PubMed Health⌕ Search

Biomedical subjects

M B Regan

Publications and source records attributed to M B Regan.

At least 19 recordsLinked to original sources
PubMed1999

Comparing ambulatory preceptors' and students' perceptions of educational planning.

To compare ambulatory preceptors' and students' perceptions of the use of educational planning (setting goals, assessing needs, formulating objectives, choosing methods, and providing feedback and evaluation) in the office setting, we mailed a survey, which was returned by 127 longitudinal ambulatory preceptors and 168 first-year and second-year medical students. Faculty perceptions did not match student perceptions of what occurred in the longitudinal preceptor program teaching sessions in educational planning areas. Students perceived these activities were occurring with much less frequency than faculty perceived. Medical education needs to move beyond the usual faculty development workshop paradigm to a more comprehensive educational development model that includes training both faculty and students in core educational skills. This will enable the ambulatory setting to reach its full educational potential in training future physicians.

Adult↗
PubMed1999

The effect of a domestic violence interclerkship on the knowledge, attitudes, and skills of third-year medical students.

PURPOSE: To determine whether participation in an intensive domestic violence interclerkship (DVI) improved the knowledge, attitudes, and skills of two successive cohorts of students at the University of Massachusetts Medical School. METHOD: The authors measured the knowledge, attitudes, and skills pertaining to domestic violence of third-year students in the classes of 1997 and 1998 using a validated written examination administered before, immediately after, and six months after participation in a 3.5-day or two-day DVI, respectively; they compared the scores using paired t-tests. Nine months after the DVI, the students' domestic violence screening skills were measured by a performance-based assessment (OSCE); using unpaired t-tests, the authors compared the OSCE scores with those of a previous third-year class that had not participated in a DVI. Immediately after the OSCE, the students reported their levels of confidence in domestic violence screening and their satisfaction with the domestic violence curriculum; using chi-square analysis, those self-reports were compared with those of the class with no DVI. RESULTS: The students who participated in the DVIs immediately and significantly improved their knowledge, attitudes, and skills (p < .001), and fully or partially sustained those improvements six months later (p < .001). Nine months after the DVI, the students performed domestic violence screening more effectively (p < .001), expressed greater comfort with domestic violence screening (p < .001), and felt better-prepared by the curriculum to address domestic violence issues (p < .001) than did the students with no DVI. CONCLUSION: Participation in a short, focused DVI curriculum produced sustainable improvements in knowledge, attitudes, and skills that were successfully applied by third-year medical students to effective domestic violence screening. Interclerkships are an effective way to fit into the clinical curriculum those subjects that transcend the traditional biomedical domain and intersect all areas of medical practice.

Adult↗
PubMed1997

Heel blood perfusion responses to pressure loading and unloading in women.

Heel pressure ulcers are significant and costly problems causing suffering and potential limb loss from infection and compromised blood flow. Heel blood perfusion (HBP) deficits accompanying loading likely affect the skin breakdown process, but little is known about the loading and off-loading changes. To clarify this issue, combined laser-Doppler Imaging (LDI) and Fluxmetry were used to assess HBP before, during, and after 40 minutes of continuous heel loading in 11 female volunteers (32-60 years). During loading, an initial decrease in HBP was followed by a gradual small recovery (p < 0.001). Off-loading resulted in a significant hyperemic response with HBP exceeding baseline by a factor of 4.72 +/- 0.63 (p = 0.001) and remaining elevated for about 10 minutes. Spatial LDI data showed that hyperemic responses are maximum near the pressure center and diminish radially. These results suggest a localized, pressure-related tissue trauma, which is compensated for by a substantial hyperperfusion. The dependence (and adequacy) of this response on clinical variables including heel pressure and duration, limb vascular status, and patient health are unknown. The present seminal data and associated methods provide a platform from which these and other important clinical parameters can be systematically studied and compared.

Adult↗
PubMed1995

Effects of incontinence care cleansing regimens on skin integrity.

Soap and water and a no-rinse cleanser, with and without a moisture barrier, were examined for their effects as cleansing regimens on the perineal skin of 10 older female residents of an extended care facility. Each cleansing regimen was used for 3 weeks, with two weekly measurements obtained for erythema, pH, and transepidermal water loss. Results indicated that soap and water was the least efficacious regimen unless used with a moisture barrier. The no-rinse cleanser was better than soap and water in terms of skin effects and cost savings. The findings suggest that a no-rinse cleanser in conjunction with a moisture barrier is a more skin-preserving and cost-effective incontinence care cleansing regimen than soap and water for older female nursing home residents with incontinence.

Aged↗
PubMed1993

ECFMG assessment of clinical competence of graduates of foreign medical schools. Educational Commission for Foreign Medical Graduates.

OBJECTIVE: To develop an assessment of clinical competence of graduates of foreign medical schools and to determine the reliability and validity of the assessment and the feasibility of large-scale administration. DESIGN: The Educational Commission for Foreign Medical Graduates (ECFMG) clinical competence study included (1) clinical encounters with standardized patients to assess history taking, physical examination, and communication skills; (2) laser videodisk pictorials to assess identification and interpretation of diagnostic procedures; (3) written clinical vignettes to assess diagnosis and management skills; and (4) assessment of spoken English. A uniform method of operating the test centers and of training the standardized patients was developed. SETTING: Medical schools and their primary teaching hospitals and affiliated hospitals. PARTICIPANTS: Six hundred twenty-four first-year residents, of whom 525 are graduates of foreign medical schools. MAIN OUTCOME MEASURES: Scores, reliability coefficients, validity measures, feasibility of multisite administration, trends of scores over time, and acceptability by examinees. RESULTS: The ECFMG clinical competence assessment was conducted at four geographically separate test centers. Reliability coefficients were high (.85) for the integrated clinical encounter and were in a reasonable range (.71 to .82) for all test components. The assessment adds to the predictability of the residents' performance in the hospital over that of current ECFMG certification examinations. Test security was addressed by demonstrating no consistent pattern of change in scores over testing dates. Virtually all examinees thought the assessment was appropriate. Standardized patients were able to assess spoken English accurately. CONCLUSION: The feasibility of conducting a reliable and valid test of clinical competence for graduates of foreign medical schools was demonstrated for this test population.

Clinical Competence↗
PubMed1991

Assessment of clinical skills of residents utilizing standardized patients. A follow-up study and recommendations for application.

OBJECTIVE: To determine the reliability and validity of "standardized patients" to assess clinical performance of internal medicine residents. DESIGN: Each resident spent 2 half-days interacting with 19 standardized patients (nonphysicians taught to portray patients in a reproducible fashion). Each resident was asked to obtain focused histories, perform relevant physical examinations, and provide patient education or counseling. At the end of each 10- to 15-minute encounter, the resident was asked to identify positive findings on physical examination and to prioritize a differential diagnosis. Other, more traditional indicators of clinical skills were also obtained. PARTICIPANTS: Three hundred ten residents from nineteen internal medicine training programs in the New England region of the United States. RESULTS: Reproducible estimates of data gathering and interviewing skills were achieved with 1 day of testing. Validity analyses were difficult to interpret because of the lack of an external "gold standard." However, faculty judgments of performance from reviewing videotapes corresponded with standardized-patient-based scores. Differences in group performance were also demonstrated across years of training and between U.S. or Canadian and foreign medical graduates. CONCLUSIONS: Systematic and effective procedures for developing standardized-patient-based test materials and for training standardized patients have been developed. This technique is best used for measuring data gathering and interviewing skills. Correlations with commonly used evaluation methods were generally low; this may be because standardized patients measure different skills. Local use of this technique by residency programs and the development of regional consortia sharing resources, costs, and expertise are advocated.

Clinical Competence↗
PubMed1991

Positive effects of a clinical performance assessment program.

Since 1986, there has been a clinical performance assessment program for fourth-year students at the University of Massachusetts Medical School. Students interact with several standardized patients (SPs) and complete other tasks such as interpretation of electrocardiograms and interpretation of X-rays. Scores are generated both by checklists and rating forms completed by the SPs and by paperwork completed by the students at the end of each encounter. Since 1986, students have been asked how frequently they have been observed by faculty and residents as they interacted with actual patients; the students report that such observations have markedly increased. Since 1989, there has been increased feedback to students by the attending faculty during and following clinical rotations. Although it is difficult to claim cause and effect, it is clear that since the inception of this exercise, the faculty have made a conscious effort to improve students' clinical skills by providing increased observation and feedback.

Clinical Competence↗
PubMed1990

Results of a survey on the use of standardized patients to teach and evaluate clinical skills.

In 1989, a survey was sent to each U.S. and Canadian medical school requesting information about how standardized patients are used for teaching and evaluating clinical skills, and 95% of the schools responded. Although there was widespread use of standardized patients throughout the curricula, the role and training of these patients varied markedly within a given school as well as across schools. One outcome of this survey is the development of a network to share resources, protocols, and training material to enhance the development of this educational strategy.

Clinical Competence↗
PubMed1990

An assessment of the clinical skills of fourth-year students at four New England medical schools.

This paper describes a collaborative effort among five New England medical schools to assess important clinical skills of fourth-year medical students graduating in the class of 1988; results are presented from the four schools that provided sufficient data. Faculty from each school developed 36 patient cases representing a variety of common ambulatory-care problems. Over the course of a day, each student, on average, interacted with 16 different standardized patients, who were nonphysicians trained to accurately and consistently portray a patient in a simulated clinical setting. The students obtained focused histories, performed relevant physical examinations, and provided the patients with education and counseling. At each school, the performance of a small number of the students fell below standards set by the faculty. These deficiencies were not detected with the evaluation strategies currently being used. Although the use of standardized patients should not substitute for the process of faculty observing students as they interact with real patients, it appears that standardized patients can provide faculty with important information, not readily available from other sources, about students' performances of essential clinical activities and the levels of their clinical skills.

Ambulatory Care↗
PubMed1989

The Medical Education Evaluation Program of the state of Ohio.

In October 1988, seven foreign medical graduates participated in the first administration of the examination devised by the Medical Education Evaluation Program (MEEP) mandated by the State Medical Board of Ohio. The MEEP was established to provide an objective evaluation of an applicant's clinical competencies; passing the MEEP examination was intended to certify that the applicant's clinical skills were comparable to those of a medical student graduating from a school accredited by the Liaison Committee on Medical Education. An applicant who successfully passed the MEEP examination and fulfilled the other Ohio licensure requirements would be eligible to take the Federation Licensing Examination (FLEX) and apply for an unrestricted license to practice medicine in Ohio. The paper describes the origin and development of the MEEP examination and the testing modalities selected (multiple-choice examinations and the use of standardized patients). Four fundamental areas were tested; these are named and described, along with the method for calculating scores for each area and the criteria for passing the different components of the examination. Although the small sample size prohibited meaningful data analysis for the performance of the first group of MEEP candidates, the MEEP examination appears to meet psychometric standards of certifying and licensing examinations, based on data from comparable tests taken by beginning fourth-year medical students in New England and NBME Part III examination examinees. Some potential pitfalls of the MEEP examination are mentioned, as well as the fact that it presents a challenge to boards of medical examiners of other states to implement performance-based assessments of physicians who graduate from non-accredited medical schools.

Clinical Competence↗
PubMed1987

A diagnostic fourth-year performance assessment.

The University of Massachusetts Medical Center, Worcester, attempted to develop a standardized, performance-based test battery aimed directly at assessing the critical aspects of clinical competence required for graduation from medical school. The battery used a blend of standardized patient-based and written test materials and was designed to yield a profile of scores, providing a "diagnosis" of student strengths and weaknesses on a skill-by-skill basis. Results indicate that a stable, reproducible assessment of clinical skills can be achieved in a one- to two-day test battery, depending on the specific skills measured. The resulting score profile provides faculty with important information about the clinical competence of students that is not readily available from other sources, thus improving the breadth and accuracy of student assessment. A long-term goal is that performance-based testing techniques will be incorporated into the licensure process to evaluate clinical skills and ensure the competence of graduating physicians.

Academic Medical Centers↗
PubMedDate not supplied

Shifts in medical student beliefs about AIDS after a comprehensive training experience.

We evaluated the beliefs of second-year medical students regarding critical issues in the AIDS epidemic before and after an intensive two-day training symposium. Paired responses, collected for three consecutive years, were available for 187 students. Our results indicate that, although the students generally held progressive beliefs on prevention and public policy prior to training, a significant minority held views that differ from expert opinion. After the training experience, we observed substantial shifts of opinion on several issues. For example, among those who initially believed that physicians should record results of HIV testing in patient charts without patient permission, 45% shifted to disagreement. On mandatory premarital testing, 43% of those initially supporting it shifted to disagreement. On some issues, such as contact tracing, where expert opinion is less clear, student opinion moved very little overall. Over the three-year period, we found evidence of a trend towards less concern over HIV transmission to men from causal sex with infected female partners and a trend towards acceptance of glove-wearing when handling all blood specimens. In conclusion, we demonstrate that the beliefs of medical students concerning difficult issues posed by the AIDS epidemic can be changed substantially in the short-term by a specially designed intensive educational program. Reinforcement and persistence of these changes should now be a concern for medical educators.

Acquired Immunodeficiency Syndrome↗