Biomedical subjects

John Boker

Publications and source records attributed to John Boker.

10 recordsLinked to original sources

PubMed2006

Comparative survey of Complementary and Alternative Medicine (CAM) attitudes, use, and information-seeking behaviour among medical students, residents & faculty.

BACKGROUND: There is significant and growing national interest for introducing Complementary and Alternative Medicine (CAM) instruction into allopathic medical education. We measured CAM attitudes, use, and information-seeking behaviors as a baseline to evaluate future planned CAM instruction. METHODS: Cross-sectional and longitudinal survey data on CAM attitudes, modality use, and common information resources was collected for (a) medical students (n = 355), (b) interns entering residencies in medical and surgical disciplines (n = 258), and (c) faculty from diverse health professions attending workshops on evidence-based CAM (n = 54). One student cohort was tracked longitudinally in their first, second and third years of training. RESULTS: Compared to medical students and interns, faculty who teach or intend to integrate CAM into their instruction had significantly (p < .0005) more positive attitudes and used CAM modalities significantly (p < .0005) more often. Medical students followed longitudinally showed no change in their already positive attitudes. The 3 survey groups did not differ on the total number of CAM information resources they used. Each group surveyed used about two out of the five common information sources listed, with the Internet and journals most frequently cited. CONCLUSION: Students, interns and a selected faculty group demonstrate positive attitudes toward CAM and frequently use various CAM modalities. CAM instruction should therefore be focused on acquiring knowledge of available CAM modalities and skills to appraise evidence to appropriately advise patients on best approaches to CAM use. Trainees may benefit from exposure to a wider array of CAM information resources.

Academic Medical Centers↗

PubMed2006

What do medical students learn from early clinical experiences (ECE)?

What are the common learning themes perceived by medical students during ECE with varying practice settings and patient profiles? Retrospective qualitative and quantitative analyses of structured descriptive reports completed by one class (n = 92) for 895 observed patient encounters identified common learning themes. Identified themes were examined by practice setting and patient characteristics. Student response rates were 85 to 94% across settings. Fifty-five percent of ECE were in outpatient settings. Chief complaints were predominantly medical (67%); only 20% represented psychosocial and 8% preventive care, respectively (5% were ambiguous). The five most common learning themes (out of 13 themes coded) were communication (>50%), procedures/time management, cross-cultural issues, feeling useful as a student, and presenting medical problems. Cross-cultural issues were addressed mainly in community settings. Negative learning occurred only rarely (<3%). Student observations from ECE can be used by course managers to design effective early clinical exposures to address specific course learning objectives.

Adult↗

PubMed2006

Point-of-view writing: A method for increasing medical students' empathy, identification and expression of emotion, and insight.

CONTEXT: Although interest exists among medical educators in using writing that reflects on clinical experience to enhance medical students' communication skills, empathy, and overall professionalism, little empirical research documents the value of this approach. This study explored whether students trained in one type of writing would first demonstrate increased awareness of emotional aspects of a clinical encounter in their writing; and second, be evaluated more positively in an OSCE situation by standardized patients. METHOD: Ninety-two students were assigned to either a point-of-view writing or a clinical reasoning condition as part of a second year doctoring course. At the end of the year, students were evaluated in an OSCE format on 3 cases, and completed a writing assignment about an ER death from cardiac arrest. Student essays were scored according to presence or absence of various themes. A linguistic analysis of the essays was also performed. Point-of-view and clinical reasoning group scores were compared on both measures, as well as on the standardized patient OSCE ratings. RESULTS: Students trained in point-of-view writing demonstrated significantly more awareness of emotional and spiritual aspects of a paper case in a writing assignment than did students trained in clinical reasoning. By contrast, students in the clinical reasoning group were more likely to distance from the scenario. The two groups did not differ on SP OSCE ratings. CONCLUSION: Training in point-of-view writing can improve medical students' written skills on certain affective dimensions. It is not clear that these skills can translate into clinical behavior.

Adult↗

PubMed2006

Using the tool for assessing cultural competence training (TACCT) to measure faculty and medical student perceptions of cultural competence instruction in the first three years of the curriculum.

PURPOSE: To compare faculty and student perceptions of cultural competence instruction as measured by the AAMC's Tool for Assessing Cultural Competence Training (TACCT) as part of a comprehensive curricular needs assessment. METHOD: In 2005, 25 basic science and clinical course directors and 92 third-year medical students at the University of California, Irvine, School of Medicine were asked to indicate which of 67 separate items listed on the TACCT describing knowledge, skill, and attitude about cultural competence were covered during the first three years of the curriculum. The mean percentage of "yes" responses to each item was computed and compared for both faculty and students. RESULTS: Response rates were 100% (25/25) for course directors and 75% (69/92) for students. Students systematically perceived that cultural competence instruction occurred more often in the curriculum (range of 28% to 93% "yes" responses) compared to the faculty (range of 8% to 64%). However, faculty and students demonstrated a high level of concordance (intraclass correlation coefficient = 0.89 across all items) in their perceptions about instruction, as measured by their relative rank orderings of the 67 TACCT items. Students and faculty identified clusters of TACCT items pertaining to health disparities, community partnerships, and bias/stereotyping as least likely to be presented. CONCLUSIONS: Faculty and third-year students at one medical school responded congruently about the relative degree to which cultural competence instruction occurred. The TACCT can be used to identify significant gaps in cultural competence training and inform curricular revision. Further studies involving other schools are warranted.

Cultural Diversity↗

PubMed2006

Student Senior Partnership Program: University of California Irvine School of Medicine.

The Student Senior Partner Program (SSPP) forms the core of the required medical student geriatrics curriculum at the University of California-Irvine School of Medicine (UCISOM). The program utilizes a longitudinal modular format that extends over the first three years of medical school. Instruction is presented in didactic, patient interactive, and facilitated small group discussion sessions. Initial educational outcomes have been positive. Ongoing challenges include faculty recruitment and retention, recruiting a group of senior partners that reflects the diversity of the community, and managing generational and ethno-cultural conflicts. The program offers unique opportunities for innovative development in geriatrics education.

Adult↗

PubMed2005

A novel 3-year longitudinal pilot study of medical students' acquisition and retention of screening eye examination skills.

OBJECTIVE: To assess the acquisition and retention of screening ophthalmic clinical skills over 3 years of medical school. DESIGN: Observational, longitudinal, multiple skills measures. PARTICIPANTS: All 96 students enrolled in a single graduating class at a public medical school in California. METHODS: Immediately after the second-year ophthalmic clinical skills course, all students were evaluated by their preceptors and self-rated for competence in defined skills. Follow-up assessments were done during 2 required third-year clerkships without additional formal ophthalmic clinical exposure. Three complete history and physical examination chart notes routinely submitted for course grading in third-year clerkships were selected randomly for each student by clerkship directors in family medicine and internal medicine, masked for identity, and then scored for appropriateness. Funduscopic skills were assessed objectively with a simulator in the third-year Clinical Performance Examination. During a fourth-year 4-day ophthalmology clerkship, students were trained and reassessed with the same simulator. Just before graduation, a self-assessment questionnaire was administered to the entire class. MAIN OUTCOMES MEASURES: Twelve skills were assessed: ability to evaluate visual acuity (VA); pupils; extraocular muscles; confrontation fields; lids; cornea; conjunctiva/sclera; anterior chamber depth; and, funduscopically, the disc, macula, vessels, and retina. RESULTS: Faculty rated 88% to 90% of students as able to assess acuity, pupils, ductions, and fields, and 72% to 82% as able to visualize various parts of the fundus. Seventy-six percent of students felt comfortable after funduscopic training. In 364 analyzed chart notes, one VA was measured, and pupils were examined in 66% of notes, ductions in 54%, and fields in 3%. Only 11% of notes documented attempted funduscopy; <2% suggested actual visualization. In the Clinical Performance Examination, 32% of students accurately described some aspect of the disc, with an improvement to 84% of 38 students retested after brief ophthalmology training in year 4. Of 54 (56%) respondents to the exit questionnaire, 59% felt comfortable visualizing some aspect of the fundus. CONCLUSIONS: There is worrisome erosion of students' acquired screening skills across the third-year clerkships. Skill reinforcement in the fourth year yielded improved performance. Attention must be directed to reinforcing basic ophthalmology skills training within medical school curricula to assure competence of graduates.

California↗

PubMed2005

Just a spoonful of humanities makes the medicine go down: introducing literature into a family medicine clerkship.

BACKGROUND: This project introduced medicine-related poetry and prose to a Year 3 family medicine clerkship with the purpose of determining students' perception of the usefulness of such materials to enhance empathy, improve patient management, and reduce stress. Although humanities are represented in the curricula of many medical schools, we need more information on how best to incorporate them during the clinical years. METHOD: In 2000, we used a needs assessment survey to identify learner perceptions of medical humanities. Using this information, in 2001-03 we developed and implemented a humanities-based curriculum consisting of readings linked to clinical vignettes, comments about humanities reading in required clinical Subjective, Objective, Assessment, Plan (SOAP) notes, and either station-specific or general poetry accompanying student end-of-clerkship objective structured clinical examinations. We collected both quantitative and qualitative data assessing student reactions and examined the data using non-parametric statistics and content analysis, respectively. RESULTS: Students showed moderate interest in incorporating humanities in medical education as a way of enhancing empathy, improving understanding and reducing frustration. Assessment of the clerkship humanities curriculum suggested a positive influence on students in terms of empathy for the patient's perspective, and a lesser, but still positive, impact on patient management. DISCUSSION: Responses from this group of learners suggest that there is receptivity toward introducing medical humanities into family medicine curricular venues and that such effort can have a generally positive effect on learner empathy, awareness and understanding toward patients and doctors.

Clinical Clerkship↗

PubMed2004

Development and validation of the CAM Health Belief Questionnaire (CHBQ) and CAM use and attitudes amongst medical students.

BACKGROUND: The need for Complementary and Alternative Medicine (CAM) and holistic approaches in allopathic medical school curricula has been well articulated. Despite increased CAM instruction, feasible and validated instruments for measuring learner outcomes in this content area do not widely exist. In addition, baseline attitudes or beliefs of medical students towards CAM, and the factors that may have formed them, including use of CAM itself, remain unreported. METHODS: A 10-item measure (CHBQ--CAM Health Belief Questionnaire) was constructed and administered to three successive classes of medical students simultaneously with the previously validated 29-item Integrative Medicine Attitude Questionnaire (IMAQ). Both measures were imbedded in a baseline needs assessment questionnaire. Demographic and other data were collected on students' use of CAM modalities and their awareness and use of primary CAM information resources. Analysis of CHBQ items was performed and its reliability and criterion-related validity were established. RESULTS: Response rate was 96.5% (272 of 282 students studied). The shorter CHBQ compared favorably with the longer IMAQ in internal consistency reliability. Cronbach's coefficient alpha was 0.75 and 0.83 for the CHBQ and IMAQ respectively. Students showed positive attitudes/beliefs towards CAM and high levels of self-reported CAM use. The majority (73.5%) of students reported using at least one CAM modality, and 54% reported using at least two modalities. Eighty-one percent use the internet as a primary source of information for CAM. CONCLUSIONS: The CHBQ is a practical, valid and reliable instrument for measuring medical student attitudes/beliefs and has potential utility for measuring the impact of CAM instruction. Medical students showed a high self-reported rate of CAM use and positive attitudes towards CAM. Short, didactic exposure to CAM instruction in the first year of medical school did not additionally impact these already positive attitudes. Unlike the IMAQ, which was intended for use with physicians, the CHBQ is generic in design and content and applicable to a variety of learner types. Evaluation measures must be appropriate for specific CAM instructional outcomes.

Adult↗

PubMed2004

Teaching empathy to first year medical students: evaluation of an elective literature and medicine course.

BACKGROUND: Empathy is critical to the development of professionalism in medical students, and the humanities-particularly literature-have been touted as an effective tool for increasing student empathy. This quantitative/qualitative study was undertaken to assess whether reading and discussing poetry and prose related to patients and doctors could significantly increase medical student empathy and appreciation of the relevance of the humanities for their own professional development. METHOD: In 2000-2001, first year students (n=22) volunteered for an eight-session literature and medicine elective and were randomly assigned to either immediate participation in the class or a wait-list group, who participated in the same class 6 months later. Complete pre- and post-intervention data for 16 students from both groups were obtained for two quantitative measures of empathy and an attitudes-toward-the-humanities scale. Students also participated in a qualitative group interview pre- and post-intervention. RESULTS: Empathy and attitudes toward the humanities improved significantly (p<0.01) after participation in the class when both groups of students were combined. The scaled treatment effect size was in the moderate range (> or =0.60 standard deviation units) for both measures that had statistically significant pre-to-post changes. Furthermore, student understanding of the patient's perspective became more detailed and complex after the intervention. Students were also more likely post-intervention to note ways reading literature could help them cope with training-related stress. CONCLUSION: A brief literature-based course can contribute to greater student empathy and appreciation for the value of humanities in medical education.

Adult↗

PubMedDate not supplied

Current trends in urologic laparoscopic surgery.

PURPOSE: We examined the status of laparoscopy in urology and the impact of residency and fellowship training on the performance of laparoscopy as primary surgeon. We also examined whether performing nonsurgical tasks requiring two-handed dexterity had any link to the adoption of laparoscopic techniques by urologists. MATERIALS AND METHODS: A total of 8760 laparoscopy questionnaires containing 135 queries were mailed to urologists listed on the American Urological Association practicing urologists mailing list. The questions sought information on area of practice, time in practice, fellowship training, ambidexterity, laparoscopic experience, and experience with robotics. The response rate was 1.8% (155 of 8760). RESULTS: There appeared to be no significant correlation between the performance of laparoscopic surgery and participation in activities requiring bimanual dexterity. However, a correlation of strong statistical significance did exist between laparoscopic residency training and performance of laparoscopy after residency (p=0.003. There also was a correlation between fellowship training in laparoscopy/endourology and doing laparoscopy as primary surgeon. CONCLUSIONS: Participation in laparoscopic surgery during residency training is a major determining factor in performance of laparoscopy as a primary surgeon in practice. Younger surgeons trained in laparoscopy during residency are performing more laparoscopy post residency than those without laparoscopic training during residency. At present, there is a need to train more urologists in laparoscopy at the postgraduate level.

Adult↗