Biomedical subjects

M R Bergen

Publications and source records attributed to M R Bergen.

12 recordsLinked to original sources

PubMed2001

Physician confidence and interest in learning more about common geriatric topics: a needs assessment.

OBJECTIVE: To assess physicians' confidence in and interest in learning more about 18 specific geriatric topics. DESIGN: Written survey. SETTING: Annual meetings of the American College of Physicians (ACP) and the American Academy of Family Physicians (AAFP). PARTICIPANTS: Seven hundred and fifty-eight physicians (547 ACP members, 211 AAFP members). MEASUREMENTS: For each topic, participants rated their confidence in performance, their peers' need for education, and their interest in learning more, using a five-point Likert scale. RESULTS: Survey participants were on average 16 years out of medical school and 61% were in a community primary care practice that included many geriatric patients on a primarily fee-for-service basis. High levels of interest in learning more about dementia, functional assessment, urinary incontinence, and sensory impairment were found. A substantial correlation (r =.44, P <.0001) between the proportion of seniors reported in the physicians' practice and confidence in performance in the areas surveyed was identified. CONCLUSIONS: These findings provide useful information on the physician-learner's perception of needs, which is important in the design of effective continuing education efforts in geriatrics.

Aged↗

PubMed2000

Impact of a program to diminish gender insensitivity and sexual harassment at a medical school.

PURPOSE: To measure the effect of an intervention to reduce gender insensitivity and sexual harassment at one medical school. METHOD: Stanford University School of Medicine undertook a multifaceted program to educate faculty and students regarding gender issues and to diminish sexual harassment. The authors developed a survey instrument to assess the faculty's perceptions regarding environment (five scales) and incidences of sexual harassment. Faculty were surveyed twice during the interventions (1994 and 1995). RESULTS: Between the two years, the authors measured significant improvements in mean ratings for positive climate (p = .004) and cohesion (p = .006) and decreases in the faculty's perceptions of sexual harassment (p = 0006), gender insensitivity (p = .001), and gender discrimination (p = .004). The faculty also reported fewer observations of harassing behavior during the study period. CONCLUSIONS: An intervention program to diminish gender insensitivity and sexual harassment can measurably improve a medical school's environment.

Data Collection↗

PubMed1999

Regional teaching improvement programs for community-based teachers.

PURPOSE: Community-based clinical teachers provide an important cadre of faculty for medical education. This study was designed to examine the feasibility and value of an American College of Physicians-sponsored regional teaching improvement program for community-based teachers. SUBJECTS AND METHODS: We conducted five regional (Connecticut, New Hampshire/Vermont, New York, Ohio, and Virginia) 1- to 2-day teaching-improvement workshops for 282 faculty (49% community based, 51% university based). The workshops were conducted by regional facilitators trained by the Stanford Faculty Development Program using large group and small group instructional methods to teach participants a framework for analyzing teaching, to increase their repertoire of teaching behaviors, to define personal teaching goals, and to identify the educational needs of their teaching site. Participants used Likert ratings [1 (low) to 5 (high) scale] to assess workshop quality, facilitator effectiveness, and rewards for and barriers to teaching in their clinics. Using retrospective pre- and postintervention ratings, participants also assessed workshop impacts on teacher knowledge, attitudes, and skills. Finally, participants completed open-ended questions to identify recommended changes to improve their clinic as an educational site for students and residents. RESULTS: At all sites, participants evaluated the program as highly useful (4.6 +/- 0.6, mean +/- SD). Participants' ratings indicated that the program had a positive effect on their knowledge of teaching principles (4.0 +/- 0.9), an increase in their teaching ability (P <0.001), and an increase in their sense of integration with their affiliated institution (P <0.001). CONCLUSIONS: Regional training of university and community faculty can be an effective way of promoting the improvement of teaching and the collaboration between community-based teachers and academic centers. National physician organizations and regionally based facilitators can provide important resources for the delivery of such training.

Adult↗

PubMed1998

A pilot study of faculty development for basic science teachers.

PURPOSE: Relatively little research has focused on faculty development methods that assist basic science teachers to improve their instructional skills. This study was designed to assess the effectiveness for basic science faculty of a faculty development seminar series that had been previously shown useful for clinical teachers. METHOD: The Stanford Faculty Development Program's seminars on clinical teaching were adapted for basic science instruction. Eight pathology faculty participated in a series of nine small-group seminars designed to provide teachers with knowledge of a framework for analyzing teaching and identifying areas for improvement, and skill-based training in specific teaching behaviors. Each seminar included (1) brief lectures, (2) review of videotaped reenactments of teaching interactions, (3) role-play exercises with videotape review, and (4) formulation of personal and departmental teaching goals. RESULTS: Program evaluation included multiple measures: participant self-assessment, student ratings of the participants, and blinded ratings of pre- and post-seminar videotapes of participants' classroom teaching. All measures indicated a positive effect of the intervention. CONCLUSION: Faculty development programs have significant potential to enhance basic science instructors' teaching effectiveness.

Adult↗

PubMed1997

Measurement of the validity of utility elicitations performed by computerized interview.

OBJECTIVES: The authors evaluate a measure of the validity of utility elicitations and study the potential effects of invalid elicitations on population utility values. METHODS: The authors used a computerized survey to describe and measure preferences for three common side-effects of anti-psychotic drugs (tardive dyskinesia [TD], akathesia [AKA], pseudo-parkinsonism). The authors compared the validity of elicitations in 41 healthy volunteers to 22 schizophrenic patients. Preferences were measured using visual analog scale (VAS), pair-wise comparison (PWC), and the Standard Gamble (SG) methods. To assess the validity of each groups' responses, the authors compared the consistency of subjects' rank-order of the desirability of states across methods of preferences assessment (CAMPA). RESULTS: All healthy volunteers and 82% of patients completed the computer survey; of these subjects, 97% of healthy volunteers and 70% of patients indicated they thought they understood the task required of them. However, only 78% of healthy subjects and 44% of patients had a consistent rank ordering of preferences among VAS and PWC ratings; only 80% and 61%, respectively, had a consistent rank ordering preferences among SG and PWC ratings. For two of the three health states, inconsistent subjects had statistically higher SG utilities (for TD, 0.94 versus 0.87, and for AKA 0.92 versus 0.86; P < 0.05). CONCLUSIONS: The CAMPA test can identify potentially invalid preference ratings. Potentially invalid preference ratings may bias the "population" utilities for health states.

Adolescent↗

PubMed1997

Willingness-to-pay utility assessment: feasibility of use in normative patient decision support systems.

The authors developed an automated patient interviewing tool to elicit individuals' willingness-to-pay (WTP) utilities under conditions of uncertainty and examined the reliability of this method and its potential usefulness in clinical decision support. We tested this method in 52 healthy volunteers using a computer-based interview that trained subjects in standard gamble (SG) and WTP methods, and elicited preferences for moderate Gaucher disease using WTP and SG. We assessed the validity of the WTP method by calculating the cost-effectiveness threshold implied by subjects' WTP and SG utilities; we also assessed subjects' understanding and comfort with using WTP for decision making by a questionnaire. The WTP method had good test-retest reliability (r = 0.796), and produced a cost-effectiveness ratio and ratings for understanding and clarity that support its validity. Moreover, many subjects felt that WTP was a reasonable (83%) method for therapeutic decision making and expressed comfort (62%) in using the method for their own health care decisions. These results suggest that a probabilistic method for WTP utility assessment is potentially useful for acquiring patient preferences for use in normative decision support systems.

Adult↗

PubMed1996

A climate survey for medical students. A means to assess change.

An instrument was developed to assess the perceptions of students regarding six aspects of school climate and their experience of and attitudes toward sexual harassment and gender insensitivity. During clerkship orientation, 77 students (92% return rate), half female, were given the survey. Cronbach alpha reliabilities for the six scales ranged from .71 to .85. One significant female/male difference among the three scales of general school climate was observed; two significant female/male differences occurred among the three scales relating to gender concerns. Seventy percent of both males and females reported having observed sexually harassing behavior during the previous year; 46% of females and 15% of males reported experiencing sexually harassing behavior during the year. Observing and/or personally experiencing sexual harassment was associated with a decrease in positive climate ratings and an increase in negative climate ratings.

Adult↗

PubMed1995

IMPACT: an object-oriented graphical environment for construction of multimedia patient interviewing software.

This paper describes our software for rapid construction of multimedia computer interviews. The program, which we call IMPACT, was designed to measure preferences for health outcomes using the standard gamble and other decision analytic techniques. IMPACT is also a multimedia shell program that allows researchers to interactively construct patient interviewing instruments without programming or scripting. It supports the integration of text, graphics, synthesized speech, digital sound and QuickTime movies into interviewing instruments through a point-and-click interface. IMPACT also supports branching logic and randomizing the presentation order of materials within an instrument. This allows customization of the presentation based on patient responses and facilitates experimental designs. Validation studies show that preference assessments performed using IMPACT have high test-retest reliability (r = 0.83, n = 96). Post-test surveys (n = 52) show that most subjects understand valuation methods (86%) and believe that the explanations provided were clear (96%) and that methods were reasonable (80%). The majority of subjects thought the preference assessment methods were not difficult to use (53%) and would have been comfortable using such methods for medical decisions (53%).

Computer Graphics↗

PubMed1992

Improving clinical teaching. Evaluation of a national dissemination program.

This study assessed a dissemination approach to improve clinical teaching. We hypothesized that (1) physicians from a variety of institutions nationwide could be trained to conduct teaching improvement seminars for faculty colleagues; (2) such seminars would be perceived as highly useful; (3) pre/post self-evaluations by faculty participants and evaluations of faculty participants by house staff/students would indicate improved teaching performance. Selected medical faculty completed 1 month of facilitator training at the Stanford Faculty Development Program, Palo Alto, Calif. They then delivered teaching improvement seminars for other faculty. From 1986 to 1988, 12 facilitators from 12 institutions trained 107 faculty at their home institutions in their initial seminar series. Their seminars were rated as highly useful by participants. Both faculty self-assessments and house staff/student ratings indicated improved teaching performance. We concluded that this dissemination approach provides one possible mechanism for ongoing teaching improvement within institutions across the country.

Education, Medical, Undergraduate↗

PubMed1992

Impact of a clinical preventive medicine curriculum for primary care faculty: results of a dissemination model.

BACKGROUND: This study was designed to test a dissemination model for providing clinical preventive medicine (CPM) training to general internal medicine faculty across the United States. METHODS: The model incorporated direct instruction of a few faculty as seminar facilitators who, in turn, taught a CPM curriculum to their faculty colleagues, who then could teach it to housestaff and students. The CPM curriculum consisted of six seminars that focused primarily on the risk factors for chronic diseases and on behavior change methods for modifying smoking, diet, and exercise. RESULTS: Faculty who participated in the seminars had significant pre- to post-test increase in knowledge and reported self-efficacy to implement CPM strategies with patients, as well as changes in CPM clinical practices. These faculty, in turn, successfully disseminated CPM information to their housestaff, who also had increases in self-efficacy and changed clinical practices regarding CPM topics. CONCLUSIONS: The successful implementation of the dissemination model attests to its viability as a mechanism for disseminating CPM curricula and increasing the emphasis on CMP issues in both clinical teaching and clinical encounters with patients.

Adult↗

PubMedDate not supplied

Developing and testing a multimedia presentation of a health-state description.

Quality-adjustment weights for health states are an essential component of cost-utility analysis (CUA). Quality-adjustment weights are obtained by presenting large numbers of subjects with multiattribute descriptions of health states for rating. Comprehending multiattribute health states is a difficult task for most respondents. The authors hypothesized that multimedia (MM) presentation using computers might facilitate this task better than would a paper-based text (Text). To test this hypothesis, they developed closely matched MM and Text descriptions of health states in the first-person narrative style, and developed a method of testing the presentation of a health state. Subjects were randomized to exposure to either MM or Text and subject recall of the health state and recognition of features of the health state were tested. How well defined the preferences of the subjects were after each presentation method was assessed by having the subjects mark on a double-anchored visual-analog scale the "best" and "worst" they believed the quality of life in the health state might be. MM subjects had better recall (11.85 vs 9.44 of a total of 24 meaning units, p = 0.098) and better recognition (4.71 vs 4.22, p = 0.08). The average interval between the "best" and "worst" ratings was shorter for the MM subjects (2.19 cm vs 3.26 cm, p = 0.12).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMedDate not supplied

The effect of search procedures on utility elicitations.

OBJECTIVE: Elicited preferences for health states vary among scaling methods, manners of describing health states, and other features of the elicitation process. The authors examined the effects of changing the search procedure for a subject's utility on mean utility values. METHODS: A randomized controlled trial of two search procedures (titration and "ping-pong") using two otherwise identical computer programs that describe health states related to Gaucher's disease, then measuring subjects' preferences. SETTING: Paid, healthy volunteers recruited from the community through advertisements. RESULTS: The mean time tradeoff (TTO) and standard gamble (SG) utility values for life with severe anemia and splenomegaly and life with chronic bone pain from Gaucher's disease were between 0.10 and 0.15 higher with the titration search procedure than with the ping-pong procedure. Effects of the search procedure were additive with variability due to scaling methods, resulting in mean differences in utility ratings for the same health state of as much as 0.28 among procedures and scaling methods. Effects of search procedures on utility values persisted on repeated testing at week 2 and week 3; there was no evidence of convergence to a single "true" utility value over time. CONCLUSIONS: The procedure used to search for subjects' utility values strongly influences the results of preference-assessment experiments. Effects of search procedures persist on repeated testing. The results suggest that utility values are heavily influenced by, if not created during, the process of elicitation. Thus, utility values elicited using different search procedures may not be directly comparable.

Adult↗