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PubMed2005

Milestones of the medical school and medical progress of Singapore over the past 100 years.

The Medical School started off in an old female lunatic asylum on the site of the general hospital at Sepoy Lines. It was founded on 3 July 1905 and was called the Straits and Federated Malay States Government Medical School. In 1916, the Licentiate in Medicine and Surgery (LMS) was recognised fully by the General Medical Council of Britain as a registrable qualification. In 1921, the medical school was renamed King Edward VII College of Medicine to reflect its academic status. In 1926, the College and its hospitals were inspected by Sir Richard Needham, who had been sent by the General Medical Council of Great Britain. In his report, he told the Council that in his opinion, the graduates should be given the MBBS degree because of the high standard of the Medical School. The medical school was closed by the Japanese on 16 February 1942. After the end of World War II, the College of Medicine resumed classes in June 1946. In 1962, the medical faculty became the Faculty of Medicine of the University of Singapore. From 1984 to 1986, following the university's move to Kent Ridge, the Faculty's clinical school also moved to the National University Hospital. In 2004, plans were well underway for the opening of the country's second medical school on the grounds of the Singapore General Hospital.

Education, Medical↗

PubMed2006

Attitudes and awareness of final-year predoctoral dental and medical students to medical problems in dentistry.

An increasing proportion of the population is medically compromised. Dental and medical staff need to communicate and cooperate to afford these patients the best possible health care. In this study, the attitude towards and awareness of medical problems were examined in final-year predoctoral (undergraduate) dental and in final-year medical students. The results revealed that most dental students felt their knowledge of and training in medical problems in dentistry to be moderate to good. In contrast, most medical students thought both their knowledge and training in medical problems in dentistry to be only poor to moderate. Dental students rated the importance of medical problems in dentistry higher than did medical students.

Attitude↗

PubMed2006

Medical students' attitudes toward underserved patients: a longitudinal comparison of problem-based and traditional medical curricula.

Medical education has been shown to negatively influence student attitudes toward certain types of patient populations. Past research does not inform current educational practice because today's medical school environment is different from when most of the published research was conducted. There are more female students, curricular innovations such as problem-based learning have changed the framework for educational delivery, and longitudinal studies, which could inform when interventions may be needed, are uncommon. The purposes of this longitudinal, prospective cohort study were to compare the attitudes of Problem-based learning and Traditional curriculum students toward providing care for medically indigent patients as they progressed through the four-year undergraduate medical education curriculum, and to determine if gender differences were apparent and persisted over time. Attitudes of one cohort of students enrolled in separate curricula were studied. The outcome measure was the Medical Student Attitudes Toward the Underserved questionnaire, which was administered three times. A linear mixed effects regression analysis was performed to examine changes in factor scores over time and whether these changes differed between Problem-based and Traditional students, and males and females. Longitudinal findings revealed that commitment to caring for the medically underserved was greater when students entered medical school than when they graduated. Students in both curricula, as well as male and female students, experienced increasingly negative attitudes over the four year period. Decline in attitudes toward medically underserved patients was similar to previous research results. This study showed that attitudes of students were not influenced by the preclinical curriculum they experienced.

Adult↗

PubMed1998

Medical informatics education by medical professors within their discipline.

A system for medical informatics education for medical students has been developed in the medical school. This paper describes the concept underlying the development of this system and its progressive outcomes over 8 years. In order to stimulate students to acquire computer-related knowledge and skills, this subject has been integrated into the course works of various medical subjects such as physiology. In addition, acquired knowledge and skills are evaluated within each subject by the production of reports for example, using computers. This provides a concrete example for students of the relevance of the information sciences to the solving of medical problems. A well equipped computer facility for the study of medicine also plays a significant role in inspiring student incentive. A computer room equipped with Macintosh computers was opened adjacent to the main medical library and is used in the same manner as the library, with books replaced by computers. In addition, all new students acquire their own Macintosh PowerBook. These various initiations have facilitated concept that the computer may be applied to medical problem solving at any time or place and may become as commonplace as a pen in daily medical practice.

Computers↗

PubMed2005

Viewpoint: patient-centered medical care requires a patient-centered medical record.

If patient-centered medicine is to become a widespread reality in academic medical centers, educational initiatives must include reform of the medical record. The medical record is part of the hidden, or informal, curriculum of medical school and residency that defines for students and residents the essential ingredients of competent medical care. Whatever its merits, the conventional, problem-oriented medical record (POMR) is a pathology-oriented record that helps perpetuate a disease-focused, biomedical model of practice Patient-centered medicine requires a patient-centered medical record (PCMR), one that addresses the person and perspective of the patient as competently as it addresses the patient's disease. The author proposes a PCMR that includes a concise, upfront Patient Profile; speaks of "chief concerns," not "chief complaints"; makes Patient Perspective a captioned component of the History of Present Illness; replaces the POMR's formula SOAP (Subjective, Objective, Assessment, Plan) with HOAP (History, Observations, Assessment, Plan); includes important patient perspectives on the Problem List; and calls for additional, written attention to the person and perspective of the patient throughout the course of medical care Patient-centered records can guide and teach clinicians at every level of training and experience to practice patient-centered medicine. Moreover, such records can also provide measurable evidence that this teaching has been successful.

Education, Medical↗

PubMed2004

Use of medical emergency team (MET) responses to detect medical errors.

BACKGROUND: No previous studies have investigated whether medical emergency team (MET) responses can be used to detect medical errors. OBJECTIVES: To determine whether review of MET responses can be used as a surveillance method for detecting medical errors. METHODS: Charts of all patients receiving MET responses during an 8 month period were reviewed by a hospital based Quality Improvement Committee to establish if the clinical deterioration that prompted the MET response was associated with a medical error (defined as an adverse event that was preventable with the current state of medical knowledge). Medical errors were categorized as diagnostic, treatment, or preventive errors using a descriptive typology based on previous published reports. RESULTS: Three hundred and sixty four consecutive MET responses underwent chart review and 114 (31.3%) were associated with medical errors: 77 (67.5%) were categorized as diagnostic errors, 68 (59.6%) as treatment errors, and 30 (26.3%) as prevention errors. Eighteen separate hospital care processes were identified and modified as a result of this review, 10 of which involved standardization. CONCLUSIONS: MET review may be used for surveillance to detect medical errors and to identify and modify processes of care that underlie those errors.

Emergency Service, Hospital↗

PubMed2004

[Teaching courses on aspects of medical history taking and communication skills in Germany: a survey among students of 12 medical faculties].

BACKGROUND: Good communication between patients and doctors has positive effects on health and the patients' quality of life. Communication skills can be trained. In many countries communication skills training is an important part of medical education and continuing medical education. In this study German medical students were questioned about current communication training. METHODS: Questionnaires were sent to 28 Medical Schools in Germany and distributed in General Practice courses. Using Likert scales students were asked to rate both existing teaching courses on communication skills and their ability to communicate. RESULTS: 377 students of 12 Medical Schools participated in this study. Two Medical Schools offer teaching courses on communication skills as part of their regular curriculum. On a scale ranging from 1 (no such courses available) to 7 (courses fully available) students assessed the practical teaching of communication skills to be 3 (median). In addition, on a scale ranging from 1 to 7 students rated their general communication skills as 3 (median) and their ability of taking a sexual history and breaking bad news as 4 (median). CONCLUSION: Although these results are not representative, they give a general idea of communication skills teaching in Germany. During their clinical education students should be especially trained for difficult situations in the patient-doctor encounter. The international experience of other Medical Schools should be taken into account when implementing communication skills training as part of medical education.

Curriculum↗

PubMed2005

Medical professional liability insurance and its relation to medical error and healthcare risk management for the practicing physician.

PURPOSE: To review the history and current issues surrounding medical professional liability insurance and its relationship to medical error and healthcare risk management. DESIGN: Focused literature review and authors' experience. METHODS: Medical professional liability insurance issues are reviewed in association with the occurrence of medical error and the role of healthcare risk management. RESULTS: The rising frequency and severity of claims and lawsuits incurred by physicians, as well as escalating defense costs, have dramatically increased over the past several years and have resulted in accelerated efforts to reduce medical errors and control practice risk for physicians. Medical error reduction and improved patient outcomes are closely linked to the goals of the medical risk manager by reducing exposure to adverse medical events. Management of professional liability risk by the physician-led malpractice insurance company not only protects the economic viability of physicians, but also addresses patient safety concerns. CONCLUSIONS: Physician-owned malpractice liability insurance companies will continue to be the dominant providers of insurance for practicing physicians and will serve as the primary source for loss prevention and risk management services. To succeed in the marketplace, the emergence and importance of the risk manager and incorporation of risk management principles throughout the professional liability company has become crucial to the financial stability and success of the insurance company. The risk manager provides the necessary advice and support requested by physicians to minimize medical liability risk in their daily practice.

Delivery of Health Care↗

PubMed2005

Evaluation of a new approach to implement structured, evidence-based emergency medical care in undergraduate medical education in Germany.

Since June 2002, revised regulations in Germany allow medical faculties to implement new curricular concepts. The medical faculty of the Rheinisch-Westfälische Technische Hochschule (RWTH) Aachen, Germany, decided to start a major reform experiment in winter 2003, focussing on an interdisciplinary integration of organs and organ systems such as the cardiovascular or respiratory system. Furthermore, students will have contact with patients at an early stage of their studies. Thus, re-organisation of course contents should lead to a chance to improve practical experience. With the public having the right to expect that physicians and all physicians in training possess a basic knowledge of emergency medical care and the necessary skills to manage acute problems, it was decided to start the first year of the Medical Reform Curriculum Aachen with 3 weeks interdisciplinary introduction into emergency medical care. The task consisted of defining interdisciplinary core objectives and the need to implement teaching and learning principles necessary for further education. Due to this, the content of this course should have practical relevance for the students concerning their practical experiences in the future. The result is an introductory course in emergency medical care in the first semester, coordinated with the lectures. Besides skill training on basics of emergency medical care (basic life support (BLS), early defibrillation), practical training in other lifesaving techniques (e.g., immobilisation skills) and basic principles of daily clinical care are included. In addition, personal safety and a standard algorithm for assessing the patient are covered by problem-based learning sessions. The course evaluation data clearly showed acceptance of the new approach and enhances possibilities of extending implementation of relevant topics concerning emergency medical care within the Medical Reform Curriculum Aachen.

Curriculum↗

PubMed2001

Modeling a medical environment: an ontology for integrated medical informatics design.

Modern medical environments have seen an increase in technological complexity and pressures of handling more patients with fewer resources, resulting in higher demands on medical practitioners. Medical informatics designers will have to focus on the problem of organizing medical information more effectively to enable practitioners to cope with these challenges. This article addresses this research problem for the particular area of medical problem solving in patient care. First, we describe a traditional modeling approach for medical reasoning used as a basis for developing some decision support systems. We argue these models may be faithful to what is known about biomedical knowledge, but they have limitations for human problem solving, especially in unanticipated situations. Second, we present an ontological framework, known as the abstraction hierarchy (Rasmussen, IEEE Trans. Man. Cybernetics 15 (1985) 234-243), for integrating patient representations that are faithful to existing biomedical knowledge and that are consistent with what is known about human problem solving. Through an example of a critical event in the operating room, we reveal how this framework can support medical problem solving in unanticipated situations. Third, we show how to use these representations as a frame of reference for mapping medical roles, responsibilities, sensors, and controls in an operating room context. Finally, we provide some insight for medical informatics designers in using this framework to design novel training programs and human-computer displays.

Decision Support Techniques↗

PubMed2003

Medical messages in the media--barriers and solutions to improving medical journalism.

CONTEXT: Medical issues are widely reported in the mass media. These reports influence the general public, policy makers and health-care professionals. This information should be valid, but is often criticized for being speculative, inaccurate and misleading. An understanding of the obstacles medical reporters meet in their work can guide strategies for improving the informative value of medical journalism. OBJECTIVE: To investigate constraints on improving the informative value of medical reports in the mass media and elucidate possible strategies for addressing these. DESIGN: We reviewed the literature and organized focus groups, a survey of medical journalists in 37 countries, and semi-structured telephone interviews. RESULTS: We identified nine barriers to improving the informative value of medical journalism: lack of time, space and knowledge; competition for space and audience; difficulties with terminology; problems finding and using sources; problems with editors and commercialism. Lack of time, space and knowledge were the most common obstacles. The importance of different obstacles varied with the type of media and experience. Many health reporters feel that it is difficult to find independent experts willing to assist journalists, and also think that editors need more education in critical appraisal of medical news. Almost all of the respondents agreed that the informative value of their reporting is important. Nearly everyone wanted access to short, reliable and up-to-date background information on various topics available on the Internet. A majority (79%) was interested in participating in a trial to evaluate strategies to overcome identified constraints. CONCLUSIONS: Medical journalists agree that the validity of medical reporting in the mass media is important. A majority acknowledge many constraints. Mutual efforts of health-care professionals and journalists employing a variety of strategies will be needed to address these constraints.

Australia↗

PubMed2005

Antiretroviral medication errors in a national medication error database.

Antiretroviral medications have reduced the morbidity and mortality associated with HIV. In contrast to these benefits, medication errors involving antiretrovirals represent opportunities for causing harm. We analyzed 400 medication errors that involved at least one single or combined HIV antiretroviral product that had been reported to a national medication error reporting program (MEDMARX). Our analysis revealed that 3% of the errors were harmful. Most of the errors (45%) occurred in the dispensing phase of the medication use process, a finding that differs significantly from many published studies. The most frequent types of errors were wrong dose (37.5%) and wrong medication (32%). Lamivudine (Epivir, Glaxo-SmithKline, Research Triangle Park, NC) was the most commonly identified product to be involved in the errors. Community hospitals were more likely to have prescribing errors than teaching hospitals. Similar brand and generic names were associated with many of the errors. With frequent dosing of many HIV medications, health care organizations must have a process to clarify orders rapidly and maintain current references (including photos) of antiretrovirals. Prescribers should clearly spell out the intended product and avoid abbreviations. Participating in voluntary medication error reporting programs increases the awareness of the threats of medication errors involving antiretrovirals.

Adverse Drug Reaction Reporting Systems↗

PubMed2006

The Israel Center for Medical Simulation: a paradigm for cultural change in medical education.

Simulation-based medical education (SBME) is a rapidly growing field, as is illustrated by the increased development of simulation centers worldwide. SBME is becoming a powerful force in addressing the need to increase patient safety through quality-care training. Recognizing the benefits of SBME, increasing numbers of bodies involved in medical and health care education and training are establishing simulation centers worldwide. The general model of most facilities focuses on a single simulation modality or a specific branch of medicine or health care, limiting their overall impact on patient safety and quality of care across the health care systems. MSR, the Israel Center for Medical Simulation, is a comprehensive, national, multimodality, multidisciplinary medical simulation center dedicated to enhancing hands-on medical education, performance assessment, patient safety, and quality of care by improving clinical and communication skills. The center uses an "error-driven" educational approach, which recognizes that errors provide an opportunity to create a unique beneficial learning experience. The authors present the Israeli experience as an alternative model, and describe the impact of the MSR model on the Israeli medical community during four years of activity. They also describe the opportunities this model has opened towards changing the culture of medical education and patient safety within Israel Although this model may require modification when implemented in other medical systems, it highlights important lessons regarding the power of SBME in triggering and bringing about cultural changes in traditional medical education.

Computer Simulation↗

PubMed2006

Risk of multiple myeloma following medication use and medical conditions: a case-control study in Connecticut women.

BACKGROUND: Certain commonly used drugs and medical conditions characterized by chronic immune dysfunction and/or antigen stimulation have been suggested to affect important pathways in multiple myeloma tumor cell growth and survival. We conducted a population-based case-control study to investigate the role of medical history in the etiology of multiple myeloma among Connecticut women. METHODS: A total of 179 incident multiple myeloma cases (21-84 years, diagnosed 1996-2002) and 691 population-based controls was included in this study. Information on medical conditions, medications, and medical radiation was obtained by in-person interviews. We calculated odds ratios (OR) as measures of relative risks using logistic regression models. RESULTS: A reduced multiple myeloma risk was found among women who had used antilipid statin therapy [OR, 0.4; 95% confidence interval (95% CI), 0.2-0.8] or estrogen replacement therapy (OR, 0.6; 95% CI, 0.4-0.99) or who had a medical history of allergy (OR, 0.4; 95% CI, 0.3-0.7), scarlet fever (OR, 0.5; 95% CI, 0.2-0.9), or bursitis (OR, 0.4; 95% CI, 0.2-0.7). An increased risk of multiple myeloma was found among women who used prednisone (OR, 5.1; 95% CI, 1.8-14.4), insulin (OR, 3.1; 95% CI, 1.1-9.0), or gout medication (OR, 6.7; 95% CI, 1.2-38.0). CONCLUSIONS: If our results are confirmed, mechanistic studies examining how prior use of insulin, prednisone, and, perhaps, gout medication might promote increased occurrence of multiple myeloma and how antilipid statins, estrogen replacement therapy, and certain medical conditions might protect against multiple myeloma may provide insights to the as yet unknown etiology of multiple myeloma.

Adult↗

PubMed2003

Predictors of older adults' capacity for medication management in a self-medication program: a retrospective chart review.

UNLABELLED: The aim of this project was to identify variables that predicted older adults' ability to manage medications. METHODS: The study used a retrospective cohort design and was set in a self-medication program within a rehabilitation hospital. A random sample of charts from 301 participants in the self-medication program was reviewed. RESULTS: Logistic regression models accounted for 26.7% and 55.8% of the variance in the probability of making one or more self-medication errors during the initial and final weeks of the program, respectively. The importance of cognition in predicting medication management capacity was seen in bivariate and multivariate analyses and through a number of interactions with other predictors. Statistically significant predictors in one or both analyses included medication regimen complexity, Mini-Mental State Exam (MMSE) score, duration of institutionalization, depression, and interactions between (a) medication regimen complexity and MMSE score and (b) ability to cook and MMSE score. DISCUSSION: The direct effects of cognition and medication regimen complexity were important predictors of medication management capacity.

Activities of Daily Living↗

PubMed2005

Adequacy of online medical command communication and emergency medical services documentation of informed refusals.

BACKGROUND: In the out-of-hospital setting, when emergency medical services (EMS) providers respond to a 9-1-1 call and encounter a patient who wishes to refuse medical treatment and/or transport to the hospital, the EMS providers must ensure the patient possesses medical decision-making capacity and obtain an informed refusal. In the city of Cleveland, Ohio, Cleveland EMS completes a nontransport worksheet that prompts the paramedics to evaluate specific patient characteristics that can influence medical decision-making capacity and then discuss the risks of refusing with the patient. Cleveland EMS then contacts an online medical command (OLMC) physician to authorize the refusal. OLMC calls are recorded for review. OBJECTIVES: To assess the ability of EMS to determine medical decision-making capacity and obtain an informed refusal of transport. METHODS: This study was a retrospective review of a cohort of recorded OLMC refusal calls and of the accompanying written documentation by Cleveland EMS. The completeness of the verbal communication between the paramedic and OLMC physician and the written documentation on the nontransport worksheet were measured as surrogate markers of the adequacy of determining medical decision-making capacity and obtaining an informed refusal. RESULTS: One hundred thirty-seven OLMC calls for patient-initiated refusals were reviewed. Vital signs and alertness/orientation were verbally communicated more than 83% of the time. The presence of head injury, presence of alcohol or drug intoxication, and presence of hypoglycemia were verbally communicated less than 31% of the time. Verbal communication stating that the risks of refusing had been discussed with the patient occurred 44.5% of the time. The written documentation of the refusal encounter was more complete, exceeding 95% for vital signs and alertness/orientation, and exceeding 80% for the remaining patient characteristics. The rate of written documentation that the risks of refusing had been discussed with the patient was 48.7%. Discrepancies between the verbal and written paramedic reports were clinically insignificant. CONCLUSIONS: Paramedic and OLMC physician communication for patients refusing out-of-hospital medical treatment and/or transport is inadequate in the Cleveland EMS system. A written nontransport worksheet improves documentation of the refusal encounter but does not ensure that every patient who refuses possesses medical decision-making capacity and the capacity to provide an informed refusal.

Adolescent↗

PubMed2004

"Social medication" and the control of children: a qualitative study of over-the-counter medication among Australian children.

OBJECTIVE: The aim of the study was to identify the patterns of use of over-the-counter (OTC) medications among children. METHODS: The study used a qualitative design, with in-depth interviews of 40 parents with children <5 years of age. RESULTS: There were 3 striking and readily apparent themes in the use of OTC medications among children. One was the administration of OTC medications as a form of "social medication," to give parents control over children's behavior that they perceived as fractious and irritating. A related theme was the use of OTC medications to reduce the inconvenience to the parents of having a sick child, again giving parents greater control and better time-management abilities. Finally, acetaminophen was considered by many parents to have almost miraculous properties in calming, sedating, and lifting the mood of children. CONCLUSIONS: The use of OTC medications for the treatment of minor ailments among children is widespread, despite the lack of evidence of efficacy of the most commonly used medications and the potential for toxicity. With the increasing propensity to look to medication as a means of supporting changing lifestyles, there is an urgent need to review the prevalence and effects of social medication.

Acetaminophen↗

PubMed1999

[Present situation of medical care for foreigners at medical facilities in Chiba City].

OBJECTIVE: The number of foreigners residing in Japan has increased during the past decade. The aim of this survey was to clarify the present situation and the disadvantages in the medical care for foreigners. METHODS: In October 1997, we mailed a questionnaire to all clinics and hospitals in Chiba City. The questionnaire included questions regarding the number of foreign patients who visited during the past three months, the proportion of patients who have any health insurance, procedures for handling foreign patients, and the disadvantages in medical care for them. RESULTS: Of the 210 respondents (183 clinics and 27 hospitals), 133 facilities (63.3%) provided medical care for foreign patients during the past three months, and 187 (89.0%) during the past year. In 102 facilities (76.7%), the number of foreign patients was fewer than 10 during the past three months. The mean number of foreign patients was 13.8 per facility (12.2 per clinic, and 23.5 per hospital). Of these foreign patients, 68.6% had any health insurance. In 172 facilities (81.9%), foreign patients were accepted in the same way as the Japanese. The main disadvantages in medical care for foreigners were difficulty in understanding because of communication problems, and default in payment of medical expenses for the foreigners with no health insurance. In 154 facilities (73.3%), no special preparation to communicate with foreign patients was provided, and few facilities could understand foreign languages except for English. In 20 facilities, fees for medical care had been left unpaid by foreign patients during the past year, and the total outstanding amount was about 23,800,000 yen. CONCLUSION: In Chiba City, many medical facilities provide medical care for foreign patients. This study suggests that support for communication with foreigners and compensation for default in medical expenses are necessary.

Communication↗