Biomedical subjects

Michael Fleming

Publications and source records attributed to Michael Fleming.

5 recordsLinked to original sources

PubMed2003

Videoconferencing for practice-based small-group continuing medical education: feasibility, acceptability, effectiveness, and cost.

INTRODUCTION: Small-group, practice-based learning is an effective and well-accepted method of continuing medical education (CME). However, one limitation is that many physicians work in communities with fewer than the minimum number recommended for an effective learning group. Videoconferencing has the potential to remove this limitation. The purpose of this study was to evaluate the feasibility, acceptability, effectiveness, and cost of conducting practice-based, small-group CME learning by videoconference. METHODS: Through a videoconferencing link, 10 learners in three communities were guided through four practice-based learning modules by a trained facilitator at a fourth site. Data were collected through evaluation questionnaires, direct observation by the research team, pre- and post-knowledge tests, a focus group, and an interview. RESULTS: A total of 31 learners participated in the four modules. Videoconferencing was generally well accepted by learners. The facilitator and research team observers noted that muting microphones, video quality, audio quality, and audio lag all somewhat hindered discussion. Overall, the facilitator found moderating by videoconference only slightly more difficult than a face-to-face session. There was evidence of knowledge gain, with post-test scores being 20% higher than pretest scores (p = .006). Learners reported nine practice changes from taking the modules. At commercial rates, telecommunications costs per videoconferenced module were approximately CAN$1,200. DISCUSSION: Videoconferencing has the potential to bring the benefits of small-group, practice-based learning to many physicians; however, strict attention to videoconferencing techniques is required. Cost is also an important consideration.

Attitude of Health Personnel↗

PubMed2003

Services integration and cost-effectiveness.

Alcohol treatment services are increasingly combined with other health and social services to address the needs of multiple-problem clients. Hence, it has been of growing policy interest to find the most effective and the most cost-effective ways of linking these services. This symposium presents some recent studies in this area. The small but growing body of studies in this area has great potential to inform public policy debates.

Alcoholism↗

PubMed2002

Helping family physicians improve their cardiac auscultation skills with an interactive CD-ROM.

INTRODUCTION: There have been few studies of the cardiac auscultation skills of residents and family physicians. This study assessed a group of family physicians' cardiac auscultation skills and use of a computerized self-instructional program to improve these skills. METHODS: Forty-two volunteer family physicians participated in an initial assessment of cardiac auscultation skills using test recordings of 12 common heart sounds. They were provided with a CD-ROM instructional program and were asked to devote 15 hours of self-study to the program and to return in 9 months for reassessment. RESULTS: The 42 family physicians in the initial assessment identified 39% of the heart sounds. Twenty-one returned for reassessment and showed significant improvement. Their initial mean score was 4.3 of 12 (35%), and their final mean score was 8.0 of 12 (67%). They found the CD-ROM program to be a valuable resource. The feature most liked was the unlimited opportunity to review sounds, cases, and tutorials. Most frequent problems related to computer access or skills. Eleven respondents reported using the program to resolve patient problems in their clinical practices. DISCUSSION: The cardiac auscultation skills of a group of volunteer family physicians showed low initial scores that improved significantly after self-study with a CD-ROM instructional program. The program was a valuable self-instructional aid, and physicians used it as a resource in clinical practice. However, only 50% of the initial group completed the self-study and returned for final assessment. Providing more support and assistance in the initial phase, especially with computer use, may enable completion of similar computerized self-study programs.

CD-ROM↗

PubMed2002

[Primary care and alcohol use disorders: evaluation of a faculty-development program in Venezuela].

OBJECTIVE: Primary care offers an opportunity to identify and treat persons who drink alcohol above permissible levels. In order to prepare primary care practitioners around the world to prevent and treat alcohol-related problems, the National Institute on Alcohol Abuse and Alcoholism of the United States of America has developed and tested a model international program for educating physicians about such problems. The model was designed to increase the clinical, teaching, and research skills of medical school faculty who work with medical students, residents, and primary care physicians. Venezuela was one of the countries selected for the initiative. METHODS: During September 1999 a five-day faculty-development course consisting of 19 workshops was conducted at the University of Zulia, which is located in the city of Maracaibo, Zulia, Venezuela. Teaching strategies included class presentations, role plays, case presentations, skills-building workshops, and having each participant develop a teaching plan that he or she would use. RESULTS: Thirty-three faculty members from 9 of Venezuela's 10 medical schools participated in the project. The 18 female and 15 male participants had an average age of 44 years. The areas of specialization of the 33 participants were: family medicine (9 participants), psychiatry (7), pediatrics (6), obstetrics (4), internal medicine (3), and unspecified (4). Of the 33 participants, 25 of them (76%) completed a six-month follow-up interview. This group said they had significantly increased their competence in 14 clinical areas and that they had successfully implemented new teaching activities within their respective medical schools and residency programs. CONCLUSIONS: This model proved to be an effective strategy for increasing training for physicians in the prevention and treatment of alcohol-related problems in Venezuela. The evaluation confirms similar findings in other countries where the program has been implemented.

Adult↗

PubMed2002

"Nurse, I only had a couple of beers": validity of self-reported drinking before serious vehicular injury.

BACKGROUND: Of the more than 40000 Americans killed each year in vehicular crashes, 40% are involved in alcohol-related collisions. Although self-reported alcohol use has become an anchor for alcohol intervention after traffic crashes, clinicians are often skeptical about the truthfulness of self-reporting. OBJECTIVE: To determine the validity of self-reported alcohol consumption of vehicular occupants hospitalized for a serious, alcohol-related injury. METHODS: Non-alcohol-dependent subjects 18 years and older who were injured in motor vehicle crashes were interviewed. The self-reported number of standard drinks, time that drinking commenced, sex, and weight were used to calculate estimated blood alcohol concentration. This value was compared with the blood alcohol concentration measured at admission. RESULTS: Of the 181 subjects, 60% provided sufficient data to calculate the estimated concentration. Seven men with admission concentrations of 10 mg/dL or more denied drinking. Among the 113 subjects with estimated concentrations who acknowledged drinking (excluding the 7 who denied drinking), the mean concentration at admission was 158.67 mg/dL, and mean estimated concentration was 83.81 mg/dL. According to multiple regression analyses, weight and number of drinks accounted for 3% of the variance in alcohol concentration at admission for women (R=0.174, F2,40=0.623, P=.54) and for 29% of the variance in men (R=0.543, F2,128=26.71, P< .001). CONCLUSIONS: Most persons who drink before vehicular injury acknowledge drinking. Self-reported data from men generally reflect the overall trend of alcohol consumption but with systematic underreporting. Reports from women are less predictable.

Accidents, Traffic↗