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Biomedical subjects

David Snadden

Publications and source records attributed to David Snadden.

9 recordsLinked to original sources
PubMed2006

Free choice and career choice: Clerkship electives in medical education.

INTRODUCTION: Medical education experiences, particularly in clinical years, are reported determinants of career choice. Less is known about features of clinical education experiences including length, discipline, setting and choice, which may serve as landmarks in career choice decisions. This study's purpose was to explore the benefits of a free choice clerkship elective, and more specifically, its role in clarifying career choice. METHODS: Using framework and content analysis methodology, we analysed University of British Columbia, third-year medical student anonymised assignments regarding free choice and 2-week clerkship elective experiences. This clerkship was designed to provide students with clerkship experiences outside the conventional curricular model, while encouraging student choice of ambulatory and community settings. Assignment questions included: reasons for choosing elective; whether learning objectives were met; influence of elective on career choice; and unique elective experiences. Iterative review, coding, analysis and indexing of assignments were carried out to identify themes and corroborate findings. RESULTS: Emergent themes included: positive views of experience; transferable knowledge and skills; and influencer of future education and career choices. Although students were encouraged to choose clerkship experiences outside the conventional curricular model, most students chose the elective to clarify future career decisions. DISCUSSION: This qualitative descriptive study highlights the influence of highly regarded, free choice clerkship elective experiences in the career decision making process in medical education. Further examination of the details of clerkship elective experiences which influence career choice is recommended.

Attitude to Health↗
PubMed2004

Revalidation for general practitioners: randomised comparison of two revalidation models.

OBJECTIVE: To compare two models of revalidation for general practitioners. DESIGN: Randomised comparison of two revalidation models. SETTING: Primary care in Tayside, Scotland. PARTICIPANTS: 66 Tayside general practitioners (principals and non-principals), 53 of whom completed the revalidation folders. Interventions Two revalidation models: a minimum criterion based model with revalidation as the primary purpose, and an educational outcome model with emphasis on combining revalidation with continuing professional development. MAIN OUTCOME MEASURES: Feasibility and acceptability of each approach and effect on the doctor's continuing professional development. The ability to make a summative judgment on completed models and whether either model would allow patient groups to have confidence in the revalidation process. RESULTS: The criterion model was preferred by general practitioners. For both models doctors reported making changes to their practice and felt a positive effect on their continuing professional development. Summative assessment of the folders showed reasonable inter-rater reliability. CONCLUSIONS: The criterion model provides a practical and acceptable model for general practitioners to use when preparing for revalidation.

Accreditation↗
PubMed2004

Linking appraisal of PRHO professional competence of junior doctors to their education.

In the UK, new medical graduates are known as Pre-registration House Officers (PRHOs). Postgraduate Deans are responsible for the PRHO year and for the final certification of PRHOs to allow them to be fully registered by the GMC as medical practitioners. However, as much as appraisal of professional growth is central to PRHO training, they are in need of a robust assessment mechanism to detect, at an early stage, individuals with significant clinical and professional deficiencies. Documented, reliable and valid ongoing information on PRHO performance will provide information for early intervention and will establish 'hard' observable evidence, for certification decisions. Thus, an approach that links appraisal/assessment of professionalism and clinical skills to education is the way forward. This paper describes a new approach to appraisal/assessment of PRHOs, which is currently being piloted in a number of regions in Scotland. The conceptual paradigm was developed during the last three years as a proposal for a Scottish national PRHO reform. 'Grounded' qualitative studies were employed to explore trainees' and trainers' perceptions of the expected competences (outcomes) of PRHO performance for appraisal/assessment purpose. The GMC recommendations are reviewed in light of the study results. An assessment model emerged that links appraisal to education. PRHOs' cumulative performance is documented over one year of training resulting in diagnostic profiles that provide guidance for evaluation and training of PRHOs. Poor performers are flagged in the early stages of training, thus allowing early intervention. The feasibility and acceptance of the model by educators, the health system and PRHOs has yet to be established.

Education, Medical↗
PubMed2002

Exploring medication use to seek concordance with 'non-adherent' patients: a qualitative study.

BACKGROUND: 'Concordance' has been proposed as a new approach towards sub-optimal medication use; however, it is not clear how this may be achieved in practice. AIM: To develop a strategy for understanding sub-optimal medication use and seek concordance during primary care consultations. DESIGN: A developmental qualitative study using a modified action research design. SETTING: Three Scottish general practices. METHOD: Patients using treatment sub-optimally and having poor clinical control were offered extended consultations to explore their situation. Their authority to make treatment decisions was made explicit throughout. Clinicians refined a consultation model during ten 'Balint-style' meetings that ran in parallel with the analysis. The analysis included all material from the consultations, meetings, and discussion with patients after the intervention. RESULTS: Three practitioners recorded 59 consultations with 24 adult patients. A six-stage process was developed, first to understand and then to discuss existing medication use. Understanding of medication use was best established using a structured exploration of patients' beliefs about their illness and medication. Four problematic issues were identified: understanding, acceptance, level of personal control, and motivation. Pragmatic interventions were developed that were tailored to the issues identified. Of the 22 subjects usefully engaged in the process, 14 had improved clinical control or medication use three months after intervention ceased. CONCLUSIONS: A sensitive, structured exploration of patients' beliefs can elucidate useful insights that explain medication use and expose barriers to change. Identifying and discussing these barriers improved management for some. A model to assist such concordant prescribing is presented.

Chronic Disease↗
PubMed2002

Clinical governance in Scotland: an educational model.

The concepts underpinning clinical governance are similar throughout the United Kingdom but models for its implementation will differ widely. This model aims to enable practices to identify areas for further learning and development against specific outcomes. Criteria sets and standards are suggested and a governance plan is used to allow practices to prioritise their objectives. Resourcing will always be a major issue and such a model should be fully evaluated.

Education, Medical, Continuing↗
PubMed1992

Ethical dilemmas of cervical cancer screening.

Cervical screening presents several ethical dilemmas to family physicians. The author reviews the risks associated with screening, costs versus benefits of running a screening program, and the issues surrounding patient autonomy and patient coercion. Is saving one life worthwhile, and at what cost? Cervical screening programs are imperative in family practice, but only if harm to the patient is minimized and ethical objections are addressed.

Coercion↗