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PubMed1987

[The need to teach research methodology in the career of medical surgeon].

A survey on the interest in doing medical research, present or previous involvement in it, and opinions on the need for a research course in the medical doctor and surgeon degree program was administered to 310 persons. The participants were divided into seven groups in accordance with their main lines of work: professors, administrative personnel, doctors at the primary, secondary and tertiary care level, residents, and medical students. The participants were in favor of research: 93.5% felt that they would have profited from a research course during their undergraduate studies and 94.8% were of the opinion that an introductory course in scientific research was needed in the graduate program; although 23.5% of the administrative personnel (a figure significantly different from the other groups, p less than 0.05) thought that the course was unnecessary. From the data obtained, the authors consider that an introductory course in scientific research should be included in the medical doctor and surgeon degree program.

Attitude of Health Personnel↗
PubMed2001

[Between metaphor and certainty: teaching an introductory course in complementary medicine].

In recent years it has been recognized that it is increasingly important to teach complementary medicine (CAM) in medical schools, residency programs and CME courses. We report our experience in teaching an elective introductory course in CAM to residents and specialists in the department of family medicine in the Bruce Rappaport Faculty of Medicine at the Technion, Haifa, Israel. Teaching four modules in CAM (herbal medicine, traditional Chinese medicine, homeopathy and nutritional medicine) during a 16-session course induced a positive change in the students attitude toward CAM and increased their interest in evidence-based CAM. In addition, the students increased their use of CAM for both themselves and their families, decreased their overall tendency to refer patients to CAM practitioners but increased their actual referral rate for patients who were considered to benefit from complementary treatment. The majority of the course participants considered teaching physicians CAM to be of great importance.

Complementary Therapies↗
PubMed1996

1996 Joseph E. Whitley, MD, Award. Evaluation of an introductory course in chest radiology.

RATIONALE AND OBJECTIVES: The author developed and evaluated the effectiveness of an educational program for teaching the fundamentals of chest radiology to radiology residents. METHODS: Nineteen radiology residents completed a course that consisted of 17 1-hour chest radiology conferences. All seven 1st-year radiology residents were required to attend every conference; more senior-level residents were encouraged to attend, but their attendance was not mandatory. All conferences were given by the same instructor with the use of a didactic slide and radiograph presentation, videotape, heart-lung model, and a 120-page syllabus. Residents were encouraged to participate in a daily quiz. Resident learning was measured by means of a pre- and postcourse examination. RESULTS: Conference attendance rate was 93% for 1st-year residents and 75% for more senior residents. Nineteen residents took both the pre- and postcourse examination; mean scores increased from 65.6% to 86.2% (P < .0001), and course evaluation scores were very positive (means ranged from 1.0 to 1.1, with 1 = very good and 5 = poor). CONCLUSION: An educational program in chest radiology was developed for residents. Both objective and subjective evaluations indicated that resident participation in the introductory chest course was an effective means of learning the basics of chest radiology. The residents were in support of making this course a required part of the residency curriculum.

Audiovisual Aids↗
PubMedDate not supplied

Preliminary investigation of a culturally specific smoking cessation intervention for Hispanic smokers.

PURPOSE: The purpose of this study was to compare a culturally specific, multicomponent behavioral smoking cessation program for Hispanic smokers with a low-intensity, enhanced self-help control condition. DESIGN: Participants who completed pretreatment assessment were randomly assigned to treatment conditions. Smoking status was evaluated at posttreatment, 6-month follow-up, and 12-month follow-up intervals. SETTING: The study was based in predominantly Hispanic neighborhoods in Queens, New York. PARTICIPANTS: Ninety-three Hispanic smokers participated: 48 men and 45 women. INTERVENTION: The multicomponent treatment involved a clinic-based group program that incorporated a culturally specific component consisting of videotaped presentations of culturally laden smoking-related vignettes. The self-help control program was enhanced by the use of an introductory group session and follow-up supportive telephone calls. MEASURES: Smoking outcomes were based on cotinine-validated abstinence and self-reported smoking rates. Predictors of abstinence were examined, including sociodemographic variables, smoking history, nicotine dependence, acculturation, partner interactions, reasons for quitting, self-efficacy, and linguistic competence. RESULTS: Significant group differences in cotinine-validated abstinence rates in favor of the multicomponent group were obtained, but only at posttreatment. With missing data included and coded for nonabstinence, validated abstinence rates at posttreatment were 21% for the multicomponent group and 6% for the self-help group. At the 6-month follow-up, the rates were 13% for the multicomponent group and 9% for the self-help group. By the 12-month follow-up, the rates declined to 8% and 7% for the multicomponent and self-help groups, respectively. A dose-response relationship between attendance at group sessions and abstinence status was shown at posttreatment and 6-month follow-up intervals. CONCLUSIONS: The results of the present study failed to show any long-term benefit from use of a clinic-based, culturally specific multicomponent smoking cessation intervention for Hispanic smokers relative to a minimal-contact, enhanced self-help control.

Adult↗
PubMed1965

ON TRAINING MEDICAL TEACHERS.

Neither clinical competence nor research skill can any longer be regarded as sufficient qualification for the role of teacher in medicine. If he is to be judged well prepared, the contemporary medical educator should be not only sufficiently familiar with educational science to plan wise educational strategy but sufficiently skilled in the use of instructional techniques to select and use sound educational tactics. His preparation for this role should be a matter of plan rather than accident. The six-week program described here is intended to provide an introductory opportunity for such training.

Clinical Competence↗
PubMed2002

Development of family medicine education in Moldova with Carelift International.

BACKGROUND: As in other former Soviet republics, Moldova's health system has been dependent upon multispecialty and hospital care. The government has undertaken a planning process to develop a primary care-based system utilizing family physicians. Carelift International and Moldova State Medical and Pharmaceutical University joined together to design an educational program to help create a family medicine specialty in the country. METHODS: Introductory concepts were incorporated into a workshop co-sponsored by the World Health Organization, Carelift International, UNICEF and Moldova Ministry of Health. Faculty teams participated in Carelift's 8-week US program, comprising a range of topics in family medicine: educational development at all levels, public health applications, health care organization, insurance, financing, and technology. Training also included 1 week in Finland, a fellowship in Lithuania, an in-country workshop on rural health, and a supplemental 5-week US immersion program. OUTCOMES: A Department of Family Medicine was established, and a residency program instituted. It has already been strengthened with a 2-week introduction to the specialty, and rotations in family practice centers. Continued improvements and updates are planned. Urban and rural model family practice centers serve concurrent purposes of teaching, demonstrating and health care. Carelift shipped equipment for the principal center and a department library, and is equipping a teaching family practice center near the university. The Society of Family Physicians of Moldova was founded. The introduction of family medicine as a discipline into the health system of Moldova could be a valuable model for other former Soviet republics.

Journal Article↗
PubMed1976

A model for the improvement of medical faculty lecturing.

The development of a program designed to improve the teaching effectiveness of faculty members of a new Introductory Psychopathology course at the University of Washington School of Medicine is described. Two consultants from the Office of Research in Medical Education worked closely with the faculty in designing the evaluation program during the preparation of the course. The literature on lecture effectiveness is reviewed, as are existing instructional evaluation instruments. The integration of this information and the needs of the involved faculty produced a lecture observation schedule designed to facilitate the observation of a lecture and the immediate feedback which followed each of the 15 lectures evaluated. The process of using this instrument to assist the faculty in self-improvement is discussed. While the specific evaluation method described may not be appropriate for all situations, it may serve as a model for the development of similar programs in other settings.

Evaluation Studies as Topic↗
PubMed1993

Medical interviewing and interpersonal skills teaching in US medical schools. Progress, problems, and promise.

OBJECTIVE: To assess educational practices, problems, and needs in the teaching of medical interviewing and interpersonal skills. DESIGN: Questionnaires sent to curricular deans and introductory course leaders at all US medical schools in 1991. RESULTS: Of 130 programs, 114 deans (88%) and 92 course directors (71%) responded. Respondents indicated some advances since a similar survey in 1977: Virtually all medical schools now offer teaching in medical interviewing and interpersonal skills. More faculty from a greater variety of disciplines are involved in this teaching. Most programs feature observation and feedback of students' interviews with patients, and use a variety of effective teaching methods, including simulated patients and role-playing, both little used in 1977. The majority of schools address students' personal growth through discussion or support groups. However, there are problems. Most schools lack a faculty development process. About half of the introductory courses on medical interviewing take place within physical diagnosis courses, often, it appears, without systematic observation, feedback, and evaluation of student skills. Many programs do not explicitly incorporate certain educational principles into their course designs. As in 1977, there appears to be little coordination or sequencing of teaching interpersonal skills throughout the curriculum in most medical schools. Most deans identified significant barriers to improving teaching. CONCLUSIONS: While a number of educational advances have occurred there is still great variation in the quality and intensity of courses offered in US medical schools. However, the pace of progress bodes well for the future.

Curriculum↗
PubMed2003

[Recommendations for cardiovascular rehabilitation in the very elderly].

Cardiac rehabilitation has gained widespread acceptance as an integral component in the management of patients with several forms of cardiac disease. Nevertheless, the benefits deriving from cardiac rehabilitation, and the most appropriate modalities of delivering this treatment, are still uncertain in patients older than 75 years who, beyond a high morbidity and mortality from ischemic heart disease, are characterized by frequent comorbidities, disability, psychological and emotional abnormalities, and cognitive impairment. All these conditions may concur to limit physical exercise capacity, are frequent causes of physical disability and deteriorated quality of life, and are a barrier to enrolling older patients into standardized rehabilitation programs. On the other hand, available evidence on cardiac rehabilitation in older patients derive from non homogeneous patient series, which are not fully representative of the average patient older than 75 years, whose peculiar clinical characteristics are largely different from those of subjects in 65-75 years age range. Therefore, the scientific community should design new strategies to promote recruitment of older individuals into cardiac rehabilitation programs. This can be attained by both spreading the results of beneficial effects of cardiac rehabilitation in advanced age and by precisely identifying the goals, as well as by defining assessment, rehabilitation and follow-up protocols targeting the peculiar characteristics of old and very old patients. This article offers a concise review of available evidence on cardiac rehabilitation in older patients, and a series of recommendations that may be useful in the clinical practice. In the first, introductory section, we describe the main components of comprehensive, cardiac rehabilitation programs of older patients (namely: physical exercise based on both endurance and muscle strength training; the role of multidisciplinary approach integrated into a secondary prevention strategy; interventions in the emotional and cognitive domain), as they result from an extensive analysis of the literature. On this regard, attention will be put to define the specific characteristics by which reported interventions may, or may not, have conformed to the many peculiarities of older individuals. In the further section, results of cardiac rehabilitation of older patients are described organizing them according to the different outcomes attained, with illustration of the effects on cardiocirculatory response to physical exercise, quality of life, body composition, lipid profile, arterial blood pressure control, myocardial ischemia, progression of cardiac failure, neuropsychological and cognitive profile, mortality and morbidity, and cost/benefit analysis. Also in this section, particular attention will be devoted to select and illustrate those results that are most valuable in the management and care of the oldest old. General principles that, based on available evidence, should guide the design of cardiac rehabilitation programs and the prescription of exercise to older cardiac patients, will be detailed next. In particular, we will underline the key role of a comprehensive, preliminary multidimensional and multidisciplinary assessment--whose basic components will also be given in detail-, and will describe the guidelines to design the rehabilitation program, the several methods of training to be used in the different phases of the rehabilitation program, and the most valuable and correct methods to assess both short- and long-term results. The general principles of specific rehabilitation protocols that can be used in older patients will be also described. In this context, we will detail the specific goals and instruments used in the preliminary assessment of cardiocirculatory response to physical exercise, as well as of nutritional habits and nutritional status, physical status and motion capacity, neuropsychological and cognitive profile, quality of life and possible functional limitations. In the last section, educational interventions, and physical endurance and muscle strength training programs, will be described. In this description, particular attention will be devoted to the concept of tailoring the rehabilitative program to the results of preliminary assessment. Indeed, the presence of comorbidity or of significant functional limitations should imply the design of alternative rehabilitation programs, which should be based on strongly individualized modalities as well as intensity and duration of physical exercise training. In summary, this article is intended to encourage and help the cardiological community to recruit even the oldest old into cardiac rehabilitation programs, through an adjustment and individualization process of the rehabilitative pathway that should be based on the enclosed recommendations and guidelines. This could reduce the otherwise high exclusion rate of older patients, who are frequently deprived of the potential benefits from cardiac rehabilitation consisting, at least, in improved functional capacity, neuropsychological and emotional profile, and quality of life.

Aged↗
PubMedDate not supplied

Introductory small cash incentives to promote child spacing in India.

The Ammanpettai Family Welfare Program began in 1985 as a pilot program to determine whether offering small monthly cash incentives for a limited period would be a cost-effective way to increase the use of modern temporary methods of contraception among rural Indian women who do not want to become pregnant but are not ready to adopt sterilization. The program has demonstrated that a modest cash incentive for 3-5 months attracts very large numbers of women to a clinic where they learn about and are provided with the pill, condoms, or the IUD. In catchment areas where official government reports showed temporary-methods prevalence rates of 3-5 percent at best, the Ammanpettai incentive program has attracted up to 70 percent of eligible women to join the program and try the method of their choice. By requiring that participants bring their youngest child to the clinic, the program provides for mother and child health surveillance, including immunizations. The great majority of rural women who join the program work as field laborers, have little or no schooling, and have little knowledge of or experience with modern contraceptive methods. Continuation rates are 25-50 percent at one year if follow-up is maintained by village resident women distributors. The program has been extended to several rural primary health centers in Thanjavur District, to 14 government health posts in the city of Madras, and to a semiurban area and several rural areas in Bihar. The cost-effectiveness of this program compares favorably with that of the current government family welfare program.

Adult↗
PubMed1983

[Respiratory rehabilitation in the pneumology department of Iesi Hospital. Statistical findings and program considerations].

The Authors refer the results a clinical-statistical research revealing that more than one-third of the yearly admissions to the pneumological divisions of the U.H. in Jesi are represented by patients who re-enter because of COLD with R.I. at various degree. On the basis of the selective criteria which can be found in literature, it's shown that the above patients can largely take advantage of rehabilitating treatment aiming both at the functional recovery and at the prevention of relapses, with a consequent fall in hospital admissions, carrying doubtless social advantages. The Authors also assert that such a treatment, though involving an équipe-approach, must be carried out by the pneumologist as the respiratory rehabilitation is to be considered, both for its aims and its methodologies as a branch of pneumology. Starting from this introductory statement the Authors go on making consideration on regional health programming in the pneumology field, particularly the rehabilitating one.

Adult↗
PubMed2000

Correlation between the internalization theme of racial identity attitude survey-B and systolic blood pressure.

OBJECTIVES: This brief report describes our first attempts at defining relationships between racial identity attitudes as measured by the Racial Identity Attitudes Survey-B (RIAS-B) and cardiovascular responses during the presentation of stressful stimuli. DESIGN: We manipulated verbal tasks to study reactivity and derived correlation coefficients to define relationships between racial identity attitudes and cardiovascular responses. METHOD: The participants (N = 17) were African-American students participating in a summer program to enhance minority careers (N = 15) or enrolled in introductory psychology. All students held a dominant Internalization theme for racial identity as assessed by the RIAS-B. After the initial baseline, the participants responded to three verbal tasks incorporating the description of a frustrating event with racial overtones (HIAFF), a description of the furniture in their house (LOAFF) and serial digit multiplication (MATH). RESULTS: The data indicate significant correlations between the Internalization score on the RIAS-B and the systolic blood pressure (SBP) for tasks as grouped by content (HIAFF r = .60; MATH r = .55) or by sequence (TASK1 r = .53, TASK2 r = .50). There were no significant correlations between Internalization score and pulse rate or diastolic blood pressure (DBP). Students had a high incidence of a positive family history for cardiovascular diseases (70%). CONCLUSIONS: The data suggest that as identity accumulation increases, so does reactivity. Internalization and the related self-esteem that this theme might engender does not attenuate the cardiovascular stress response in African-American college students with a prevalence of a positive family history for cardiovascular disease.

Adolescent↗
PubMed1983

Immediate and prolonged effect of individual preventive measures in caries and gingivitis susceptible children.

A longitudinal study on the effect of an individualized preventive program was carried out on 10-11 year old children with higher caries and/or gingivitis prevalence than the average. The program was based on bimonthly professional toothcleaning as well as hygiene and dietary instructions. After an introductory period of 3 months the frequency of visits was individualized according to the gingival condition of the children (every 2nd to 4th week). For one group this program was supplemented by instruction in dental flossing for proximal tooth cleaning on a daily basis. The effects of the preventive measures were evaluated after an experimental 2 year period. Two years after withdrawal of the preventive measures, the longitudinal effects were recorded. In all 627 children were examined and of these 87 children were selected for the study on gingival and cariological indications. It was possible to follow 74 children throughout the 4 year period. After 2 years the number of new caries lesions was significantly reduced in the test groups as compared to the controls. The caries increment in the test group was 1.7 new surfaces per individual and in the control 4.5. The corresponding figures at the follow-up examination was 8.5 and 5.9 respectively. Thus any prolonged effect of the preventive program could not be confirmed. An improved cariological status was also recorded among the children selected on gingival indications. The increment was 0.8 in the test and 3.8 in the control group during the experimental period. The corresponding figures at the supervisory control was 1.8 and 4.6 new surfaces respectively indicating a prolonged effect among these children. The interpretation of the results from the "flossing" group was not clear-cut, since the flossing was performed unsupervised. However, no new decayed tooth surfaces were recorded in those children who had claimed that they had used floss at least every second day. The gingival situation improved in all test groups and was visible even in the follow-up study.

Child↗
PubMed2001

Parish nursing and Clinical Pastoral Education.

Parish nursing is growing within the church. Providing Clinical Pastoral Education (CPE) to parish nurses can be a rich experience for them, their congregations, and persons in leadership positions. In turn, such educational efforts can provide CPE programs with a legitimate and credible community outreach. This contribution describes a CPE Introductory Unit for parish nurses and explores its implications for the nurses, their congregations and the CPE movement.

Adult↗
PubMedDate not supplied

Recruitment strategies used by an allied health education program to increase student enrollment.

OBJECTIVE: To increase student enrollment in and public awareness of a Clinical Laboratory Science (CLS) program so that the program would not be eliminated by the University. SETTING: The Medical Technology (MT) program at the University of Delaware (UD). PRACTICE DESCRIPTION: The MT program is a 2 + 2 university-based program established in 1948. The program is accredited for 26 students. PRACTICE INNOVATIONS: Various recruitment activities were used to increase enrollment including presentation at high schools, and panel discussions and open houses held on campus. Extensive publicity on and off campus was used to inform the community about CLS. MAIN OUTCOME MEASURE: Student enrollment in the program and the results of a survey administered to students enrolled in a CLS introductory course. RESULTS: There were 22 students in the 1993-1994 graduating class compared to 10 in the 1992-1993 class. The enrollment also increased for the junior, sophomore, and freshman classes. Because of increased student enrollment and public awareness, the University decided not to eliminate the MT program. CONCLUSION: No single recruitment activity contributed to the increased numbers; rather, it appears that all of the activities contributed to the rise in enrollment of MT majors at UD.

Delaware↗
PubMed1998

Patient choice in diabetes education curriculum. Nutritional versus standard content for type 2 diabetes.

OBJECTIVE: To examine the effects of patient choice between two education curriculums that emphasized either the standard or nutritional management of type 2 diabetes on class attendance and other outcomes among a mostly Hispanic patient population. RESEARCH DESIGN AND METHODS: A total of 596 patients with type 2 diabetes were randomly assigned to either a choice or no choice condition. Patients in the choice condition were allowed to choose their curriculum, while patients in the no choice condition were randomly assigned to one of the two curriculums. Outcomes were assessed at baseline and at a 6-month follow-up. RESULTS: When given a choice, patients chose the nutrition curriculum almost four times more frequently than the standard curriculum. Contrary to our hypothesis, however, patients who had a choice did not significantly increase their attendance rates or demonstrate improvements in other diabetes outcomes compared with patients who were randomly assigned to the two curriculums. Patients in the nutrition curriculum had significantly lower serum cholesterol at a 6-month follow-up, whereas patients in the standard curriculum had significant improvements in glycemic control. Of the randomized patients, 30% never attended any classes; the most frequently cited reasons for nonattendance were socioeconomic. Hispanic patients, however, were just as likely as non-Hispanic patients to attend classes and participate at the follow-up. Patients who attended all five classes of either curriculum significantly increased their diabetes knowledge, gained less weight, and reported improved physical functioning compared with patients who did not attend any classes. CONCLUSIONS: Although providing patients with a choice in curriculums at the introductory level did not improve outcomes, differential improvements were noted between patients who attended curriculums with different content emphasis. We suggest that diabetes education programs should provide the opportunity for long-term, repetitive contacts to expand on the modest gains achieved at the introductory level, as well as provide more options to match individual needs and interests and to address socioeconomic barriers to participation.

Adult↗
PubMed1987

[Evaluation of the effectiveness of chemoradiotherapy of stage IIIA Hodgkin's disease].

A total of 106 case histories of primary patients with stage III Hodgkin's disease aged 15 and older were analyzed. The treatment consisted of 2 introductory courses of polychemotherapy after MOPP scheme followed by a radical program of radiotherapy in 2-4 weeks, resulting in 88.7% of complete remissions. The 5-year survival rate was 81.3-6.3%, a 5-year recurrence-free course was noted in 83.8-5.2%. The 5-year survival rate was significantly lower in the patients with "unfavorable" histological types (mixed cellular and lymphoid depletion). A recurrence-free course over the same period was worse in men than in women, and in the patients with 5 and more zones of involvement.

Adolescent↗