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At least 613 records · Page 34Linked to original sources

PubMed2002

Can a pain management and palliative care curriculum improve the opioid prescribing practices of medical residents?

BACKGROUND: Although opioids are central to acute pain management, numerous studies have shown that many physicians prescribe them incorrectly, resulting in inadequate pain management and side effects. We assessed whether a case-based palliative medicine curriculum could improve medical house staff opioid prescribing practices. DESIGN: Prospective chart review of consecutive pharmacy and billing records of patients who received an opioid during hospitalization before and after the implementation of a curricular intervention, consisting of 10 one-hour case-based modules, including 2 pain management seminars. MEASUREMENTS: Consecutive pharmacy and billing records of patients who were cared for by medical residents (n = 733) and a comparison group of neurology and rehabilitative medicine patients (n = 273) that received an opioid during hospitalization in 8-month periods before (1/1/97 to 4/30/97) and after (1/1/99 to 4/30/99) the implementation of the curriculum on the medical service were reviewed. Three outcomes were measured: 1) percent of opioid orders for meperidine; 2) percent of opioid orders with concomminant bowel regimen; and 3) percent of opioid orders using adjuvant nonsteroidal anti-inflammatory drugs (NSAIDs). MAIN RESULTS: The percentage of patients receiving meperidine decreased in the study group, but not in the comparison group. The percentages receiving NSAIDs and bowel medications increased in both groups. In multivariate logistic models controlling for age and race, the odds of an experimental group patient receiving meperidine in the post-period decreased to 0.55 (95% confidence interval [95% CI], 0.32 to 0.96), while the odds of receiving a bowel medication or NSAID increased to 1.48 (95% CI, 1.07 to 2.03) and 1.53 (95% CI, 1.01 to 2.32), respectively. In the comparison group models, the odds of receiving a NSAID in the post-period increased significantly to 2.27 (95% CI, 1.10 to 4.67), but the odds of receiving a bowel medication (0.45; 95% CI, 0.74 to 2.00) or meperidine (0.85; 95% CI, 0.51 to 2.30) were not significantly different from baseline. CONCLUSIONS: This palliative care curriculum was associated with a sustained (>6 months) improvement in medical residents' opioid prescribing practices. Further research is needed to understand the changes that occurred and how they can be translated into improved patient outcomes.

Aged↗

PubMed2003

Improving the physical diagnosis skills of third-year medical students: a controlled trial of a literature-based curriculum.

OBJECTIVE: To determine if a literature-based physical diagnosis curriculum could improve student knowledge, skill, and self-confidence in physical diagnosis. DESIGN: Prospective controlled trial of an educational intervention. SETTING: Required internal medicine clerkship for third-year medical students at Brown Medical School. PARTICIPANTS: Third-year medical students who completed the internal medicine clerkship during the academic year 1999-2000: 32 students at 1 clerkship site received the intervention; a total of 50 students at 3 other clerkship sites served as controls. INTERVENTION: Physical diagnosis curriculum based on 8 articles from the Journal of the American Medical Association's Rational Clinical Examination series. Intervention students met weekly for 1 hour with a preceptor to review each article, discuss the sensitivity and specificity of the maneuvers and findings, and practice the techniques with an inpatient who agreed to be visited and examined. MEASUREMENTS AND MAIN RESULTS: Physical diagnosis knowledge for the 8 topics was evaluated using a 22-item multiple choice question quiz, skill was evaluated using trained evaluators, and self-confidence was assessed using an end-of-clerkship survey. Intervention students scored significantly higher than the control group on the knowledge quiz (mean correct score 70% vs 63%, P =.002), skills assessment (mean correct score 90% vs 54%, P <.001), and self-confidence score (mean total score 40 vs 35, P =.003), and they expressed greater satisfaction with the physical diagnosis teaching they received in the clerkship. CONCLUSION: This physical diagnosis curriculum was successful in improving students' knowledge, skill, and self-confidence in physical diagnosis.

Clinical Clerkship↗

PubMedDate not supplied

Assessment of AACN baccalaureate nursing education curriculum model in the People's Republic of China: a transcultural exploratory study.

This study examines the relevance of The Essentials of Baccalaureate Education for Professional Nursing Practice (American Association of Colleges of Nursing, 1998) to baccalaureate nursing curriculum development in the People's Republic of China. A Likert-type survey was developed to measure Chinese nurse educators' perceptions regarding the 21 key concepts extracted from The Essentials document in both the present curriculum and an ideal curriculum across three dimensions: importance, cultural relevance, and extent of exposure. Surveys were sent to all known baccalaureate nursing programs in China (N = 22) with a 50 percent return rate. Descriptive statistical analyses supported the universality of the majority of the 21 key concepts from The Essentials document. Some of the concepts, however, were not as readily transferable because of differences in the Chinese sociopolitical and cultural contexts for baccalaureate nursing education. Findings from this study lend support for the potential global relevance of The Essentials document. Additional transcultural and comparative studies are recommended to further test the relevance of The Essentials document in other cultures. Meanwhile, international nurse educators need to be aware of the possible limits of adopting The Essentials document without values clarification, critical discrimination, and adaptation to their home cultures.

Attitude↗

PubMedDate not supplied

Achieving quality care at the end of life: a focus of the End-of-Life Nursing Education Consortium (ELNEC) curriculum.

This article introduces the didactic content and teaching strategies presented in the End of Life Nursing Education Consortium (ELNEC) curriculum on the topic of "Achieving Quality Care at the End of Life." The American Association of Colleges of Nursing joined forces with the City of Hope National Medical Center to begin a national education initiative, entitled the, "End of Life Nursing Education Consortium" (ELNEC) (available: http://www.aacn.nche.edu/elnec/). Funded for nearly $3 million from the Robert Wood Johnson Foundation, ELNEC was launched in February 2000 as a consortium of many organizations to ensure a collective professional approach to improve end-of-life care. The ELNEC curriculum is a train the trainers course with the expectation that those trained in the ELNEC curriculum will disseminate knowledge related to end-of-life care.

Curriculum↗

PubMed2000

Bioscience in the pre-registration curriculum: finding the right teaching strategy.

With the transition of pre-registration nursing programmes into higher education, a disproportionate number of problems have arisen in relation to the bioscience component of the curriculum. Therefore, a survey was undertaken to obtain the views of students (n = 294) and staff (n = 57) to identify effective teaching strategies to facilitate students' learning and understanding of this difficult area of the curriculum. In contrast to the staff, the majority of students found all three teaching strategies (lectures, tutorials and laboratory sessions) of approximately equal value to their learning and practice. Our findings suggest that students' problems with the biosciences could be ameliorated by adjustments in curriculum apportionment. Our data would support the continuation of lead lectures and laboratory work in bioscience. However, a tutorial system, specifically designed to overcome the particular difficulties experienced by nursing students in this area, is needed. This should augment, not replace, lectures and teaching laboratories. There was little indication that such a redistribution of resources would be favoured by the majority of the staff.

Attitude of Health Personnel↗

PubMed2000

The place of nursing history in an undergraduate curriculum.

It has been stated that the history of nursing is, in itself, a suitable subject for research (Maggs 1996) but that historians of nursing have looked to the broader social sciences for their frame of reference. Over the past decade or more there has been debate as to the purposes of nursing history and its relevance to the education of modern nurses and to practice. There is also discussion as to the contribution nursing history has, or could, make to nursing theory and its development. Nursing history has been part of nursing curricula for many years in some shape or form, with variation in its timing, structure, content and the emphasis and importance placed on it by nurse educators. We have recently reintroduced nursing history to the curriculum in the form of a stand alone course. The aim of this paper is to describe the formal reintroduction of nursing history into the curriculum and its place in a newly developed honours undergraduate programme. A review of the literature will be undertaken which will outline the main areas of importance. The review will be followed by a discussion of the history of nursing course and its inception. Using points identified in the literature, the rationale for content and structure are made and the integration of history with theoretical and practical aspects of nursing is explained. The impact of the supporting sciences, both physical and behavioural, and issues surrounding students efforts to reconcile the art and science of nursing are analysed. The introduction has posed questions which are currently being addressed and changes will be made for the new academic year.This supports the philosophy of the Nursing & Midwifery School that history has relevance to the education of nurses and therefore a significant place in the curriculum.

Curriculum↗

PubMed2001

Principles in practice: an Australian initiative in nursing curriculum development.

This paper explains how curriculum values distilled from educational and nursing literature have been incorporated into a new bachelor of nursing program in an Australian University. The curriculum philosophy has been constructed to acknowledge the current learning climate and diverse learning styles, the active role teachers must play in developing competent nurses and critical thinkers, as well as the need to celebrate nursing's diversity whilst building a strong identity. The philosophy of this new curriculum is to reclaim the human dimension of nursing and inject renewed vigour and enthusiasm into the work of teachers and students.

Curriculum↗

PubMed2002

[Interdisciplinary longitudinal curriculum "Medical psychology, psychotherapy and psychosomatics" (MPPP) at the University of Ulm].

We report the clinical part of the longitudinal curriculum MPPP which was developed by the departments of Medical Psychology, Psychotherapy and Psychosomatic Medicine at the University of Ulm. The commitment and creativity of the participating students in their two undergraduate years inspired us to offer them an interest-guided curriculum for their six clinical semesters. Our paper reports the extensive results of two evaluations that we conducted during the clinical part of this new teaching-model. It became evident that we were successful in transferring continuous, intense and patient-centred psychosomatic and psychosocial contents. Yet the transfer of basic and methodological knowledge was not realised to the extent the students would have appreciated. The positive results of our project encouraged us to expand the concept of an interest-guided curriculum onto the whole academic education in psychotherapy and psychosomatic medicine at our university.

Curriculum↗

PubMed2006

Evaluation of the Outreach School Garden Project: building the capacity of two Indigenous remote school communities to integrate nutrition into the core school curriculum.

ISSUE ADDRESSED: This paper describes the Outreach School Garden Project, which was conducted in two remote Indigenous school communities in north-west Queensland. This project integrated nutrition into the key learning areas of the core school curriculum by using a school-based garden as a nutritional education tool. METHODS: Evaluation was by a descriptive qualitative approach supplemented by some quantitative data consistent with Indigenous research methods. The objectives were linked to the Health Promoting Schools Framework, using concepts of community capacity building, action research, social capital and experiential learning. RESULTS: Nutrition was extensively integrated into the core school curriculum by the teaching staff, who required no specific nutrition knowledge or gardening skills prior to the implementation. Students' knowledge and skills in nutrition and gardening were increased over the six-month period and positive improvements in the physical and social environment at the school were observed. CONCLUSION: A school-based nutrition garden enables the teaching and learning of basic nutrition through the core school curriculum. This concept was an innovative, practical nutritional education tool to engage and build the capacity of Indigenous students, school staff and the broader community in nutrition.

Community-Institutional Relations↗

PubMed1998

Curriculum design for professional development in public health nutrition in Britain.

OBJECTIVES: To describe how the Nutrition Society developed public health nutrition as a profession between 1992 and 1997, and to analyse the influences propelling on this professionalization. DESIGN: Qualitative case study. SETTING: Britain. RESULTS: The Nutrition Society of Britain consulted with various stakeholders (such as dietitians, researchers, professionals and practitioners and educators from the UK, and latterly from mainland Europe) to build a consensus about the definition, roles and functions of public health nutritionists and the need for, and scope of, this new profession. Building on this consensus, the Society developed a curriculum in line with British national nutrition policy. Analysis shows that the design and philosophy of the curriculum is explicitly international and European in orientation, in keeping with the tradition of the discipline and the Society. The curriculum is designed in terms of specialist competencies in public health nutrition, defining competency so that registered public health nutritionists are advanced practitioners or leaders: this is in keeping with contemporary trends in professional education generally and as expressed by the UNU/IUNS and at Bellagio, in nutrition in particular. CONCLUSIONS: Despite a unique relationship with British state and policy, this case of professionalization contributes to contemporary international inter- and intraprofessional debates about the nature of public health nutrition and is consistent with professional educational theory.

Curriculum↗

PubMed2002

WebCT: integrating computer-mediated communication and resource delivery into a new problem-based curriculum.

WebCT, front-end software for Internet-delivered material, became an integral part of a problem-based learning, student-centred curriculum introduced in January 2001 at the Nelson R. Mandela School of Medicine (South Africa). A template for six curriculum and two supplementary modules was developed. Organiser and Tool pages were added and files uploaded as each module progressed. This study provides feedback from students with regard to the value of WebCT in their curriculum, as well as discussing the value of WebCT for the delivery of digitized material (e.g., images, videos, PowerPoint presentations). In an anonymous survey following the completion of the first module, students, apparently irrespective of their level of computer literacy, responded positively to the communication facility between staff and students and amongst students, the resources and the URLs. Based on these preliminary responses, WebCT courses for all six modules were developed during 2001. With Faculty support, WebCT will probably be integrated into the rest of the MBChB programme. It will be particularly useful when students are off campus, undertaking electives and community service in the later years.

Computer-Assisted Instruction↗

PubMed2004

Curriculum and assessment in higher specialist training.

Higher Specialist Training (HST) has been radically reformed in the last decade, and specialties have been urged to conduct further reform. This paper reports on an explorative investigation into curriculum provision and assessment within four specialties in the West Midlands. Methods include analysis of curriculum documents; observation of the RITA process; and interviews with consultants (4), specialist registrars (5) and members of the regional higher specialist training management team (3). Three major themes identified within the interviews are discussed: the content and use of the curriculum; the impact of service-based learning; and issues around assessment.

Certification↗

PubMed2004

A systematic review of teaching and learning in palliative care within the medical undergraduate curriculum.

End of life care or palliative care has been acknowledged as important over the last 30 years and it is essential that doctors have core training in palliative care during their undergraduate training. There is little knowledge of the nature of teaching of palliative care within the undergraduate curriculum. This review was undertaken to determine the evidence to create an effective and appropriate undergraduate curriculum in palliative care. All relevant databases were electronically searched from 1966 until 2001 and selected contemporary work included. Key authors were contacted and grey literature and conference abstracts were searched. Efforts were made to quality grade any evaluation studies of teaching, learning and assessment. Two hundred and eighty abstract citations were obtained--192 papers were excluded due to lack of relevance to this study. Eighty-eight abstracts were obtained and forty-nine papers included in the review. There were no randomized controlled trials of educational interventions or open effect studies. All studies included were descriptive and were graded as level of evidence C. The main findings include lack of consistency in what undergraduates are taught about palliative care. Teaching tends to be fragmented, ad hoc and lacks co-ordination. There are difficulties in recruiting appropriate teachers. Palliative care is rarely formally assessed. Teaching focused more on the acquisition of knowledge and skills rather than attitudes. It is suggested that guidelines should be established within each medical school to develop an integrated curriculum for palliative care with due reference to the multidisciplinary nature of palliative care.

Curriculum↗

PubMed2005

The elusive content of the medical-school curriculum: a method to the madness.

A major problem for curriculum and course planners is coping simultaneously with the expanding knowledge base and having less time to teach. A widely used solution is to include huge amounts of information in the curriculum. A better solution is to identify a manageable core of relevant knowledge. One way is to begin with program goals and systematically identify content with increasing specificity that would be needed to achieve those goals. Another is the empirical determination of content, which has not been widely attempted. These studies would include experiments and practice analyses. There is a need to mount greater and more rigorous efforts to help advance the scholarship and to provide useful information to curriculum planners. Large-scale, multi-site studies that compare the results from various methods and from different sources will be more useful to medical education generally. In these days of exploding information and technology and greater understanding of how people learn, more than ever, efforts need to be focused on finding the very specific content that will result in the best learning for our students.

Curriculum↗

PubMed2006

Basic life support skills training in a first year medical curriculum: six years' experience with two cognitive-constructivist designs.

RATIONALE: Although the Basic Life Support (BLS) ability of a medical student is a crucial competence, poor BLS training programs have been documented worldwide. Better training designs are needed. This study aims to share detailed descriptions and the test results of two cognitive-constructivist training models for the BLS skills in the first year of medical curriculum. METHOD: A BLS skills training module was implemented in the first year curriculum in the course of 6 years (1997-2003). The content was derived from the European Resuscitation Council Guidelines. Initially, a competence-based model was used and was upgraded to a cognitive apprenticeship model in 2000. The main performance-content type that was expected at the end of the course was: competent application of BLS procedures on manikins and peers at an OSCE as well as 60% achievement in a test consisting of 25 MCQ items. A retrospective cohort survey design using exam results and a self-completed anonymous student ratings' questionnaire were used in order to test models. RESULTS: Training time for individual students varied from 21 to 29 hours. One thousand seven hundred and sixty students were trained. Fail rates were very low (1.0-2.2%). The students were highly satisfied with the module during the 6 years. CONCLUSION: In the first year of the medical curriculum, a competence-based or cognitive apprenticeship model using cognitive-constructivist designs of skills training with 9 hours theoretical and 12-20 hours long practical sessions took place in groups of 12-17 students; medical students reached a degree of competence to sufficiently perform BLS skills on the manikins and their peers. The cognitive-constructivist designs for skills training are associated with high student satisfaction. However, the lack of controls limits the extrapolation of this conclusion.

Clinical Competence↗

PubMed2006

Preparation for clinical practice: a survey of medical students' and graduates' perceptions of the effectiveness of their medical school curriculum.

This paper describes the perceptions of students and graduates of the Hebrew University-Hadassah medical school in Israel regarding the effectiveness of their medical education in preparing them for work in the clinical setting. The six-year curriculum consists of three years of mainly lecture-based Basic Science courses, and three years of clinical education, consisting of clinical clerkship rotations of various lengths. An anonymous questionnaire containing 114 items was distributed to 294 students (in their clinical years) and 500 graduates of the faculty. A total of 371 respondents completed the questionnaire (response rate 49%). Overall 60% of the respondents were generally satisfied with the medical training they received. However, respondents indicated many deficiencies in the curriculum, and in their competences. More than half of the respondents felt that Basic Science courses lacked clinical relevance. Almost 40% of the respondents reported that students were not taught sufficient clinical skills in preparations for clinical practice. At least 50% of the respondents reported that they had not received adequate exposure to 26 out of the 36 important clinical activities and skills during clerkships. Only 33% of the respondents agreed that the fundamental knowledge, skills, attitudes and values that medical students should possess at the time of graduation were made explicitly clear to them. Perspectives of students and graduates were compared. In many questions significantly more graduates tended to rate their learning experience better than students. This study illuminates many aspects of the curriculum the faculty needs to address in order to prepare physicians effectively and efficiently for clinical work. It also stresses the need to integrate better preclinical and clinical studies, and to change to active learning methods. This study demonstrates the necessity of gathering information from students and graduates to evaluate their medical education experience.

Biomedical Research↗

PubMed2004

Development of the European Colposcopy Core Curriculum: use of the Delphi technique.

The objective of this study was to develop a European competence-based colposcopy core curriculum using the Delphi technique. Thirty expert colposcopists from 21 countries participated. A four-round iterative questionnaire was used. Competencies were rated using a five-point Likert scale. Competences rated as 4 or more by at least 90% of the respondents were regarded as necessary for the core curriculum. Eighteen participants took part in all four rounds, and 27 were active in each of the last three rounds. Fifty-one core competences were selected from a list of 76 competences collated by the group as a whole. The majority (n = 44) of the selected core competences received a score of 4 or greater in each round. Overall, there was some evidence of increasing consensus but the individual shift in opinion was slight. The Delphi technique was an effective tool for obtaining an expert consensus and enabled group "ownership" of the identified core curriculum.

Clinical Competence↗

PubMed1990

An analysis of the PPCF as a theoretical framework for an instrument to examine teacher priorities for selecting curriculum content.

The purpose of the research was to develop an instrument to examine physical education teachers' priorities for curricular decision-making. The purpose dimension of the Purpose Process Curriculum Framework (PPCF) was used as the theoretical structure for content decisions. Three studies are reported that investigate the reliability and validity of the proposed instrument. Items were evaluated for relevance and validity of the proposed instrument. They were evaluated for relevance and theoretical consistency by physical education teachers (Study 1) and curriculum specialists (Study 2). Acceptable items were then placed in a ranking format and field tested with physical educators in three school districts (Study 3). Results from Study 1 indicated that secondary level physical education teachers supported the relevance of items to reflect the educational setting in their classes. In Study 2, mean ratings of curriculum specialists established that 19 of the 22 categories were theoretically consistent with the PPCF. However, internal consistency coefficients (alpha) for 10 of the 22 purposes were less than .70. Follow-up field tests with physical educators in Study 3 indicated that only one category, joy of movement, had a coefficient above .70. In this research internal consistency coefficients were too low to make a claim for the reliability of the concept scales of the instrument. The multidimensionality of the purpose concepts raised questions regarding the validity of the PPCF and prohibited the use of the framework as a theoretical basis for instrument development.

Curriculum↗