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Biomedical subjects

P J McLeod

Publications and source records attributed to P J McLeod.

At least 19 recordsLinked to original sources
PubMed2004

If formal CME is ineffective, why do physicians still participate?

Formal or traditional CME can be criticized because organizers often ignore adult learning principles when designing courses. Critics also suggest that formal CME courses have limited impact on attendees' behaviors and practices. The authors agree that attention must be paid to pedagogic principles to assure success of educational courses, but feel that the extant negative evidence related to the impact of formal CME is narrow in scope and of inadequate strength to seriously damn formal approaches. Survey responses were received from 853 practicing physicians who say they still regularly attend formal CME courses. They are motivated to attend to satisfy specific professional needs and for personal reasons. Formal CME is still popular despite what its critics say. The authors are convinced that attention to physicians' perceived needs, effective use of social marketing strategies, and adherence to adult learning principles can assure successful delivery of CME and that formal CME is a useful complement to physician-driven informal CME.

Clinical Competence↗
PubMed2004

Clinical teachers' tacit knowledge of basic pedagogic principles.

Academic faculty members in medical schools rarely receive formal instruction in basic pedagogic principles; nevertheless many develop into competent teachers. Perhaps they acquire tacit knowledge of these principles with teaching experience. This study was designed to assess clinical teachers' tacit knowledge of basic pedagogic principles and concepts. The authors developed a multiple-choice question (MCQ) exam based on 20 pedagogic principles judged by a panel of education experts to be important for clinical teaching. Three groups of clinician-educators sat the test: (1) clinicians with advanced education training and experience; (2) internal medicine specialists; (3) surgical specialists. All four groups of clinicians-educators passed the test, indicating that they possess a reasonable tacit knowledge of basic pedagogic principles. Those with advanced education training performed much better than members of the other two groups while specialists and residents working in teaching hospitals outperformed specialists from non-teaching hospitals. It is possible that converting this tacit knowledge to explicit knowledge may improve individual teaching effectiveness.

Delphi Technique↗
PubMed2001

Seven principles for teaching procedural and technical skills.

The authors developed a cognitive-theory-based checklist of seven important principles for teaching technical skills. They then used the checklist in a workshop for doctors who teach procedural and technical skills. Participants in the workshop found the principle-based approach to be more effective than the traditional "see one, do one, teach one" approach.

Canada↗
PubMed2000

Using focus groups to design a valid questionnaire.

The authors planned to study the roles and concerns of senior faculty members at their institutions. To elaborate the aims of their study and to help them design a valid questionnaire, they conducted focus groups with senior faculty. The authors describe how the information gleaned from the focus groups helped them develop their questionnaire.

Clinical Competence↗
PubMed1999

Program design and delivery in Canadian CME drug therapy courses.

OBJECTIVE: To examine how drug therapy course directors design and deliver drug therapy courses, and whether they employ adult education principles to assure effective education. DESIGN: Analysis of a three-part questionnaire sent to directors of drug therapy courses in Canada. PARTICIPANTS: The questionnaire was sent to all seven directors of drug therapy courses at medical schools that are accredited continuing medical education providers. RESULTS: All directors completed and returned the questionnaires. To decide on course content, most use feedback from previous course attendees, peer consultations, course committee member discussions and their own perceptions of learners' needs. Courses generally use conventional teacher-dominated technology rather than methods that emphasize active learner participation. CONCLUSION: Directors of Canadian continuing medical education drug therapy courses reasonably employ adult education principles when deciding learner needs and designing teaching vehicles.

Canada↗
PubMed1999

Coding accuracy of hospital discharge data for elderly survivors of myocardial infarction.

OBJECTIVE: To assess the coding accuracy of primary and secondary discharge diagnoses in the Quebec hospital discharge database for elderly persons with myocardial infarction (MI). DESIGN: Retrospective chart review in a convenience sample of six Montreal hospitals. The diagnoses listed in the medical chart were compared with those listed in the hospital discharge database. For each subject, the Charlson comorbidity index was calculated twice, once based on the medical chart and again based on the hospital discharge database. PATIENTS: Subjects aged 65 years and over who had an MI coded as the primary discharge diagnosis in the hospital discharge database and who were discharged alive. MAIN RESULTS: For 234 MI survivors, the positive predictive value (ie, probability that a patient with MI reported in the hospital discharge database had an MI diagnosed by the discharging physician) for coding MI was 0.96 (95% CI 0.94, 0.98). Comorbid medical conditions and complications of the MI were under-reported in the hospital discharge database, which meant that the Charlson index based on the hospital discharge database was an average of 0.71 units lower than the Charlson index based on the medical chart. CONCLUSIONS: When studying survivors of MI by using hospital discharge databases, the advantages must be weighed against potential drawbacks in the quality of the information. Hospital discharge databases are almost as reliable as medical charts for identifying MI patients, but there is substantial under-reporting of comorbid medical conditions.

Aged↗
PubMed1997

Use of standardized patients to assess between-physician variations in resource utilization.

CONTEXT: As medical costs are increasingly being scrutinized, there is heightened interest in defining variations in physician behavior in clinical settings. OBJECTIVE: To evaluate if standardized patient (SP) technology is a reliable and feasible method of studying interphysician variations in test ordering, referral requests, prescribing behavior, and visit costs. DESIGN: The study was conducted with blinded SP visits to family medicine and internal medicine residents, university-affiliated family physicians, and community-based family physicians. Resource utilization and visit costs were assessed using test requisitions, consult requests, and prescriptions that were collected by the SPs. SETTING: Physicians' offices in ambulatory care, hospital-based clinics and in the community. PARTICIPANTS: Four persons (aged 57-77 years) trained to simulate having osteoarthritis of the hip. In one simulation, the patient had gastropathy due to nonsteroidal anti-inflammatory drug use, and in the other, the patient sought therapy for hip discomfort. MAIN OUTCOME MEASURES: Reliability of cost estimates of physician services, tests, consultations, prescriptions, and total visits and test-ordering behavior for nonsteroidal anti-inflammatory gastropathy. RESULTS: Overall, 112 (63%) of the physicians who were sent invitations to the study agreed to participate. Of 312 total SP visits conducted over a 1-year period, unblinding due to SP detection occurred on 36 occasions (11.5%). Reliable cost estimates of physician services, tests, and consultations, and moderately reliable estimates of total visit costs, were obtained with 4 visits per practicing physician and with 2 visits per resident. There were extreme variations in total visit costs generated by the study physicians. A small number of physicians had a major impact on this variability. CONCLUSION: Standardized patient technology provides a reliable, feasible method to assess variations in resource utilization between physicians.

Diagnosis-Related Groups↗
PubMed1997

Faculty development in Canadian medical schools: a 10-year update.

OBJECTIVE: To compare the current status of faculty development practices in Canadian medical schools with the status of such practices in 1986. DESIGN: Mail survey. SETTING: All 16 Canadian medical schools. PARTICIPANTS: Faculty development coordinators at the medical schools. OUTCOME MEASURES: Existence of faculty development committees, funding for faculty development activities, types of activities and recognition of faculty participation in such activities. RESULTS: Completed responses were received from all schools. They indicated a significant, positive evolution in faculty development since the previous survey, conducted in 1986. Most schools have established a faculty development committee and provide funds for such activities as workshops, sabbatical leaves and conference attendance. Although traditional development practices are prevalent, there is now widespread emphasis on computer technology, information retrieval, management skills and research. Experienced faculty and other experts are more widely used for consultation on teaching. Very little has been done to evaluate the impact of faculty development. CONCLUSION: Faculty development in Canadian medical schools has undergone a major, positive transition during the last 10 years.

Canada↗
PubMed1997

Defining inappropriate practices in prescribing for elderly people: a national consensus panel.

OBJECTIVE: To develop a consensus-based list of inappropriate practices in prescribing for elderly people. DESIGN: Mail survey of a 32-member national panel. SETTING: Academic medical centres across Canada. PARTICIPANTS: Thirty-two specialists selected arbitrarily, including 7 clinical pharmacologists, 9 geriatricians, 8 family practitioners and 8 pharmacists. OUTCOME MEASURES: Consensus that the practice would introduce a substantial and significant increase in the risk of serious adverse effect and is common enough that its curtailment would decrease morbidity among elderly people, ranking of clinical importance of the risk, and availability of equally or more effective and less risky alternative therapy. RESULTS: The 32-member national panel developed a list of 71 practices in prescribing for elderly people and rated the clinical significance of each on a scale of 1 (not significant) to 4 (highly significant). The practices in prescribing identified fell into 3 categories: drugs generally contraindicated for elderly people, drug-disease interactions and drug-drug interactions. The mean significance rating was greater than 3 for 39 practices. For each practice, alternative therapies were recommended. There was surprising congruence among the specialists on the significance rating and the suggested alternative therapies. CONCLUSION: The authors have developed a valid, relevant list of inappropriate practices in prescribing for elderly people, to be used in a practice-based intervention study.

Aged↗
PubMed1997

Aphicide persistence on spinach and mustard greens.

Laboratory bioassays with green peach aphids, Myzus persicae (Sulzer), were conducted on samples from field grown spinach and mustard greens to determine the persistence of triazamate, dimethoate, and mevinphos. Treatment with each insecticide resulted in similar mortality initially on both crops. Mortality on samples from mevinphos treated plants declined considerably by 1 d after treatment. Dimethoate persisted for > 4 d at a level that would kill at least some aphids during the allotted time. Persistence of triazamate and dimethoate activities were similar on spinach. Triazamate, however, resulted in greater aphid mortality through time on mustard greens than did dimethoate.

Animals↗
PubMed1997

Does knowledge of drug prescribing predict drug management of standardized patients in office practice?

Drug prescribing for the elderly is an important area of medical knowledge since inappropriate prescribing may lead to significant adverse drug events. The objective of this study was to evaluate the association between knowledge of drug use and quality of drug management by general practitioners in practice. A cross-sectional study design was used to evaluate a sample of 37 GPs in practice. A set of common musculoskeletal problems was chosen to evaluate doctors' knowledge of non-steroidal anti-inflammatory drug use, while performance in practice was assessed using elderly standardized patients. The reliability of knowledge test scores was evaluated using measures of internal consistency. The relationship between knowledge of drug use and quality of therapeutic management in practice was evaluated by rank order and linear correlation analysis. Demographic characteristics of participating and non-participating doctors were similar. The reliability of the knowledge test was 0.55. The reliability of performance scores was 0.66. The correlation between overall performance on the standardized patient cases and total knowledge test score was 0.22 (95% confidence interval = 0-0.63). Knowledge test scores were poorly correlated with quality of therapeutic management in office practice. This indicates that knowledge tests alone cannot predict quality of performance with regard to drug prescribing for the elderly in primary care office practice.

Clinical Competence↗
PubMed1997

Characteristics of physicians who frequently prescribe long-acting benzodiazepines for the elderly.

Long-acting benzodiazepines (LABZs) are relatively contraindicated for elderly patients because they increase the risk of impaired cognitive function, falls, and hip fractures. The purpose of this study was to identify the characteristics of physicians who frequently prescribe LABZs for elderly patients. The authors examined the prescribing profile of 4,976 physicians who saw at least 20 elderly Quebec medicare registrants in 1990. Physicians who frequently prescribed LABZs for their elderly patients were more likely to have graduated before 1979, to be general practitioners as opposed to specialists, to practice in long-term care settings, and to have graduated from a medical school in Quebec as opposed to other schools in Quebec, in other provinces, or in other countries. The authors have identified several characteristics of physicians who frequently prescribed LABZs for the elderly. Strategies to improve prescribing in this field should target this group of physicians.

Aged↗
PubMed1997

[Characteristics of physicians prescribing more psychotropic drugs to women than to men].

In industrialized countries, gender differences observed in health condition and the use of medical services appear insufficient to explain a greater consumption of psychotropic drugs in women than men. The authors have tested the hypothesis that physician prescribing patterns largely explains this observation. They demonstrate, using data from the Régie de l'assurance maladie du Québec for people aged 65 and over, that physicians' sociodemographic and practice characteristics are significantly associated with the percentage of men and women who receive a psychotropic drug prescription in their practice.

Adult↗
PubMed1996

Do too many cooks spoil the broth? Multiple physician involvement in medical management of elderly patients and potentially inappropriate drug combinations.

OBJECTIVES: To determine (a) whether the risk of a potentially inappropriate drug combination (PIDC) increases with the number of physicians involved in the medical management of an elderly patient and (b) whether the risk of a PIDC is reduced if a patient has a single primary care physician or a single dispensing pharmacy, or both. DESIGN: Cross-sectional retrospective provincial database study. PARTICIPANTS: A regionally stratified random sample of 51,587 elderly medicare registrants in Quebec who (a) visited at least one physician in 1990, (b) were not living in a health care institution for the entire year and (c) had been dispensed at least one prescription for a cardiovascular drug, a psychotropic drug or a nonsteroidal anti-inflammatory drug (NSAID). OUTCOME MEASURES: Information on all physician visits and drugs dispensed during 1990. Physician claims were used to identify the number of physicians involved in a patient's management and whether the patient had one primary care physician. Prescription claims were used to identify the number of PIDCs, prescribing physicians and dispensing pharmacies. RESULTS: The prevalence of PIDCs ranged from 4.0% (among those in the NSAID group) to 20.3% (among those in the psychotropic drug group). Of the PIDCs identified, 17.6% to 25.8% resulted from contemporaneous prescribing by different physicians. The number of prescribing physicians was the most important risk factor for a PIDC in all drug groups (odds ratio [OR] 1.44 to 1.71). The presence of a single primary care physician lowered the risk for cardiovascular and psychotropic PIDCs (OR 0.70 and 0.79 respectively) but not for NSAID PIDCs (OR 0.94). The use of a single dispensing pharmacy lowered the risk of a PIDC in all drug groups (OR 0.68 to 0.79). CONCLUSION: The greater the number of physicians prescribing medications for an elderly patient, the greater is the risk that the patient will receive a PIDC. A single primary care physician and a single dispensing pharmacy may be "protective" factors in preventing PIDCs.

Aged↗