Biomedical subjects

Judith L Bowen

Publications and source records attributed to Judith L Bowen.

4 recordsLinked to original sources

PubMed2004

Impacts of computerized physician documentation in a teaching hospital: perceptions of faculty and resident physicians.

OBJECTIVE: Computerized physician documentation (CPD) has been implemented throughout the nation's Veterans Affairs Medical Centers (VAMCs) and is likely to increasingly replace handwritten documentation in other institutions. The use of this technology may affect educational and clinical activities, yet little has been reported in this regard. The authors conducted a qualitative study to determine the perceived impacts of CPD among faculty and housestaff in a VAMC. DESIGN: A cross-sectional study was conducted using semistructured interviews with faculty (n = 10) and a group interview with residents (n = 10) at a VAMC teaching hospital. MEASUREMENTS: Content analysis of field notes and taped transcripts were done by two independent reviewers using a grounded theory approach. Findings were validated using member checking and peer debriefing. RESULTS: Four major themes were identified: (1) improved availability of documentation; (2) changes in work processes and communication; (3) alterations in document structure and content; and (4) mistakes, concerns, and decreased confidence in the data. With a few exceptions, subjects felt documentation was more available, with benefits for education and patient care. Other impacts of CPD were largely seen as detrimental to aspects of clinical practice and education, including documentation quality, workflow, professional communication, and patient care. CONCLUSION: CPD is perceived to have substantial positive and negative impacts on clinical and educational activities and environments. Care should be taken when designing, implementing, and using such systems to avoid or minimize any harmful impacts. More research is needed to assess the extent of the impacts identified and to determine the best strategies to effectively deal with them.

Attitude of Health Personnel↗

PubMed2004

Faculty development needs.

We compared prior training in 4 areas (general teaching skills, teaching specific content areas, teaching by specific methods and in specific settings, and general professional skills) among community-based teachers based in private practices (N = 61) compared with those in community sites operated by teaching institutions (N = 64) and hospital-based faculty (N = 291), all of whom attended one of three national faculty development conferences. The prevalence of prior training was low. Hospital-based faculty reported the most prior training in all 4 categories, teaching hospital affiliated community-based teachers an intermediate amount, and private practice community-based teachers the least (all P <.05). This association remained after multivariable adjustment for age, gender, and amount of time spent in teaching and clinical activities. Preferences for future training reported frequently by the private practice community-based teachers included: time management (48%); teaching evidence-based medicine (46%); evaluation of learners (38%); giving feedback (39%); outpatient precepting (38%); and "teaching in the presence of the patient" (39%).

Adult↗

PubMed2004

Outcomes of a national faculty development program in teaching skills: prospective follow-up of 110 medicine faculty development teams.

BACKGROUND: Awareness of the need for ambulatory care teaching skills training for clinician-educators is increasing. A recent Health Resources and Services Administration (HRSA)-funded national initiative trained 110 teams from U.S. teaching hospitals to implement local faculty development (FD) in teaching skills. OBJECTIVE: To assess the rate of successful implementation of local FD initiatives by these teams. METHODS: A prospective observational study followed the 110 teams for up to 24 months. Self-reported implementation, our outcome, was defined as the time from the training conference until the team reported that implementation of their FD project was completely accomplished. Factors associated with success were assessed using Kaplan-Meier analysis. RESULTS: The median follow-up was 18 months. Fifty-nine of the teams (54%) implemented their local FD project and subsequently trained over 1,400 faculty, of whom over 500 were community based. Teams that implemented their FD projects were more likely than those that did not to have the following attributes: met more frequently (P=.001), had less turnover (P=.01), had protected time (P=.01), rated their likelihood of success high (P=.03), had some project or institutional funding for FD (P=.03), and came from institutions with more than 75 department of medicine faculty (P=.03). The cost to the HRSA was $22,033 per successful team and $533 per faculty member trained. CONCLUSIONS: This national initiative was able to disseminate teaching skills training to large numbers of faculty at modest cost. Smaller teaching hospitals may have limited success without additional support or targeted funding.

Education, Medical, Continuing↗

PubMed2002

Assessing quality and costs of education in the ambulatory setting: a review of the literature.

PURPOSE: Time-pressured interactions with little direct observation or feedback characterize teaching in ambulatory settings. The authors report findings from the literature on teaching and learning in the ambulatory setting and propose opportunities for further research that addresses these barriers. METHOD: The authors searched 1995-1999 databases for all empirical studies that focused on research conducted in ambulatory settings. Publications were reviewed for evidence of inclusion criteria. Findings were sorted into categories previously described for defining and evaluating quality of ambulatory care educational programs. RESULTS: Most studies were conducted in departments of internal medicine (40%), focused on medical students (43%), and took place in a single program (77%), making generalizations difficult. Students and residents are learning in ambulatory environments, and the types of patients they encounter are likely to prepare them for practice. Patient care outcomes have emerged as a measure of learning. Teachers may be the single most important factor, yet they lack self-confidence as teachers. Community-based preceptors teach because of enjoyment of teaching and the opportunity to stay current. However, none of the studies addressed the impact of the Medicare documentation requirements on satisfaction with teaching. Teaching settings cost about one third more than non-teaching settings to operate. CONCLUSION: This review identifies many gaps in our knowledge of effective clinical teaching practices, and of learning environments in which that teaching takes place. The predominance of single-institution studies limits generalizability of current findings. A prioritized research agenda should be established and funded, focusing on improving the efficiency and effectiveness of teaching and learning in ambulatory settings.

Ambulatory Care↗