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Biomedical subjects

John W Epling

Publications and source records attributed to John W Epling.

8 recordsLinked to original sources

Physician-identified barriers to intimate partner violence screening.

BACKGROUND: Intimate partner violence (IPV) causes approximately 2 million injuries and 1300 deaths each year. Despite the high frequency of IPV among women seeking healthcare, only a small proportion report being asked by healthcare professionals about abuse. This study examined perceived barriers to IPV screening among obstetricians/gynecologists, family physicians, and internists, so that protocols for IPV training can be tailored to those particular areas of difficulty. METHODS: A cross-sectional survey of 143 obstetricians and gynecologists, family practice physicians, and internists in a medium-sized upstate New York city was conducted. Factor analysis was performed. Two IPV barrier domains emerged and were examined using a multivariate analysis to determine associations between the domains and physician characteristics. RESULTS: For general knowledge, there were greater perceived barriers if the respondent was male but fewer perceived barriers if the respondent was an obstetrician/gynecologist and fewer perceived barriers if the respondent had 5-10 years in practice. For practice policy, there were greater perceived barriers if the physician was in a private practice setting and fewer perceived barriers if the physician was an obstetrician/gynecologist. CONCLUSIONS: These findings provide direction for training in IPV recognition. They support a need for continued training throughout the physician's career. More importantly, the findings support a need for better practice systems to encourage routine screening for IPV by healthcare providers.

Adult↗

A Web-based approach to teaching students about diagnostic reasoning.

BACKGROUND: Web-based curricula can decrease classroom time and provide self-paced, active learning experiences for medical students. INTERVENTION: In our family medicine clerkship, we implemented a Web-based module on applying diagnostic reasoning to determine the likelihood that a patient has Group A beta-hemolytic streptococcal pharyngitis based on the history, physical examination, and diagnostic tests. RESULTS: Students rated the module more favorably than other classroom sessions and homework assignments. Most students accurately calculated pretest and posttest probabilities in a write-up of an actual patient with a sore throat. CONCLUSIONS: This Web-based module was well received and effective.

Clinical Clerkship↗

Measuring orientation to population-based prevention.

BACKGROUND: Assessing orientation to population-based preventive alternatives is useful in the evaluation of preventive medicine curricula. METHODS: An instrument was developed using hypothetical situations describing a health issue that could be encountered by a primary care physician. Options to be selected were in three categories: (1) treatment, (2) clinical prevention, or (3) population-based prevention. Respondents allocated 900 points among alternatives for nine situations (100 points per situation). Pilot testing of the instrument was implemented, comparing the responses of public health physicians with two groups (Syracuse and Baltimore) of family medicine physicians. RESULTS: For the overall instrument, the scores on the population scale and population-treatment differential showed statistically significant differences between the public health physicians and both groups of family medicine physicians (p<0.01). For medical students taught the Case-Based Series in Population-Oriented Prevention (C-POP), there was an overall increase in the population scale (p<0.0001) and the population-treatment differential (p<0.0004). CONCLUSIONS: The development of a scenario-based tool to assess changes in population-based prevention orientation shows preliminary promise for future evaluation efforts involving preventive medicine curricula.

Clinical Competence↗

Evaluation of a preventive medicine curriculum: incorporating a case-based approach.

BACKGROUND: Evaluating the acquisition of skills in prevention is an increasing priority in prevention education. Assessment instruments were developed to measure student skills before and after an education intervention at State University of New York (SUNY)-Upstate Medical University. METHODS: The evaluation method used three testing instruments that measure preventive medicine skills. We selected three surrogate topics, each their own instrument: sexually transmitted disease, lead toxicity, and ischemic heart disease. All three instruments measure four key preventive medicine skills areas: (1) using and interpreting data sources; (2) measuring disease frequency, including incidence and prevalence; (3) making inferences and identifying bias in data presentations; and (4) identifying appropriate study design and screening tests. Second-year medical students were assessed before and after our preventive medicine course in spring 2002, using our evaluative instruments. RESULTS: Before and after instruction analysis, overall, and by skills area tested revealed a significant increase in student preventive medicine skills (p< or =0.001) in all four categories. On conclusion of the case-based curriculum, students were also asked to rate the cases. The majority (60%) of the students thought the cases were of value to their medical education, and 58% believed that they added to their skills in population prevention. CONCLUSIONS: These instruments can measure change in preventive medicine skills before and after a course in preventive medicine.

Consumer Behavior↗

Case-based teaching in preventive medicine: rationale, development, and implementation.

The importance of prevention teaching is increasingly recognized in medical education, but its implementation in medical school curricula is hampered by its cross-specialty nature, lack of curricular time, and perception as a topic of less importance than the traditional basic and clinical sciences. The Case-Based Series in Population-Oriented Prevention (C-POP) was developed to address national objectives for prevention education in a format that recognizes the students' abilities and preferences for case-based learning. This series uses small-group discussion cases that can be adapted to a variety of settings and instructor capabilities. These cases guide the learners from a specific clinical problem to the broader clinical and population-based prevention issues for the topic. The cases were developed with the use of local health department scenarios and data and have been taught and refined in a number of settings. As part of the curriculum development project, evaluation tools that examined prevention skills and orientation were developed and tested. With its emphasis on small-group learning, clinical relevance, and adaptability to a variety of learner and instructor needs, the C-POP project effectively integrates prevention concepts into medical education.

Curriculum↗

Future applications of case-based teaching in population-based prevention.

The Case-Based Series in Population-Oriented Prevention (C-POP) introduced in this supplement to the American Journal of Preventive Medicine provides a set of tools to integrate clinical- and community-based prevention into interactive teaching cases. These cases, which address recommended core competencies in prevention education, have been taught to both medical students and preventive medicine residents. Initial experience with the cases indicates that this method is a promising tool to enhance prevention education in medical schools and primary care residencies. Because prevention education is essential in other fields, such as public health and nursing, extension of this approach to other professional schools is possible. Such extension is feasible because the cases are designed to be adaptable for different levels of education, flexible to be tailored to local situations, and expandable to accommodate changes in the field. In addition, the cases can be made accessible to all educators through a national library and in interactive web-based format. This article describes how the C-POP series can be used to strengthen prevention education for a wide audience of physician and nonphysician learners.

Computer-Assisted Instruction↗

A critical look at prevention: colorectal cancer screening.

This case-colorectal cancer screening-is one of a series of teaching cases in the Case-Based Series in Population-Oriented Prevention (C-POP). It has been developed for use in medical school and residency prevention curricula. The complete set of cases is presented in this supplement to the American Journal of Preventive Medicine. This preventive medicine teaching case discusses the concepts of diagnostic test evaluation, prevention, and screening using the example of colorectal cancer screening. Features of the case include a health policy exercise concerning community screening programs and an exercise in clinical prevention decision making.

Colorectal Neoplasms↗