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Biomedical subjects

J P Hafler

Publications and source records attributed to J P Hafler.

11 recordsLinked to original sources
PubMed2000

Scholarly activities recorded in the portfolios of teacher-clinician faculty.

PURPOSE: To explore what contributions to scholarship teacher-clinician faculty list in the portfolios that they use as evidence for promotion. METHOD: In 1998, the authors randomly selected 15 Harvard Medical School teacher-clinicians (five from each rank of assistant, associate, and full professor) from among 120 such faculty members who had been successfully promoted between 1990 and 1997. Using a descriptive research study design, the authors counted and categorized the contributions to scholarship, teaching, and committee service that the faculty listed in their portfolios. They did not assess the quality or weighting of the contributions. RESULTS: According to the portfolios, the faculty members had contributed to both teaching and scholarships at local, regional, and national levels. They listed not only peer-reviewed original journal articles, but also works that integrated and synthesized knowledge: specifically, chapters, textbooks, editorials, syllabi, newsletters, computer resources, and videotapes. Faculty generally had published in multiple areas of scholarship, which fell in two domains: the faculty member's subspecialty and medical education. The number of publications increased at each promotion level. The faculty also participated in broad-based teaching and education at the student, resident, fellow, and continuing medical education levels. Leadership contributions in education had occurred not only locally and regionally but also at a national level. Finally, faculty participated actively in service to the medical school, hospital, and national organizations, with leadership roles at the associate and full professor levels. CONCLUSION: The academic culture at Harvard Medical School has shifted from promotion based solely on original scholarship to promotion based on a broad array of educational contributions. The faculty, as they seek promotion, create portfolios that list written scholarship, teaching, and service at the local, regional, and national levels and at all ranks of promotion.

Faculty, Medical↗
PubMed2000

Yesterday a learner, today a teacher too: residents as teachers in 2000.

Resident physicians spend numerous hours every week teaching medical students and fellow residents, and only rarely are they taught how to teach. They can, however, be taught to teach more effectively. Teaching skills improvement initiatives for residents are taking a more prominent place in the educational literature. Limited evidence now suggests that better resident teachers mean better academic performance by learners. A small but important body of research supports selected interventions designed to improve residents' teaching skills, but not all studies have demonstrated significant educational benefits for learners. An increasing number of valid and reliable instruments are available to assess residents' clinical teaching, including objective structured teaching examinations and rating scales. In all specialties, rigorous research in evidence-based teacher training for residents will help prepare academic medical centers to meet the diverse and changing learning needs of today's physicians-in-training.

Clinical Competence↗
PubMed1999

Addressing sexual abuse in the primary care setting.

OBJECTIVE: To describe factors that prompt pediatric practitioners to suspect child sexual abuse, the barriers to inquiry, and the approach to management of cases of possible abuse. DESIGN: Qualitative, descriptive, and case-based. METHODS: Six focus group interviews were conducted. Maternal and Child Health Bureau-sponsored collaborative office rounds groups nationwide participated in discussions of five vignettes. Each group interview lasted 1.5 hours and had 7 to 16 participants (n = 65). Audiotaped data were transcribed and analyzed independently for themes by two reviewers. RESULTS: Five themes emerged from the group interviews: anticipatory guidance, red flags, approach to management, terminology used in discussions, and barriers to inquiry. All groups discussed giving anticipatory guidance about sexual abuse. Half (3/6) believed girls were more likely to be victimized, and some (2/6) gave more anticipatory guidance to girls for this reason. Although some groups reported giving anticipatory guidance about sexual abuse, many reported inconsistencies in their practice. All groups identified historical, behavioral, and physical red flags for sexual abuse but believed that they were not trained in residency to recognize these signs. There was no consensus regarding the approach to management of cases of possible sexual abuse, and many participants did not know the types of questions that they should be asking children when they suspect abuse. Members of all groups reported using imprecise terms when they discuss sexual issues with families. Most (4/6) believed that it was a practitioner's responsibility to inquire about abuse but believed that their discomfort with sexual topics was a barrier to inquiry. All believed that the most significant barrier to inquiry was inadequate training in the area of sexual abuse and that cases are missed because of lack of training. CONCLUSIONS: Highly motivated pediatric practitioners reported that they give anticipatory guidance about sexual abuse inconsistently, that they were not trained to recognize red flags for sexual abuse, and that they do not have a consistent approach to cases of suspected abuse. Additionally, they reported that they are not comfortable discussing sexual issues and that they miss cases of sexual abuse primarily because of lack of training. Educational interventions that target these themes are essential to improve the ability of pediatricians to screen children and to intervene when sexual abuse is identified.

Adolescent↗
PubMed1998

The cellular immune response to Bordetella pertussis in two children with whooping cough.

There is increasing evidence that the cellular immune response to Bordetella pertussis plays an important role in the immune protection. Particularly in animal models, Bordetella pertussis-specific T-cells have been shown to confer immunity. In this case report, we therefore investigated the cellular immune response to whole cell Bordetella pertussis bacteria, to the pertussis antigens filamentous hemagglutinin and pertussis toxoid defined by lymphoproliferation and cytokine secretion. Two children with whooping cough were compared to three individuals vaccinated against whooping cough with a whole cell pertussis vaccine. In contrast to the vaccinated controls, the cellular immune response to Bordetella pertussis in children with whooping cough was characterized by a strong proliferation of T cells to whole pertussis bacteria as well as to filamentous hemagglutinin and pertussis toxoid. This response was defined by a marked Th-1 type T cell response with IFN-gamma secretion to all Bordetella pertussis antigens. However, in the control individuals IFN-gamma was secreted only to whole cell Bordetella pertussis bacteria and filamentous hemagglutinin but not to pertussis toxoid. A Th-2 type cytokine response could not be detected in any condition. Our observations suggest that in the immune defense of a natural Bordetella pertussis infection, the Th-1 specific T cell response to filamentous hemagglutinin and particularly to pertussis toxoid may play a major role.

Adhesins, Bacterial↗
PubMed1997

Intern learning and education in a short stay unit. A qualitative study.

OBJECTIVE: To study interns' perceptions of their learning during their rotation through a short stay unit (SSU). DESIGN: Case-based, qualitative research study. SETTING: A tertiary care pediatric hospital (The Children's Hospital, Boston, Mass). PARTICIPANTS: Ten interns who had worked in the SSU in the 3 months prior to June 1, 1995, and on a general medical team in the previous 12 months. INTERVENTION: None. MAIN OUTCOME MEASURES: In July 1995, the interns participated in focused, open-ended interviews lasting about 40 to 60 minutes to document their perceptions of their learning during their SSU rotation. The interviews were recorded on audiotape and transcribed prior to analysis. Data were analyzed to discern and categorize themes from the interns' responses. RESULTS: All interns responded favorably to their educational and learning experiences during their rotation through the SSU. Two major themes emerged: (1) the interns' learning, which was affected by the role of the attending physician, the organization and structure of the SSU, and the teaching strategies in the SSU; and (2) the interns' collaborative work with the nursing staff in the SSU, which affected patient care but did not facilitate the interns' learning. CONCLUSION: Clustering in the SSU of patients whose symptoms suggested straightforward diagnoses enhanced interns' educational experiences.

Adult↗
PubMed1995

The pedagogic characteristics of a clinical conference for senior residents and faculty.

OBJECTIVE: To determine the pedagogic characteristics of a clinical conference for senior pediatric residents and selected faculty. PARTICIPANTS AND SETTING: Nineteen senior pediatric residents and 14 selected faculty members participated in a daily clinical conference at Children's Hospital, Boston, Mass. DESIGN: Qualitative research design using videotapes of nine consecutive hour-long sessions to generate pedagogic topics to be investigated using a questionnaire administered to participating residents and faculty. Narrative responses were analyzed to find pedagogic themes. RESULTS: Analysis of videotapes generated the following three topics: What facilitated learning? What was learned? What makes the process of teaching and learning effective? In the questionnaire residents indicated that learning was facilitated by resident-faculty interactions (19/19), faculty participation (19/19), and information resources (12/19). Content learned included information (16/19), approach to diagnosis (11/19), management strategies (14/19), and different perspective (14/19). An effective process of teaching and learning was attributed to case-based resident initiated discussion (19/19), facilitation by the chief resident (16/19), and non-competitive discussions in which expert faculty played a nondominant role (19/19). Faculty identified identical factors relating to all three themes. The mean rating of the conference was 4.5/5 (SD, +/- 0.50) and 4.7/5 (SD, +/- 0.45) by residents and faculty, respectively (Likert scale, 1 to 5). CONCLUSIONS: The pedagogic effectiveness of this conference was attributed to a resident-centered, case-based learning format and a discussion process characterized by noncompetitive interactions among faculty and residents, strong group facilitation by the chief resident, and participation of faculty experts in a nondominant role.

Faculty, Medical↗
PubMed1994

A case-study approach. Fellows' perceptions of a teaching course.

OBJECTIVE: To determine general and behavioral pediatric fellows' perceptions of a formal teaching course. DESIGN: Qualitative research design using a case-study approach. SETTING: Children's Hospital in Boston, Mass. PARTICIPANTS: All first-year general and behavioral pediatric fellows (n=5) taking the teaching course. INTERVENTION: A 12-week teaching course given to all participants. MEASUREMENTS/MAIN RESULTS: Data were collected using questionnaires completed by fellows; focused, open-ended interviews with fellows; and student ratings of fellows' teaching. Analysis revealed that after the course, the fellows perceived "teaching'' as an interactive, student-directed process; attained a greater awareness of the value of feedback; recognized new teaching opportunities; and changed their teaching strategies to reflect student-directed teaching. CONCLUSION: This formal course influenced fellows' approach to teaching.

Boston↗