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Biomedical subjects

L Z Nieman

Publications and source records attributed to L Z Nieman.

At least 19 recordsLinked to original sources
PubMed1997

Designing evaluations for a women's health education program.

Explicitly incorporating women's health into the medical school curriculum is a relatively new process for educators. Moreover, until recently, no standard definition of women's health had been developed. Because there are no specific evaluation designs for women's health programs, evaluators must adapt existing evaluation concepts to fit the needs of the program. Evaluation is a broad concept that includes assessments of knowledge, skills, and attitudes to reach decisions about program improvements. The purpose of this article is to describe methods of evaluating women's health programs, including how to tailor basic evaluation concepts to the program. Several areas of women's health programming are discussed as background to creating the innovative design for this new program evaluation. An example of an evaluation design for a totally integrated women's health curriculum is presented, including some preliminary data and a discussion of strategies for overcoming obstacles to initiating women's health evaluations.

Curriculum↗
PubMed1996

Teaching medical students by role playing: a model for integrating psychosocial issues with disease management.

BACKGROUND: Medical students on third-year rotations seem to be focused more on the particulars of disease management than on patient management. They often pay too little attention to the psychological and social needs of the patient and to the importance of working in a multidisciplinary team. The authors postulated that a model for teaching breast cancer management that included role playing, self-study, and active student involvement would facilitate the integration of psychosocial and affective issues into scientific content and would demonstrate the importance of the team approach in managing patients with breast cancer. METHODS: One month following a problem-oriented, case-based, interactive session focusing on clinical management of breast disease, each student was assigned the role of either "patient" or one of four "specialists"-1) a general surgeon, 2) a medical oncologist, 3) a radiation oncologist, or 4) a plastic surgeon. A packet of readings containing discipline-specific information was distributed to each "specialist" and a similar preparation packet was distributed to each "patient." One week later students from each specialty met in "multidisciplinary groups" and five "patients" with written scenarios of recently diagnosed primary breast cancer rotated among them. Important decision-making choices were discussed in each consultation. Following their consultations in the "multidisciplinary" groups, the "patients" met with the entire group of 20-25 students and with physician faculty to discuss differences in the information obtained. They compared "specialists'" styles of presentation and attitudes. Specific issues involving coordination of care among "specialists" were carefully highlighted. RESULTS: All students participated and the teaching sessions were well received. CONCLUSIONS: Role playing facilitates the discussion of psychosocial issues and aptly demonstrates to students the need for a multidisciplinary approach to breast cancer treatment. This model is applicable to other types of cancer and to other groups of cancer educators.

Adult↗
PubMed1995

Interactive computer-based programs for a cancer learning center.

This paper describes the design and evaluation of a computer-based instruction (CBI) program that was integrated into a multidisciplinary cancer curriculum at the Medical College of Pennsylvania. Instruction took place in a cancer learning center. Modules contained literature, posters, slide sets, videocassette films, and "see, touch, and feel" models to teach and practice breast, testicular, rectal, laryngeal, and colonoscopic examinations. The CBI (programmed on HyperCard) contained tutorials divided into three levels of learning objectives: level one, epidemiology and prevention; level two, diagnosis and staging; and level three, management and prognosis. Simulated cases and test items were developed for each level. To evaluate students' perceptions of the program and provide them with feedback about their performances, the authors designed a questionnaire, held a focus group, and developed a built-in tracking system for the CBI. Results showed that the program was well received, the students answered the test items correctly, and the students wanted more time to study cancer. A description of some of the problems encountered with technology and equipment is provided for faculty who may be interested in designing and implementing similar CBI programs.

Computer-Assisted Instruction↗
PubMed1994

Sex and gender bias in anatomy and physical diagnosis text illustrations.

OBJECTIVE: To examine the sex and gender distribution of illustrations in two atlases, five anatomy texts, and five physical diagnosis texts. DESIGN: Of 4060 illustrations that were identifiable by sex and gender in 12 commonly used anatomy and physical diagnosis textbooks, 3827 were categorized by two reviewers as female, male, or neutral. RESULTS: Females were represented, on average, in 21.2% of the anatomy text illustrations; males were represented, on average, in 44.3%; 34.4% of the illustrations were neutral. Of the nonreproductive anatomy illustrations, a mean of 11.1% (range, 4.6% to 23.8%) depicted women and 43.1% (range, 35.4% to 56.2%) depicted men. Of nonreproductive anatomy illustrations, a mean of 45.8% (range, 27.2% to 59.9%) were neutral. Overall, the physical diagnosis text illustrations demonstrated a more equal sex and gender distribution (21.5% female and 24.8% male). However, in the reproductive chapters of the physical diagnosis texts, females were depicted in a mean of 71.1% (range, 63.2% to 79.0%) of the illustrations, while in the nonreproductive chapters, females were depicted in 8.8% of total illustrations. CONCLUSIONS: In anatomy and physical diagnosis texts, women are underrepresented in illustrations of nonreproductive anatomy. The finding that males are depicted in a majority of nonreproductive anatomy illustrations may perpetuate the image of the male body as the normal or standard model for medical education.

Female↗
PubMed1994

Creation and assessment of a structured review course in physical diagnosis for medical residents.

OBJECTIVE: To evaluate the effects of a course in physical diagnosis on the knowledge, skills, and attitudes of internal medicine trainees. DESIGN: A controlled, prospective assignment of housestaff to a year-long curricular program, linked to a set of pre- and posttests. Houseofficers who could not attend the teaching sessions functioned as control subjects. SETTING: An internal medicine training program at an urban medical school. SUBJECTS: 56 (86.1%) of 65 eligible internal medicine housestaff (post-graduate years 1 through 3) participated in the intervention and assessment. A comparison group of 14 senior medical students participated in the pretest. INTERVENTION: 12 monthly lectures emphasizing skills useful in emergencies or validated by the literature. MEASUREMENTS: The pre- and posttests included: 1) a multiple-choice questionnaire to assess knowledge; 2) professional standardized patients to assess selected skills; and 3) Likert-type questionnaires to assess self-motivated learning and attitude toward diagnosis not based on technology. MAIN RESULTS: The residents expressed interest in the program and on a six-point scale rated the usefulness of lectures and standardized patients as 3.5 +/- 1.3 and 4.3 +/- 1, respectively. For no system tested, however, did they achieve more than 55.2% correct answers (range: 24.2%-55.2%, median = 41.04), and their performance did not differ from that of the fourth-year medical students. There was no significant difference in pre/posttest improvement between the control and intervention groups. CONCLUSIONS: These data confirm the deficiencies of physical diagnostic skills and knowledge among physicians in training. These deficiencies were not corrected by the classroom lecture series. Improvement in these skills may require a more intense experiential program made part of residency requirements.

Analysis of Variance↗
PubMed1993

The teaching and practice of cardiac auscultation during internal medicine and cardiology training. A nationwide survey.

OBJECTIVES: To assess the time and importance given to cardiac auscultation during internal medicine and cardiology training and to evaluate the auscultatory proficiency of medical students and physicians-in-training. STUDY DESIGN: A nationwide survey of internal medicine and cardiology program directors and a multicenter cross-sectional assessment of students' and housestaff's auscultatory proficiency. SETTING: All accredited U.S. internal medicine and cardiology programs and nine university-affiliated internal medicine and cardiology programs. PARTICIPANTS: Four hundred ninety-eight (75.6%) of all 659 directors surveyed; 203 physicians-in-training and 49 third-year medical students. INTERVENTIONS: Directors completed a 23-item questionnaire, and students and trainees were tested on 12 prerecorded cardiac events. MAIN OUTCOME MEASURES: The teaching and proficiency of cardiac auscultation at all levels of training. RESULTS: Directors attributed great importance to cardiac auscultation and thought that more time should be spent teaching it. However, only 27.1% of internal medicine and 37.1% of cardiology programs offered any structured teaching of auscultation (P = 0.02). Programs without teaching were more likely to be large, university affiliated, and located in the northeast. The trainees' accuracy ranged from 0 to 56.2% for cardiology fellows (median, 21.9%) and from 2% to 36.8% for medical residents (median, 19.3%). Residents improved little with year of training and were never better than third-year medical students. CONCLUSIONS: A low emphasis on cardiac auscultation appears to have affected the proficiency of medical trainees. Our study raises concern about the future of this time-honored art and, possibly, other bedside diagnostic skills.

Attitude of Health Personnel↗
PubMed1993

Death notification in the emergency department: a survey of residents and attending physicians.

STUDY OBJECTIVE: To delineate the topics discussed with families during the death notification process and to identify which of these topics are stressful to the physician. Also, the survey served as a needs assessment in designing an educational program for emergency medicine residents in death notification. DESIGN AND PARTICIPANTS: Forty-five residents and 20 attendings physicians in emergency medicine at the Medical College of Pennsylvania were given an anonymous, self-administered, 47-item questionnaire seeking demographic information and assessing topics discussed during notification, perceived importance to the family of these topics, and the stressfulness of these topics. RESULTS: One hundred percent of the participants responded to the survey. Hospital care, prehospital care, and cause of death were most often discussed with the family, although no topic was discussed 100% of the time by all physicians. Those items that may be perceived as emotionally charged, such as organ donation and autopsy, were rated as more stressful and were less frequently addressed during notification. CONCLUSION: Factual information is discussed most often, and emotional issues are considered most stressful. Therefore, a program in death notification must address those issues that must be handled during a notification and provide mechanisms for residents to feel comfortable with emotional responses from the family.

Attitude to Death↗
PubMed1992

Defining and accomplishing clinically related objectives in an eight-hour oncology course for first-year medical students.

Designing a clinically relevant cancer curriculum for freshmen attending medical schools with a traditional curriculum poses the following challenges: (1) there is limited curriculum time; (2) the subject matter is complex. The authors defined some of the responsibilities of the general physician in regard to cancer and six related objectives that first-year students could accomplish in an eight-hour multidisciplinary oncology course. A case-based, modified essay examination required students to demonstrate that they could begin to integrate principles of prevention, screening, diagnosis and staging, and treatment modalities. Ninety percent of the students accomplished the objectives. However, in working up the cancer case, 70% of the students did not mention the physical examination and 53% forgot multidisciplinary consultation. In a curriculum with limited objectives, first-year students can begin to deal efficiently with the complexities of cancer. Evaluation data revealed those objectives and related physician responsibilities requiring reinforcement in subsequent training.

Curriculum↗
PubMed1992

Designing and evaluating an episodic, problem-based geriatric curriculum.

BACKGROUND: Medical school geriatric training has been directed primarily at improving students' attitudes and knowledge about elderly patients. This study evaluated a clinical problem-based geriatric course for medical students. METHODS: The two-semester geriatric course was presented to 136 second-year medical students. Faculty taught students about clinical reasoning in ambulatory geriatrics using written cases, patient-actors, literature reviews, lectures, and discussions. At the end of the course, students' clinical activity was evaluated using audiotaped interviews with standardized geriatric patients. A questionnaire examined students' knowledge, attitudes, and their evaluation of the course. RESULTS: All 136 students completed the post-course standardized patient interview, and 105 (77%) completed questionnaires. Students rated the course favorably and had high confidence scores for ability to assess geriatric problems. Students' knowledge increased during the course compared to a precourse examination (P less than .05). Evaluation of post-course standardized patient interviews revealed that students who scored higher on the knowledge test tended to ask more psychosocial questions during the interview (r = 0.38). Students who scored higher on the attitude test spent more time eliciting patients' feelings during the interview (r = 0.38). Those with lower scores on the attitude test spent more time asking factual, nonpsychosocial questions (r = 0.28). CONCLUSIONS: A clinical problem-based geriatric course for preclinical medical students can be successful in improving students' knowledge. Attitudes and knowledge effect the questions a student asks during the medical interview.

Attitude of Health Personnel↗
PubMed1991

A comparison of computer-assisted instruction and small-group teaching of cardiac auscultation to medical students.

Cardiac auscultation is suffering from declining interest, caused by competing diagnostic technology and inadequate training of doctors. Computer-assisted instruction (CAI) supporting graphics and digitized sound could be ideally suited for teaching and sharpening this skill. To evaluate this premise we randomized 35 third-year medical students to 3 hours of seminar teaching plus the use of audiotapes (group 1), the self-use of a MacIntosh-based CAI (group 2), or both (group 3). All students took a pre- and post-test consisting of eight pre-recorded cardiac events and were also assessed for computer anxiety. Although there were no significant differences between pre- and post-tests for each group and among groups, group 1 had a 4.5% deterioration in its diagnostic score compared to the 7.2% and 3.2% improvements of groups 2 and 3 respectively. Group 2 used the CAI significantly more than group 3. We conclude that CAI is at least as effective as seminars in teaching cardiac auscultation to third-year medical students.

Clinical Competence↗
PubMed1988

Training and validating the use of geriatric simulated patients.

After presenting four patient roles during an audio-taped final examination of 68 second-year medical students' interview skills, seven geriatric simulated patients evaluated the interview skills of the students. Reviews of randomly-selected audiotapes revealed that the patients were highly consistent and accurate in their evaluations, indicating that geriatric simulated patients may be an untapped resource for medical training.

Aged↗
PubMed1987

Training and evaluating teams of simulated patients.

The purpose of this study was to train and evaluate teams of standardized (simulated) patients as part of a required course in family medicine for second-year medical students. During three hours of training, six women were trained to play the same person. These standardized teams played four roles during the 12-week course. Each simulator was interviewed by three student interviewers who were part of six groups of ten to 12 students, each group led by a physician. All sessions were audiotaped, and a coding system was developed. The completeness of response, new unscripted items, and accuracy of information provided by the simulators were measured using the audiotape sessions as sources of data. In addition, the degree of accuracy of the affect of each simulator was assessed by faculty and students in written case histories. The results of the study show that multiple simulators are an effective way of promoting active learning and of teaching basic clinical concepts and skills. Teams of standardized patients give students a consistent learning experience when there are constraints of student group size, time, and scheduling simulations within a traditional curriculum.

Clinical Competence↗