Biomedical subjects
Publications and source records attributed to Paul Finucane.
OBJECTIVE: To determine the balance between acute and chronic medical problems in the PBL cases at 2 Australian medical schools. METHODS: Analysis of 162 PBL cases. RESULTS: Cases concentrate on acute problems in young people and neglect chronic disease in the old. CONCLUSION: This imbalance may contribute to negative attitudes towards elderly patients and people with chronic disease.
After much discussion and planning, Flinders University in Adelaide, South Australia recently introduced a new Graduate-Entry Medical Program (GEMP) which centres on problem-based learning (PBL). We describe the factors that stimulated the development of this new course, discuss its aims and philosophies and provide a brief outline of its structure. Advice and practical help was freely provided by several institutions who had undertaken similarly radical curricular reform and without this, a difficult task would have been much harder. We hope that our experiences will be of interest and help to others who are considering curricular reform.
A desire to take a 'problem-solving' approach to clinical teaching, combined with a lack of resources for a 'standard' problem-based learning (PBL) approach prompted the authors to develop a new teaching strategy that builds on the ideas of others and which they call clinical-problem solving (CPS). In this paper, they describe the CPS approach, its perceived strengths and weaknesses, and their experience with it to date. They believe that CPS provides a dynamic learning environment and one that can be adapted to a variety of settings. Perhaps its greatest attribute is its ability to provide a problem-solving approach to learning while requiring far fewer resources than PBL. For example, course material that would have required 300 hours of tutor time in PBL now requires 18 hours of teacher time. CPS also saves on student time and classroom space. The authors consider it to be complementary to, rather than a substitute for, PBL.
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OBJECTIVES: To determine what treatment decisions physicians will make when faced with a hypothetical incompetent elderly patient with life-threatening gastrointestinal bleeding and to examine the relative importance of physician characteristics and factors (legal and ethical concerns, hospital costs, level of dementia, patient's age, physician's religion, patient's wishes and family's wishes) in making those decisions. DESIGN: Survey. SETTING: Family practice, medical and geriatrics rounds in academic medical centres and community hospitals in seven countries. PARTICIPANTS: Physicians who regularly cared for incompetent elderly patients. MAIN OUTCOME MEASURES: A self-administered questionnaire describing the elderly patient. Respondents were asked to choose one of four levels of care and to identify the level of importance factors had in making that decision. Older physicians, those less concerned about litigation, those for whom the level of dementia was important and those for whom the patient's age was important were expected to give less aggressive care than the other physicians. MAIN RESULTS: Supportive care was chosen by 8.1% of the respondents, limited therapeutic care by 41.5%, maximum therapeutic care without admission to the intensive care unit (ICU) by 32.2% and maximum care with admission to the ICU by 18.2%. The patient's wishes were reported by 91.0% as being extremely or very important in choosing the treatment. Stepwise logistic regression analysis revealed that the following variables independently predicted the level of treatment: level of dementia, country of residence, duration of practice, legal concerns, patient's age and ethical concerns. These factors were significantly correlated with the physicians' treatment choices (p less than 0.05). CONCLUSIONS: The importance that the physicians placed on the level of dementia was the strongest predictor of the level of care that would be provided. A societal consensus on the influence of cognitive function on the appropriate level of care as well as training of physicians in ethical issues are required.