Search PubMed⌕ Search

Biomedical subjects

L Z Nieman

Publications and source records attributed to L Z Nieman.

At least 37 records · Page 2Linked to original sources
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↗
PubMed1986

Career preferences and decision-making habits of first-year medical students.

Few studies that examine the career decisions of medical students have been based upon theories of decision-making. Several theories were used by the present authors to study differences among first-year medical students in North Carolina who preferred family medicine and those who preferred other specialties. Responses by 358 first-year students to a career preferences questionnaire administered in the fall of their freshman year revealed that students who preferred family medicine were more interested than other students in using medicine as a tool to help people. They were equally persistent and thorough in their career decision-making, were at an earlier stage of decision-making, and had less concern with themselves compared with other students. Decision-making theory helps to explain the relationships found in earlier studies between students' characteristics and their specialty preferences. The results of the present study also may explain the reason for the decrease during medical school in the number of students who prefer family medicine as a career. Those results show that first-year medical students who prefer family medicine are at an earlier stage of the decision-making process than other first-year medical students.

Career Choice↗
PubMed1983

Family medicine home visit programs in U.S. and Canadian medical schools.

In this report, the authors describe the current status of home visit training programs in family medicine education in U.S. and Canadian medical schools. Thirty-two percent of the 137 medical schools with programs in family medicine provide opportunities for students to visit patients in their homes. In most of these schools, visits are mandatory, are made by one student, occur at more than one level of study, and require a written report by the student. Information gathered during the visit becomes part of the patient's medical record and is shared with health care providers. Physician participation in the visit is more frequently optional and an alternative to the participation of nonphysician faculty members or allied health professionals. Ninety-four percent of the respondents whose schools have programs report that students, faculty members, and patients have positive attitudes toward the visit. Suggestions for improving and/or designing home visit programs are provided based on the data accumulated during the study.

Canada↗
PubMed1983

Management of problem patients with multiple chronic diseases.

Residents in a university-based family medicine program perceived patients with diabetes mellitus, hypertension, and obesity as problem patients. The residents' perceptions of 166 patients were compared with information from a chart audit. A resident questionnaire outlined the goals, obstacles, and strategies pertaining to management of these patients as well as residents' perceptions of patient expectations. The results prompted a shift in focus from the problem patient to the problem patient-physician relationship and brought forth improved strategies that hold potential for making a difference in patient and physician satisfaction and outcome of care.

Attitude of Health Personnel↗
PubMedDate not supplied

Specialty career decision making of third-year medical students.

Medical Students who are deciding which specialty to enter sometimes do not choose the one they actually prefer. The purposes of this study were to compare specialty preferences of students with their choices, as well as to identify the factors on which decisions about entering family medicine are based. Of North Carolina's 429 third-year medical students, 59% responded in 1985 to a career preferences questionnaire that assessed the process of specialty decision making. Internal medicine was the most frequently chosen specialty when another was preferred. The frequency with which family practice was the career choice was affected little by differences between preferences and choices. Six factors were identified, with the curriculum as the major factor separating those who chose family practice from those who chose other primary care or non-primary care specialties. Based on these results, six suggestions are offered for medical school administrators and faculty desiring to increase the number of students selecting family practice.

Career Choice↗
PubMedDate not supplied

Faculty development for family medicine: a status report.

Stability in family medicine residency program growth has resulted in a trend to redefine faculty development in terms of changing needs. Recent literature has indicated these needs to be in the areas of increased research, improved clinical skills, reassessment of content and methods of faculty development, and changes in educational methods. To identify the status of faculty development programs in 1985, 126 family medicine university-based programs were surveyed. Data were obtained regarding the content of faculty development programs, the perceived competence of faculty in six clinical teaching areas and three academic areas, and the importance of eight areas of faculty development. The most frequent activity reported by the 74 respondents was in the area of teaching and evaluation. Research was the academic area listed in which directors noted a particular lack of competence. In the clinical content area, both procedural skills and critical care stood out as areas of faculty needs. Results suggested that more than one track of faculty development should be provided to meet complex and changing faculty development needs.

Education, Continuing↗