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OBJECTIVE: To determine if socioeconomic status, as measured by education level, is associated with mortality due to systemic lupus erythematosus (SLE), and to determine if these associations differ among ethnic groups. METHODS: Sex- and race-specific mortality rates due to SLE by education level were computed for persons age 25-64 years using US Multiple Causes of Death data from 1994 to 1997. SLE-specific mortality rates were compared with all-cause mortality rates in 1997 to determine if the association between education level and mortality in SLE was similar to that in other causes of death. RESULTS: Among whites, the risk of death due to SLE was significantly higher among those with lower levels of education, and the risk gradient closely paralleled the 1997 all-cause mortality risks by education level. However, in African American women and men and Asian/Pacific Islander women, the risk of death due to SLE was lower among those with lower education levels, contrary to the associations between education level and all-cause mortality in these groups. Comparing the distribution of education levels among deaths due to SLE and all deaths in 1997, persons with lower education levels were underrepresented among deaths due to SLE in African Americans and Asian/Pacific Islanders. CONCLUSION: Among whites, higher education levels are associated with lower mortality due to SLE. These associations were not present in ethnic minorities, likely due to underascertainment of deaths due to SLE in less-well educated persons. This underascertainment may be due to underreporting of SLE on death certificates, but may also represent underdiagnosis of SLE in ethnic minorities with low education levels.
A department of medical education is becoming an essential requirement for a medical school. This publication is intended for those wishing to establish or develop a medical education department. It may also prove useful to teachers in medicine by providing information on how such a department can support their activities. This will vary with the local context but the principles are generalizable. Medical education departments are established in response to increased public expectations relating to healthcare, societal trends towards increased accountability, educational developments, increased interest in what to teach and how to educate doctors and the need to train more doctors. The functions of a department of medical education include research, teaching, service provision and career development of the staff. The scope of its activities includes undergraduate and postgraduate education, continuing professional development and continuing medical education. These activities may be extended to other healthcare professions. Flexibility is the key to staffing a department of medical education. Various contractual arrangements, affiliations and support from non-affiliated personnel are needed to provide a multi-professional team with a range of expertise. The precise structure of the department will depend on the individual institution. The name of the department may suggest its position within the university structure. The director provides academic leadership for the department and his/her responsibilities include promotion of staff collaboration, fostering career development of the staff and establishing local, regional and international links. Financial support may come from external funding agencies, government or university sources. Some departments of medical education are financially self-supporting. The department should be closely integrated with the medical school. Support for the department from the dean is an essential factor for sustainability. Several case studies of medical education departments throughout the world are included as examples of the different roles and functions of a department of medical education.
OBJECTIVES: Clinical medical education depends on the availability of instructive patient encounters, or "good teaching cases." While all medical students hope to see enough patients of sufficient scope and variety, exposure to good teaching cases has been traditionally limited by time and chance. Students may graduate from medical school without having seen a number of important cases, each of which may represent a knowledge gap they will carry forward into internship and future patient care. Recently, however, the advent of high-fidelity patient simulators has enabled instructors to recreate realistic patient scenarios in a standardized fashion. Using the simulator, we wanted to create a medical education service-like any other clinical teaching service, but designed exclusively to help students fill in the gaps in their own education, on demand. We hoped to mitigate the inherent variability of standard clinical teaching, and to augment areas of deficiency. DESCRIPTION: Using a Human Patient Simulator(TM) (Medical Education Technologies, Inc.), which is equipped with a transmitted voice and reactive eyes, chest movements and breath sounds, heart tones and palpable pulses, a multidisciplinary group of physicians and educators designed a simulator-based medical education service. The premise was that students should have the ability to realistically practice and discuss medicine with a physician-mentor at any time they wish, with full access to simulator-enabled cardiac monitoring, diagnostic resources, pharmacologic agents, and invasive procedures. Students were informed of the program by e-mail and by course instructors. A dedicated pager was established for the on-call physician-educator, and the number disseminated to students. Physician-educators included faculty members scheduled for dedicated teaching time, and senior residents participating in a medical education elective. On-call physicians were responsible for fielding educational requests, developing appropriate scenarios, and scheduling instructional time. Upon arriving at the skills lab for their appointments, students would proceed to interview, evaluate, and treat the mannequin-simulator as if it were a real patient, using the instructor for assistance as needed. All students participated in an educational debriefing after each session. Instructors could also request formal observation and feedback on their teaching style, in collaboration with an existing faculty development program. DISCUSSION: Students enjoy the opportunity to practice medicine on-demand with dedicated clinical mentoring by a practicing physician. Course directors are interested in scheduling simulator time to help bring to life tutorial-based teaching cases and other course material for their students. By offering a medical education elective for residents, we have bolstered the pool of available instructors, provided a valuable learning experience for residents as teachers, and fostered additional opportunities for collaboration between the medical school and clinical training sites. Customized, realistic clinical correlates are now readily available for students and teachers, allowing reliable access to "the good teaching case."
The objective of the study described in this article was to determine the perceived continuing-education needs of employed public health educators. A three-wave mailing of a questionnaire was sent to a national sample of 500 public health educators who were asked to rate their preparation on 41 subcompetencies. Of 299 returned surveys (63%), 149 indicated that they were not currently practicing public health educators. Thus, analysis was based on 150 respondents. Six subcompetencies were perceived by 25% or more of the respondents as topics in which they needed more training. Health educators reported a need for continuing education, focused primarily on administration and evaluation of programs and applying appropriate research principles. Furthermore, the public health educators overwhelmingly preferred to attend a conference or workshop (85%) as their method of obtaining further continuing education. Health education programs and professional organizations need to take note of the identified continuing-education needs when developing future educational programs to adequately update health educators.
The purpose of this descriptive study was to identify the concerns and characteristics that distinguish diabetes educators who use computers for patient education from those who do not. Three hundred certified diabetes educators who were current members of the American Association of Diabetes Educators were surveyed using the Stages of Concern Questionnaire and a demographic questionnaire compiled by the author. Results indicated that diabetes educators are interested in computer-based patient education as an educational strategy, even though most diabetes educators are not currently using the computer for patient education. Primary barriers to using computers were identified as lack of computer availability for patients and limited financial resources. Because computers are becoming more pervasive in disseminating information about diabetes and new educational software is being developed for patients, diabetes educators need to learn more about this educational methodology for teaching their patients about diabetes.
Research about educational best practices is negatively perceived by many dental faculty. Separation between teaching and learning strategies commonly employed in dental education and evidence-based educational techniques is real and caused by a variety of factors: the often incomprehensible jargon of educational specialists; traditional academic dominance of research, publication, and grantsmanship in faculty promotions; institutional undervaluing of teaching and the educational process; and departmentalization of dental school governance with resultant narrowness of academic vision. Clinician-dentists hired as dental school faculty may model teaching activities on decades-old personal experiences, ignoring recent educational evidence and the academic culture. Dentistry's twin internal weaknesses--factionalism and parochialism--contribute to academic resistance to change and unwillingness to share power. Dental accreditation is a powerful impetus toward inclusion of best teaching and learning evidence in dental education. This article will describe how the gap between traditional educational strategies and research-based practices can be reduced by several approaches including dental schools' promotion of learning cultures that encourage and reward faculty who earn advanced degrees in education, regular evaluation of teaching by peers and educational consultants with inclusion of the results of these evaluations in promotion and tenure committee deliberations, creating tangible reward systems to recognize and encourage teaching excellence, and basing faculty development programs on adult learning principles. Leadership development should be part of faculty enrichment, as effective administration is essential to dental school mission fulfillment. Finally, faculty who investigate the effectiveness of educational techniques need to make their research more available by publishing it, more understandable by reducing educational jargon, and more relevant to the day-to-day teaching issues that dental school faculty encounter in classrooms, labs, and clinics.
Under UNESCO (UN Educational, Scientific and Cultural Organization) EPD auspices, a comparative study on family life education, sex education and human sexuality is being undertaken by EPD in collaboration with UNESCO Regional Offices covering four regions of the world--Asia and the Pacific, Africa, Latin America and Caribbean, and Arab States. Over the past 20 years, some 90 countries in the world have implemented population education programs. These programs follow different conceptual frames of reference based on predominant national problems and thrusts. Many of these have included family life education, sexuality and human reproductive issues. In the light of emerging issues and problems, it has been urged that key concepts and contents on family life education should be revised and updated accordingly, taking into account the specificity of sociocultural contexts. Before undertaking the revision and updating of contents, an analysis of the contents of existing national and regional training and teaching/learning materials in the four regions is currently being undertaken. The results of these analyses will serve as basis for the reconceptualization of population education/family life education within the new EPD philosophy, taking into account the emerging needs in the areas of information, training, and educational materials development. The studies which are currently under preparation look into the following: (i) the justifications for implementing family life education programs; (ii) content analysis of family life education and sex education programs in terms of rationale, objectives, concepts, themes and contents, teaching strategies and methodologies, etc.; (iii) changing scenes in the 90s; (iv) emerging key issues and concepts; (v) objectives, concepts and contents to be reinforced or revised for training and teaching purposes; (vi) recommendations for a reconceptualization/reorientation; and (vii) lessons learned and future needs and requirements.
Nursing education relies heavily on curriculum models originating in general education as a basis for curriculum design in nursing. As the content-product debate continues in general education, nurse educators will once again find themselves in a difficult situation of having to choose the best curriculum model in their efforts to reform nursing education. However, cognisance should be taken that whatever choices one makes, there are differences between professional education and general education. Although it might be appropriate for general education to choose a particular model because of its congruence with the curriculum designer's ideological views, many external forces impinge on professional education. Professional regulating bodies, the public and employers expect certain outcomes for professional education programmes. Nursing education programmes therefore should view the process and product models as alternatives rather than absolutes. There might be instances in which the process approach is suitable, whereas some programme aims might lend themselves perfectly to the product model.
Many workers assume that genetically determined differences in intellectual ability will be influenced little by changes in educational policy or other environmental interventions. Others, however, have suggested that increasing equality of educational opportunity will lead to an increase in the heritability of educational attainment. The resolution of this issue has been delayed until now because of the extremely large sample sizes which would be required. Education data on twins and their parents, from the Norwegian twin panel, provide a unique opportunity to determine the impact on the heritability of educational attainment of the more liberal social and educational policies introduced in Norway after the Second World War. As reported here, for individuals born before 1940 there is a strong effect of family background on educational attainment, accounting for 47% of the variance, though genetic factors account for an additional 41% of the variance. For females born after 1940 and before 1961, the relative importance of genetic (38-45%) and familial environmental (41-50%) differences changes very little. For males born during the same period, the broad heritability of educational attainment has increased substantially (67-74%), and the environmental impact of family background has correspondingly decreased (8-10%). For males, at least, having well-educated parents no longer predicts educational success, as measured by duration of education, independent of the individual's own innate abilities.
Children with spina bifida (SB) often require special education. To date, little information is available about the educational career of these children. This study focuses on educational career and predictors of attending special education of young adults with SB, using a cross-sectional study including 178 young Dutch adults with SB aged from 16-25. The main outcome was attending regular versus special education. For searching predictive power we selected age, gender, type of SB, level of lesion, hydrocephalus (HC), number of surgical interventions, ambulation, continence and cognitive functioning. Chi-square tests and binary logistic regression were used in the data analysis. Participants with HC attended special primary education more often (59%) than participants without HC (17%). For those participants with HC, the necessity of special primary education was associated with below average intelligence (75% versus 35%), wheelchair dependence (82% versus 39%) and surgical interventions (74% versus 44%). Only half of the participants with HC followed regular secondary education, whereas for participants with SB without HC, the outcome in secondary education was similar to that of the general population (92%). Intelligence was the main predictor of attending special secondary education (odds 5.1:1), but HC (odds 4.3:1) and wheelchair dependence (odds 2.6:1) were also a significant. Other variables were not significant predictors of special secondary education.
AIM: This paper reports a study that leads to understanding challenges facing nurse educators implementing mandatory continuing nursing education in The People's Republic of China. BACKGROUND: Mandatory continuing nursing education was instituted to maintain and develop registered nurses' competence in the context of healthcare reform in China in 1996. However, there is an increasing complaint of credit-focused and teacher-centred learning in Chinese literature. Despite an increasing appeal to improve the learning situation, little consensus has been reached. By examining nurse educators' perceived challenges and their coping strategies in implementing mandatory continuing nursing education, this study illuminates the possibilities for reform in mandatory continuing nursing education. METHODS: Data were collected through in-depth interactive dialogues between the researcher and five nurse educators in five healthcare organizations in China, utilizing Gadamer's philosophical hermeneutics. FINDINGS: Three themes were found in this study described as finding a way to support nurses' competence within a constrained situation, reconciling credit requirements and representing all stakeholders' interests. CONCLUSIONS: A tension between the mandatory continuing nursing education policy and the context of implementing the policy can contribute to credit-focused and teacher-centred learning. Regular policy review and educational support for nurse educators are crucial aspects to improve mandatory continuing nursing education.
BACKGROUND: In light of changes in the medical profession, the different requirements placed on physicians and the evolving needs of the healthcare system, the need arose to examine the medical education curriculum in Israel. This survey, conducted by the Samuel Neaman Institute for Science and Technology, summarizes 20 years of medical education in Israel's four medical schools, as the first stage in mapping the existing state of medical education in Israel and providing a basis for decision-making on future medical education programs. OBJECTIVES: To characterize the academic background of graduates, evaluate their attitudes towards current and alternative medical education programs, and examine subgroups among graduates according to gender, medical school, high school education, etc. METHODS: The survey included graduates from all four Israeli medical schools who graduated between the years 1981 and 2000 in a sample of 1:3. A questionnaire and stamped return envelope were sent to every third graduate; the questionnaire included open and quantitative questions graded on a scale of 1 to 5. The data were processed for the entire graduate population and further analyzed according to subgroups such as medical schools, gender, high school education, etc. RESULTS: The response rate was 41.3%. The survey provided a demographic profile of graduates over a 20 year period, their previous educational and academic background, additional academic degrees achieved, satisfaction, and suggestions for future medical education programs. CONCLUSIONS: The profile of the medical graduates in Israel is mostly homogenous in terms of demographics, with small differences among the four medical schools. In line with recommendations of the graduates, and as an expression of the changing requirements in the healthcare system and the medical profession, the medical schools should consider alternative medical education programs such as a bachelor's degree in life sciences followed by MD studies, or education programs that combine medicine with disciplines such as law, engineering, computer science, among others.