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Biomedical subjects

M S Lipsky

Publications and source records attributed to M S Lipsky.

At least 19 recordsLinked to original sources
PubMed2006

Medical students' assessments of skill development in rural primary care clinics.

INTRODUCTION: This study assessed the impact of a rural primary care preceptorship on medical students' self-perceived ability to provide acute, chronic, and preventive care, to perform procedures, to communicate with patients, and to understand the community and healthcare system. METHODS: Students were surveyed about their self-assessed skills on 11 major components (97 items) immediately before and after a 16 week preceptorship in a rural primary care clinic. Responses were analyzed for 96 medical students using a paired comparisons t-test and univariate statistics. RESULTS: Students' skills significantly increased on all components and items. The skills most highly assessed post-preceptorship were those skills related to the management of chronic problems, the provision of patient education and health maintenance, and the ability to handle undifferentiated and acute problems. Among the 11 components assessed, students ranked their skills in performing procedures the lowest. The largest cumulative gain in skills was in the areas of understanding health systems and the community. CONCLUSIONS: This study provides a unique opportunity to look at skill development before and after a rural clerkship. From the student's perspective, the 16 week preceptorship appears to be of significant educational benefit. Future studies need to examine other measures of performance and outcomes of training in rural primary care settings.

Adult↗
PubMed2001

A national survey of procedural skill requirements in family practice residency programs.

BACKGROUND AND OBJECTIVES: Procedural skill training is a controversial but important component of family practice residency programs. This study examines the use and composition of required procedure lists in US family practice residency programs. METHODS: The study used a cross-sectional nine-item questionnaire. This survey was sent to 467 residency program directors listed in the 1999 American Academy of Family Physicians Directory of Family Practice Residency Programs. RESULTS: A total of 326 programs (70%) responded to the survey. Of these, 242 programs (74% of respondents) reported use of a required procedure list. Sixty-six programs provided a list. Of these, 63 lists were interpretable. The number of required procedures on the lists ranged from a minimum of 3 procedures to a maximum of 117, with an average of 42. A total of 265 distinct procedures were identified, with 25 procedures named on more than half of the lists. Thirteen programs (21%) mandated competency in required procedures, but only five programs (8%) gave clear definitions of what constituted competency. There were no significant differences in lists among training program type, university affiliation, number of hospitals used for rotation, size of affiliated hospital, or number of residents. CONCLUSIONS: The expectations of individual programs vary greatly in terms of required procedures. Few programs define how to evaluate the technical competency of their residents.

Clinical Competence↗
PubMed2000

Diagnosis of vaginitis.

Vaginitis is the most common gynecologic diagnosis in the primary care setting. In approximately 90 percent of affected women, this condition occurs secondary to bacterial vaginosis, vulvovaginal candidiasis or trichomoniasis. Vaginitis develops when the vaginal flora has been altered by introduction of a pathogen or by changes in the vaginal environment that allow pathogens to proliferate. The evaluation of vaginitis requires a directed history and physical examination, with focus on the site of involvement and the characteristics of the vaginal discharge. The laboratory evaluation includes microscopic examination of a saline wet-mount preparation and a potassium hydroxide preparation, a litmus test for the pH of vaginal secretions and a "whiff" test. Metronidazole is the primary treatment for bacterial vaginosis and trichomoniasis. Topical antifungal agents are the first-line treatments for candidal vaginitis.

Antifungal Agents↗
PubMed2000

Evaluation of nursing home patients. A systematic approach can improve care.

As the US population ages, the proportion of patients receiving long-term care is increasing. To meet the challenge of providing quality care for these patients, physicians need to be prepared to efficiently evaluate their needs and formulate individualized care plans. In this article, Drs King and Lipsky discuss the unique aspects of caring for nursing home patients, including the role of patients' families in the overall plan. They present a practical, structured approach to evaluation and follow-up care, which they have encapsulated into two handy assessment forms.

Aged↗
PubMed1999

The short-term impact of a continuing medical education program on providers' attitudes toward treating diabetes.

OBJECTIVE: The objective of this study was to evaluate the short-term impact of a 7-h type 2 diabetes continuing medical education (CME) program. Outcomes included a measure of health care providers' diabetes knowledge and the Diabetes Attitude Scale (DAS), a validated measure of attitudes toward diabetes. RESEARCH DESIGN AND METHODS: A CME program on type 2 diabetes was presented by an expert panel in Chicago during November 1998. A before-after trial with pre- and postintervention measurements of diabetes knowledge and attitudes toward diabetes was administered as part of the program. A convenience sample of the 129 health care providers in attendance resulted in 91 (71%) completed pre- and postintervention surveys. RESULTS: Within-subjects analysis revealed increases in knowledge and more favorable attitudes toward diabetes after the program. Between-subjects analysis revealed that attitude changes differed for physicians as compared with allied health care providers. CONCLUSIONS: A CME program was associated with an increase in knowledge of diabetes and more favorable attitudes toward diabetes as measured by the DAS. The DAS changes were subtly different for the physician group as compared with the allied health care provider group. These results suggest that the DAS can be a useful instrument for measuring the short-term impact of educational interventions.

Allied Health Personnel↗
PubMed1999

Students' evaluations of teaching and learning experiences at community- and residency-based practices.

BACKGROUND: Research has identified students' preferences for clinical sites and the clinical teaching behaviors of preceptors valued by students. This study investigated medical students' perceptions of preceptor teaching behaviors and student performance information at community- and residency-based sites. METHODS: The sample was 594 third-year medical students who completed a 4-week rotation in family medicine at community- and residency-based sites. Students completed two evaluation instruments that addressed clinical experiences and perceptions of effective teaching by clinical preceptors. RESULTS: For the majority of items, no statistically significant differences were found between students' rating of preceptors at private practices and residency sites. Generally, the students rated both types of preceptors as favorable. Student clinical performance was rated higher at community sites. CONCLUSIONS: Overall, preceptor teaching behaviors at community practices and residency programs were rated favorably by students. Differences were noted between site types in their clinical evaluation of students.

Clinical Clerkship↗
PubMed1997

The opinions and experiences of family physicians regarding direct-to-consumer advertising.

BACKGROUND: The use of direct-to-consumer advertising (DTCA) by pharmaceutical companies is increasing. Our study examines the opinions and experiences of family physicians concerning DTCA. METHODS: A survey instrument designed to elicit the opinions, experiences, and perceptions of family physicians about DTCA was sent to a 2% (N = 880) systematic sampling of active physician members of the American Academy of Family Physicians. Descriptive statistics were used to analyze responses with t tests and chi 2 tests for independence used to examine subgroup response differences. RESULTS: Four hundred fifty-four (52%) physicians responded to the survey. Most physicians (95%) had encountered DTCA personally, and had been approached by an average of 7 patients over the previous 6 months with requests for specific prescription drugs. Prescription antihistamines and antihypertensive drugs were the most commonly requested. Overall, 80% of the physician respondents believed that print DTCA was not a good idea, while 84% expressed negative feelings about television and radio advertising. Both groups cited "misleading biased view" and "increased costs" as the most common disadvantages. Some reported benefits included "better informed patients" and "promoting physician-patient communication." CONCLUSIONS: Overall, the study group physicians had negative feelings about DTCA in both print and electronic media. Studies directly examining patient perspectives, as well as cost benefits, are necessary to test the validity of the physicians' perceptions about DTCA.

Advertising↗
PubMed1996

Evaluation and initial management of patients with ascites.

Large amounts of ascitic fluid may cause distention, weight gain, anorexia and nausea. Smaller accumulations may be asymptomatic and difficult to detect clinically. In addition to signs associated with the cause of ascites, the physical examination may reveal shifting dullness, a fluid wave and peripheral edema. Ultrasound examination is useful in establishing the diagnosis and in locating the optimal site for paracentesis. Calculation of the serum-ascites albumin gradient provides useful diagnostic information. High gradients usually indicate portal hypertension, while low gradients may indicate infection or carcinomatosis. Management is directed toward alleviating the underlying cause of ascites and reducing symptoms. Initially, restriction of salt intake to 2 g per day is usually advised. Most patients require diuretic therapy. Spironolactone, the usual first-choice agent, may be combined with furosemide in selected patients. If diuretic therapy is unsuccessful, large-volume paracentesis, peritoneovenous portosystemic shunting, transjugular intrahepatic shunting or liver transplantation may be required.

Algorithms↗
PubMed1996

The CyberDoc project: using portable computing to enhance a community-based primary care clerkship.

In July 1995, MCP-Hahnemann School of Medicine of the Allegheny University of the Health Sciences introduced its first-ever required clerkship in family medicine. It was decided that computer skills and applications would be an integral part of this rotation, and a special program, CyberDoc, was developed for the clerkship by some of the university's informatics professionals and family medicine faculty. CyberDoc is a suite of laptop-computer applications, based almost exclusively on "off-the-shelf" database and connectivity programs and designed expressly for students at community-based training sites. CyberDoc allows faculty members to track students' progress at off-site clerkships, and allows the students to access pharmaceutical and drug-interaction databases, the university's online academic information system (including MEDLINE), all basic Internet functions, e-mail, and an array of other applications. The authors briefly describe the background, goals, and structure of the CyberDoc project, as well as the preliminary outcomes of CyberDoc's pilot year.

Clinical Clerkship↗
PubMed1994

Management of diabetic ketoacidosis.

Diabetic ketoacidosis is a common acute complication of insulin-dependent diabetes mellitus. It is defined as the triad of hyperglycemia, acidosis and ketosis. Once diabetic ketoacidosis is suspected, the diagnosis should be established rapidly and treatment initiated. Fluid administration, insulin therapy and correction of metabolic abnormalities are the cornerstones of therapy. Treatment of any underlying illnesses, particularly infection, is also essential to ensure the best possible outcome. Appropriate patient monitoring allows the clinician to assess therapy and make necessary adjustments.

Adult↗
PubMed1994

Physicians' perceptions of the impact of the reclassification of vaginal antifungal agents.

BACKGROUND: In January 1991, miconazole and clotrimazole were released as nonprescription therapy for vaginal candidiasis. Considering the number of women suffering from vaginal symptoms annually, these new over-the-counter (OTC) products may have a considerable impact on women's health care. METHODS: All 191 family physicians and obstetrician and gynecologist members of the Toledo and Lucas County Academy of Medicine were surveyed in June 1992. The survey instrument was constructed to include questions regarding physician perceptions of the impact of OTC antifungal agents on preventive care; the type of advice they currently give patients concerning the use of OTC antifungal agents; and their estimates of the incidence of misdiagnosis and reported side effects resulting from use of OTC antifungal agents. RESULTS: Of the surveyed physicians, 24% concluded that the reclassification of antifungal agents was a positive change for their female patients, 19% believed it was a negative change, and the remaining 57% noted no impact on their patients' well-being. Over 40% of the physicians indicated that four to six of their patients had delayed treatment for other vaginal conditions because of inappropriate use of an OTC antifungal preparation within the last year. On a positive note, the physicians in favor of the OTC preparations believed their patients were getting faster and more economical care and were in "control of their health care." CONCLUSIONS: Physicians participating in this study reported mixed opinions concerning the reclassification of vaginal antifungal agents and raised several pertinent questions that require further examination.

Antifungal Agents↗
PubMed1993

Autopsy: role of the family physician.

The rate of autopsy in the United States has declined from about 50 percent in the 1940s to less than 15 percent today. Although many clinicians feel that modern technology has made postmortem examinations obsolete, autopsies are still important for ensuring quality, assessing new technology and providing new medical information. The primary care physician is responsible for requesting autopsies when appropriate and for informing family members of the findings. Conducting a family conference is an effective method of reviewing autopsy results.

Autopsy↗
PubMed1993

Extent to which guided-discovery teaching strategies were used by 20 preceptors in family medicine.

BACKGROUND: Learners learn more and are able to categorize problems at higher levels when their teachers use guided-discovery strategies (e.g., questions and advice to investigate relationships between concepts), as opposed to directly telling learners the answers. This study examines the extent to which clinician preceptors of residents use guided-discovery strategies when faced with a diagnostic problem-solving situation. METHOD: Twenty family medicine preceptors from four residencies volunteered in 1991-92 to role-play with a simulated first-year resident on a single standardized case. Judges coded the preceptors' verbal behaviors by type (question, statement, or advice) and by category. The categories were teacher, i.e., behaviors relating to more than the present case (hence exemplifying guided-discovery strategies), and consultant, i.e., behaviors relating to the successful disposition of the case (without overt concern for the education of the resident). RESULTS: Of the preceptors' 846 verbal behaviors, 602 (71%) were coded as teacher behaviors, but only 329 (39%) were teacher behaviors that were of the specific types (high-level advice or questions promoting reflectivity, i.e., mindfulness) described in the literature as being most likely to promote learners' reflectivity and transfer of knowledge and skills from a lower level of abstraction to a higher level. CONCLUSION: The results suggest that the 20 perceptors were aware of the importance of "getting residents to think" and did use teaching strategies known to promote transfer. However, their repertoire of strategies was limited.

Family Practice↗