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Biomedical subjects

G T Moore

Publications and source records attributed to G T Moore.

At least 19 recordsLinked to original sources
PubMed2001

Time to learn: the outlook for renewal of patient-centred education in the digital age.

BACKGROUND: Major forces in society and within health systems are fragmenting patient care and clinical learning. The distancing of physician and trainee from the patient undermines learning about the patient-doctor relationship. The disconnection of care and learning from one successive venue to another impedes the ability of trainees to learn about illness longitudinally. METHODS: As a conceptual piece, our methods have been those of witnessing the experiences of patients, practitioners, and students over time and observing the impact of fragmented systems and changing expectations on care and learning. We have reflected on the opportunities created by digital information systems and interactive telemedicine to help renew essential relationships. RESULTS: Although there is, as yet, little in the literature on educational or health outcomes of this kind of technological enablement, we anticipate opportunities for a renewed focus on the patient in that patient's own space and time. Multimedia applications can achieve not only real-time connections, but can help construct a "virtual patient" as a platform for supervision and assessment, permitting preceptors to evaluate trainee-patient interactions, utilization of Web-based data and human resources, and on-line professionalism. CONCLUSIONS: Just as diverse elements in society are capitalizing upon digital technology to create advantageous relationships, all of the elements in the complex systems of health care and medical training can be better connected, so as to put the patient back in the centre of care and the trainee's ongoing relationship to the patient back in the centre of education.

Clinical Competence↗
PubMed2000

Specific clinical competencies for managing care: views of residency directors and managed care medical directors.

CONTEXT: Although medical educators recognize the need to prepare physicians to work effectively in managed care environments, managed care is often perceived negatively by academic physicians. Curricular reform has been hampered by a failure to seek agreement about specific clinical competencies that are important to both managed care directors and medical educators. OBJECTIVES: To identify specific clinical competencies in the managed care setting and to assess agreement between residency directors and managed care medical directors on the importance of these competencies. DESIGN, SETTING, AND PARTICIPANTS: Surveys (1998-1999) of a national sample of 59 residency directors involved in managed care training programs (response rate, 94%); a sample of 186 residents in these programs and 258 matched control residents (response rate, 77%); and national samples of 147 managed care organization (MCO) medical directors (response rate, 67%) and 140 primary care residency program directors in areas of high MCO penetration (response rate, 73%). MAIN OUTCOME MEASURES: Specific clinical managed care tasks as defined by residency directors; self-reported confidence in performing these tasks by sample residents vs control residents; and importance of these tasks as rated by MCO medical directors and residency program directors. RESULTS: Twenty-six specific clinical managed care tasks were identified by the residency directors. Residents who participated in managed care training were significantly more confident than their counterparts in performing 20 of the 26 tasks (P<.01 for all). Residency directors and MCO medical directors viewed 65% of these tasks as important to patient care during the next 5 years. Of the 10 tasks most highly rated by residency directors and MCO medical directors, 9 were the same, addressing time management, ethics, case management, practice guidelines, cost-effective clinical decision making, referral management, disease management, patient satisfaction, and clinical epidemiology. CONCLUSIONS: Our data indicate that residency directors and managed care medical directors value mastery of many of the same specific clinical competencies in managed care. Previously documented negative attitudes toward managed care among academic physicians may obscure an underlying concordance about the skills essential to managing the health of populations. JAMA. 2000;284:1093-1098

Administrative Personnel↗
PubMed2000

Long-term outcomes of the New Pathway Program at Harvard Medical School: a randomized controlled trial.

PURPOSE: To evaluate the long-term effects of an innovative curriculum, the New Pathway (NP) Program, on behaviors and attitudes related to humanistic medicine, lifelong learning, and social learning. METHOD: Long-term follow-up of Harvard Medical School students who participated in a randomized controlled trial. Descriptive study using 1998 telephone interviews of 100 1989 and 1990 graduates (50 who had studied the NP curriculum, 50 who had studied the traditional curriculum). The NP Program consisted of problem-based learning tutorials, with coordinated lectures, labs, experiences in humanistic medicine, and clinical experiences; the traditional program consisted of basic science lectures and labs. RESULTS: Of 22 measures on the survey, NP and traditional students differed significantly on only five (three humanism; two social learning): 40% of NP students and 18% of traditional students went on to practice primary care or psychiatry. NP students rated their preparation to practice humanistic medicine higher than did traditional students and expressed more confidence in their ability to manage patients with psychosocial problems. NP students were more likely than were traditional students to believe that faculty from the first two years continued to influence their thinking. NP students liked the pedagogic approaches of their program more than traditional students did. There was no difference between the groups on measures of lifelong learning. CONCLUSIONS: Differences between NP and traditional students in the humanism domain first appeared during medical school and residency and remained significant well into practice, suggesting that humanistic medicine can be taught and learned.

Attitude↗
PubMed1994

The "teaching HMO": a new academic partner.

Health care reform is a potential threat to the academic missions of medical schools and academic health centers. But managed care, the source of much of their concern, may also represent a way for medical schools to improve their future academic outcomes. Harvard Medical School and the Harvard Community Health Plan, a large health maintenance organization (HMO) in greater Boston, recently formed the first medical school department to be based in a freestanding HMO. This arrangement is an example of a model that replicates, in a managed care organization, the long-standing and highly successful teaching hospital academic structure in academic medical centers. The authors describe this model in detail, show how the Harvard collaboration works, and explain the benefits each institution saw in creating a joint entity, the rationale for making that new entity an academic department, and the implications for other academic health centers. They conclude that the Harvard experience shows that alliances between medical schools and large HMOs can create vibrant practice settings for teaching and research in academic areas (such as prevention and primary care medicine) that have been relatively neglected in recent times, and that the "teaching HMO" may have the potential to transform academic medicine in the next century just as the teaching hospital transformed it in this century.

Academic Medical Centers↗
PubMed1994

The influence of the New Pathway curriculum on Harvard medical students.

BACKGROUND: This study evaluated the effect of a radically redesigned curriculum at Harvard Medical School on preclinical students' knowledge, skills, personal characteristics, approaches to learning, and educational experiences. METHOD: Multiple measures were used to collect data from 121 students from the entering classes of 1989 and 1990 who had been randomly assigned to the New Pathway or traditional curricula; all had applied to be in the new curriculum. RESULTS: The New Pathway students reported that they learned in a more reflective manner and memorized less than their control counterparts in the traditional curriculum during the preclinical years. The New Pathway group preferred active learning and demonstrated greater psychosocial knowledge, better relational skills, and more humanistic attitudes. They felt more challenged, had closer relationships with faculty, and were somewhat more anxious than those in the traditional program. There was no difference in problem-solving skills or biomedical knowledge base. CONCLUSION: Students in the new curriculum learned differently, acquired distinctive knowledge, skills, and attitudes, and underwent a more satisfying and challenging preclinical medical school experience without loss of biomedical competence. These findings should encourage other schools to consider such a curriculum.

Clinical Competence↗
PubMed1994

Health promotion and disease prevention: integration into a medical school curriculum.

Many authorities have identified deficiencies in the education of medical students in health promotion and disease prevention. This report describes an attempt to address this problem through the longitudinal integration of health promotion and disease prevention into several major courses in the student curriculum at Harvard Medical School. We used adult learning theory to develop the curricular approach, and designed educational experiences to match the professional development of the student at different phases of medical education. Primary, secondary, and tertiary prevention were particularly germane for students in the first, second, and third years, respectively. During clerkships in the third and fourth years, especially those with a focus on ambulatory patients, students built upon earlier experiences to integrate health promotion and disease prevention into clinical practice. By unifying the teaching of disease prevention with several major required courses, we aimed to create an environment in which students could experience their learning about disease prevention in the same manner that we aspired to have them practise it: integrated throughout clinical medicine.

Community Medicine↗
PubMed1994

Will the power of the marketplace produce the workforce we need?

The medical manpower market will work best as an agent for change in primary care when there is vigorous demand, a sophisticated buyer, and not too large a gap to fill--conditions that we can expect with managed care growth in U.S. urban settings in the next decade. In these circumstances, the primary care supply will adjust without the need for regulatory intervention. The most dramatic workings of the market will be in stripping from the system the excess payments for practicing subspecialist physicians. However, market forces will not quickly moderate the growing oversupply of doctors nor their maldistribution to areas of need. Focused public policy manpower interventions will be needed to correct these deficits quickly.

Economic Competition↗
PubMed1992

The case of the disappearing generalist: does it need to be solved?

The proportion of generalist physicians in the United States has declined steadily over 50 years, bringing it to the lowest percentage of trained primary care physicians of any developed country; the trend toward subspecialization is accelerating. Many analysts believe this imbalance between generalists and subspecialists to be a major cause of America's high health care costs, heavy dependence on biotechnology, and consumer dissatisfaction. Others argue that sub-specialists can provide excellent primary care services, and the decrease in the number of generalists is not a problem. Three contrasting views on the implications of this trend state that today's generalists are an important and scarce resource that must be bolstered; that subspecialists can replace generalists as providers of primary care; and that the free market will determine the best manpower mix. A final view, on the marketplace option, posits that generalism will not recover until it creates a vital, and unique, role in handling the primary care challenges of the twenty-first century. These competing viewpoints are used to clarify assumptions underlying our major policy options in the arena of health manpower.

Consumer Behavior↗
PubMed1991

Let's provide primary care to all uninsured Americans--now!

Gridlock in the political process makes comprehensive health insurance for the uninsured an unlikely prospect in the near future. While the debate continues, we should provide basic primary care services to all uninsured Americans. Primary care is the most economical safety net we can offer our citizens. By prepaying participating physicians, we could provide this needed care at a cost the nation could afford and with excellent prospects for controlling expenditures over time.

Delivery of Health Care↗
PubMed1991

The effect of compulsory participation of medical students in problem-based learning.

Problem-based learning (PBL) is an instructional method that has attracted many advocates since its introduction in medical education almost 20 years ago. PBL features the use of student-directed tutorials, medically relevant problems to set study objectives, and independent learning. Educators have worried that not all students will do well with this method. This study compared a group of students who had chosen to be in a PBL curriculum with a group who had not, as they undertook a curriculum that contained both PBL and lecture-based courses. Academic performance was virtually identical regardless of learning method. Students slightly favoured the courses that featured the method they had originally chosen, but a significantly larger proportion of students shifted their preference from the lecture to the problem-based approach than vice versa. Students' academic performance does not appear to suffer when they are involuntarily enrolled in a PBL curriculum and many come to prefer this type of curriculum.

Attitude of Health Personnel↗
PubMed1990

Health maintenance organizations and medical education: breaking the barriers.

Academic medical centers (AMCs) are under pressure to increase ambulatory medical education, but their capacity for such teaching is limited. Health maintenance organizations (HMOs) are a large and growing institutional setting that could participate in clinical education. Until now, relatively few HMOs and AMCs have reached agreements about teaching, because traditional suspicions have blocked collaboration. Responding to a case prepared as the basis of discussion, about 450 academics and HMO medical directors explored the barriers to and incentives for cooperation between AMCs and HMOs in clinical education. The two groups identified different issues as barriers to collaboration, leaving considerable room to negotiate agreements. AMCs, especially, need to be prepared to offer meaningful academic and financial inducements to attract HMOs to participate in teaching.

Academic Medical Centers↗