Health professionals' experiences with continuing and distance education.
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Attitude of Health Personnel↗
Biomedical subjects
C L Gjerde
Publications and source records attributed to C L Gjerde.
A faculty development program in basic teaching skills.
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Faculty, Medical↗
Using videoconferencing to train community family medicine preceptors.
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Community Medicine↗
Unique learning contributions of a family medicine preceptorship.
BACKGROUND: There is a belief among family medicine educators that a third-year family medicine rotation provides unique clinical learning experiences, but there is limited research to support this belief. This study identified clinical skills performed by third-year medical students only during a community-based family medicine preceptorship, even when the family medicine rotation occurs after all other required clerkships. METHODS: During 6 academic years (1990-1996), 87 third-year students completed the family medicine preceptorship as their final rotation and rated their experience with 80 clinical activities (preventive health care, clinical problem management, and procedures) after completing all required clerkships other than family medicine and again after the family medicine preceptorship. Ratings measured whether the activities occurred on the family medicine rotation, only on other rotations, or combinations of both. RESULTS: More than 50% of students who performed five preventive skills (health maintenance for adolescents, young adults, middle-aged adults, or senior citizens and weight control counseling) gained that experience only during the family medicine preceptorship. The majority of students actively managed six clinical problems (acute strains and sprains, low back pain, sinusitis, strep throat, acute bronchitis, and osteoarthritis) uniquely during the family medicine preceptorship. The preceptorship offered few unique opportunities to perform procedures. CONCLUSIONS: This family medicine educational experience was not merely a repeat of what is experienced on the traditional major rotations. The family medicine preceptorship provided a setting where students were able to perform several important ambulatory, primary care skills they had not performed during their core curriculum of traditional third-year rotations.
Clinical Competence↗
The effects of precepting on and the support desired by community-based preceptors in Iowa.
PURPOSE: To survey community-based family physician-preceptors about teaching costs, issues, and support desired. METHOD: In late 1994 a questionnaire was mailed to all 139 community family physicians who served as preceptors for the University of Iowa College of Medicine's third-year family practice preceptorship. The questionnaire contained items regarding teaching costs and the kinds of assistance desired from the university, the difficult and enjoyable aspects of precepting, and demographic data. Analyses were done to explore the associations between the preceptors' demographic variables and the effects of precepting on number of patients seen, practice income, and time spent at work. Also tested were the associations between the demographic variables and the kinds of support desired. RESULTS: In all, 130 surveys were returned, for a response rate of 94%. Nearly all of the respondents were Caucasian, male, and residency trained; 61% were in group practices. While precepting, 87% spent more time at work, 31% saw fewer patients, and 25% lost practice income; mean daily cost estimates of precepting were 51 more minutes at work, 1.4 fewer patients seen, and $34 in lost income. The support the preceptors were most interested in receiving was training in and access to computer-based information. Financial compensation was desired more often by the physicians whose first year of practice was after 1977 (p = .009). Motivations for precepting included positive interactions with students and enjoyment of teaching. Time concerns were overwhelmingly the most difficult aspect of precepting. CONCLUSION: The physicians-many of whom noted their enjoyment of teaching for its intrinsic rewards-spent a significant amount of extra time teaching while precepting, and thus both lost income and saw fewer patients. Medical schools need to recognize the valuable contributions of preceptors and find ways to support them.
Attitude of Health Personnel↗
The effect of right or left placement of the positive response on Likert-type scales used by medical students for rating instruction.
PURPOSE: To determine whether students' ratings of instruction demonstrate a primary effect, to determine whether the primacy effect relates to the number of response options, and to assess whether the primacy effect relates to how favorably the instructional activity is rated. METHOD: Inf 1995-96 six different forms of a 13-item course-evaluation questionnaire (with Likert-type items) were used to evaluate two second-year courses, Respiratory and Hepatic, at the University of Wisconsin Medical School; the first was one of the most highly rated courses at Wisconsin, and the second was less highly rated. The forms differed by whether they contained five, six, or seven response options, and whether the "strongly agree" rating was on the left side or the right side of the page. The second-year class that participated in the study comprised 140 students. The six different forms of the course-evaluation questionnaires were randomly distributed to the students in equal numbers. Results were analyzed with a number of statistical methods. RESULTS: Completed questionnaires were obtained from 132 students (94%) in Respiratory and from 119 students (85%) in Hepatic. Overall, the forms with the positive rating on the left side had more positive ratings and less variance. For Respiratory, primacy affected the response variance. For Hepatic, primacy affected the response means. CONCLUSION: Faculty-evaluation systems are increasingly using students' ratings for making important decisions regarding salaries, teaching assignments, tenure, etc. The evidence that the primacy effect influences such ratings highlights the need to standardize as much as possible how such ratings are obtained.
Education, Medical↗
Skills actively performed during a family medicine community-based preceptorship.
BACKGROUND: This study assessed the clinical learning experiences provided to third-year medical students during a 2-week, required, community-based family medicine preceptorship. METHODS: After completing the preceptorship, students classified their level of performance on 80 clinical activities. During 3 academic years, 486 third-year students completed the preceptorship. RESULTS: Delivery of well-child care was the only prevention skill in which a high percentage of students (more than 67%) received experience; students received moderate experience (34%-67% of students) with another seven prevention skills. Students received a high level of active experience with four clinical problems--upper respiratory tract infection, acute otitis media, sinusitis, and strep throat--and a moderate level of active experience on another 17 clinical problems. There were no procedural skills on which students received a high level of experience, but students received a moderate level of experience with 10 procedural skills. CONCLUSIONS: This brief family medicine preceptorship provided a clinical setting in which students actively engaged in several facets of ambulatory primary care. For accountability, programs need to more clearly articulate what exposure is to be gained in each clinical rotation, strive to enhance active practice, and document levels of student performance.
Clinical Competence↗
A break-even analysis of optimum faculty assignment for ambulatory primary care training.
BACKGROUND: The increased demand that faculty teach residents in ambulatory clinics necessitates the development of ambulatory care teaching models that are both educationally effective and financially viable. This study was designed to identify the resident-to-faculty ratios needed to provide financially viable faculty supervision of residents while maintaining acceptable resident waiting times for teaching. METHOD: A computer simulation was developed to estimate the number of residents one or two faculty teachers could supervise in a university-based primary care teaching clinic. The number of residents was calculated for three waiting-time constraints and three scenarios of faculty tasks. A financial analysis of each model was performed. RESULTS: With no non-teaching tasks, two teachers were able to supervise 11 residents and keep waiting times under two minutes, while one teacher was able to supervise only three residents with this waiting-time constraint. The financial break-even point was achieved by all of the two-teacher models, but by none of the one-teacher models. CONCLUSION: In all three scenarios, using two teachers resulted in more than double the number of residents supervised and in higher utilization of faculty time (higher productivity) than did using one teacher. The two-teacher models of ambulatory supervision allowed for sufficient numbers of residents to be supervised so that teaching costs could be covered from patient care revenues; the one-teacher models did not break even financially. These simulations offer a viable option for academic institutions that are struggling to maintain teaching quality in the face of financial constraints.
Ambulatory Care↗
Student and faculty collaboration in a clinic for the medically underserved.
BACKGROUND AND OBJECTIVES: Growing numbers of uninsured and underinsured individuals in the United States have resulted in increased needs for health care for medically underserved populations. Educational strategies are needed that provide opportunities for students to develop the attitudes, knowledge, and skills necessary for providing quality health care for underserved patients. METHODS: Medical students, residents, and faculty of the University of Wisconsin-Madison Medical School worked together to establish extracurricular opportunities for first- and second-year students to participate in medical clinics serving the poor and homeless. The process for the development and operation of a volunteer clinic is described. RESULTS: In the last 2 years, 163 medical students, 27 residents, and 21 faculty have provided care to more than 1,000 patients. Patients, students, residents, and faculty reported high satisfaction with the experience. CONCLUSIONS: Medical students, residents, and faculty working in collaboration can provide increased access to care for the medically underserved. Engaging in community-oriented primary health care early in their medical education provided positive learning opportunities for medical students, especially those interested in generalist careers.
Attitude of Health Personnel↗
Patients with dementia and their caregivers 3 years after diagnosis. A longitudinal study.
OBJECTIVES: To document caregivers' perceptions of the deterioration in functional ability of persons with dementia over time, to identify the most problematic behavior for caregivers at two stages of dementing illness, and to compare the perceived informational needs of caregivers at diagnosis and 3 years later. DESIGN: Single cohort. Surveys were mailed at time 1 and respondents were followed up after 3 years (time 2). SETTING: Midwestern hospital dementia assessment clinic with a family physician director. Continuing care was by community physicians. SUBJECTS: Thirty elderly patients with dementia who were evaluated at the dementia clinic. Data were provided by their caregivers. RESULTS: Patients' scores on the Activities of Daily Living section of the questionnaire declined (bathe self, P = .03; transfer from bed or chair, P = .03; and groom self, P = .06). Significant deterioration in behaviors over time was found in incontinence (P = .04). Fewer patients were depressed at time 2 (P = .02). The patient behaviors found most troublesome at time 1 were worrying about memory loss, losing or hiding things, feeling blue, experiencing restlessness, having difficulty calculating, experiencing a lack of interest, and having false ideas. At time 2, the greatest problems were having a short attention span, failing to recognize persons or things, experiencing a lack of interest, experiencing restlessness, repeating himself or herself, forgetting where he or she is, speaking incoherently, and being incontinent. Questions caregivers most wanted answered at time 1 concerned possible treatment, the future course of illness, and the cause of the symptoms. At time 2, the concerns were the future course of illness, possible treatment, and disease inheritance. There was significantly more interest in family agreement about care (P = .004) and the need for legal guardianship (P = .001) at time 2. CONCLUSIONS: Caregivers' perceptions of the most frequent and troublesome behaviors of patients with dementia were documented at different stages of the disease. The importance caregivers attached to their requests for information reflected changing but continuing needs for reassurance about the patient's diagnosis and treatment and for help with the psychosocial consequences of dementia. Physicians must be aware of caregivers' needs at different stages of the disease process and be equipped to help them appropriately.
Activities of Daily Living↗
Ambulatory medical education: teachers' activities, teaching cost, and residents' satisfaction.
PURPOSE: To assess faculty activities and costs in supervising ambulatory patient care at a family practice clinic, and to assess resident satisfaction with access to ambulatory care teaching. METHOD: This time-and-motion study was conducted in 1993 over two three-week periods (at the end of one academic year and at the beginning of another) in a family practice clinic affiliated with the University of Iowa College of Medicine. Observers recorded time spent by 14 faculty on teaching and non-teaching activities. Thirty-two residents were surveyed about their satisfaction with access to teaching. RESULTS: Over 59 half-days, 2,644 faculty service events were recorded; 47% were teaching events (supervising care delivered by residents) and 53% were non-teaching events (providing care for other clinic patients). Mean teaching time was greater for first-year residents; they consulted faculty more frequently and required more teaching time per consultation. The most common non-teaching activities were telephone calls out, telephone calls in, and inquiries from nurses and office staff. Ten percent of non-teaching activities interrupted teaching, and 17% of the residents reported their teaching had been interrupted. Eighty percent of the residents were satisfied with their access to teaching, but 12% reported they had had to postpone discussing pressing patient problems. Resident dissatisfaction correlated with longer perceived waiting time, interruption of teaching, and faculty inaccessibility. CONCLUSION: Faculty should plan to spend two to three times longer to teach lower-level residents than upper-level residents. By delegating some non-teaching activities to other personnel, faculty can reduce teaching costs and increase resident satisfaction.
Ambulatory Care↗
Expectations and satisfaction of runners with injury treatments.
Seventy-eight runners competing in three Iowa races were surveyed concerning their most recent running injury for which they sought medical care from a family physician, an orthopedic surgeon, or a podiatrist. Their reasons for choosing a doctor, expectations of care, and satisfaction with treatment received were assessed. Most patients selected the orthopedic (50%) or podiatric (42%) physicians upon the recommendation of other runners; only 13% of the family physicians were selected from recommendations. Orthopedic and podiatric patients were more likely than family physician patients to expect x-rays. There was no difference in overall patient satisfaction with treatment received from the three groups of physicians. The runners felt that all physician groups treated their running injuries equally well.
Athletic Injuries↗
Psychological interpretation of labels used to evaluate third-year medical students.
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Clinical Competence↗
Office procedural skills in family medicine.
In a study of 131 residents, 34 faculty members, and 236 graduates at nine family practice residency programs in Iowa, 29 office and outpatient procedural skills (for example, repair of lacerations) were identified as representing the ideal core content for family practice residency training, and another 11 procedures (for example, endometrial biopsy) were identified as elective procedures. The faculty members' responses that residents were taught these 40 procedures by direct supervision were much higher than third-year residents' reports of having been supervised while performing them. There was a positive relationship between the percentage of residents who reported having been supervised and the percentage who felt competent to perform the procedures. There was strong agreement among faculty members, residency graduates, and the residents that residents should be evaluated by direct observation of their performance of both core and noncore procedures. Therefore, the view that evaluation by direct observation would be resisted by residents is not supported by this study. As a result of these findings, the authors encourage programs to establish processes for assessing and documenting residents' performances of office and outpatient procedures.
Clinical Competence↗
A comparison of four empathy instruments in simulated patient-medical student interactions.
Prior investigations of empathy in medicine have used several available instruments for assessment, including a scale developed by Hornblow, Hogan's empathy scale, the Carkhuff-Truax empathic understanding scale, and the Barrett-Lennard relationship inventory. The purpose of the study reported in this article was to investigate the intercorrelations of the scores on these four instruments when used in a medical student-simulated patient interaction. The results showed that measures of empathy based on observed behavior of the students were highly intercorrelated but that empathy self-assessed by the students themselves as having that trait did not correlate significantly with any of the behavior-based measures. No significant effect on these findings was attributable to the timing of the instrument administration, to the students' interpersonal skills training or experience in taking histories and performing physical examinations, or to the sex of the students and the observers.
Clinical Competence↗
The visiting lectureship in radiology: an evaluation.
This study was designed to assess the effectiveness of didactic lectures in radiology by visiting faculty. Residents attending a lecture given by a visiting professor of radiology were subjected to a pre- and postlecture test on the contents of the lecture. Results indicated substantial gain in base knowledge of the subject material. Other studies indicate that increasing medical knowledge through lectures is of debatable effectiveness. This study indicates significant information transfer when short-term retention was tested. The level of retention was independent of the two sites of training and independent of level of training.
Analysis of Variance↗
Resident and faculty perceptions of effective clinical teaching in family practice.
Increasing interest in clinical teaching has led to the realization that the unique subset of skills which characterizes effective clinical teaching needs to be identified. Such identification will lead to development of these skills and improvement in the quality of clinical teaching. Family practice faculty are vitally concerned with improving their clinical teaching skills, since clinical teaching is the core of education in family medicine and since many family physicians who become preceptors have had no formal training as teachers. In this investigation of effective clinical teaching behaviors, faculty and residents generally agree in their perceptions of the helpfulness of 58 clinical teaching behaviors. Neither group felt that emphasis on references and research is as important a factor in effective clinical teaching as are residents' active participation in the learning situation and positive preceptor attitudes toward teaching and residents. It was perceived that the ineffective clinical teacher has a negative attitude toward residents, is inaccessible, and lacks skills in providing feedback, while the effective clinical teacher has skills in two-way communication, creates an educational environment that facilitates learning, and provides constructive feedback to residents.
Attitude of Health Personnel↗
Promotion criteria: perceptions of faculty members and departmental chairmen.
Medical school promotions committees tend to depend heavily on departmental evaluations of candidates for promotion. Unfortunately, departments often lack clear promotion guidelines; this results in confused perceptions of promotion criteria. Faculty members and department chairman do not always see eye to eye. When asked to indicate which activities contributed the most toward achieving promotion to higher academic rank, faculty members in a large midwestern medical school perceived research to be the single most important activity. Departmental chairmen had a broader perception, however, and included research, teaching patient care and administration/service in their list of desirable and essential activities. Faculty members and chairman differed significantly (p less than .01) in their mean ratings of 12 of 69 activities. Such perceptual discrepancies can lead to conflict and disagreement that can be avoided by straightforward explanations of promotion criteria and more clearly defined job descriptions and time allocations.
Clinical Competence↗