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PubMed1997

The influence of accreditation on educational change in U.S. medical schools.

The authors examined the influence of accreditation on educational change and reform in U.S. medical schools in the past decade, by reviewing the survey databases and site visit reports of 90 schools that had comprehensive accreditation surveys by the Liaison Committee on Medical Education (LCME) between July 1992 and June 1997. In this study, substantive change was defined as centralizing the design and management of the curriculum, as well as one or more of the following reforms: integrating basic and clinical science instruction and/or conversion to interdisciplinary courses; implementing methods of active, small-group, independent, and hypothesis-based learning; and substantially increasing students' exposure to ambulatory and primary care. Accreditation reports were reviewed to determine the extent to which the LCME previously had admonished schools for shortcomings in their educational programs and advised curricular changes. Notice was taken of grant support by national foundations promoting educational reform, in relation both to the correction of accreditation deficiencies and to curricular reform undertaken by schools on their own initiative. The study also scrutinized the evolution of accreditation standards promoting educational reform, and the LCME's support of initiatives for shortening the period of medical education and promoting performance-based teaching and the assessment of clinical skills. On entering the 1990s, the LCME toughened the standards for design and management of the medical curriculum and for the evaluation of educational program effectiveness that schools must conduct. The greater assessment rigor identified educational shortcomings in 61 of 90 medical schools coming up for accreditation surveys during 1992-1997. On those occasions, 34 of the 61 schools had instituted reforms or were on the verge of doing so. Twenty-five of the schools carrying out reforms (73%) had received major foundation grants, compared with ten of the 27 schools (37%) that had accomplished little. Fifteen schools that had not been reproached earlier were found on the 1992-1997 surveys to have undertaken substantial innovation on their own initiative, five with the help of major foundation awards. The study also shows that a number of schools implemented parts of more sweeping reforms with the help of smaller foundation grants for more discrete purposes. In some instances, it has not been possible to differentiate the influence of the LCME as a force for educational reform from the incentives for change created by national foundations. Overall, the LCME, through its standards and assessment practices, and in synergy with schools and kindred agencies promoting change, is now on the leading edge of improved education and evaluation in the nation's medical schools.

Accreditation↗
PubMedDate not supplied

Reorganization of a burn unit in response to underutilization: a critical assessment.

The incidence of burn injury in the United States has declined over the past few years, resulting in a dramatic decrease in the number of admissions to burn centers. This decrease has generated considerable concern, leading to a variety of proposals to modify burn units to control the cost of inpatient care. In 1986 Albany Medical Center Hospital, a 654-bed regional academic health sciences center, closed its burn unit and implemented a program to manage thermally injured patients in the intensive and progressive care areas of the medical center. A retrospective study was performed to compare patient outcomes and length of stay for the dedicated burn unit and the integrated burn program. Between the year before and the year after this change there was no significant difference in mortality rate, length of stay, or number of positive blood cultures. The relationship between burn severity and length of stay was unaltered by the burn program change. A comparison of data collected just after the change to those collected 2 years later again showed no difference, except that the annual census had dropped more than 50%. The results suggest that burn units can be converted to integrated burn programs without compromising patient care outcomes, although the lack of a cohesive burn team and the unavailability of beds designated for patients with burns ultimately resulted in a deemphasis of the burn program and consequent marked reduction in the number of patients with burns seen in the institution.

Burn Units↗
PubMedDate not supplied

[The development, transfer and use of medical technology as a special subject of research].

Regardless of the real exposion of scientific findings and information concerning medical sciences, research in the field, especially fundamental one, has rather insignificant influence on the development of new technologies, applicable in everyday medical practice (pull technologies). Far greater significance has been put on research in other fields, usually initiated with other purposes. "Side product" of that research is the development of these technologies which are best applicable in medicine (push-technologies). This is not the only reason why, as a rule, there is no direct connection between researchers and those supposed to apply and use new technologies. Initiation of evaluational research in the field of medical technologies will be the only way to establish the relationship between the two groups of actors: researchers and implementators.

Medical Laboratory Science↗
PubMed1991

Providing access to blacks and Hispanics in dietetics education.

To increase the number of blacks and Hispanics in dietetics and three other health professions, the Health Sciences Recruitment and Retention Program was developed and implemented in 1985 by the College of Health at Florida International University in Miami. The coordinated undergraduate program assisted in a federal grant to accomplish the objectives of recruiting and retaining minority students. High school and community college students were recruited using a slide/tape presentation featuring black and Hispanic professionals. In addition, the college offered a summer course entitled "Perspectives of the Health Sciences Professions" to students entering their senior year in high school. In this course, students learned how dietitians, medical laboratory scientists, and physical and occupational therapists treat various disease states. Field trips and site visits provided additional exposure to the professions. A summer orientation and tutorial program was established to retain minority students enrolled in the coordinated undergraduate program. We recommend that this program be considered as a model for dietetics educators to use in developing other programs to increase the number of minorities in the profession.

Black or African American↗
PubMed1997

Social science and the public agenda: reflections on the relation of knowledge to policy in the United States and abroad.

It is tempting to oversell the practical value of applied research. A hard look at the effects of U.S. social science on public policy in areas such as active labor market policies (training, job creation, placement, etc.), crime prevention, fiscal policy, poverty reduction, and health care reform suggests an inverse relationship between social science consensus and policy and budgetary decisions. Fragmented and decentralized political economies (e.g., the United States) foster policy segmentation and isolated, short-run single-issue research--often politicized and misleading. More corporatist democracies (such as Sweden, Norway, Austria, and Germany) evidence a tighter relation between knowledge and power in which a wider range of issues is connected, longer-range effects are sometimes considered, and research is more often actually used for planning and implementation. Even in less hospitable societies, however, social science does make its way in the long run. Favorable conditions and examples are discussed.

Cross-Cultural Comparison↗
PubMed1979

The LeMoyne-Owen College--UTCHS cooperative educational program: a model for minority recruitment.

A program of cooperative education between LeMoyne-Owen College and the University of Tennessee Center for the Health Sciences (UTCHS) was designed to attract students from the undergraduate institution to the various health professional schools at UTCHS. The program was initiated by a black faculty member at UTCHS. It involved a faculty exchange between the two institutions and the implementation of several changes in the pre-health science curriculum at the undergraduate institution. Other components of the program included: the gift of equipment and supplies to LeMoyne-Owen College by UTCHS; counseling of LeMoyne-Owen students by UTCHS faculty members; the generation of private funds by the faculty and staff at UTCHS for the support of LeMoyne-Owen students participating in the cooperative education program; and broad exposure of LeMoyne-Owen students to the laboratories and clinical facilities at UTCHS.

Black or African American↗
PubMed1985

A proposed expert system for nursing practice. A springboard to nursing science.

The knowledge on which nursing practice is based comes largely from traditional sources, expert nurses passing on the wisdom of their experience to novices. Nursing research, although increasing, is usually parallel to nursing practice, and its findings, at best, are implemented only after long delays. Consequently, the most effective nursing responses to a particular client problem may be undiscovered or unknown. Nursing information systems reflect the nature and usage of nursing knowledge. They offer standard care plans, but the knowledge and decision structures for individualizing care remain exclusively in the mind of the nurse. Nurses may have great freedom to enter information into the information system, but the information is rarely retrievable in a form suitable for evaluation or research. Nursing practice, and the knowledge on which it is based, could be enhanced through the use of a novel expert system. This paper describes how such a system could be developed, with examples from the authors' prototype programs. Taxonomies of data, diagnoses, objectives, and interventions would make it possible to compare patients and to determine the relative effectiveness of nursing interventions. A built-in evaluation component would provide feedback and correction. Everyday nursing practice would become a field for research, and the knowledge gained from research would immediately be fed back into practice. In its development and in its implementation, this kind of system would help to build nursing science.

Computers↗
PubMedDate not supplied

Quantitative methods for quality improvement.

Measuring clinical and financial outcomes in health care is a science in the early stages of development and implementation. Many tools and techniques are derived from industry models of continuous quality improvement and epidemiology. Epidemiologic (enumerative) and statistical process control (analytic) methods are effective alternatives to traditional quality assurance methods of evaluating patient care that encompass clinical and financial outcomes. Their use has resulted in significant improvement of clinical outcomes and financial performance, and has increased physician involvement in the process. Although cost will be the driving force of health care reform for the next few years, demonstration of high-quality care by providers through outcomes measurement will differentiate long-term from short-term winners in an environment of managed competition. This fact will make the science of outcomes management increasingly more important.

Chicago↗
PubMed1998

Towards quality of care in child health programmes: a challenge for the partnership in health and social sciences.

Several child health care programmes, though often well conceived, are poorly implemented at field level and focus primarily on quantitative achievements to the neglect of quality of care. This paper presents a quality of care (QOC) framework for child health programmes from the perspectives of the management system of an organization and the provider-client interface at point of service delivery. The paper subsequently describes the application of qualitative and quantitative research tools drawn from the social sciences and health sciences for planning and evaluating quality of care. An integrated and complementary use of these tools is recommended. It is suggested that minimum standards, which are region specific, be articulated for quality maintenance in child health programmes. These standards may be upgraded as quality improves. Finally, the challenges which a partnership of the health and social sciences may have to take up are discussed. These include advocacy for prioritization of QOC in child health programmes, facilitating an environment which supports quality of care, promoting inter-disciplinary action research, training students in social science research in universities and research organizations, documenting success stories.

Child↗
PubMed2000

Implementing a new model of integrated women's health in academic health centers: lessons learned from the National Centers of Excellence in Women's Health.

The National Centers of Excellence in Women's Health Program (CoE) represents a new model for women's health in academic health centers that unites women's health research, teaching, clinical care, public education and outreach, and career advancement for women in the health sciences. Lessons learned from the first 3 years of implementation indicate that this type of model requires a transformation from the traditionally fragmented set of activities in academic health centers to an integrated system united around the goal of advancing women's health. The transformation requires institutional commitment, dedicated players, and an ability to build on existing resources and bring added value to the institution. Challenges and strategies to link women's health activities and increase collaboration are also discussed.

Academic Medical Centers↗
PubMed1999

Opening the black box: using process evaluation measures to assess implementation and theory building.

The past decade has seen increasing recognition in prevention science of the need to move away from a black box approach to intervention evaluation and toward an approach that can elaborate on the mechanisms through which changes in the outcomes operate (Chen & Rossi, 1989; Durlak & Wells, 1997; Spoth et al., 1995). An approach that examines issues of program implementation is particularly critical in the design of efficacy studies of school-based preventive interventions. Numerous preventive intervention strategies are now delivered within the schools, often by regular classroom teachers. The extent to which teachers faithfully deliver a particular curriculum or incorporate instructional strategies emphasized by an intervention is a critical question for the overall project evaluation. This article illustrates the utilization of process measures from a multicomponent school-based prevention program to examine implementation of a teaching staff development intervention, and the program's underlying theoretical basis. Given the nested study design, the analyses utilize hierarchical linear models (Bryk & Raudenbush, 1992) to examine changes in teaching strategies by condition and investigate the hypothesized relationships between teaching practices and student behaviors based on the program's theoretical framework. Results suggest that teaching practices in two of the six intervention focus areas were positively impacted in the first 18 months of the project. Findings also support the relationships between teachers' instructional practices and students' behavior.

Child↗
PubMed1979

The implementation of a large-scale self-instructional course in medical information resources.

The implementation of library orientation and bibliographic instruction in health sciences centers presents some interesting as well as perplexing problems. The Rowland Medical Library at The University of Mississippi Medical Center had to confront and reexamine these problems when faced with the requirement to teach 298 freshman and sophomore medical students in one ten-week quarter. This paper outlines the development and implementation of a large-scale self-instructional approach to library instruction. The package consisted of an audiotape, a videotape, a written program, self-teaching quizzes, a performance test, and a student evaluation. Performance test results and student evaluation data are presented which indicate that this format can successfully be employed to meet course objectives and to be accepted by students.

Audiovisual Aids↗
PubMed1989

A parallel implementation of the ALOPEX process.

Optimization techniques have found many applications in science, engineering, and industry. In all applications, the best value of a "cost function" is sought in a well-defined domain; this cost function in general depends on many parameters. An iterative optimization technique has been developed (ALOPEX) that uses feedback in order to optimize the response of a system. The cost function for this process is problem dependent and therefore quite flexible. The method has been applied successfully to different optimization problems such as pattern recognition, receptive field studies in the visual system of animals, curve fitting, etc. We present two special purpose hardware implementations for ALOPEX. The first method takes time O(logN + logm) and uses O(mN2) processing elements. The second method takes O(logN + m) time and uses O(N2) processing elements. Our basic architecture is a binary tree with N2 leaves (equal to the length of the vectors) and therefore had depth O(logN). Different implications of the two approaches will be discussed including similarities with the biological visual process.

Algorithms↗
PubMed1991

The impact of economic issues on Nigerian health sciences libraries.

Economic issues are among the most important factors affecting health sciences libraries in Nigeria. These issues are influenced by the political, cultural, geographic, and demographic characteristics of the country. Significant economic issues are the dependence of the national economy on a single commodity, large foreign debt and spiraling inflation, stringent foreign exchange control measures, and inadequate realization by authorities of the role and importance of health sciences libraries. With shrinking budgets, resources, and staff, health sciences libraries can neither grow nor afford library automation. Health sciences librarians must take initiatives for cooperative activities to increase and make the most of resources, pursue nontraditional methods of fund-raising, educate authorities about the role and importance of libraries, and develop and implement a plan for the development and growth of health sciences libraries in the country.

Financing, Government↗
PubMed1989

The science of public health surveillance.

Improved public health surveillance can lead to earlier implementation of prevention and control measures. Better surveillance data lead to a more rational establishment of priorities. More timely and accurate data facilitate earlier epidemic detection and control. With better surveillance data, the impact of intervention activities and other public health programs can be evaluated more accurately. In this paper we describe how to improve the science of surveillance in terms of data collection, analysis, and dissemination and its application to public health practice. We then discuss the potential benefits and costs of such efforts and suggest methods for evaluating alternative approaches. The argument for science in surveillance, on the other hand, may be subject to excess. Surveillance is not an end unto itself, but rather a tool. This tool should be refined and modified to adapt to the goals of a particular public health program. It is the development of methods to apply creative ideas to surveillance, and the rigorous assessment of the process, that will benefit from the application of scientific principles.

Data Interpretation, Statistical↗
PubMed1983

Clinical instruction in medicine: a national survey.

In this paper the authors report on the medicine phase of three parallel studies undertaken to investigate clinical teaching skills in medicine, dentistry, and nursing. The intent of the overall study was to gather and assess broad-based information useful in the design and implementation of clinical teaching improvement programs in the health sciences. A 14-member consortium representing five schools each in medicine and dentistry and four in nursing collaborated by using a modified Delphi technique to resolve conflict and differences, through group judgments, in preferences to choices among educational goals and activities. Based upon an educational needs assessment, the design of the study and of the research methodology allows replication at individual institutions and provides a systematic approach for designing and implementing faculty development programs with specific skill emphasis at the clinical level.

Clinical Competence↗
PubMed1994

Applications of medical informatics in antibiotic therapy.

The Infectious Disease Society of America is concerned about the excessive and inappropriate use of antibiotics in U.S. hospitals. Applications of Medical Informatics can help improve the use of antibiotics and help improve patient care by monitoring and managing enormous amounts of patient information. Monitoring the duration of every antibiotic ordered in the hospital or keeping tract of the antibiotic susceptibilities for five years are examples of tasks better performed by computers. The impact of computers in medicine is seen by some as disappointing. The computer revolution has not had the impact in medicine experienced by other areas. The acceptance and use of computers by medicine will be evolutionary rather than revolutionary. In 1979, the MYCIN project demonstrated that the computer could aid physicians in the selection of antibiotics. However, MYCIN was never clinically used because physicians were require to enter all patient information into the computer. The development of computerized medical records is an essential step to further the development and implementation of computer-aided decision support. The science of Medical Informatics is still relatively new but is emerging as a distinct academic field. A few hospitals are now installing information systems and have determined that these systems will play an essential role in their ability to survive into the next century. The telephone and the automobile have been recognized as two of the most important tools for improving medical care during the past 100 years. People could more readily get medical care and the time to transmit medical information was greatly reduced through physician use of the telephone and automobile. The computer is a tool that can be used to help physicians manage the great amount of medical information being generated every day. The computer can also alert the physician of patient conditions that need attention. However, it is the physician who must use and apply the computer provided information. Thus, the computer will assist but not replace physicians in providing medical care.

Anti-Bacterial Agents↗