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PubMedDate not supplied

"Medical Miranda"--improved emergency medical dispatch information from police officers.

INTRODUCTION: Medical Miranda, also called Secondary Emergency Notification of Dispatch (SEND), is a low cost, effective, and welcome addition to emergency medical dispatching systems. The benefits are recognized by emergency medical dispatchers who receive feeder calls from associated public safety agencies that have trained both their field staff and call-takers in the Medical Miranda protocol. HYPOTHESIS: The dispatchers would be more satisfied with feeder agencies that used the SEND protocol. METHODS: A survey was conducted and analyzed, taking advantage of a situation in which two agencies (one used SEND) fed calls to the same communication center. RESULTS: Dispatchers were more satisfied with the information gained from the feeder agency that used the SEND protocol and believed that the officers and dispatchers of that agency had a far better understanding of the emergency medical dispatcher's needs. CONCLUSIONS: When the emergency medical dispatcher does not talk directly with the reporting scene personnel or caller, Medical Miranda increases the usefulness of the information the dispatcher receives, helps the dispatcher better understand the reported medical emergency, and improves response appropriateness in emergency medical service (EMS) systems where responses routinely are prioritized.

Attitude of Health Personnel↗

PubMed2000

[Undergraduate medical education. Students' perspective and medical school policy].

OBJECTIVES: Student attendance to lectures in French medical schools is often poor. We surveyed undergraduate medical students in our medical school, repeating a similar survey conducted ten years earlier. The results are presented with the conclusions of the faculty seminar that followed this survey. METHODS: A closed item questionnaire was distributed in June, 1998, through the hospital wards where the students were posted. After two reminders, the final response rate was 71% (247/348). RESULTS: Overall, 71% of the students declared that they never, or only occasionally, attended lectures in the medical school. Reasons included lack of time (75%), the curriculum diverging from the program of the selective examination that gives access to graduate specialization programs (59%), or insufficient practical clinical content (36%); 46% believed that this teaching prepared them to practice family medicine (11% some specially), and 92% that the way it was organized was not compatible with preparing for the selective examination. On the other hand, 75% of the students in the final two years of the curriculum declared that attending regularly special preparation seminars for the selective examination, to succeed at this test (91%), but also to prepare for family practice (25%). Respectively, 75%, 68% and 66% declared that undergraduate medical courses should, ideally, prepare them for the selective examination, but also for the practice of family medicine, and for graduate medical education. CONCLUSIONS: These results echoed the difficulties of the faculty of the medical school to reconcile preparing students both for their future medical practice and for the selective examination. Two working groups were asked to identify independently appropriate educational objectives according to each perspective: their conclusions appeared to be quite compatible. Based on these conclusions, institutional objectives were ratified to guide the educational policy of our medical school, including the following: to reinforce the consistency and progressiveness of the curriculum; to promote active and autonomous student learning approaches; to develop faculty teaching skills, curriculum evaluation and recognition of teaching activities.

Curriculum↗

PubMed2001

Trends in medical specialty choice among Israeli medical graduates, 1980-1995.

BACKGROUND: Which medical specialties do Israeli medical graduates choose? Answers to this question can serve as an essential means of evaluating both Israeli medical education and the healthcare system. OBJECTIVES: To determine the distribution of medical specialty choice, its change over time and the possible influence of the medical school on the choice; to study the graduates' gender, gender variability in specialty choice and time trends in both; and to assess the choice of family medicine as a career among the graduates as a group, by medical school, gender, and time trends. METHODS: The study population comprised all graduates of the four medical schools in Israel during 16 years: 1980-1995 inclusive. Data were obtained from the four medical schools, the Israel Medical Association's Scientific Council, and the Ministry of Health. Data allowed for correct identification of two-thirds of the graduates. RESULTS: A total of 4,578 physicians graduated during this period. There was a significant growth trend in the proportion of women graduates from 22.6% in 1980 (lowest: 20.0% in 1981) to 35.3 in 1995 (highest: 41.5% in 1991). Overall, 3,063 physicians (66.8%) started residency and 1,714 (37.4%) became specialists. The four most popular residencies were internal medicine, pediatrics, obstetrics and gynecology, and family medicine. Ten percent of Israeli graduates choose family medicine. CONCLUSIONS: The overall class size in Israel was stable at a time of considerable population change. Women's place in Israeli medicine is undergoing significant change. Family medicine is one of the four most popular residencies. A monitoring system for MSC in Israel is imperative.

Career Choice↗

PubMed2003

Medical informatics and the quality of health: new approaches to support patient care - findings from the IMIA Yearbook of Medical Informatics 2003.

OBJECTIVES: The Yearbook of Medical Informatics is published annually by the International Medical Informatics Association (IMIA) and contains a selection of excellent papers on medical informatics research which have been recently published (http://www. yearbook.uni-hd.de). The 2003 Yearbook of Medical Informatics took as its theme the role of medical informatics for the quality of health care. In this paper, we will discuss challenges for health care, and the lessons learned from editing IMIA Yearbook 2003. RESULTS AND CONCLUSIONS: Modern information processing methodology and information and communication technology have strongly influenced our societies and health care. As a consequence of this, medical informatics as a discipline has taken a leading role in the further development of health care. This involves developing information systems that enhance opportunities for global access to health services and medical knowledge. Informatics methodology and technology will facilitate high quality of care in aging societies, and will decrease the possibilities of health care errors. It will also enable the dissemination of the latest medical and health information on the web to consumers and health care providers alike. The selected papers of the IMIA Yearbook 2003 present clear examples and future challenges, and they highlight how various sub-disciplines of medical informatics can contribute to this.

Delivery of Health Care↗

PubMed2006

Medical error management and the role of information technology--a new approach to investigating medical handover in acute care settings.

While identifying reasons why medical errors occur and constructing models of how to manage them has proved relatively straightforward, implementing and meaningfully evaluating solutions in 'real-world' settings has proven considerably more difficult. From an information systems (IS) perspective, although the promise of technology remains powerful, the continuing high incidence of medical errors suggest that eHealth approaches are struggling to acquire a clear understanding of the complex, dynamic and multi-layered nature of acute care settings and clinical practices, and to respond effectively to address the range of errors that actually occur. Using medical handover as a field-site, this research-in-progress paper presents an adaptation of James Reason's 'Swiss Cheese Model' to conceptualize the complex factors at play in medical errors in terms of human, system and informational elements. This research paper then examines how drawing on this model it is possible to generate and implement a methodological approach that both enhances a holistic understanding of medical error management and illuminates criteria that can be used to meaningfully identify an appropriate role for information technology in medical error mitigation. This research-in-progress paper aims to make a significant contribution to research into medical error management in 'real-world' acute care settings. This research is part of a bigger project that aims to develop, implement and evaluate an information technology artefact as part of an holistic information systems approach to improving medical error management at medical handover.

Continuity of Patient Care↗

PubMed1980

[Medical ethics and politics - one aspect of the history of medical ethics].

Medical ethics became a medical topic of its own in the 16th and 17th centuries as a part of what could be called "public medicine". They served the interests of University-trained doctors by strenghthening their autonomy and by submitting their rivals to medical control. The patients' interests are considered more or less identical with the doctor's. Towards the 19th century an ideologization of medical ethics is observable which has partly been responsible for the inhumane ethical concepts of certain of the 20th century collectivists as well as for certain inhumanities within individualistic ethics of our times and regions. When these ideologies became problematic the question of the relation between patient's and doctor's interests arose. For this and other reasons medical ethics have been rethought in the 60s of the present century. Increased attention has been paid to the realm of non-standardizable ethical behaviour. Thus "situation ethics" were conceived - and, more recently, "communication ethics" which arises from social interchange. Where his own interests are concerned, these ethical concepts require the doctor, not to pursue or deny them but simply to be aware of and to discuss them openly. The practical equivalent of communication ethics is the doctor's dialogue with a patient who personally looks after his own interests, as well as ethical commissions and interdisciplinary symposia on medical ethics. Thus medical ethics are again part of a "public medicine". This development is congruent with the interests of the medical profession insofar as this profession and its concepts have been severely criticized in the last twenty years - an open discussion of medical ethics might contribute to medicine's equilibrium.

Ethics, Medical↗

PubMed2007

The anatomy demonstrator of the future: an examination of the role of the medically-qualified anatomy demonstrator in the context of tomorrow's doctors and modernizing medical careers.

In 1993, the UK General Medical Council published Tomorrow's Doctors leading to a nationwide restructuring of undergraduate medical courses. Traditional courses with distinct pre-clinical and clinical phases gave way to a more integrated approach to undergraduate medical education, with an emphasis on the quality and variety of teaching provided. More than a decade after Tomorrow's Doctors, postgraduate medical training is being transformed. Modernising Medical Careers is leading to the introduction of a two-year Foundation Programme, with subsequent streamlined specialist training. In the context of these changes, we consider how the creation of posts for medically-qualified anatomy demonstrators would present an opportunity to fulfil needs in both undergraduate education and postgraduate training. We outline the threats facing established posts, and how these problems may be resolved. We hope that this overview of the challenges facing undergraduate and postgraduate education in the UK, with particular reference to anatomy, may offer some useful insight to teachers and learners in other countries. We conclude that the role of the medically-qualified anatomy demonstrator has proved valuable in the context of Tomorrow's Doctors, and that this role can evolve and expand as part of the 21st century "modern medical career."

Anatomy↗

PubMed1997

Are fourth-year medical students effective teachers of the physical examination to first-year medical students?

OBJECTIVE: To determine if fourth-year medical students are as effective as faculty in teaching the physical examination to first-year medical students. DESIGN: Stratified randomization of the first-year students. SETTING: A public medical school. PARTICIPANTS: All 100 first-year medical students in one medical school class were randomly assigned (controlling for gender) to either a faculty or a fourth-year student preceptor for the Physical Examination Module. MAIN RESULTS: The first-year students of faculty preceptors scored no differently on the written examination than the students of the fourth-year medical student preceptors (82.8% vs 80.3%, p = .09) and no differently on a standardized patient practical examination (95.5% vs 95.4%, p = .92). Also, the first-year students rated the two groups of preceptors similarly on an evaluation form, with faculty rated higher on six items and the student preceptors rated higher on six items (all p > .10). The fourth-year student preceptors rated the experience favorably. CONCLUSIONS: Fourth-year medical students were as successful as faculty in teaching first-year medical students the physical examination as measured by first-year student's performances on objective measures and ratings of teaching effectiveness.

Adult↗

PubMedDate not supplied

Medical student illness and impairment: a vignette-based survey study involving 955 students at 9 medical schools.

BACKGROUND: Physician impairment is defined by the presence of a physical, mental, or substance-related disorder that interferes with the ability to practice medicine competently and safely. The seeds of impairment may be sown early in adulthood, and medical students experience health issues that may receive insufficient attention in the context of a rigorous training period. Few empirical studies have examined the attitudes of medical students toward recognizing and acting upon signs of potentially impairing illnesses in peers. METHOD: Medical students at 9 medical schools were invited to participate in a written survey exploring personal health care issues during training. As part of this larger project, students were asked to imagine their response in 3 situations to a medical student who is discovered to have serious symptoms and potential impairment secondary to mental illness, substance abuse, or diabetes. RESULTS: Responses were gathered from 955 students (52% overall response rate). For all of the vignettes, "tell no one but encourage him/her to seek professional help" was the most prevalent reaction (45%, 53%, and 49%, respectively) as opposed to seek advice (37%, 35%, and 42%) and notify the Dean's office (18%, 12%, and 9%). Willingness to report varied by school, and women were somewhat less likely to formally report medical student illness. CONCLUSION: This study suggests that medical students attach great importance to preserving the confidentiality of fellow medical students who may experience even very severe symptoms. This pattern may have important implications for the early recognition and treatment of potentially impairing disorders. Greater attention to these issues may help assure the health of early career physicians as well as the many patients whose safety and well-being are entrusted to their care.

Disability Evaluation↗

PubMed2003

Incidence of and sequels to medical problems discovered in medical students during study-related activities.

PURPOSE: Students often act as subjects during practical and clinical skills training sessions. This routine seems to be quite acceptable for them but may present side-effects. Disorders, sometimes of a serious nature, have been discovered in medical students during clinical skills training. Because the incidence of and sequels to medical problems discovered in medical students during study-related activities are unknown, we carried out an explorative study. METHODS: An anonymous questionnaire was administered to 1132 students (85%) in our medical school. RESULTS: A total of 740 students (65% response rate) returned the questionnaire. Of them 124 (16.8% of respondents) reported 139 incidents. The estimated incidence was 1.5% per year. In 63 cases (45%) the diagnosis of a consulted doctor was known. Pathology (e.g. a ventricular septal defect) was revealed in 30 students (21%), a normal physiological variation (e.g. a functional cardiac murmur) in 22 (16%) and no abnormality was found in 11 (8%). Most of the incidents (65%) occurred during clinical skills training. The incidents were experienced negatively by 35% of the students. CONCLUSION: Based on these findings, we estimate the incidence of medical problems discovered in medical students during study-related activities to be 1.5%. This and the moral and legal implications emphasise that every medical school should realise the possibility of consequences. In our opinion, this realisation should result, minimally, in the development of a protocol for students and faculty that outlines procedures for handling such incidents. Information should also be provided explaining these possible side-effects of medical education.

Adaptation, Psychological↗

PubMed1990

The association between students' research involvement in medical school and their postgraduate medical activities.

The authors examined the impact of students' research involvement during medical school on their postresidency medical activities. The three medical schools involved--The Pennsylvania State University College of Medicine (PSU), The University of Connecticut School of Medicine (UCONN), and The University of Massachusetts Medical School (UMASS)--have nearly indistinguishable applicant, matriculant, and curriculum profiles. However, at PSU a research project is a curriculum requirement for students who did not do medical research prior to entering medical school. Questionnaires were sent to all graduates from the classes of 1980, 1981, and 1982. A total of 567 graduates completed the questionnaires, an overall response rate of approximately 76%. Medical school research experience was reported by 83% (183) of the PSU graduates, 34% (52) of the UCONN graduates, and 28% (54) of the UMASS graduates. When compared on a school-by-school basis, the graduates from the three schools did not differ with respect to residency specialty training, fellowship training, academic appointments, career practice choices, or postgraduate research involvement. However, when all the graduates studied were examined as a single group, medical school research experience was found to be strongly associated with postgraduate research involvement.

Academic Medical Centers↗

PubMed2004

Use of and attitudes to a hospital information system by medical secretaries, nurses and physicians deprived of the paper-based medical record: a case report.

BACKGROUND: Most hospitals keep and update their paper-based medical records after introducing an electronic medical record or a hospital information system (HIS). This case report describes a HIS in a hospital where the paper-based medical records are scanned and eliminated. To evaluate the HIS comprehensively, the perspectives of medical secretaries and nurses are described as well as that of physicians. METHODS: We have used questionnaires and interviews to assess and compare frequency of use of the HIS for essential tasks, task performance and user satisfaction among medical secretaries, nurses and physicians. RESULTS: The medical secretaries use the HIS much more than the nurses and the physicians, and they consider that the electronic HIS greatly has simplified their work. The work of nurses and physicians has also become simplified, but they find less satisfaction with the system, particularly with the use of scanned document images. CONCLUSIONS: Although the basis for reference is limited, the results support the assertion that replacing the paper-based medical record primarily benefits the medical secretaries, and to a lesser degree the nurses and the physicians. The varying results in the different employee groups emphasize the need for a multidisciplinary approach when evaluating a HIS.

Attitude of Health Personnel↗

PubMed2004

Basic medical science education must include medical informatics.

Medical Informatics is the science and art of processing medical information. In this age of "Information Explosion" choosing the useful one is rather difficult, and there lies the scope of electronic database management. However, still many outstanding personnel related to the healthcare sector take pride in being "computer illiterate". The onus of the best use lies on the end-user health care providers only. Another term tele-health encompasses all the e-health and telemedicine services. Computer aided or assisted learning (CAL) is a computer based tutorial method that uses the computer to pose questions, provide remedial information and chart a student through a course. Now the emphasis in medical education, is on problem based learning (PBL) and there CAL could be of utmost help if used judiciously. Basic Medical Education and Research lays the foundation for advancing and applying proper healthcare delivery systems. There is no doubt that deep knowledge of anatomy is mandatory for successful surgery. Also, comprehensive knowledge of physiology is essential for grasping the principles of pathology and pharmacology adequately, to avoid incorrect and inadequate practice of medicine. Similarly, medical informatics is not just a subject to be learnt and forgotten after the first professional MBBS examination. The final aim of every student should not only be to become a good user but also an expert for advancing medical knowledge base through medical informatics. In view of the fast changing world of medical informatics, it is of utmost necessity to formulate a flexible syllabus rather than a rigid one.

Education, Medical↗

PubMed1987