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Biomedical subjects

J H Littlefield

Publications and source records attributed to J H Littlefield.

At least 19 recordsLinked to original sources

Third year medical student attitudes toward learning urology.

PURPOSE: We studied certain research questions, including the learning environments in which third year medical students perceive that they acquire urological knowledge and skills, and whether medical students interested in urology as a career have different perceived learning needs than those interested in other specialties. MATERIALS AND METHODS: A survey instrument was pilot tested and revised. The instrument elicited student perceptions of how they best learned urological diagnosis and skills. Student attitudes toward the third year urology rotation and career motivation toward urology were assessed. Consecutive students were surveyed after completing the third year urology rotation. RESULTS: Most students perceived that they learned to manage most urological problems by seeing patients in outpatient clinics and they learned to perform physical examination and urinalysis interpretation by seeing patients. The overall usefulness of various learning environments was highest for seeing patients in clinic, followed by resident teaching, following inpatients, independent reading, watching open surgery, formal conferences, watching endoscopic surgery and routine menial work. Students interested in urology as a career choice were equally motivated by seeing patients in clinic, the subject matter and seeing surgery. CONCLUSIONS: Third year medical students perceive that the most important urological learning environment is outpatient evaluation of patients. The urological learning needs of third year medical students are not different in those interested and not interested in urology as a career.

Attitude↗

Identification of high-risk residents.

BACKGROUND: Identification of high-risk residents allows remediation and support for administrative action when necessary. This study characterizes differences in documentation of marginally performing residents in a general surgery residency. METHODS: High-risk residents were identified by the former program director. Twenty-four of one hundred fifteen residents over a 10-year period had one to four problematic areas: cognitive, synthetic, family/health, and interpersonal skills. Outcomes included finished (18), voluntary withdrawal (1), and involuntary withdrawal (5). A case-control study matching controls to cases by date of entry into the training program was used. Records were reviewed for demographics, preentry qualifications, American Board of Surgery In-Training Exam (ABSITE) scores, letters of complaint or praise, events of counseling, and monthly ratings. The records of 48 residents were reviewed. Ward evaluations were on eight categories with a 5-point Leikert scale (3-unacceptable to 7-outstanding). The evaluation score assigns points only to low ratings. High scores represent progressively poorer performance. A Wilcoxon signed ranks test was used to compare the cases and controls for continuous variables. The McNemar test was used in comparisons of categorical data with binary outcomes. Exact P values are reported. RESULTS: Objective data were similar for both groups. Study residents tended to score higher on monthly evaluations at Year 2 and by Year 3 this achieved significance (0.026). Study residents were more likely to have negative faculty letters (0.016) and events of counseling by a faculty member (0.017) and the program director (0.005). CONCLUSIONS: Identification of residents at risk should begin as early as possible during training. A combination of faculty evaluations and evidence of letters of counseling can detect high-risk residents. Programs may use such indicators to support decisions regarding remedial work or administrative action.

Documentation↗

Does a health maintenance curriculum for pediatric residents improve performance?

OBJECTIVE: To assess the knowledge and skills of residents in health maintenance and to measure the effectiveness of a new curriculum. DESIGN: Longitudinal cohort study of first- and second-year pediatric residents over 2 academic years (AY). Residents in AY 1995-1996 (n = 32) comprised a control group. Residents in AY 1996-1997 (n = 36) served as a study group who completed a structured 12-week program of reading materials, small group discussions, and case scenarios. METHODS: A needs assessment identified 7 topic areas in health maintenance: health screening, immunizations, nutrition, development, behavior, injury prevention, and dental health. Control and study residents' cognitive knowledge, chart documentation, and clinical performance were assessed using a 50-item multiple choice examination, medical records audit, and standardized patient evaluations. RESULTS: Mean examination scores, chart documentation, and clinical performance did not differ significantly between first- and second-year control residents. In the study group, mean examination scores of first-year residents were not significantly better than controls. Second-year residents significantly improved their knowledge about health screening, nutrition, and dental health compared with controls but showed no improvement in other areas. Medical record documentation increased significantly among study residents compared with control residents. Clinically, first-year residents significantly improved in the task of health screening (relative risk [RR] 6.33) and markedly improved (36.8% vs 66.7%) their injury prevention counseling compared with controls. Second-year residents showed significant increases in health screening (RR 6.09) and taking a nutritional history (RR 1. 44) compared with controls. Assessment of the curriculum by residents showed a high degree of satisfaction with the program. CONCLUSIONS: Pediatric residents who had clinical experience and completed the curriculum demonstrated significant improvements in their medical record documentation and selective gains in knowledge and clinical performance of health maintenance compared with residents with clinical experience only. A structured curriculum in health maintenance and a multifaceted assessment system can identify and enhance the skills of pediatric residents.

Adult↗

Education of nonscientists about new alcohol research: results of two types of presentations plus 6-month follow-up.

Education of nonscientists by scientists is assumed to be beneficial for enhancing public understanding of the research process and increasing public excitement about science. However, evaluation of audience response to receiving such information has rarely been performed. In particular, the effectiveness of communicating new research on alcohol abuse and alcohol dependence has never been evaluated. Evaluation data in the present study show significant knowledge transfer, belief changes, and participant reports of possible behavioral changes in targeted audiences. These occur when alcohol researchers present basic neuropharmacological concepts and new neurobiological research to audiences consisting primarily of chemical dependency counselors, social workers, criminal justice workers, physicians, nurses, family, clergy, and others interested in alcohol-related problems (defined as "clinicians" and the "reachable public"). Together, these results suggest that it is possible to change the beliefs, knowledge, and behavior of chemical dependency clinicians and the reachable public about alcoholism, its causes, and its treatment.

Adult↗

A cost-effectiveness analysis of three staffing models for the delivery of low-risk prenatal care.

BACKGROUND: Health care costs are increasing at more than twice the rate of inflation, thus, public officials are seeking safe and economic methods to deliver quality prenatal care to poor pregnant women. This study was undertaken to determine the relationship between the cost and effectiveness of three prenatal clinic staffing models: physician based, mixed staffing, and clinical nurse specialist with physicians available for consultation. METHODS: Maternal and neonatal physiological outcome data were obtained from the hospital clinical records of 156 women attending these clinics. The women were then interviewed concerning their satisfaction with their prenatal care clinic. The financial officer from each clinic provided data on the clinic staffing costs and hours of service. RESULTS: There were no differences in outcomes for the maternal-neonatal physiological variables, although newborn admission to the Neonatal Intensive Care Unit (NICU) approached significance among the clinics. The clinic staffed by clinical nurse specialists had the greatest client satisfaction and the lowest cost per visit. CONCLUSIONS: The use of clinical nurse specialists might substantially reduce the cost of providing prenatal care while maintaining quality, and might thereby save valuable resources.

Ambulatory Care↗

Impact of orthognathic surgery on normal and abnormal personality dimensions: a 2-year follow-up study of 61 patients.

The psychological adjustments and self-concepts of 61 orthognathic surgery patients were evaluated before surgery and at 1 month, 6 months, 1 year, and 2 years after surgery. The impact of orthognathic surgery on self-concept and personality adjustment was assessed. Significant improvements in group scores were found with the use of a repeated measures ANOVA in the following subscales of personality disturbances: general maladjustment, psychosis, neurosis, personality disorder, and personality integration. A significantly positive effect was also observed in the following subscales of self-concept: self-esteem, self-satisfaction, self-identity, physical self, family self, social self, and total self-conflict. The improved changes in psychological profile two years after orthognathic surgery are encouraging.

Adolescent↗

Comparing learning logs and note summaries in a dental research methods course.

This paper reports a study that examines how two types of writing influenced dental students' performance in critical thinking and recall in a graduate research methods course. Forty-five students in this five-week, lecture-based course were stratified by dental specialty and randomly assigned to one of two groups. The treatment group kept learning logs, expressing personal understanding of lecture material; a second group wrote note summaries, entailing the reorganization of key lecture points. Each student was asked to write for a ten-minute interval during each class meeting. Mean scores for the log writers were higher on a post-course essay measure of critical analysis; note summarizers performed better on recall; while in the direction predicted, differences did not reach statistical significance. Note summarizers' attitude toward future use of their activity in other classrooms was more positive and they complied more highly with their activity than did the log writers. This preference for the note summary method suggests that students may find the structured nature of the summary more useful when being introduced to a dental concept.

Education, Dental, Graduate↗

Telephone management curriculum for pediatric interns: a controlled trial.

The purpose of this study was to evaluate the effect of a role-play telephone management curriculum on history taking and management skills. The study was a nonrandomized controlled trial carried out in the outpatient department of a primary care pediatric residency training program. Six PL-I residents (treatment group) participated in a role play curriculum during their first month of rotation through the outpatient department; seven PL-I residents (control group) received no formal instruction in telephone management. Baseline performance was measured on entry into the study using telephone calls made by a "simulated" mother using standardized scripts. Follow-up calls were made approximately 3 months later. Transcripts of these calls were rated by examiners who were unaware of group assignment using a standardized instrument that measured three aspects of performance: general history taking, specific history taking, and general management. Results were as follows: Mean posttest scores for the combined groups were: 59.4% (general history taking), 75.9% (specific history taking), and 77.7% (general management). By analysis of covariance, treatment group residents had significantly higher posttest scores in general history taking than control group residents (67.1% v 53.6%, P = .004). This difference occurred without a significant increase in the time spent answering the call. These data indicate that a role play curriculum results in improved performance in at least one aspect of telephone management.

Analysis of Variance↗

Improving nutrition components in medical and dental school curriculums.

This article has presented an alternative approach to the traditional, freestanding, concentrated course in nutrition. The integration of nutrition into other courses, with continuous reinforcement throughout the 4-year curriculum, may result in better learning and retention by the student. However, the lack of an accurate curriculum representation presents a problem in selecting topics that integrate with other courses. The unobtrusive approach to nutrition curriculum improvement involves three key points: development of the Nutrition Curriculum Guide, which provides detailed information on what is currently being taught, comparison of what is actually being taught with a set of ideal objectives in order to identify redundancies or omissions, and orchestrating the efforts of faculty in courses throughout the 4-year curriculum to help students integrate nutrition-related topics from the various disciplines. When one makes practical application of the unobtrusive approach, the most difficult problem is defining which interdisciplinary topics are currently being taught. An education specialist and the Tracer Method are important resources for one who is seeking to ameliorate the problem.

Curriculum↗

Videotape review: a valuable tool for self-assessment of teaching skills.

This paper describes the components of an instructor improvement program known as VISIT (Videotaping Instruction for Self-Assessment of Instructional Technique). Through the use of videotape recordings of classroom, laboratory or clinical teaching and observation by trained observers, faculty can pinpoint instructional strengths and problem areas, plan refinements and evaluate the impact of these refinements. Ten years of experience with VISIT indicates that post-lecture consultation sessions between the instructor and observer are vital to the success of this activity.

Educational Measurement↗

The reliability and utility of clinical competency assessments for drug monograph preparation by pharmacy students.

This educational research project evaluated the utility and reliability of an evaluation system designed to assess the clinical competency of pharmacy students in the preparation and presentation of a comparative drug monograph. The educational program consisted of a mini-course to review drug information resources and skills and a drug information clinical clerkship. The evaluation system for student performance (competency) included 15 criteria (competency areas), a set of descriptors for each criterion, and a scaling mechanism. This competency assessment system for monograph services quantified the overall level of competency and identified specific strong and weak competency areas. The reliability of the system was good in general (standardized alpha-coefficient = 0.701), over time, and among several preceptors. Students indicated that the system was fair and provided them with feedback. Clinical competency assessment should be structured to minimize subjectivity and must be tested for reliability; then, such evaluations can become more consistent and equitable.

Clinical Clerkship↗

Development of core competencies in clinical nutrition.

A nationwide survey of core competencies of nutrition knowledge and skills that primary care physicians should know and/or be able to do has been completed. Nutrition competencies were synthesized from a review of clinical nutrition practices as reported in the medical literature and by medical school faculty group discussions. A nutrition competency questionnaire was sent to 445 practicing physicians and to 752 department chairpersons in every US medical school in the disciplines of family practice, medicine, obstetrics and gynecology, pediatrics, psychiatry, and surgery. The overall response rate for practitioners and faculty combined was 46.03%. Of the 55 nutrition competencies, 28 items received very strong support (greater than 90% of respondents marked agree or completely agree). Twenty-two competencies received strong support (80 to 89% of respondents marked agree or completely agree), and five items received mixed support (40 to 79% of respondents marked agree or completely agree). Statistical comparisons of the item responses between practitioners and faculty were significantly different (p less than 0.05) on 19 (35%) of the items. It is anticipated that the 50 nutrition competencies that have received strong or very strong agreement among the 551 physicians representing primary care disciplines across the US will serve as guidelines for continued development of medical school curriculum and continuing medical education in clinical nutrition.

Clinical Competence↗

Evaluating performance in writing drug information consultations.

A form for evaluating written drug information consultations was used to measure the performance of pharmacy students in a drug information service clerkship; the reliability of the evaluation process was also assessed. Drug consultations were written by 74 clerks during a four- or five-week rotation. A total of 147 consultations were written: Nine clerks wrote one consultation, 57 clerks wrote two, and eight clerks wrote three. The consultations were evaluated on 11 criteria by 18 different preceptors using an evaluation form. Performance on each criterion was rated on a four-level scale. Clerk improvement over time, reliability of the instrument, and inter-rater reliability for preceptors were analyzed statistically. The overall mean score for all consultations was 84 7%. Some improvement was observed between the first and second consultations completed by clerks, but the difference was not significant. Reliability of the evaluation process was good (coefficient of alpha = 0.666). There as no significant difference among preceptors. The authors concluded that the written drug information consultation evaluation form was a valid and reliable method for measuring individual and program competence.

Clinical Competence↗

A description and four-year analysis of a clinical clerkship evaluation system.

Major issues related to evaluating student performance in clinical clerkships are reviewed, and the development of a clerkship evaluation system which attempts to deal with each issue is described. Three evaluation methods are utilized: multiple choice examination, oral examination, and ward ratings. Scores from each evaluation method for the classes of 1977-80 were analyzed to determine dependability and validity. Results indicate that the multiple choice and oral exam scores were highly dependable each year; however, the ward ratings were not dependable during the first year of use. Over the four-year period, the ward rating criteria were kept the same, annual feedback to individual faculty was provided, and residents were added as raters. The cumulative effect appears to have been a pronounced improvement in the dependability of the ward rating scores. As a result, ward rating scores now receive greater emphasis in evaluating student clerkship performance.

Education, Medical, Undergraduate↗