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At least 19 recordsLinked to original sources

Students' use of anatomy modules in problem-based medical education at McMaster University.

BACKGROUND: The McMaster University Faculty of Health Sciences has a collection of self-directed anatomy learning modules that are available to help medical students prepare for tutorial discussions of health care problems. How students use this resource has never been adequately surveyed. METHOD: The rates of, patterns of, and reasons for module use among the 200 students in their first and second years were surveyed by questionnaire in late 1992. Responses were analyzed with contingency tables. RESULTS: Questionnaires were completed by 80 students (52 in their first year and 28 in their second). Anatomy module use depended not only on the students' levels in the program (i.e., curriculum years), but also on their pre-medical backgrounds in biology. The students did not use modules because their tutors and clinical-skills preceptors required it. The students who worked through modules considered themselves better prepared for tutorials, where their learning was evaluated. CONCLUSION: Though use of this resource varied among individuals, most McMaster students believed that module use helped them to make useful contributions to tutorial discussions.

Adult↗

Nurse practitioners in primary care. I. The McMaster University educational program.

In 1971 McMaster University offered an educational program for nurse practitioners sponsored jointly by the Faculty of Medicine and the School of Nursing. Priority in the pilot program was given to nurses employed in family practice settings and to those participating in related McMaster studies. Because of the implications of a change in role for both nurse and physician, one requirement for acceptance of a nurse in the program was participation of the physician-associate in the educational program.The program prepares registered nurses to extend their responsibilities in primary health care activities for the assessment and management of patients in family practice. The current evaluations of the pilot-study results suggest that such programs can contribute effective resources towards meeting expectations of ready access to primary care by the people of Canada.

Comprehensive Health Care↗

The content of the medical curriculum at McMaster University: graduates' evaluation of their preparation for postgraduate training.

This paper describes McMaster University medical graduates' perceptions of how well their medical curriculum prepared them for postgraduate training. The graduates view their overall preparation for postgraduate work as sound. These perceptions were compared with independent assessments by internship supervisors for one graduated class. The graduates suggest their preparation for postgraduate work differs somewhat from fellow interns. Graduates reported feeling very well prepared compared to fellow postgraduate trainees in independent learning, self-evaluation and problem solving skills. They also judge their preparation in data gathering skills, behavioural science knowledge, ability to deal with social and emotional problems of patients, medical record keeping skills, preventive, follow-up and in-patient care as very good compared to peers. They identified two content areas, pharmacology and the basic medical sciences, as requiring more attention in the curriculum. These findings are discussed and related to the approach to medical education at McMaster University.

Curriculum↗

[Evaluation of a German version of WOMAC (Western Ontario and McMaster Universities) Arthrosis Index].

The WOMAC (Western Ontario and McMaster Universities) Osteoarthritis Index is a tested questionnaire to assess symptoms and physical functional disability. We adapted the WOMAC for the German language and tested its metric properties, test-retest reliability and validity in 51 patients with knee and hip OA. All WOMAC scales (pain, stiffness, function) were internally consistent with Cronbach's coefficient alpha ranging from 0.80 to 0.96. Test-retest reliability was satisfactory with intraclass correlation coefficients ranging from 0.55 to 0.74. All scales and the global index calculated as the mean of scale scores had a bimodal distribution and a slight ceiling effect. As hypothesized the WOMAC scales were associated with radiological OA-severity and limitations of range-of-motion. Patients with more severe symptoms and functional disability perceived more limitations in their roles at home and at work. The presented German version of the WOMAC is a reliable and valid instrument for the assessment of symptoms and physical functional disability in patients with knee and hip OA.

Activities of Daily Living↗

Hip disability and osteoarthritis outcome score. An extension of the Western Ontario and McMaster Universities Osteoarthritis Index.

To further develop the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC LK 3.0) for people with hip disability with or without hip osteoarthritis (OA), 52 subjects (median age 64 yrs, 35 women) answered a version of the Index with additional dimensions, twice, with a one-week interval. Reproducibility, percentage of zero scores (best possible scores), mean score of symptoms, and importance, were analyzed. This resulted in the Hip disability and osteoarthritis outcome score (HOOS LK 1.1), a 39-item questionnaire with five separate sub-scales. There were higher median scores (more symptoms) for three of HOOS sub-scales Pain, Activity limitations--sport and recreation, and Hip-related Quality of life compared to those in the WOMAC, improving the ability to assess change in patients over time. The HOOS appears to be an evaluative instrument for assessing important self-rated hip problems for people with hip disability with/without hip OA, but additional studies are needed.

Adult↗

Educational methods at McMaster University, Canada.

The methods of education currently being used at McMaster University, Ontario, Canada are new and radical and the principles are described. Some of these methods may have special application in education for general practice.

Curriculum↗

Career choices of McMaster University medical graduates and contemporary Canadian medical graduates.

The MD program at McMaster University, Hamilton, Ont., differs from that at most other Canadian universities in the profile of students admitted and in its teaching methods. To investigate influences of selection policy outcomes and the education program, the career choices of 408 McMaster graduates were compared with those of 1620 graduates of other Canadian English-language schools by analysis of data from the CMA's Physician Manpower Data Bank. Compared with graduates of other schools, McMaster graduates were more likely to have chosen internal medicine, less likely to have chosen surgery and equally likely to have chosen primary care as their medical field. Of those in primary care, a higher proportion of McMaster graduates than other graduates held certification in family medicine. This was largely responsible for the overall higher rate of certification in the McMaster group. While the nature of practice and time spent on patient care did not differ between the two groups, several variables, including time spent on professional activities other than patient care, proportion involved in research and classroom teaching, and proportion of salaried physicians employed by universities, indicated a higher than average level of interest in academic medicine among the McMaster graduates. This could be partially explained by differences in the student profile if students who are interested in education are more likely to choose an educationally innovative medical school.

Canada↗

Problem-based learning in physical therapy: a review of the literature and overview of the McMaster University experience.

Problem-based learning (PBL), as implemented in the health sciences, is an educational method in which the focus of learning is a small-group tutorial in which students work through health care scenarios. The goals of the health care scenarios are to provide a context for learning, to activate prior knowledge, to motivate students, and to stimulate discussion. Learning is student-centered rather than faculty-centered, and self-directed learning is emphasized. The method was developed in the McMaster University medical school program and has since been adopted by many health care professional schools around the world. The theoretical basis and suggested advantages and disadvantages of PBL are outlined. Three approaches to PBL have been identified in the literature: completely integrated PBL curricula, transitional curricula, and a single-course approach. The advantages and disadvantages of each approach are addressed. The physical therapist (PT) program at McMaster University is a completely integrated problem-based curriculum. The history and process of PBL in general and in the PT program are reviewed. The implications of our experience for the development of other PBL courses and curricula are discussed. Evidence for proposed differences in students' performance and outcomes in PBL versus traditional curricula is critically reviewed. Recommendations are made for implementing PBL in PT curricula.

Curriculum↗

A new look at the Western Ontario and McMaster Universities Osteoarthritis Index using Rasch analysis.

OBJECTIVE: The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) is a valid and widely used instrument for the assessment of osteoarthritis patients. We examined whether applying Rasch analysis, a new item-response theory, supports its metric properties. METHODS: The metric properties were examined in a cohort of patients with osteoarthritis of the hip or knee. In an exploratory approach, a validated German version of the WOMAC was analyzed using Rasch analysis for its unidimensionality and construct definition. RESULTS: One hundred fifty-eight patients were included in the study. The 3 WOMAC domains--pain, stiffness, and physical function--were unidimensional when examined separately. In an analysis including all items, the stiffness items did not fit the model. This indicates that they are distinct from the pain and function items. Item difficulty analyses revealed redundancy between corresponding pain and function items addressing the same task (e.g., "pain while standing upright" and "difficulty while standing"). CONCLUSION: Applying Rasch analysis to the 3 WOMAC domains confirms their unidimensionality. However, the pain and function items seem to represent the same construct. Thus, it may be possible to simplify these domains to avoid redundancy. The impact of reducing items must nevertheless be examined.

Activities of Daily Living↗

Measuring the population impact of knee pain and disability with the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC).

This study has used the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) in an unsolicited postal questionnaire to investigate the impact of knee pain and disability in the general older population. The study provides WOMAC population data for those aged over 50 and demographic and psychosocial associations with severity of WOMAC scores. A pilot survey (n=240) and repeatability study (n=80) were undertaken to test completion of the WOMAC in this new setting. The main questionnaire was mailed to 8,995 men and women aged over 50 registered with three general practices in North Staffordshire, UK. Completion rates for WOMAC items were high. Substantial reliability was found for pain and physical function scales (both >0.80). Fourteen percent of the over 50 population in this study had severe knee pain, 20% had severe difficulty with at least one area of physical functioning, 12% had both. The strongest link with severe difficulty with physical functioning was chronicity (odds ratio (OR)=6.49, 95% CI 4.65, 9.04). Other independent links were age over 75 years (odds ratio (OR)=4.11, 95% confidence interval (CI) 3.03, 5.58), depression (OR=2.80, 95% CI 2.22, 3.54), bilateral knee injury (OR=2.23, 95% CI 1.63, 3.06) and body mass index>30 (OR=2.00, 95% CI 1.51, 2.64). Similar associations were found for severe pain. The findings suggest that the WOMAC is a reliable measure for use in postal surveys. It has advantages over other instruments when measuring pain and physical function difficulty related to the knee. Chronicity, older age, injury, obesity and depression were all linked with higher WOMAC scores for knee pain severity and disability among knee pain sufferers in the general older population.

Activities of Daily Living↗

The medical undergraduate programme at McMaster University: learning epidemiology and biostatistics in an integrated curriculum.

The medical undergraduate programme at McMaster University is a three-year integrated course in which major emphasis is placed upon self-directed, problem-based learning. Group tutorials are the major meeting place for students, and there are very few formal lectures. In this paper we describe the curriculum in broad outline and the way in which epidemiology and biostatistics have been incorporated into it in the past seven years.

Curriculum↗

Reliability and validity of the Western Ontario and McMaster Universities (WOMAC) Osteoarthritis Index in Italian patients with osteoarthritis of the knee.

OBJECTIVE: The Western Ontario and McMaster Universities (WOMAC) Osteoarthritis (OA) Index is a tested questionnaire to assess symptoms and physical functional disability in patients with OA of the knee and the hip. We adapted the WOMAC for the Italian language and tested its metric properties in 304 patients with symptomatic OA of the knee. METHODS: Three hundred and four consecutive patients, attending 29 rheumatologic outpatient clinic in northern, central, and southern Italy, were asked to answer two disease-specific questionnaires (WOMAC and Lequesne algofunctional index) and one generic instrument (Medical Outcomes Study SF-36 Health Survey-MOS SF-36). A sample of 258 patients was readministered the WOMAC 7-10 days after the first visit and the structured interview, which also assessed demographic and other characteristics. Internal consistency was assessed using Cronbach's alpha, reliability using intraclass correlation coefficients (ICCs), and construct and discriminant validity using Spearman's correlations, Wilcoxon rank sum test, and Kruskal-Wallis test. RESULTS: All WOMAC subscales (pain, stiffness, and physical function) were internally consistent with Cronbach's coefficient alpha of 0.91, 0.81, and 0.84, respectively. Test-retest reliability was satisfactory with ICCs of 0.86, 0.68, and 0.89, respectively. In comparison with the SF-36, the expected correlations were found when comparing items measuring similar constructs, supporting the concepts of convergent construct validity. Very high correlations were also obtained between WOMAC scores and Lequesne OA algofunctional index. WOMAC physical function, but not WOMAC stiffness and pain subscales, was weakly associated with radiological OA severity (P=0.03). Also, WOMAC pain score was inversely correlated (P=0.01) with years of formal education. Examination of discriminant validity showed that the scores on the WOMAC and SF-36 followed hypothesized patterns: the WOMAC discriminated better among subjects with varying severity of knee problems, whereas the SF-36 discriminated better among subjects with varying levels of self-reported health status and comorbidity. CONCLUSION: The Italian version of WOMAC is a reliable and valid instrument for evaluating the severity of OA of the knee, with metric properties in agreement with the original, widely used version.

Aged↗

The clinical librarian and the patient: report of a project at McMaster University Medical Centre.

In June 1975 a clinical librarian project was initiated in the Gastroenterology Programme of McMaster University Medical Centre. The objectives of the project were to assist patients in participating more knowledgeably in their own health care and to assist health professionals in applying the latest information from biomedical literature to patient care. The implementation and development of the service are described, including the use of feedback from patients and health professionals to assess the impact of the librarians' participation in clinical settings. Benefits included: 1) increased accessibility of information resources to patients, 2) a greater awareness by health professionals of the usefulness of biomedical literature and the library in patient care, and 3) an opportunity for the librarian to gain a first-hand view of activities and information needs in a clinical setting. Key points in determining the successful implementation of the project are given.

Canada↗

The effect of radiology electives on career choice at McMaster University.

Recruitment ot radiology is said to be affected by the extent to which radiologists participate in medical student teaching. At McMaster University, where radiologists make major contributions to the medical school curriculum, students appear to show little interest in radiology as a career. The characteristics, attitudes and career choices of students at McMaster who undertook elective periods in radiology between 1973 and 1976 were examined. Though students rated the elective experience very highly, none intended to become a radiologist. Half of the group wished to take up family practice, the proportion in the school as a whole being similar. This is consistent with policies of student selection and education at McMaster. Most of those choosing family practice did not change their career choice between entry to and exit from the school. Involvement of radiologists in the curriculum had no detectable positive influence on career choice.

Adult↗

Validation of the Spanish version of the WOMAC questionnaire for patients with hip or knee osteoarthritis. Western Ontario and McMaster Universities Osteoarthritis Index.

The aim of this study was to validate a translated version of the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) questionnaire in Spanish patients with hip or knee osteoarthritis (OA). The WOMAC questionnaire and the SF-36 were administered to a sample of 269 patients on the waiting list for hip or knee replacement. We studied the convergent validity and the item-scale correlation using Pearson's correlation coefficient and Spearman's pi. For the reliability study we used another sample of 58 patients who received the WOMAC twice within 15 days. The Pearson's, Spearman's pi, and intraclass correlation coefficients were calculated. Internal consistency was measured by Cronbach's alpha. The responsiveness study was carried out by resending the two questionnaires to all patients 6 months after surgical intervention; responsiveness was measured by means of the paired t-test, the effect size I and the standardised response mean. The Pearson's coefficients for the convergent validity ranged from -0.52 to -0.63. The coefficients obtained for the item-scale correlation of the pain area were 0.74 or higher, 0.91 or higher for stiffness, and 0.61 or higher for function. When measuring the test-retest reliability, the coefficients ranged from 0.66 to 0.81. Internal consistency yielded a Cronbach's alpha ranging from 0.81 to 0.93. The responsiveness showed an effect size I ranging from 1.5 to 2.2 in patients who underwent hip replacement; for those who underwent knee replacement the range was 1 to 1.8. The standardised response mean ranged from 1.3 to 1.9 for patients with hip OA; those with knee OA ranged from 0.8 to 1.5. The Spanish version of WOMAC is a valid, reliable and responsive instrument in patients with hip or knee OA.

Aged↗

Can the western Ontario and McMaster Universities (WOMAC) osteoarthritis index be used to evaluate different hip joints in the same patient?

The Western Ontario and McMaster Universities (WOMAC) osteoarthritis index was originally designed for disease-specific evaluation of patients with lower extremity osteoarthritis (1988), but has not been validated for evaluation of more than one joint at the same time in the same patient. Thirty-three patients with bilateral total hip arthroplasties answered a questionnaire containing both the WOMAC osteoarthritis index and the Harris hip score (HHS) (1969), a joint-specific health status measure that was designed to include evaluation of bilateral hip arthroplasty. Differences in scores between hips were highly correlated for HSS and WOMAC total score (P = .0001), HHS pain and WOMAC pain subscores (P = .0001), and HHS function and WOMAC physical function subscores (P = .0001). WOMAC stiffness and HHS range of motion were not significantly correlated (P = .1308). In 23 patients (70%), both scores graded the hips with the same comparative outcome. When comparative outcomes were different, the average difference was less than 3 points (of 100 possible points). These results demonstrate that patients with bilateral hip arthroplasty can apply the WOMAC osteoarthritis index questions to individual hips at the same time as effectively as the joint-specific HHS questions.

Health Status Indicators↗

A comparative study of signal versus aggregate methods of outcome measurement based on the WOMAC Osteoarthritis Index. Western Ontario and McMaster Universities Osteoarthritis Index.

OBJECTIVE: To compare signal versus aggregate measurement strategies using the VA3.0S version of the Western Ontario and McMaster Universities (WOMAC) Osteoarthritis (OA) Index. METHODS: Seventy patients with OA of the knee were asked to identify a signal item for each of the 3 dimensions of the WOMAC OA Index at baseline and termination of a 12-week, double blind, randomized, controlled trial. RESULTS: The signal method detected statistically significant alterations in health status at relatively small sample sizes and with a relative efficiency close to or at unity. In addition to a low prevalence of deterioration in nonsignal items, we observed some inconsistency in signal selection. CONCLUSION: Signal methods of measurement may provide an alternative approach to outcome measurement provided issues of nonsignal deterioration and the consistency of signal selection can be addressed.

Aged↗

Validation study of a computerized version of the Western Ontario and McMaster Universities VA3.0 Osteoarthritis Index.

OBJECTIVE: To study the validity and feasibility of a computerized version of the Western Ontario and McMaster Universities (WOMAC) Osteoarthritis Index. METHODS: Thirty patients with osteoarthritis (OA) of the knee completed both a paper and a computerized version of WOMAC in random order. The visual analog scaled version of WOMAC, VA3.0, was used. We studied criterion validity by comparing the paper and computerized versions. RESULTS: All patients completed the computerized version without undue difficulty. Criterion validity, based on aggregated subscale scores, was excellent: Pain, ICC = 0.89, Stiffness, ICC = 0.87, Physical Function, ICC = 0.95. CONCLUSION: The computerized version of WOMAC VA3.0 is a valid alternative to the paper version.

Aged↗