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Biomedical subjects

Kristi J Ferguson

Publications and source records attributed to Kristi J Ferguson.

17 recordsLinked to original sources
PubMed2006

Using patient-generated cases to teach students skills in responding to patients' emotions.

Responding to patients' emotions has been identified as a core skill in medical interviewing. To give medical students realistic practice in responding to patients' emotions, an exercise was initiated in which simulated patient (SP) cases were developed in collaboration with SPs. Small groups were visited by two SPs, who portray emotional scenarios based on symptoms for which they had previously sought a doctor's care or considered seeking care. SPs also identified circumstances that would provoke emotional reactions for their case. Students and facilitators rated this activity highly. Benefits included more realistic case portrayals, less training time for SPs and more efficient use of SPs.

Education, Medical, Undergraduate↗
PubMed2006

Increasing departmental and college-wide faculty development opportunities through a teaching scholars program.

The University of Iowa Teaching Scholars Program was initiated in 1999 at the University of Iowa Carver College of Medicine (CCOM) with the overall goal of promoting leadership in faculty development related to teaching skills. Specific goals of this program are (1) to promote the development of a cadre of faculty members who have the skills to implement faculty development within their departments and the CCOM; (2) to increase departmental involvement in faculty development efforts; (3) to increase resources available for dissemination of college-wide faculty development efforts; and (4) to acknowledge the extra effort faculty put into developing their skills and knowledge in medical education and in providing continuing education to their faculty colleagues. All clinical and basic science departments in the CCOM are given the opportunity to have a faculty member participate in the program. Unlike other programs reported in the literature, competitive decisions for program participation are made at the departmental level. The three-year program combines monthly meetings and other activities to train faculty to provide faculty development in teaching skills. Each scholar develops and implements a project to address departmental faculty development needs as well as needs of other departments in the CCOM. To date (2006), 50 faculty members from 19 different departments have participated in the program with an average of 12 scholars per class. The program has resulted in a substantial increase in departmental and college-wide faculty development programming and has had a positive impact on individual scholars' teaching skills and leadership roles.

Curriculum↗
PubMed2006

An experimental comparison of rater performance on an SP-based clinical skills exam.

BACKGROUND: Research has provided only limited information regarding how best to structure rater training and the best rating formats for a standardized-patient (SP) based assessment. PURPOSE: The purpose of this study was to determine the efficacy of rater discussions as an expert rater training method and to compare the expert's rating of recorded video performances with real-time SP ratings on both a global and checklist evaluation instrument. METHODS: We implemented an experimental study of a discussion-based expert rater training method to compare generalizability and interrater reliability of trained experts, untrained experts, and SP raters in a 4th-year clinical skills exam. RESULTS: In terms of reliability, SP raters did as well as expert raters on the checklist and better than expert raters on global ratings. For the expert raters, training via a discussion method did not significantly improve the reliability of checklist ratings or global ratings. Within the experts groups, those with checklists performed better than those with global ratings. CONCLUSIONS: For SP-based exams designed to assess basic clinical skills, SP ratings appear to perform as well or better than expert ratings. Discussion-based expert training yielded no improvements in expert rater performance, and expert checklist scores generated more reliable results than the expert global rating scores.

Clinical Competence↗
PubMed2005

Attitudes of faculty and students toward case-based learning in the third-year obstetrics and gynecology clerkship.

OBJECTIVE: This study was undertaken to compare the attitudes of faculty and medical students toward case-based learning and lecture format during the obstetrics and gynecology clerkship. STUDY DESIGN: For this prospective comparative study, student presentations were alternately assigned to traditional lecture- or case-based format every 6 weeks. Presentations were made to other students and a single faculty. A total of 31 faculty members, 30 student presenters, and 122 student participants completed evaluations. Teaching methods were compared. RESULTS Faculty members favored lecture format over case-based learning for "attentiveness and interaction of the group" (3.9 vs 4.5, P < .018) and for "meeting the objectives" (3.7 vs 4.5, P < .002). Student participants favored case-based learning in "understanding the relationship between knowledge and clinical practice" (4.34 vs 4.06, P < .05) and "enjoyed" (4.34 vs 3.90, P < .008). Student presenters showed no differences between groups. CONCLUSION: Faculty favored lecture format whereas student participants favored a case-based presentation. Student presenters were comfortable with both formats.

Attitude↗
PubMed2005

In their own words: presenting the patient's perspective using research-based theatre.

INTRODUCTION: In this paper we describe the development of a performance piece based on patients' stories of interacting with health care providers, its introduction into the curriculum to dramatise the patient's perspective on health care, and the evaluation of student responses. METHODS: The piece, entitled In Their Own Words, was created from transcripts of interviews with authors who wrote about their experiences of illness. Over the past 4 years, students have performed the piece as a dramatic reading as part of a required course for Year 1 medical students. RESULTS: Analysis of the students' written reflections identified 5 major themes describing what students learned from the performance piece. These themes were: illness evokes emotions and providers must address both the physical and emotional needs of their patients; patients want health care providers to listen well and to understand patients' perspectives; providers' words and gestures profoundly affect patients; patients do not want to be defined, identified or treated as only their symptoms or illnesses, and information and conditions that clinicians consider routine can be very distressing for patients. DISCUSSION: These themes identified in the students' comments represent critical concepts that health care providers must understand so that they can build therapeutic relationships with their patients. Thus, In Their Own Words is an effective tool for increasing students' awareness of patients' experiences of illness, which is a key aspect of learning to provide effective patient-centred care. Presenting patients' stories through dramatic readings represents an innovative approach to incorporating the patient's perspective into medical education.

Communication↗
PubMed2005

Outcomes of a teaching scholars program to promote leadership in faculty development.

BACKGROUND: Provision of adequate opportunities for faculty to receive training in teaching skills requires persons with faculty development expertise to provide this training. PURPOSE: In this study, we examined outcomes of a teaching scholars program (TSP) aimed at promoting leaders in faculty development in teaching skills in individual departments and throughout the institution. METHOD: A 3-year TSP, established in 1999, combines monthly meetings and other activities to train faculty representing departments throughout the College of Medicine to provide faculty development in teaching skills. Analysis of program participants' curriculum vitae was conducted to compare preprogram and postprogram faculty development activities. RESULTS: There was substantial increase in program participants' facilitation of teaching skills workshops and development of teaching improvement systems within their home departments. Participants also facilitated an increased number of college-wide workshops. Secondary outcomes included increases in educational leadership positions and education-related presentations and publications. CONCLUSION: The TSP is a successful local model for increasing the resources available for teaching improvement.

Curriculum↗
PubMed2005

Using a peer evaluation system to assess faculty performance and competence.

BACKGROUND AND OBJECTIVES: Identification of reliable methods to evaluate the newly mandated American Board of Medical Specialties (ABMS)/Accreditation Council for Graduate Medical Education (ACGME) competencies of the board-certified physician is in its early stages. In this study, we evaluated a comprehensive faculty peer evaluation system designed to assess the six competencies as well as faculty performance in their primary departmental roles and teaching. METHODS: Using a one-page form containing 19 items, all faculty members evaluated all other faculty within a single department. Annual individual faculty reviews included discussion of these aggregated evaluations. RESULTS: The reliabilities for the ACGME competency subscales ranged from .61 to .79. While overall scores were relatively high, there was variability across faculty. Factor analysis demonstrated that evaluation items load onto three scales. The first relates to clinical practice and teaching, the second to departmental citizenship, and the third to research. An item related to systems-based practice loaded on none of the factors. Research faculty outscored other faculty on the items reflecting research skills. Faculty who had primary administrative responsibility scored higher than other faculty on measures related to role within the department. No differences in subgroup scores for clinical skills were observed. CONCLUSIONS: Using a method in which all faculty evaluate each other can result in objective, reliable measures of faculty performance.

Accreditation↗
PubMed2004

Using a longitudinal database to assess the validity of preceptors' ratings of clerkship performance.

PURPOSE: To examine the validity of using scores from a clinical evaluation form as an assessment of clinical competence. METHOD: Investigators collected a longitudinal clinical skills assessment database that included scores reflecting performance on standardized patient interactions, case-based learning performance, scores on multiple-choice clinical examinations, and preceptors' ratings of students during their clerkships. Pearson correlation coefficients and coefficients corrected for attenuation were calculated between the mean preceptor rating CEF score and the other measures collected during years one and two. RESULTS: Estimates from an earlier across-clerkship generalizability study of the CEF demonstrated that a mean rating computed across 28 forms and four clerkships (the average measurement frequencies observed in this study), yielded an estimated G-coefficient of 0.62 (Kreiter and Ferguson, 2001). Reliabilities for the other measures ranged from 0.23 to 0.56. Nine of the twelve clinical skill measures correlated with the CEF. For those significantly correlated measures where reliabilities could be calculated, correlations corrected for attenuation ranged from 0.46 to 0.58. CONCLUSION: This study indicates that the skills measured by the CEF are related to other clinical performance measures and, conversely, that pre-clinical measures of skills that are believed to be important during clinical years are in fact predictors of preceptors' ratings of clinical performance later in medical school. In addition, the magnitude of the disattenuated coefficients suggests that ratings on the CEF are dependent on important aspects such as clinical knowledge. This study suggests that when averaged over a large number of observations, mean CEF scores demonstrate validity coefficients large enough to support their use as part of an evaluation of students' clinical performance.

Clinical Clerkship↗
PubMed2004

Teaching medical students and residents skills for delivering bad news: a review of strategies.

Although delivering bad news is something that occurs daily in most medical practices, the majority of clinicians have not received formal training in this essential and important communication task. A variety of models are currently being used in medical education to teach skills for delivering bad news. The goals of this article are (1) to describe these available models, including their advantages and disadvantages and evaluations of their effectiveness; and (2) to serve as a guide to medical educators who are initiating or refining curriculum for medical students and residents. Based on a review of the literature and the authors' own experiences, they conclude that curricular efforts to teach these skills should include multiple sessions and opportunities for demonstration, reflection, discussion, practice, and feedback.

Education, Medical↗
PubMed2004

Critical incidents of nonadherence with standard precautions guidelines among community hospital-based health care workers.

OBJECTIVE: To identify, categorize, and assess critical incidents of nonadherence to standard precautions. DESIGN: Qualitative and quantitative analysis of a written, mail-out survey. SETTING: Community hospitals. PARTICIPANTS: Statewide stratified random sample of community hospital-based health care workers at risk for blood exposure. MAIN VARIABLE: Responses to the question: "Think of an incident during the past year when you didn't adhere to universal precautions. Please describe the situation and why you didn't adhere." RESULTS: Reasons given for not using precautions included: belief that stopping to use standard precautions would have put the patient at risk (22%); using precautions would have interfered with patient care (20%); precautions were not warranted in a specific situation (14%); did not anticipate the potential for exposure (14%); and high job demands that had caused respondent to be in a hurry (11%). Less often, equipment was not available (7%), respondent forgot (6%), respondent thought that the patient did not pose a risk (4%), or the available equipment was not effective (3%). In terms of overall exposure rates, 34% of those who described an incident had experienced a sharps injury during the previous 3 months and 42% had experienced a mucocutaneous exposure. In terms of overall nonadherence, 44% wore gloves less than 100% of the time, while 61% washed their hands less than 100% of the time. Needlestick injuries were lowest among those who had forgotten to use precautions, while mucocutaneous exposures were highest among those who had not anticipated potential exposure while performing the task. Failure to wear gloves routinely was highest among those who said that following precautions interfered with their ability to provide care and among those who believed a particular patient to be low risk; failure to wash hands routinely was also highest among the latter group and lowest among those who said necessary equipment was not available. CONCLUSIONS: Using specific information about local incidents of nonadherence to standard precautions may enhance training, especially if the program identifies incidents of unanticipated exposure and helps workers plan for them in the future. Closer examination of job demands and responsibilities that interfere with standard precautions may increase the likelihood of adherence.

Blood-Borne Pathogens↗
PubMed2004

Evaluation of current tobacco curriculum at 12 US medical schools.

BACKGROUND: Training medical students in tobacco prevention and treatment skills is critical if we are to have competent physicians prepared to address the grave levels of morbidity and mortality associated with tobacco use. Tobacco Prevention and Cessation Education at US Medical Schools (PACE), a National Cancer Institute funded project, was launched to assess and improve curriculum content and teaching at 12 US medical schools. METHODS: The 2003 survey was completed by faculty and administrators. The survey was divided into four main sections: tobacco content and skills, curricular evaluation, faculty perceptions of barriers and promoters, and educational vision. RESULTS: Thirty-six percent of all medical school courses had some tobacco-related content. Five schools provided a total of between 4 and 8 hours of teaching, 5 schools provided 10-13 hours, and 2 schools provided 17 and 18 hours of teaching. Of the 12 schools, 8 had fewer hours devoted to tobacco teaching in the clerkships than during the 1st-year courses. Only 2 schools noted any tobacco content for Obstetrics/Gynecology clerkships, and only 4 schools provided teaching in the pediatric setting (range 5-201 minutes). CONCLUSION: In comparison to earlier studies, it appears that more tobacco content is now integrated into medical school courses. More improvement is necessary, however, particularly in tobacco use prevention. Institutions need to examine the role of faculty in prioritizing tobacco information and promoting a culture that builds competency in tobacco control and treatment.

Curriculum↗
PubMed2003

Percutaneous injury, blood exposure, and adherence to standard precautions: are hospital-based health care providers still at risk?

To examine factors associated with blood exposure and percutaneous injury among health care workers, we assessed occupational risk factors, compliance with standard precautions, frequency of exposure, and reporting in a stratified random sample of 5123 physicians, nurses, and medical technologists working in Iowa community hospitals. Of these, 3223 (63%) participated. Mean rates of hand washing (32%-54%), avoiding needle recapping (29%-70%), and underreporting sharps injuries (22%-62%; overall, 32%) varied by occupation (P<.01). Logistic regression was used to estimate the adjusted odds of percutaneous injury (aOR(injury)), which increased 2%-3% for each sharp handled in a typical week. The overall aOR(injury) for never recapping needles was 0.74 (95% CI, 0.60-0.91). Any recent blood contact, a measure of consistent use of barrier precautions, had an overall aOR(injury) of 1.57 (95% CI, 1.32-1.86); among physicians, the aOR(injury) was 2.18 (95% CI, 1.34-3.54). Adherence to standard precautions was found to be suboptimal. Underreporting was found to be common. Percutaneous injury and mucocutaneous blood exposure are related to frequency of sharps handling and inversely related to routine standard-precaution compliance. New strategies for preventing exposures, training, and monitoring adherence are needed.

Blood-Borne Pathogens↗
PubMed2002

The empirical validity of straight-line responses on a clinical evaluation form.

PURPOSE: Many preceptors fill out students' clerkship-performance forms with all items marked with the maximum value. Because items are usually designed to measure somewhat specific behaviors, the authors questioned the validity of straight-line five (SL5) responses, and conducted an empirical validity study to investigate the measurement properties of these SL5 forms. METHOD: In 1999-00 the authors undertook a correlation study and a generalizability study to assess the measurement characteristics of the SL5 forms. For the correlation study, they calculated mean scores for each of 168 students across forms, excluding the SL5 forms, then correlated this mean with the proportion of straight-line forms the student received. They conducted a generalizability analysis with and without the straight-line forms to determine the impact on score reliability. RESULTS: The proportion of SL5 forms was significantly correlated (r =.48, p <.0001) with the mean student score. Inclusion of the SL5 forms did not negatively affect the reliability of the mean score. CONCLUSION: The SL5 forms appear to be valid ratings of students' performances. An informal comparison of the comments on SL5 forms and those not displaying this format supported this conclusion.

Clinical Clerkship↗
PubMed2002

Is that your final answer? Relationship of changed answers to overall performance on a computer-based medical school course examination.

BACKGROUND: Whether examinees benefit from the opportunity to change answers to examination questions has been discussed widely. PURPOSE: This study was undertaken to document the impact of answer changing on exam performance on a computer-based course examination in a second-year medical school course. METHODS: This study analyzed data from a 2 hour, 80-item computer delivered multiple-choice exam administered to 190 students (166 second-year medical students and 24 physician's assistant students). RESULTS: There was a small but significant net improvement in overall score when answers were changed: one student's score increased by 7 points, 93 increased by 1 to 4 points, and 38 decreased by 1 to 3 points. On average, lower-performing students benefited slightly less than higher-performing students. Students spent more time on questions for which they changed the answers and were more likely to change items that were more difficult. CONCLUSIONS: Students should not be discouraged from changing answers, especially to difficult questions that require careful consideration, although the net effect is quite small.

Computer-Assisted Instruction↗
PubMedDate not supplied

Academic physicians and complementary and alternative medicine: an institutional survey.

In order to assess attitudes, awareness, and behavior related to complementary and alternative medicine (CAM) among academic physicians, a questionnaire study was conducted with faculty in one of the largest teaching hospitals in the United States. The survey assessed attitudes toward and awareness of 11 CAM therapies in regard to patient usage and usefulness. The majority of respondents believed that only 20% or less of their patients used CAM. Respondents varied widely on level of knowledge/awareness of specific CAM therapies. Those who were more knowledgeable were more likely to perceive CAM as useful and to have recommended more therapies. The modalities respondents noted as knowing the least about were deemed the least useful. Limited knowledge of most CAM therapies and limited awareness of patient CAM use points to the need for continuing education efforts for physicians, focusing on CAM.

Adult↗