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Biomedical subjects

L D Gruppen

Publications and source records attributed to L D Gruppen.

At least 37 records · Page 2Linked to original sources
PubMed1997

Teaching skills for accessing and interpreting information from systematic reviews/meta-analyses, practice guidelines, and the Internet.

Skills and practice related to accessing and interpreting clinical information from systematic reviews/meta-analyses, practice guidelines, and the Internet have been integrated into a new senior year elective designed to teach medical students how to critically appraise information from a variety of sources and evaluate it's applicability to patient care. Small groups of senior medical students under the direction of a multidisciplinary team (behavioral scientist, information specialist, physician) facilitate discussions of clinical articles using checklists designed to evaluate their quality. The central feature of the course is a demonstration of the Cochrane Database of Systematic Reviews (CDSR), an electronic journal distributed by BMJ Publishing, and the requirement that students conduct a literature review on a topic of their choice and present an oral and written summary in the form of a "draft" meta-analysis. Students are provided with strategies to "surf" the Internet/WWW for information, e.g., practice guidelines/treatment protocols, descriptions of on-going clinical trials. A total of 52 students have participated to date. Students have selected project topics across a wide range of medical disciplines, including internal medicine, family practice, OB/GYN, pediatrics, surgery, neurology, emergency medicine, and psychiatry. The course is one of the most favorably evaluated of all senior electives and rated more favorably than the overall mean ratings for all electives combined on 8 of 9 scales, including "Quality of course overall" (4.39 vs. 3.92 on 5-point scale).

Computer Communication Networks↗
PubMed1996

The use of trained patient educators with rheumatoid arthritis to teach medical students.

OBJECTIVE: To assess whether patients with rheumatoid arthritis (RA) trained as educators can enhance the integration of clinical and basic science education among second-year medical students during their rheumatology sequence. METHODS: Twenty patients with RA and strong communication skills were extensively trained to teach students how to perform the whole-body joint examination. Each arthritis educator taught three 2-hour small group sessions and participated in a concluding 2-hour panel discussion with the entire class. Changes in student knowledge and attitudes were assessed in a pre-post evaluation design. RESULTS: There were statistically and educationally significant gains in knowledge, confidence, and attitudes related to psychosocial aspects of arthritis in each of the 2 years the program was implemented. One-year followup data indicated substantial retention of these gains. CONCLUSIONS: Patients trained in arthritis education can effectively teach fundamental musculoskeletal examination skills and encourage the development of sensitivity to the impact of chronic arthritis on the daily life of other patients.

Arthritis, Rheumatoid↗
PubMed1995

Measuring attending physician performance in a general medicine outpatient clinic.

OBJECTIVE: To determine which aspects of outpatient attending physician performance (e.g., clinical ability, teaching ability, interpersonal conduct) were measurable and separable by resident report. DESIGN: Self-administered evaluation form. SETTING: University internal medicine resident continuity clinic. PARTICIPANTS: All residents with their continuity clinic at the university hospital evaluated the two attendings who staffed their clinic for the academic years of 1990-1991, 1991-1992, and 1992-1993 (average of 85 total residents per year). The overall response rate was 74%. ANALYSIS: Exploratory analyses were conducted on a preliminary evaluation form in the first two years of the study (236 evaluations of 20 different clinic attendings) and confirmatory analyses using factor analysis and generalizability analysis were performed on the third year's data (142 evaluations of 15 different clinic attendings). Analysis of variance was used to evaluate factors associated with evaluation scores. RESULTS: Analyses demonstrated that the residents did not distinguish between the attendings' clinical and teaching abilities, resulting in a single four-item scale that was named the Clinical/Teaching Excellence Scale, measured on a five-point scale from poor to outstanding (Cronbach's alpha = 0.92). A large amount of the variance for this scale score was associated with attending identity (adjusted R2 = 46%). However, two alternative approaches to evaluating the performance of the attending (preference for him or her to the "average" attending and perceived impact of the attending on residents' clinical skills) did not provide useful information independent of the Clinical/Teaching Excellence Scale. The ratings of three separate conduct scales [availability in clinic (Availability Scale), treating residents and patients with respect (Respect Scale), and time efficiency in staffing cases (Slow Staffing Scale)] were separable from each other and from the rating of clinical/teaching excellence. For the Clinical/Teaching Excellent Scale, as few as four evaluations produced good interrater reliability and eight evaluations produced excellent reliability (reliability coefficients were 0.70 and 0.84, respectively). CONCLUSIONS: Although this evaluation instrument for measuring clinic attending performance must be considered preliminary, this study suggests that relatively few attending evaluations are required to reliably profile an individual attending's performance, that attending identity is associated with a large amount of the scale score variation, and that special issues of attending performance more relevant to the outpatient setting than the inpatient setting (availability in clinic and sensitivity to time efficiency) should be considered when evaluating clinic attending performance.

Analysis of Variance↗
PubMed1994

The development and evaluation of new versions of the written examination for the American Heart Association Advanced Cardiac Life Support provider course.

STUDY OBJECTIVE: To create new versions of the written, multiple-choice examination used in the American Heart Association (AHA) Advanced Cardiac Life Support course, evaluate their reliability and difficulty, and then design revised versions with improved reliability and of standardized difficulty. DESIGN: Psychometric evaluation of new versions of the AHA Advanced Cardiac Life Support test and revisions. SETTING: AHA Advanced Cardiac Life Support courses. PARTICIPANTS: Candidates for completion of AHA Advanced Cardiac Life Support provider courses in five states. INTERVENTION: The course content was divided into 11 content areas that were weighted for importance and appropriateness for testing in a multiple-choice format. The weights were used to construct a blueprint for a 50-question, multiple-choice examination. Five versions of the examination were then constructed based on the content blueprint, drawing from new questions and expert revision of previously written questions. Reliability and difficulty were assessed using 915 administrations at five different sites nationwide. The initial test versions differed in their degree of difficulty, which was not explained by demographic factors. The results were used to revise three of the versions to improve reliability and equalize difficulty of the versions. MEASUREMENTS AND MAIN RESULTS: The final five versions have estimated reliability ranging from Cronbach's alpha of .62 to .86. Mean scores ranged from 87.4% to 89.1%. CONCLUSION: After field testing and revision, five examinations with acceptable reliability and roughly equal difficulty were constructed. The new examinations test the participants' knowledge of important aspects of resuscitation science and practice based on a blueprint of the course content.

American Heart Association↗
PubMed1993

Medical student use of history and physical information in diagnostic reasoning.

Clinical data gathering is central to clinical competence. Although research has demonstrated the value to experienced clinicians of information obtained from the history, little is known of how medical students use this information. In the present study, two case simulations (in rheumatoid arthritis and systemic lupus erythematosis) were developed to assess medical student information gathering and utilization. The results indicate that most of the students were already considering the correct diagnosis as a possibility after the presenting complaint and patient description. However, the medical history exerted the strongest influence on transforming the correct diagnosis from just another diagnostic possibility into the favored diagnostic candidate. Students who failed to list the correct diagnosis in the differential diagnosis after obtaining the history were significantly less likely to reach the correct diagnosis at the end of the case. These results confirm the critical importance of the history in medical problem solving.

Arthritis, Rheumatoid↗
PubMed1993

Assessing the consistency and educational benefits of students' clinical experiences during an ambulatory care internal medicine rotation.

BACKGROUND: Although ambulatory care settings are being used increasingly in undergraduate clinical education, variability in the depth and breadth of students' contacts with basic medical problems may compromise the educational benefits of this teaching modality. The present study examines the nature of such variation and the educational effectiveness of ambulatory care education. METHOD: During the one-month ambulatory care component of the third-year internal medicine rotation at the University of Michigan Medical School, 43 students in 1989-90 and 1990-91 recorded the patient problems they saw at a hospital and satellite clinics. In addition, the students' diagnostic-recognition abilities were assessed before and after the component. The extents of the students' experiences in various categories of patient problems were quantified and correlated with their diagnostic abilities in relevant content areas. RESULTS: The students saw many categories of problems but few instances in any given category. There were numerous and potentially worrisome gaps in their exposure to several typical ambulatory care problems. Although the students showed significant increases in diagnostic-recognition abilities, these increases were not correlated with the students' levels of experience in any of the relevant problem categories. CONCLUSION: The variability and potentially worrisome gaps in the students' experiences in the ambulatory care settings studied are probably representative of students' experiences in such settings, and should be considered in the implementation and evaluation of educational experiences in ambulatory care.

Adult↗
PubMed1990

Physician information seeking: improving relevance through research.

Health sciences libraries have considerable potential as resources for both formal continuing professional education, as well as the informal continuing education that results from the professional's efforts to solve problems in daily practice. While there is a growing interest in making the resources of health sciences libraries more accessible to practitioners on a routine, day-to-day basis, there also needs to be more awareness of how, when, where, and why professionals look for information in the context of practical problems. This paper reviews recent research that identifies the context in which physicians seek information and advice from external sources, the information sources that physicians access, and the factors that influence which particular sources are sought. The results indicate that physicians vary in their information needs, preferences, motivations, and strategies for seeking information. This diversity suggests that health sciences libraries, in their efforts to be more accessible, should consider "market research" to determine the needs, preferences, and use patterns of the library's targeted users. Libraries may also benefit from exploring alternative methods of improving access to their resources.

Education, Medical, Continuing↗
PubMed1988

Use of the competing-hypotheses heuristic to reduce 'pseudodiagnosticity'.

A quasiexperimental research design involving a nonequivalent control group was used to examine the efficacy of a brief educational intervention in teaching medical students to select optimal diagnostic data consistent with the competing-hypotheses heuristic and Bayes' theorem when solving clinical problems. There was no significant difference between intervention (n = 119) and control (n = 89) groups in performance at baseline, but the intervention group performed significantly better (p less than .001) than the control group after training. The results suggest that some problem-solving skills, such as learning to use the competing-hypotheses heuristic, can be enhanced or learned independent of the acquisition of content knowledge.

Bayes Theorem↗
PubMed1988

The influence of general and case-related experience on primary care treatment decision making.

In an effort to examine how general vs case-related clinical experience influenced physicians' treatment decisions, four clinical case vignettes (rheumatoid arthritis, fever of undetermined origin, exercise-induced asthma, and cor pulmonale) were presented to 387 primary care physicians. For each case, physicians indicated (1) their willingness to proceed with treatment without seeking additional information, (2) their preferences for sources of supplementary information, and (3) their preferences for continued care responsibility. The results indicated that the nature of the particular vignette had a major impact on how physicians made treatment decisions. Also, having greater case-related experience and being younger led to greater willingness to proceed with treatment and preferences for continued care responsibility. Preferences for information sources were largely independent of either form of experience. Treatment decision making appears to be quite dependent on experience with similar problems and being up-to-date on current treatment procedures.

Adult↗
PubMed1988

The contribution of different components of the clinical encounter in generating and eliminating diagnostic hypotheses.

An examination of the diagnostic hypotheses generated by physicians in 119 primary care encounters showed that "correct" diagnostic hypotheses were produced simply on the basis of the patient's chief complaint in 78% of the cases and on the basis of the history in 16%; the physical examination and "stat" laboratory tests contributed little to generating "correct" hypotheses but more to eliminating alternatives. The early generation of frequently accurate diagnostic hypotheses on the basis of very limited information suggests that considerable clinical reasoning takes place in the earliest stages of a problem.

Clinical Competence↗