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Biomedical subjects

L E Heller

Publications and source records attributed to L E Heller.

9 recordsLinked to original sources
PubMed1986

The influence of rural physicians' perception on referral patterns to a university hospital.

The patient referral process is based on a complex set of social rewards and costs for the referring physician. For the physician or institution potentially receiving referrals, a key question is, why is one institution selected over other available choices? Factor analysis of a survey of rural physicians revealed five factors of reward and cost associated with the choice of where to refer patients. Further analysis of these factors suggested that the ability to have patients admitted and treated when necessary is central to the satisfaction of the referring physician and their willingness to continue the consultant relationship. Adequate information about the consultants was also important to satisfaction. Other factors have less influence. Further, "admissions when necessary" was the only reward/cost factor which predicted physicians who referred more to the university hospital than to other hospitals. If a university hospital wants to develop strategies to encourage referrals from rural physicians, it must be cognizant of these social reward-cost factors.

Data Collection↗
PubMed1984

[Methods for teaching problem-solving in medical schools].

The need to include in the medical curriculum instructional activities to promote the development of problem-solving abilities has been asserted at the national and international levels. In research on the mental process involved in the solution of problems in medicine, problem-solving has been defined as a hypothetical-deductive activity engaged in by experienced physicians, in which the early generation of hypotheses influences the subsequent gathering of information. This article comments briefly on research on the mental process by which medical problems are solved. It describes the methods that research has shown to be most applicable in instruction to develop problem-solving abilities, and presents some educational principles that justify their application. The "trail-following" approach is the method that has been most commonly used to study the physician's problem-solving behavior. The salient conclusions from this research are that in the problem-solving process the diagnostic hypothesis is generated very early on and with limited data; the number of hypotheses is small; the problem-solving approach is specific to the type of medical problem and case in hand; and the accumulation of medical knowledge and experience forms the basis of clinical competence. Four methods for teaching the solution of problems are described: case presentation, the rain of ideas, the nominal groups technique and decision-making consensus, the census and analysis of forces in the field, and the analysis of clinical decisions. These methods are carried out in small groups. The advantages of the small groups are that the students are active participants in the learning process, they receive formative evaluation of their performance in a setting conductive to learning, and are able to interact with their instructor if he makes proper use of the right questioning techniques. While no single problem-solving method can be useful to all students or in all the problems they encounter, teachers of medicine can improve their students' performance by adjusting these available methods to their particular needs and to those of their schools. The problem-solving methods described can help teachers shape the learning environment so as to develop in their students the most coherent, logical, concrete and complete set of skills possible. These methods can so be of value in improving the training of future doctors and the quality of their decisions to the benefit of their patients.

Curriculum↗
PubMed1982

The use of student evaluations in examining clinical teaching in pharmacy.

A procedure for eliciting student ratings of clerkship teacher performance was implemented. The purpose of the study was to determine the reliability of student evaluations, explore the differences in teaching roles in relation to student evaluations, and identify those teaching behaviors that were closely associated with overall teacher effectiveness. Students rated clerkship teachers on eight teaching behaviors, including organization, stimulation and enthusiasm about discipline, ability to establish rapport, active involvement with students, level of knowledge and use of sound reasoning, ability to teach clinical procedures and skills, provision of direction and feedback on learning, and accessibility. A ninth item for evaluation of overall teaching effectiveness was also included. At the end of each clinical rotation, students anonymously rated each teacher on a five-point scale. Student ratings were used to evaluate performance and to identify teachers whose clinical skills needed improvement. As one component of an overall approach to performance review, the student evaluation procedure provided for input from the consumer of the teaching activity. When necessary, educational specialists provided consultation to instructors to identify, in detail, clinical teaching behaviors that needed improvement and to suggest remedial strategies. This article describes the development and use of an approach to assess clinical teaching in the clerkships of the College of Pharmacy. After reviewing the literature to determine the characteristics of clinical teaching, an approach was established that paralleled the needs of the faculty and the constraints of the clinical settings. Once the system was implemented and the data were gathered on clinical teaching, investigations were required to examine the reliability of the survey, to identify those behaviors more closely related to effective clinical teaching, and to determine the advantages and disadvantages of using this approach. As a result, this study examines the literature on assessing clinical teaching, describes the approach developed for the College of Pharmacy, identifies some important behaviors in clinical teaching, and discusses the benefits and limitations of the assessment mechanisms to improve clinical teaching.

Education, Pharmacy↗
PubMed1977

Successful reimplantation of the penis using microvascular techniques.

The second case of traumatic amputation of the proximal shaft of the penis is reported. Microvascular techniques were used for direct anastomoses of the dorsal arteries of the penis. The apparent advantage of immediate restoration of arterial blood supply to the corpora and skin with a reduced amount of skin slough is evident.

Amputation, Traumatic↗