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Biomedical subjects

V Kowlowitz

Publications and source records attributed to V Kowlowitz.

12 recordsLinked to original sources
PubMed2001

Using the stages of change model to counsel victims of intimate partner violence.

Medical expenses from intimate partner violence (IPV) total between $3 and $5 billion annually. Many abuse victims are exposed to serious injuries, and are likely to see their physicians more frequently than other patients. Practitioners must have a reliable and realistic approach to counseling patients who are victims of IPV. This paper presents the stages of change model as a practical guide for counseling victims. Through patients' responses to a series of questions, the practitioner can identify which of five stages of change (precontemplation, preparation, contemplation, action, maintenance) the patient is in. The practitioner can then employ stage-specific strategies for counseling the patient. Using this model shifts the definition of successful outcome from the traditional focus of trying to 'fix the problem' to a patient-centered focus, working with the patient to explore the most effective strategies given his/her stage of change.

Curriculum↗
PubMed2001

Prevention practices of family medicine clerkship preceptors in North Carolina.

PURPOSE: Before implementing a new prevention curriculum, the authors assessed the prevention practices and attitudes of community family physicians in North Carolina who precepted third-year family medicine clerkship students. METHOD: An 18-item questionnaire was mailed to 165 preceptors during the 1995-96 academic year. The questionnaire explored the preceptors' levels of preparation to counsel patients, the types of prevention services they offered, and their levels of success in modifying patients' behaviors. The survey was re-sent to non-respondents. RESULTS: The response rate was 70% (n = 112); of these 75% were men and 55% had graduated after 1987. Over 60% of the preceptors "almost always" offered services in smoking cessation, exercise, diet and nutrition, and age-specific services (range 62-86%). Over 50% felt "very prepared" to counsel patients regarding smoking cessation, sexually transmitted diseases, depression, exercise, alcohol use, and age-specific services (range 53-74%). However, the preceptors in this study felt pessimistic about their success in getting patients to change their behaviors. Preceptors who had graduated more recently offered more preventive services for smoking cessation, alcohol use, and illicit drugs than did earlier graduates. DISCUSSION: Although North Carolina preceptors were pessimistic about their success in changing patients' behaviors regarding prevention, they were confident about their knowledge and skills to provide these services. This information was used to modify a prevention curriculum for third-year medical students.

Attitude of Health Personnel↗
PubMed1996

Monitoring students' clinical experiences during a third-year family medicine clerkship.

PURPOSE: To demonstrate the importance of monitoring the clinical experiences and types of supervision that students receive in physicians' offices, in order to ensure quality control during a required clerkship. METHOD: In a documentation system introduced in 1991-92, third-year students in the family medicine clerkship at the University of North Carolina at Chapel Hill School of Medicine were asked to complete an optical scan card for every patient they saw. The card information consisted of demographic data, patient continuity, medical problems, types of histories and physical examinations, patient education issues, primary care procedures, and type of supervision. The data were collected from 293 students placed in 63 practices from December 1991 through November 1993. RESULTS: Hypertension, health maintenance, and upper respiratory infection were the most frequently recorded medical problems. Although the students obtained adequate experience performing focused histories and physicals, their experiences with certain physical examinations (breast, rectal, and genital) were inconsistent. Patterns of supervision by the preceptors varied among practices. CONCLUSION: Although the validity of the data has not been assessed, previous literature and other information indicate that the documentation system successfully described the students' clinical experiences. The benefits of implementing such a monitoring system include highlighting the students' lack of certain experiences and making comparisons across sites in order to encourage change among preceptors.

Clinical Clerkship↗
PubMed1996

Pelvic examination instruction and experience: a comparison of laywoman-trained and physician-trained students.

PURPOSE: To evaluate medical student performances of pelvic examinations after completion of the obstetrics-gynecology (ob-gyn) clinical clerkship in order to compare the effectiveness of training by laywomen serving as both teachers and patients with the effectiveness of training by an attending physician as teacher, with a lay-woman serving only as the patient. The study also examined whether students were given additional training and opportunities for practice during their clinical clerkships in other disciplines. METHOD: Following completion of their ob-gyn clerk-ships in 1993 and 1994, a total of 81 students at two North Carolina medical schools answered a questionnaire eliciting demographic information, pelvic examination experience, and the content of the training they had received. The students then performed a pelvic examination on a standardized patient (SP). Their performances were evaluated by the SP using a 35-item scale, subdivided into technical and interpersonal skills. The data were analyzed by two-tailed t-tests, analysis of variance, and chi-square tests. RESULTS: The laywoman-trained students demonstrated better interpersonal skills than did the physician-trained students (p = .01). No significant difference was found in technical skills. Nearly one-fourth of the students reported that communication skills had not been taught during their ob-gyn clerkships. The students reported performing pelvic examinations often on their ob-gyn rotation but infrequently on other rotations. CONCLUSION: The authors recommend that teaching by laywomen be incorporated into the teaching of pelvic examinations and other aspects of a women's health curriculum. Interpersonal skills taught by laywomen in preclinical courses on pelvic examination may have a lasting effect that can be demonstrated after exposure to clinical clerkships. Clinical clerkships should then reinforce these skills.

Adult↗
PubMed1996

Smoking history-taking skills: a simple guide to teach medical students.

Many doctors rate themselves as ineffective smoking cessation counsellors. It is logical to initiate training efforts with medical students. We incorporated smoking history-taking in the physical diagnosis course at the University of North Carolina at Chapel Hill using a simple method to teach smoking history-taking skills and to assess its effectiveness as an educational intervention. The principal intervention was the distribution of a one-sheet Smoking-History Taking and Counseling Guide, adapted from the American Lung Association's Freedom From Smoking for You and Your Family self-help manual. The second intervention was a single prompt for 50% of the course preceptors. Students' smoking history-taking skills were evaluated in the Objective Structured Clinical Examination (OSCE) at the end of the course. Students who received the guide did significantly better on the OSCE, even after controlling for having discussed taking a smoking history with their preceptors. A simple guide combined with a one-time prompting of preceptors has a positive effect on the acquisition of smoking history-taking skills by the medical students. This strategy may also be useful for teaching and evaluating smoking-cessation counselling skills, for which good smoking history-taking is a necessary basis.

Clinical Competence↗
PubMed1993

A randomized trial of physicians and physical therapists as instructors of the musculoskeletal examination.

OBJECTIVE: To evaluate the effectiveness of physicians vs physical therapists as instructors of the musculoskeletal examination to second year medical students. METHODS: A randomized trial conducted over 3 consecutive years in a physical diagnosis course at The University of North Carolina. During the first (baseline) year, medical students received education about the musculoskeletal examination from a lecture and supervision by clinical preceptors. This increased in the second and third (intervention) years where random halves of each class received supplementary clinical instruction which included a structured manual, a videotape, and supervised practice with either general internal medicine physicians or physical therapists. Outcomes were measured from student performance on a practical test of clinical skills, and by written student evaluations of the supplementary instruction. RESULTS: As measured on the clinical examination, performance during the intervention years improved over that during the baseline year in both intervention groups. Measures of medical students' clinical skills did not correlate with measures of academic aptitude. CONCLUSIONS: Clinical education about the musculoskeletal examination should be structured and systematic. Medical students prefer clinical education that is active, provides clear directions, and gives them performance feedback.

Education, Medical, Undergraduate↗
PubMed1991

Implementing the objective structured clinical examination in a traditional medical school.

Since 1985 at the University of North Carolina at Chapel Hill School of Medicine, an objective structured clinical examination (OSCE) has been implemented at the completion of the second year as the final examination in physical diagnosis. This paper describes the format of the examination and the results of surveys of students and evaluators made in 1987, 1988, and 1989. Both the students and the evaluators (who were faculty, residents, and fellows) showed overwhelming acceptance and support of the OSCE. The data indicate that this reaction is partially because the examination is structured as a mechanism for teaching as well as for evaluation.

Clinical Competence↗
PubMed1990

The procedural skills of medical students: expectations and experiences.

The procedural skills that medical students should learn were identified by a survey of faculty and residents at the University of North Carolina at Chapel Hill School of Medicine in 1985. Those who responded indicated that it was important for students to have exposure to all 52 procedures listed on the questionnaire. Only a small number of procedures were identified by 75% or more of those who responded as being important for students to perform with proficiency (11 procedures identified by the faculty, nine by the residents). On another questionnaire, the graduating medical students indicated that, for the most part, they had experience performing these important procedures. To ensure clinical competency, expectations regarding these skills should be communicated to students, faculty, and residents and, ideally, a system should be established to assess these skills.

Clinical Clerkship↗
PubMed1980

Shaping the location of a pigeon's peck: effect of rate and size of shaping steps.

For several pigeons, pecking at particular locations within a ten-inch-wide response area was reinforced by grain presentations. The reinforced locations changed systematically to "shape" response location back and forth across the area. The rate and size of these shifts in reinforced locations were varied in both between-subject and within-subject comparisons to evaluate the influence of these variables on the shaping process. Larger step sizes produced larger shifts in location for all sizes inspected, with all sizes from .5 to 3.0 inches effective in shaping behavior. More rapid steps were approximately as effective as slower steps for all rates of shift inspected from 25 reinforcers to 400 reinforcers per step. These data suggest that shaping peck location proceeds most efficiently with rapid, relatively large shifts in criterion performance.

Animals↗
PubMedDate not supplied

How well do faculty evaluate the interviewing skills of medical students?

OBJECTIVE: To study the reliability and validity of using medical school faculty in the evaluation of the interviewing skills of medical students. DESIGN: All second-year University of North Carolina medical students (n = 159) were observed interviewing standardized patients for 5 minutes by one of eight experienced clinical faculty. Interview quality was assessed by a faculty checklist covering questioning style, facilitative behaviors, and specific content. Twenty-one randomly chosen students were videotaped and rated: by the original rater as well as four other raters; by two nationally recognized experts; and according to Roter's coding dimensions, which have been found to correlate strongly with patient compliance and satisfaction. SETTING: Medical school at a state university in the southeastern United States. PARTICIPANTS: Faculty members who volunteered to evaluate second-year medical students during an annual Objective Structured Clinical Exam. INTERVENTIONS: Interrater reliability and intrarater reliability were tested using videotapes of medical students interviewing a standardized patient. Validity was tested by comparing the faculty judgment with both an analysis using the Roter Interactional Analysis System and an assessment made by expert interviewers. MEASUREMENTS AND MAIN RESULTS: Faculty mean checklist score was 80% (range 41-100%). Intrarater reliability was poor for assessment of skills and behaviors as compared with that for content obtained. Interrater reliability was also poor as measured by intraclass correlation coefficients ranging from 0.11 to 0.37. When compared with the experts, faculty raters had a sensitivity of 80% but a specificity of 45% in identifying students with adequate skills. The predictive value of faculty assessment was 12%. Analysis using Roter's coding scheme suggests that faculty scored students on the basis of likability rather than specific behavioral skills, limiting their ability to provide behaviorally specific feedback. CONCLUSIONS: To accurately evaluate clinical interviewing skills we must enhance rater consistency, particularly in assessing those skills that both satisfy patients and yield crucial data.

Clinical Competence↗
PubMedDate not supplied

Focus groups: a useful tool for curriculum evaluation.

BACKGROUND AND OBJECTIVES: Focus group interviews have been used extensively in health services program planning, health education, and curriculum planning. However, with the exception of a few reports describing the use of focus groups for a basic science course evaluation and a clerkship's impact on medical students, the potential of focus groups as a tool for curriculum evaluation has not been explored. Focus groups are a valid stand-alone evaluation process, but they are most often used in combination with other quantitative and qualitative methods. Focus groups rely heavily on group interaction, combining elements of individual interviews and participant observation. This article compares the focus group interview with both quantitative and qualitative methods; discusses when to use focus group interviews; outlines a protocol for conducting focus groups, including a comparison of various styles of qualitative data analysis; and offers a case study, in which focus groups evaluated the effectiveness of a pilot preclinical curriculum.

Curriculum↗