Search PubMed⌕ Search

Biomedical subjects

F M Wolf

Publications and source records attributed to F M Wolf.

70 records · Page 4Linked to original sources
PubMed1984

Medical education in facilities for the elderly. Impact on medical students, facility staff, and residents.

The development of positive attitudes toward elderly patients has been identified as being an important factor in providing quality geriatric care. Medical students (N = 234) interviewed elderly individuals in three types of facilities, ranging from independent apartment living to nursing homes, as part of a required medical interviewing course. The students' attitudes were measured by an Attitudes Toward the Elderly scale before and after this course. Analyses disclosed significant posttest improvement in students' attitudes concerning the functioning, integrity, and personal acceptability of the elderly at all sites, except for attitudes toward functioning at nursing home sites. Staff and residents of participating facilities rated the experience favorably. This study shows that students' attitudes toward the elderly can be positively changed through incorporation of training at appropriate community facilities for the elderly into existing curricula.

Administrative Personnel↗
PubMed1984

Validity of patient management problems re-examined.

Newble et al. (1982) examined the construct validity of one Patient Management Problem (PMP) with groups of subjects with varied levels of medical competence, ranging from fourth-year medical students to post-intern medical registrars and consultant physicians. The present study reanalysed their data using analysis of variance followed by Scheffé a postiori comparisons of the mean scores for each group. Results suggest virtually no difference among the various groups' performances on this particular PMP, in contrast to the assertion of Newble et al. (1982) that 'the most competent groups (the post-interns) generally scored less well on the calculated indices than the senior students and interns'. While Newble et al. (1982) maintained that their findings do not show the PMP to be a valid test of competence, the present analysis suggests that their study was not an adequate test of the construct validity of PMPs due to lack of power and insufficient sample size. An alternative interpretation of this data is presented, along with implications for medical education and future research.

Analysis of Variance↗
PubMed1984

Evaluating the medical history: observation versus write-up review.

The ability to develop a medical history data base relevant to the total care of a patient is a requisite skill for clinical problem-solving. Assessment of this skill by faculty members in medical students has been based on direct observation of the student-patient encounter as well as on evaluation of the student's written patient history. In the study reported here, both methods were compared by the authors for the same student-patient interview. Preceptor ratings of the students' data-elicitation skills were correlated with their ratings of the students' interview-process skills and the time spent by the preceptor observing the interview. A criterion-based, checklist scoring of the student's write-up was not correlated with preceptor ratings. In this study, the authors suggest that a criterion-based evaluation of the student's patient write-up is a less faculty-intensive and more reliable method of evaluating medical student data-collection skills than direct observation of the student-patient encounter.

Clinical Competence↗
PubMed1981

Medical student acquisition and retention of communication and interviewing skills.

Medical students' interpersonal and communication skills were assessed over the course of their first two years of medical training. During the first year, students participated in a nine-week course designed to develop effective interviewing skills. On the average, students improved significantly on two standardized measures of communication and discrimination skills as a result of this training. Upon completion of this course, the students conducted a videotaped interview with "screened patients," persons trained in interviewing skills. Evaluation of these videotapes indicated a level of performance commensurate with performance on the written measures. A similar interview was conducted about one year after the first " screened patient" interview to assess retention of these skills. Results of the first and second video analyses indicated a significant decline in student process-oriented skills. These findings indicate that effective interviewing and communication skills can be not only learned but also forgotten.

Communication↗
PubMedDate not supplied

The effects of a cost-education program on hospital charges.

An educational intervention designed to change physicians' use of inpatient services was implemented on two general medical services for a year. The intervention consisted of a brief orientation to cost containment issues, a pamphlet that outlined practical cost containment strategies and listed the charges for commonly ordered tests and services, and access to detailed interim patients' bills generated during the hospitalization. Two concurrent control services received no intervention. Over 1,600 admissions were evaluated. The geometric mean length of stay was 0.61 days shorter on intervention services compared with control (5.15 vs. 5.76 days, p less than 0.01). The geometric mean hospital charges were $388 less for intervention patients ($3,199 vs. $3,587, p less than 0.005). Neither patients' demographic characteristics nor case mix could explain the reductions. The authors conclude that a simple program utilizing information already in existence in most hospitals can result in a significant and meaningful reduction in length of stay and charges.

Cost Control↗
PubMedDate not supplied

Strategies for integrating computer-based activities into your educational environment: a practical guide.

Strategies for implementing instructional technology are based on recent experiences at the University of Michigan Medical Center. The issues covered include 1) addressing facilities, hardware, and staffing needs, 2) determining learners' skill requirements and appropriate training activities, and 3) selecting and customizing educational software. Many examples are provided, and nine key points for success are emphasized.

Computer-Assisted Instruction↗
PubMedDate not supplied

Effects of a decision support system on the diagnostic accuracy of users: a preliminary report.

OBJECTIVES: To assess the effects of incomplete data upon the output of a computerized diagnostic decision support system (DSS), to assess the effects of using the system upon the diagnostic opinions of users, and to explore if these effects vary as a function of clinical experience. DESIGN: Experimental pilot study. Four clusters of nine cases each were constructed and equated for case difficulty. Definitive findings were omitted from the case abstracts. Subjects were randomly assigned to one of four clusters and were trained on the DSS prior to use. SUBJECTS: The study involved 16 physicians at three levels of clinical experience (six general internists, four residents in internal medicine, and six fourth-year medical students), from three academic medical centers. PROCEDURE: Each subject worked up nine cases, first without and then with ILIAD consultation. They were asked to offer up to six potential diagnoses and to list up to three steps that should be the next items in the diagnostic workup. Effects of DSS consultation were measured by changes in the position of the correct diagnosis in the lists of differential diagnoses, pre- and post-consultation. RESULTS: The DSS lists of diagnostic possibilities contained the correct diagnosis in 38% of cases, about midway between the levels of accuracy of residents and attending general internists. In over 70% of cases, the DSS output had no effect on the position of the correct diagnosis in the subjects' lists. The system's diagnostic accuracy was unaffected by the clinical experience of the users.

Decision Making↗
PubMedDate not supplied

Information gathering and integration as sources of error in diagnostic decision making.

This research examined the relative importance of information gathering versus information utilization in accounting for errors in diagnostic decision making. Two experiments compared physicians' performances under two conditions: one in which they gathered a limited amount of diagnostic information and then integrated it before making a decision, and the other in which they were given all the diagnostic information and needed only to integrate it. The physicians: 1) frequently failed to select normatively optimal information in both experimental conditions; 2) were more confident about the correctness of their information selection when their task was limited to information integration than when it also included information gathering; and 3) made diagnoses in substantial agreement with those indicated by applying normative procedures to the same data. Physicians appear to have difficulties recognizing the diagnosticity of information, which often results in decisions that are pseudodiagnostic or based on diagnostically worthless information.

Bayes Theorem↗
PubMedDate not supplied

Teaching smoking-cessation counseling to medical students using simulated patients.

OBJECTIVE: Our objective was to evaluate the effectiveness of using simulated patient instructors and the Ockene method to instruct third-year medical students in smoking-cessation counseling techniques. DESIGN: We used a clinical exercise with self-study preparation and simulated patient instructors. METHODS: One hundred fifty-nine students participated in a smoking-cessation counseling session in which cognitive and behavioral endpoints were assessed by simulated patient instructors and the students themselves. RESULTS: Student performance in the cognitive and behavioral components of model smoking-cessation counseling was acceptable. Specific areas of weakness, such as the tendency of students to underemphasize the personal and social benefits of smoking cessation, and to overestimate their competence on a number of skill items, were identified. Student evaluation of the exercise was positive. CONCLUSIONS: Smoking-cessation counseling can be taught effectively to third-year medical students by simulated patient instructors during a clinical clerkship.

Clinical Clerkship↗