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Biomedical subjects

Patricia O'Sullivan

Publications and source records attributed to Patricia O'Sullivan.

At least 19 recordsLinked to original sources
PubMed2006

Understanding the experience of being taught by peers: the value of social and cognitive congruence.

BACKGROUND: Medical schools use supplemental peer-teaching programs even though there is little research on students' actual experiences with this form of instruction. PURPOSE: To understand the student experience of being taught by peers instead of by faculty. METHODS: We conducted focus groups with first- and second-year medical students participating in a supplemental peer-teaching program at one institution. From the learner focus group themes, we developed a questionnaire and surveyed all first-year students. RESULTS: Focus groups revealed four learner themes: learning from near-peers, exposure to second-year students, need for review and synthesis, teaching modalities and for the peer-teachers, the theme of benefits for the teacher. Factor analysis of the survey responses resulted in three factors: second-year students as teachers, the benefit of peer-teachers instead of faculty, and the peer-teaching process. Scores on these factors correlated with attendance in the peer-teaching program (P < .05). CONCLUSIONS: Students valued learning from near-peers because of their recent experience with the materials and their ability to understand the students' struggles in medical school. Students with the highest participation in the program valued the unique aspects of this kind of teaching most. Areas for improvement for this program were identified.

Adult↗
PubMed2006

A case study of teaching presence in virtual problem-based learning groups.

Interest in conducting problem-based learning (PBL) on-line has increased to meet student and physician schedules. Little research describes skills needed to facilitate PBL on-line. In this paper we studied teaching presence in asynchronous PBL groups. Two raters, with average inter-rater agreements of 0.80, used an existing code to measure teaching presence in 62 PBL case discussions facilitated by one instructor over five years. This instructor was selected because of consistently high teaching evaluations. Messages sent by the instructor in the on-line PBL discussion were coded into three categories: instructional design and organization, facilitating discourse and direct instruction. Instructional design indicators were most frequent averaging 22.5 (SD = 5.6)/discussion. Facilitating discourse and direct instruction were comparable, 19.5(SD = 7.4) and 19.5 (SD = 6.7), respectively. Messages and indicators of teacher presence rose across time with a decline during subsequent PBL cases with the same group.

Clinical Clerkship↗
PubMed2006

Educational technology infrastructure and services in North American medical schools.

PURPOSE: To describe the current educational technology infrastructure and services provided by North American allopathic medical schools that are members of the Association of American Medical Colleges (AAMC), to present information needed for institutional benchmarking. METHOD: A Web-based survey instrument was developed and administered in the fall of 2004 by the authors, sent to representatives of 137 medical schools and completed by representatives of 88, a response rate of 64%. Schools were given scores for infrastructure and services provided. Data were analyzed with one-way analyses of variance, chi-square, and correlation coefficients. RESULTS: There was no difference in the number of infrastructure features or services offered based on region of the country, public versus private schools, or size of graduating class. Schools implemented 3.0 (SD = 1.5) of 6 infrastructure items and offered 11.6 (SD = 4.1) of 22 services. Over 90% of schools had wireless access (97%), used online course materials for undergraduate medical education (97%), course management system for graduate medical education (95%) and online teaching evaluations (90%). Use of services differed across the undergraduate, graduate, and continuing medical education continuum. Outside of e-portfolios for undergraduates, the least-offered services were for services to graduate and continuing medical education. CONCLUSIONS: The results of this survey provide a benchmark for the level of services and infrastructure currently supporting educational technology by AAMC-member allopathic medical schools.

Benchmarking↗
PubMed2004

An institutional system to monitor and improve the quality of residency education.

PURPOSE: This study sought to investigate whether an institution's Graduate Medical Education Committee (GMEC) could develop a system of continuous quality improvement of its residency programs using an annual survey provided by the institution for all residents. METHOD: Beginning in 2000, residents were surveyed annually about their educational and work environments. The GMEC determined standards of performance for the items on the survey based on four areas commonly cited by the Accreditation Council for Graduate Medical Education: supervision, feedback/evaluation, scholarly time, and duty hours. Residency program directors submitted action plans to improve those areas rated below the standard by the residents in the program. RESULTS: The 2000 survey served as baseline. In 2001, residency programs met the standard for 55.2% of the items, and 18 programs submitted 67 action plans. In 2002, programs met the standard for 80.6% of the items. For the items below standard, programs showed improvement in 14.9% and declined in 4.5% of the items compared with baseline. Six of the 18 programs had accreditation site visits during the study period. Five received no citations in the targeted areas. The sixth program was visited three months after it developed action plans for its six deficient areas. It received citations for two of the six areas. CONCLUSION: An institution that sponsors residency programs can develop and sustain an effective system to continuously monitor and evaluate its programs and improve the educational quality as evidenced by successful accreditation decisions.

Accreditation↗
PubMed2003

Women's early warning symptoms of acute myocardial infarction.

BACKGROUND: Data remain sparse on women's prodromal symptoms before acute myocardial infarction (AMI). This study describes prodromal and AMI symptoms in women. METHODS AND RESULTS: Participants were 515 women diagnosed with AMI from 5 sites. Using the McSweeney Acute and Prodromal Myocardial Infarction Symptom Survey, we surveyed them 4 to 6 months after discharge, asking about symptoms, comorbidities, and demographic characteristics. Women were predominantly white (93%), high school educated (54.8%), and older (mean age, 66+/-12), with 95% (n=489) reporting prodromal symptoms. The most frequent prodromal symptoms experienced more than 1 month before AMI were unusual fatigue (70.7%), sleep disturbance (47.8%), and shortness of breath (42.1%). Only 29.7% reported chest discomfort, a hallmark symptom in men. The most frequent acute symptoms were shortness of breath (57.9%), weakness (54.8%), and fatigue (42.9%). Acute chest pain was absent in 43%. Women had more acute (mean, 7.3+/-4.8; range, 0 to 29) than prodromal (mean, 5.71+/-4.36; range, 0 to 25) symptoms. The average prodromal score, symptom weighted by frequency and intensity, was 58.5+/-52.7, whereas the average acute score, symptom weighted by intensity, was 16.5+/-12.1. These 2 scores were correlated (r=0.61, P<0.001). Women with more prodromal symptoms experienced more acute symptoms. After controlling for risk factors, prodromal scores accounted for 33.2% of acute symptomatology. CONCLUSIONS: Most women have prodromal symptoms before AMI. It remains unknown whether prodromal symptoms are predictive of future events.

Adult↗
PubMed2003

A comparison of critical thinking in groups of third-year medical students in text, video, and virtual PBL case modalities.

PURPOSE: To determine whether critical thinking in problem-based learning (PBL) group discourse differed according to case modality. METHOD: The study was conducted in 2000 in the Department of Pediatrics at the University of Colorado School of Medicine in Denver. Third-year medical students on their pediatrics clerkship were divided into three groups: face-to-face with a text case, face-to-face with a digital video case, and virtual with a digital video case. Twenty-four groups were divided among the three case modalities. Using an existing coding scheme, each distinct codable unit of discourse was placed into one of 35 indicators reflective of five critical-thinking stages. For each group's discourse, a critical-thinking ratio was calculated for each of the stages. The Kruskal-Wallis test was used to compare the critical-thinking ratios for each stage across the three modalities. Residual conversation to indicate processes occurring within the group was also coded. RESULTS: A content analysis of the transcripts of 13 of the 24 group discussions occurred. The virtual groups had the highest critical-thinking ratio. Except for the problem-identification stage, the video groups had higher ratios that the text groups did. CONCLUSIONS: This exploratory study examined how the mode of case presentation affected the critical thinking of groups using the PBL format. Students who learned in a virtual modality with a digital video case engaged in more critical thinking. The data suggest that the video enhanced critical thinking in both face-to-face and virtual PBL groups.

CD-ROM↗
PubMed2003

Strategies for increasing physicians', nurses', and mammography technicians' participation in research.

BACKGROUND: Breast cancer screening in physicians' daily practices needs greater emphasis. Increasing provider participation in research in this area can be a challenge as demonstrated in our study to test interventions targeting rural health care providers. METHOD: Recruitment methods for the randomized controlled trial involving 27 counties in the Mississippi River Delta region of Arkansas included the following: introductory letters and return postcards, mailed questionnaires, telephone calls, attendance at local medical staff meetings, and telephoning the primary care offices to set a time to meet the providers at their practice sites. This final recruitment strategy of telephoning the primary care offices and arranging with the office manager to bring a CME/CEU credit program included an on-site demonstration of a CBE technique and a free lunch. RESULTS: Only the final strategy yielded provider participation for the study and was more successful in the experimental than the control counties. Providers in the control group could not receive the education program until after their post-test. CONCLUSION: Successful approaches to enrolling physicians and nurses in a study involve careful use of their time and providing benefits.

Allied Health Personnel↗
PubMed2003

Disruptive behaviors of older adults in an institutional setting. Staff time required to manage disruptions.

This study, as part of a larger project, examined the actual time recorded by nursing staff to manage 36 disruptive behaviors in older adults who are institutionalized. Disruptive behaviors were defined as socially unacceptable or isolating, observable actions with negative consequences. A prospective study was conducted using a sample of 153 patients in a Veterans Affairs institution (mean age = 72.6, SD = 10.8). Data related to time to manage disruptive behaviors were collected during 21 consecutive shifts for each patient. Nursing staff did not always intervene in all disruptive behaviors that occurred. When they did intervene, total time to manage a disruptive behavior ranged from 5.7 to 201.5 minutes (mean = 23.1 minutes, SD = 31.9).

Activities of Daily Living↗
PubMed2002

Symptom management and successful outpatient transplantation for patients with multiple myeloma.

This retrospective descriptive study compared symptoms and symptom management in patients who completed autologous peripheral blood stem cell transplantation without hospital admission with those of patients who required unplanned hospital admission during the transplantation period. The sample consisted of 87 patients with multiple myeloma treated as outpatients during a 16-month period. Medical records and electronic database records review for each patient provided data on patient characteristics, medical factors, and symptoms/symptom management. Neither age, gender, religion, payer source, treatment on or off protocol, nor positive blood culture made a difference in hospital admission. The percentage of outpatient visits that included documented teaching on self-care made a significant difference (P = .008). Longitudinal analyses of patients' documented symptoms before admission compared with nonadmitted patients captured changes over time in symptoms/symptoms management. Overall, the patients' symptoms were managed well. Significant differences were fatigue, measured as the percentage of usual energy (P = .017), and the amount of oral hydration in a 24-hour period (P < .001). Results call attention to the role that fatigue and the amount of oral hydration may have in unplanned hospital admissions and to the importance of teaching on self-care.

Adult↗
PubMed2002

Portfolios: possibilities for addressing emergency medicine resident competencies.

Portfolios are an innovative approach to evaluate the competency of emergency medicine residents. Three key characteristics add to their attractiveness. First, portfolios draw from the resident's actual work. Second, they require self-reflection on the part of the resident. Third, they are inherently practice-based learning since residents must review and consider their practice in order to begin the portfolio. This paper illustrates five different applications of portfolios. First, portfolios are applied to evaluating specific competencies as part of the training of emergency physicians. While evaluating specific competencies, the portfolio captures aspects of the general competencies. Second, the article illustrates using portfolios as a way to address a specific residency review committee (RRC) requirement such as follow-ups. Third is a description of how portfolios can be used to evaluate resident conferences capturing the competency of practice-based learning and possibly other competencies such as medical knowledge and patient care. Fourth, the authors of the article designed a portfolio as a way to demonstrate clinical competence. Fifth, they elaborate as to how a continuous quality improvement project could be cast within the portfolio framework. They provide some guidance concerning issues to address when designing the portfolios. Portfolios are carefully structured and not haphazard collections of materials. Following criteria is important in maintaining the validity of the portfolio as well as contributing to reliability. The portfolios can enhance the relationship between faculty and residents since faculty will suggest cases, discuss anomalies, and interact with the residents around the portfolio. The authors believe that in general portfolios can cover many of the general competencies specified by the ACGME while still focusing on issues important to emergency medicine. The authors believe that portfolios provide an approach to evaluation commensurate with the self-evaluation skills they would like to develop in their residents.

Clinical Competence↗
PubMed1986

The effect of two sites of high frequency vibration on cutaneous pain threshold.

The purpose of this study was to evaluate the effect of two sites of high frequency vibration on experimentally produced pain thresholds. Subjects were assigned to one of two experimental groups. Vibration was applied proximal to the site of pain threshold measurement in one group and distal to the measurement site in the other group. The cutaneous pain threshold was measured at the ulnar aspect of the wrist in both groups prior to, during, and following 5 min of vibration. Subjects were 30 right-handed, Caucasian males with a negative history of upper extremity dysfunction. A repeated measures analysis of variance (ANOVA) was used to analyze the data. There was a significant interaction between vibration site and time of pain threshold measurement. Post hoc analysis of that interaction indicated that a significant difference between experimental groups occurred only during vibration; the distal group values were significantly higher than the proximal group values (P less than 0.03). For the distal group, pain threshold values were significantly higher during vibration than pre vibration and post vibration (P less than 0.05). In the proximal group, there was no significant difference in pain threshold values across the 3 time periods. The results of this study indicate that vibration applied distal to the site of pain can provide temporary analgesia.

Adolescent↗
PubMedDate not supplied

Assessing teasing in school-age youth.

Teasing, a common childhood behavior and a frequent precursor to bullying, is known to affect children's developmental outcomes. Despite its ubiquity, no psychometrically valid instrument exists that directly assesses teasing in children. This study reports the development and validity of the Physical Appearance Related Teasing Scale-Revised (PARTS-R), a 14-item scale. The PARTS-R was evaluated using a sample (N = 89) of Arkansas students. Psychometric analysis involved item analysis, principal components analysis (PCA) with varimax rotation, and internal consistency reliability. Three factors--Forms of Harassment, Appearance-Related Teasing, and Physical-Related Teasing--were identified and accounted for 57% of the variance, confirming the conceptual intent of the instrument. Cronbach's alphas for the factors were.83,.74, and.70, respectively. Adequate stability also was demonstrated. Implications for further validation work are identified.

Adolescent↗
PubMedDate not supplied

An evaluation of standardized patients in improving clinical breast examinations for military women.

There is a need to improve the quality of clinical breast examination (CBE) and breast cancer screening for women. The purpose of this study was to determine whether instructions from a standardized patient to military healthcare providers would increase the quality of CBE and breast cancer screening for military women. The study used a 2-group pretest and posttest experimental design with random assignment by study site. Before and after the intervention, the providers completed a 13-item survey to assess their current breast cancer screening practices and the standardized patient used an investigator-developed checklist to assess the providers' breast cancer screening performance. The survey of breast cancer screening practice scores and the interview and CBE performance scores were analyzed using analysis of covariance with the pretest scores as covariates. Results showed the experimental group made significantly more improvement than did the control group in their total scores on the observational checklist of interview and CBE skills (F = 19.18, P < .001, observed power = 0.99). In conclusion, this method of continuing education was effective with military healthcare providers.

Adult↗
PubMedDate not supplied

Development of the McSweeney Acute and Prodromal Myocardial Infarction Symptom Survey.

BACKGROUND/OBJECTIVES: Coronary heart disease (CHD) is the number one cause of death in women, yet, little is known about women's symptoms. Early symptom recognition of CHD in women is essential but most instruments do not assess both prodromal and acute CHD symptoms. Our aims were to develop an instrument validly describing women's prodromal and acute symptoms of myocardial infarction and to establish reliability of the instrument, the McSweeney Acute and Prodromal Myocardial Infarction Symptom Survey (MAPMISS). METHODS: Four studies contributed to the content validity and reliability of this instrument. Two qualitative studies provided the list of symptoms that were confirmed in study 3. The resulting instrument assesses 37 acute and 33 prodromal symptoms. In study 4, 90 women were retested 7 to 14 days after their initial survey. We used the kappa statistic to assess agreement across administrations. RESULTS: The women added no new symptoms to the MAPMISS. The average kappa of acute symptoms was 0.52 and 0.49 for prodromal. Next we calculated a weighted score. The mean acute score for time 1 was 19.4 (SD = 14.43); time 2 was 12.4 (SD= 8.79) with Pearson correlation indicating stability (r = .84; P < .01). The mean prodromal score at time 1 was 23.80 (SD= 24.24); time 2 was 26.79 (SD = 30.52) with a Pearson correlation of r = .72; P < .01. CONCLUSIONS: The tool is comprehensive, has high content validity, and acceptable test-retest reliability. Low kappas were related to few women having those symptoms. The symptom scores remained stable across administrations.

Adult↗
PubMedDate not supplied

Effects of behavioral interventions on disruptive behavior and affect in demented nursing home residents.

BACKGROUND: Disruptive behaviors are prevalent in nursing home residents with dementia and often have negative consequences for the resident, caregiver, and others in the environment. Behavioral interventions might ameliorate them and have a positive effect on residents' mood (affect). OBJECTIVES: This study tested two interventions-an activities of daily living and a psychosocial activity intervention-and a combination of the two to determine their efficacy in reducing disruptive behaviors and improving affect in nursing home residents with dementia. METHODS: The study had three treatment groups (activities of daily living, psychosocial activity, and a combination) and two control groups (placebo and no intervention). Nursing assistants hired specifically for this study enacted the interventions under the direction of a master's prepared gerontological clinical nurse specialist. Nursing assistants employed at the nursing homes recorded the occurrence of disruptive behaviors. Raters analyzed videotapes filmed during the study to determine the interventions' influence on affect. RESULTS: Findings indicated significantly more positive affect but not reduced disruptive behaviors in treatment groups compared to control groups. CONCLUSIONS: The treatments did not specifically address the factors that may have been triggering disruptive behaviors. Interventions much more precisely designed than those employed in this study require development to quell disruptive behaviors. Nontargeted interventions might increase positive affect. Treatments that produce even a brief improvement in affect indicate improved quality of mental health as mandated by federal law.

Activities of Daily Living↗
PubMedDate not supplied

The Delta project: increasing breast cancer screening among rural minority and older women by targeting rural healthcare providers.

PURPOSE/OBJECTIVES: To test a multimethod approach designed for rural healthcare providers to increase breast cancer screening among low-income, African American, and older women. DESIGN: Two-year experimental pretest/post-test with random assignment by group. SETTING: Primary healthcare providers' offices. SAMPLE: 224 nurses, physicians, and mammography technicians. METHODS: Standardized patients to observe and record healthcare providers' performances, followed by direct feedback, newsletters, posters, pocket reminder cards, and lay literature about screening to use in clinics. MAIN RESEARCH VARIABLES: Healthcare providers' knowledge and attitudes as measured by survey responses, skills as measured by a checklist, and the provision of breast cancer screening as measured by mammography facilities' data. FINDINGS: Healthcare providers significantly improved in demonstration of breast cancer screening practice after the intervention. Nurses performed significantly better than physicians on the breast examination during the post-test. More women older than 50 received mammograms in the experimental counties than in the comparison counties. Culturally sensitive lay literature is needed for African American women with low literacy. CONCLUSIONS: Successful interventions included use of standardized patients to teach healthcare providers in their office settings, prompts such as posters and pocket reminder cards, and easy-to-read newsletters. IMPLICATIONS FOR NURSING: Physicians and nurses play a powerful role in motivating women to have mammograms and clinical breast examinations and to practice breast self-examination. Interventions that help these providers fulfill that role should be implemented.

Adult↗