Biomedical subjects

Klara K Papp

Publications and source records attributed to Klara K Papp.

5 recordsLinked to original sources

PubMed2006

Graduate medical training, learning, relationships, and sleep loss.

An extensive literature exists regarding the potential effect of sleep loss on human performance and the recent regulatory changes that now limit the duty hours of resident-physicians. Recent studies and reviews emphasize the effects of sleepiness on medical errors of commission and to a lesser extent omission. This review focuses on an emerging literature on the effects of sleep loss on personal, social and professional growth and development of residents. As with the early literature on sleep loss and resident performance, this literature is largely at an observational level, but there is sufficient evidence from other professions to indicate that sleep loss will affect post-graduate career and life skills. A multi-dimensional approach is needed to counter the adverse outcomes of sleep loss and fatigue and might consist of education on healthy sleep habits, family outreach, personal alertness strategies, and reversal of bias if sleepiness is personally disclosed. The multi-dimensional approach might include not only resident physicians, but also residency program directors and attending physicians at their institutions.

Affect↗

PubMed2004

The effects of sleep loss and fatigue on resident-physicians: a multi-institutional, mixed-method study.

PURPOSE: To identify and model the effects of sleep loss and fatigue on resident-physicians' professional lives and personal well-being. METHOD: In 2001-02, 149 residents at five U.S. academic health centers and from six specialties (obstetrics-gynecology, emergency medicine, family medicine, internal medicine, pediatrics, surgery) were recruited for the study. Residents were all in good standing in their programs. In a mixed-methods design, focus groups consisted of an average of seven (range, three to 14) individuals in the same year of training and residency program, for a total of 60 interns and 89 senior residents. Trained moderators conducted focus groups using a standardized, semistructured discussion guide. Participants also completed a 30-item quantitative questionnaire assessing sleepiness and workplace sleep attitudes that included the Epworth Sleepiness Scale (ESS). RESULTS: Residents described multiple adverse effects of sleep loss and fatigue on learning and cognition; job performance, including professionalism and task performance; and personal life, including personal well-being and relationships with spouse or significant other and family. Only 16% of the sample scored within the "normal" range on the ESS; 84% scored in the range for which clinical intervention is indicated. Sleepiness was consistent across institution, specialty, years of training, age, gender, marital status, and having children. CONCLUSIONS: More residents perceived that sleep loss and fatigue had major impact on their personal lives during residency, leaving many personal and social activities and meaningful personal pleasures deferred or postponed. Sleep loss and fatigue also had major impact on residents' abilities to perform their work. This finding further substantiates the growing concern about the potential impact on professional development. These observations should be taken into account in developing new training guidelines and educational interventions for housestaff.

Adult↗

PubMed2003

Competency-based goals for sleep and chronobiology in undergraduate medical education.

STUDY OBJECTIVES: Sleep and circadian rhythms are biologic processes operative in health and disease, but as yet there is no articulated curriculum for undergraduate medical education. DESIGN: A multidisciplinary expert-opinion approach was utilized to assess and define education objectives and the potential for implementation. SETTING: N/A. PATIENTS OR PARTICIPANTS: National Institutes of Health Sleep Academic Awardees. INTERVENTIONS: N/A. RESULTS: Four competencies with examples of instruction objectives were identified relating to sleep processes and sleep need, the impact of sleep and sleep disorders on human illness, the sleep history, and the application of sleep physiology and pathophysiology to patent care. Various strategies and tools are currently available for implementation and assessment of learning objectives for these knowledge and skills. CONCLUSION: The core competencies can be designed to improve physician knowledge and skills in recognizing and intervening in sleep problems and disorders. Learning objectives can be immediately incorporated into most medical school curricula. At the same time, these competencies serve as an important bridge across multiple medical content areas and disciplines and between undergraduate and postgraduate training.

Chronobiology Phenomena↗

PubMed2003

SNAPPS: a learner-centered model for outpatient education.

The unique character of medical education in the outpatient setting has created challenges in teaching and learning that cannot be solved by the adaptation of traditional inpatient approaches. Previous work and the authors' own observational study describe a relatively passive learner focused on reporting history and physical examination data to the preceptor. Based on the work of Bordage in cognitive learning, and that of Osterman and Kottkamp on reflective practice for educators, the authors have developed a collaborative model for case presentations in the outpatient setting that links learner initiation and preceptor facilitation in an active learning conversation. This learner-centered model for case presentations to the preceptor follows a mnemonic called SNAPPS consisting of six steps: (1) Summarize briefly the history and findings; (2) Narrow the differential to two or three relevant possibilities; (3) Analyze the differential by comparing and contrasting the possibilities; (4) Probe the preceptor by asking questions about uncertainties, difficulties, or alternative approaches; (5) Plan management for the patient's medical issues; and (6) Select a case-related issue for self-directed learning. The authors conducted a pilot study of SNAPPS, introducing the model to both third-year medical students and their preceptors. Feedback was enthusiastic and underscored the importance of the paired approach. SNAPPS represents a paradigm shift in ambulatory education that engages the learner and creates a collaborative learning conversation in the context of patient care.

Ambulatory Care↗

PubMed2002

Knowledge and attitudes of primary care physicians toward sleep and sleep disorders.

PURPOSE: To assess primary care physician (PCP) sleep knowledge and attitudes. METHOD: A sample of 580 PCPs practicing adult medicine in Northeast Ohio was selected, using a systematic random method (every 10th name on the American Medical Association mailing list). A three-part structured survey consisted of 30 attitude items and 33 multiple-choice test questions assessing knowledge, with some demographic questions. Repeat mailings were sent to nonrespondents 4 to 6 weeks apart from October 1999 through April 2000. RESULTS: 46 surveys were undeliverable and 105 (20%) useable questionnaires were returned. Of respondents, 94% were board certified with 76% certified in more than one area. When asked to rate their knowledge of sleep disorders, none rated themselves as excellent, 10% rated themselves as good, 60% as fair, and 30% as poor. The factors rated highest in influencing current practices regarding sleep and sleep disorders were articles in journals, continuing medical education courses, and discussions with specialists. Knowledge average was 34% (3 to 94%). Though virtually all agreed that prevention counseling should be a part of patient care, fewer agreed that they spend more time counseling patients on the benefits of sleep than of diet or exercise. CONCLUSIONS: The majority of PCPs rated their own knowledge of sleep disorders as fair or poor. Knowledge testing and attitude assessment lend credence to these perceptions.

Attitude↗