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Biomedical subjects

E V Dunn

Publications and source records attributed to E V Dunn.

13 recordsLinked to original sources
PubMed1992

Measuring the ethical sensitivity of medical students: a study at the University of Toronto.

An instrument to assess 'ethical sensitivity' has been developed. The instrument presents four clinical vignettes and the respondent is asked to list the ethical issues related to each vignette. The responses are classified, post hoc, into the domains of autonomy, beneficence and justice. This instrument was used in 1990 to assess the ethical sensitivity of students in all four medical classes at the University of Toronto. Ethical sensitivity, as measured by this instrument, is not related to age or grade-point average. Sensitivity increases between the 1st and 2nd year and then decreases throughout the rest of undergraduate medical training, such that the 4th-year students identify fewer issues than those entering medical school. Students expressing a career choice of family medicine identify more issues than their peers. Several problems with the use of the instrument and the interpretation of the data were found. Nonetheless, these findings, if reproducible, are important and their meaning needs further discussion.

Beneficence↗
PubMed1990

Evaluating ethical sensitivity in medical students: using vignettes as an instrument.

As a preliminary step to beginning to assess the usefulness of clinical vignettes to measure ethical sensitivity in undergraduate medical students, five clinical vignettes with seven to nine ethical issues each were created. The ethical issues in the vignettes were discussed and outlined by an expert panel. One randomly selected vignette was presented to first, second and third year students at the University of Toronto as part of another examination. The students were asked to list the issues presented by the patient problem. Responses from 281 students were obtained. These students identified an average of 2.72 ethical issues per vignette. Each response was classified under the domains of autonomy, beneficence and justice. Comparisons were made between classes and between vignettes. There was considerable variation between classes and the responses to different vignettes seem to indicate that different vignettes measure the various domains in different ways. It does appear that the use of vignettes is one way to measure aspects of ethical sensitivity in medical students but more study is required to clarify exactly what is being measured.

Beneficence↗
PubMed1989

Quality of care in family practice: does residency training make a difference?

As the proportion of physicians who enter residency training in family practice steadily increases, so does the need to evaluate the impact of their training and postgraduate education on the quality of care in their practices. We audited the practices of 120 randomly selected family physicians in Ontario, who were separated into four groups: nonmembers of the College of Family Physicians of Canada (CFPC), members of the CFPC with no certification in family medicine, certificated members without residency training in family medicine and certificated members with residency training in family medicine. The practices were assessed according to predetermined criteria for charting, procedures in periodic health examination, quality of medical care and use of indicator drugs. Generally the scores were significantly higher for CFPC members with residency training in family medicine than for those in the other groups, nonmembers having the lowest scores. Patient questionnaires indicated no difference in satisfaction with specific aspects of care between the four groups. Self-selection into residency training and CFPC membership may account for some of the results; nevertheless, the findings support the contention that residency training in family medicine should be mandatory for family physicians.

Adult↗
PubMed1989

Recruiting family physicians as participants in research.

Obtaining the voluntary participation of family physicians in quality of care research is a major problem in family practice research. An innovative approach was therefore required to recruit 120 randomly selected family physicians in southern Ontario in a quality of care study by the College of Family Physicians of Canada. A network of physician recruiters oriented to the study was organized for each district. This recruitment method resulted in an 84.5% participation rate. The relationship of these physician recruiters to the candidate and the method of approach were important factors in the enrolment process: the highest participation rate (95%) was obtained when the recruiters were friends of the candidate and when a personal meeting was arranged (91%). Recruiters were given an information package to help them in the recruitment process and rated the most useful items as follows: a policy statement about confidentiality, a description of the study and reprints of a published feasibility study. These results illustrate that cooperation in research in family physicians' offices can become a reality.

Confidentiality↗
PubMed1979

Industrial accidents and medication. Is there a relationship?

Although health workers are continually concerned about the effects of various medications on the public and especially on employees at work, there have been almost no studies reported which have indicated any relationship between medication taken and industrial accidents. A series of 115 consecutive employees reporting accidents to the DRG Health Center were interviewed as to medication taken in the previous 24 hours. A control group of another 115 employees were also interviewed. We found no difference in the two groups related to medication taken and thus there does not appear to be a direct relationship between medication ingestion and accident rate within this industry.

Accidents, Occupational↗
PubMed1978

Internal review--a fruitful family practice evaluation tool.

In 1975 the Department of Family and Community Medicine, University of Toronto, initiated a system of internal review of its undergraduate and postgraduate programs. During the next six months each of the major teaching resources for the family practice component of the programs was visited by an inspection team. A detailed report with recommendations was prepared and received wide distribution. After this initial review, the internal medicine and pediatric components of the curriculum were evaluated. Again reports and recommendations were made. At the present time the surgical and psychiatric components of the program are being evaluated. This ongoing internal review has had several benefits including specific changes in programs, better organization, and a better understanding of the department and its goals. Some of the difficulties are the time and organization necessary for a valid and appropriate review.

Curriculum↗
PubMed1977

A clinical evaluation of four alternative telemedicine systems.

A comparison was made of four alternative telecommunication systems used in delivering primary health care to remote populations. The media were color television, black and white television, still frame black and white television, and hands-free telephone. The patient population was that of a large organization in a Canadian province, a major component of a societal system. Over 1000 patients who came to a clinic seeking medical attention were examined remotely by one of the four systems. In addition, they were examined in the physical presence of a doctor at the clinic. The diagnoses, patient management programs, etc., of the clinic physician were used as the basis for comparison. We found no significant differences in diagnostic accuracy, proportion of supporting investigations requested, e.g., laboratory tests and X rays, time taken for the diagnostic consultations and the effectiveness of patient management across the four communication modes. On the contrary, in some instances it was found that behavior across the modes was significantly similar. Even patient attitudes showed only a slight preference for the more sensory rich modes of communication. It was concluded that there is little to distinguish the effectiveness of the four telecommunication modes when used for remote diagnostic consultations. Therefore, the cheapest mode is the most cost-effective. Phase four of the research program will compare the effects of the two least costly modes, still frame television and hands-free telephone, in an operational system in northern Ontario.

Attitude↗
PubMed1977

An evaluation of four telemedicine systems for primary care.

In an evaluation of the efficacy of four two-way telecommunication systems for use in primary care, more than 1,000 patients seeking care at a community health center received an additional remote examination by use of either color television, black and white television, still-frame black and white television, or hands-free telephone. The diagnosis, clinical tests and X rays requested, and proposed patient management were compared to the actual care received by the patients at the health center. There were no significant differences between any of the modes in relation to diagnostic accuracy, time for the diagnostic interview, tests requested, or referral rates. Furthermore, patient attitudes did not vary significantly. Thus the relatively inexpensive telephone proved to be as efficient and effective a means for delivery of remote physician care as did any of the visual communication systems.

Attitude↗
PubMed1975

An experimental evaluation of alternative communication systems as used for medical diagnosis.

While the problem of providing adequate health care to remote populations has been widely recognized, little research has been undertaken to evaluate alternative systems designed to provide such care. An essential part of such a system is the communications link between the doctor and the community he is serving. Studying this two-way subsystem is the context of primary diagnosis and patient management, efficiency and effectiveness of color television, black and white television and hands-free telephone were compared with physical presence consultation. No significant differences in performance were found among the three systems using telecommunications. Physical presence consultation was found superior only for detecting secondary medical problems. Significant rank order correlations were found, however, between the years of experience of the consulting physician and both diagnostic accuracy and appropriate patient management. Also, the attitudes of the patients, doctors and nurses alike ranked physical presence over color television over black and white television over hands-free telephone for medical consultations.

Attitude↗