motor and parietal cortices contralateral to the performing hand preceded accurate left- or right-hand performance. Additional strong activity overlying midline motor and premotor cortices preceded left-hand performance. These measurements suggest that brief, spatially distributed neural activity patterns, or "preparatory sets," in distinct cognitive, somesthetic-motor, and integrative motor areas of the human brain may be essential precursors of accurate visuomotor performance.

Adult↗
PubMed1986

An alternative in terminal care: results of the National Hospice Study.

Hospice is a program of supportive services for terminally ill patients and their families, provided either at home or in designated inpatient settings, which is purported to improve patient and family quality of life at lower cost than conventional terminal care. The National Hospice Study was a multi-site, quasi-experimental study to compare the experiences of terminal cancer patients and their families in hospices with those of similar patients and families receiving conventional terminal care. The results indicate that, although care is different in hospices, e.g. lesser utilization of aggressive interventional therapy and diagnostic testing, patients' quality of life is similar in the hospice and conventional care systems with the exception of pain and symptom control, which may be better in the inpatient hospice setting. Hospice patients are more likely to die at home and their families are satisfied with that outcome. Otherwise, no consistent superiority of family outcome was associated with the hospice approach. The cost of hospice care is less than that of conventional terminal care for patients in hospices without inpatient facilities, but the cost of hospice appears to be equivalent to conventional care for patients in hospices having beds.

Adult↗
PubMed1986

The effect of treatment setting and patient characteristics on pain in terminal cancer patients: a report from the National Hospice Study.

Debilitating pain is the symptom most often associated with cancer by the general public. The National Hospice Study (NHS) evaluated pain control among terminal cancer patients served in hospital based (HB) and home based (HC) hospices, and in conventional care settings (CC) such as outpatient clinics and oncology units. Pain was reported by the patient when able to respond and by the patients' primary care person (PCP) during repeated interviews until death. Patient and PCP pain reports were correlated at 0.43. PCPs reported that around 16% of patients were pain free in the last weeks of life while 18% were in persistent pain. Statistically adjusting for differences in the CC, HB, and HC samples, HB patients were less likely to report having persistent pain than either CC or HC patients, although there were no differences in the proportion of patients who were pain free. Age was negatively correlated with the level of pain. As expected, brain and bone metastases were related to pain in opposite directions, with more pain among those with bone involvement and less among those with brain involvement. Conclusions about whether HB hospices really are superior at pain control must be made cautiously in view of the relationship between age and pain and the greater age of hospice patients in our study.

Adult↗
PubMed1986

Analgesic use in terminal cancer patients: report from the National Hospice Study.

Little systematic research has been reported on analgesic use in terminal cancer patients. This paper presents data from the National Hospice Study on the use of analgesics by a sample of terminal cancer patients served in home based and hospital based hospice programs as well as conventional oncological settings. Patients in hospital based hospice programs were more likely than other patients to have an analgesic prescription and to have consumed analgesics. Patients in hospice settings were more likely to consume analgesia orally and less likely to have "prn" (as needed) analgesic prescriptions. The amount of analgesic consumption was inversely related to age. The paper discusses the implications of these and other findings for the treatment of pain in terminal cancer patients.

Adult↗