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Biomedical subjects

W C McGaghie

Publications and source records attributed to W C McGaghie.

At least 19 recordsLinked to original sources
PubMed2001

Development of a measure of attitude toward nutrition in patient care.

BACKGROUND: Development of reliable measures of medical student and resident attitudes about nutrition in patient care is needed before the effects of educational interventions or clinical experience can be gauged. This report describes the systematic development of a measure of attitude toward nutrition in patient care. It presents evidence about scale reliability and the absence of response bias that endorses the trustworthiness of data from the measure. METHODS: An eight-step attitude scale development procedure was used to create the Nutrition In Patient care Survey (NIPS). Data from five samples of first- and second-year medical students and first-year medical residents were subjected to factor analysis (PA2, varimax rotation), reliability analyses, and statistical analyses to test for demographic bias in the attitude data. RESULTS: A 45-item attitude measure was developed that contains five subscales derived from the factor analysis: (1) nutrition in routine care (NRC, 8 items); (2) clinical behavior (CB, 20 items); (3) physician-patient relationship (PPR, 8 items); (4) patient behavior/motivation (PBM, 3 items); and (5) physician efficacy (PE, 6 items). Each subscale yields reliable data in terms of internal consistency (alpha coefficients) and stability (test-retest reliability). Medical student and resident demographic variables have negligible influence on attitude scores. DISCUSSION: The NIPS subscales yield reliable data that can be used to assess outcomes in evaluation research on educational or clinical interventions or to predict patient care practices. Systematic attitude scale development increases the likelihood that the resulting measures will produce useful, trustworthy data.

Adult↗
PubMed2001

The effect of obesity on medical students' approach to patients with abdominal pain.

Because widely held stereotypes characterize obese people as less intelligent, unhappy, lacking in self control and more prone to psychological problems, we tested whether obese appearance alone would affect medical students' decisions about the diagnosis and management of simulated patients. We videotaped 4 patient simulators presenting each of 4 cases in 2 states: normal and obese (by using padding and bulky clothing). Seventy-two clinical students at 2 medical schools viewed the cases and answered questions about diagnostic tests and management. We found the expected biases toward patients when in their obese form as well as pessimism about patient compliance and success of therapy, but there were no significant differences in tests or treatments ordered except where appropriate for an obese patient (e.g., weight reduction diet). Thus, the appearance of obesity alone biased the students' impressions of the patients, but did not affect diagnostic test ordering.

Abdominal Pain↗
PubMed2001

America's best medical schools: a critique of the U.S. News & World Report rankings.

Rankings of American medical schools published annually by the news magazine U.S. News & World Report are widely used to judge the quality of the schools and their programs. The authors describe and then critique the rankings on methodologic and conceptual grounds, arguing that the annual U.S. News medical school evaluation falls short in both areas. Three categories of program quality indicators different from those used by U.S. News are presented as alternative ways to judge medical schools. The authors conclude that the annual U.S. News & World Report rankings of American medical schools are ill-conceived; are unscientific; are conducted poorly; ignore medical school accreditation; judge medical school quality from a narrow, elitist perspective; and do not consider social and professional outcomes in program quality calculations. The medical school rankings have no practical value and fail to meet standards of journalistic ethics.

Bias↗
PubMed2000

Medical and veterinary students' structural knowledge of pulmonary physiology concepts.

PURPOSE: The goal of this study was to assess quantitatively medical and veterinary students' knowledge structures of 12 pulmonary physiology concepts before and after receiving a focused instructional block. The "goodness of fit" and internal consistency reliability of the students' knowledge structures were evaluated. Indexes of the students' structural knowledge were correlated with customary measures of student learning of the same concepts. METHOD: Knowledge structures were assessed using a questionnaire that requested similarity judgments about all possible pairs of the concepts: n(n - 1)/2 = 66 pairs. The similarity judgment data were analyzed using the individual differences (INDSCAL) model of multidimensional scaling (MDS). Dimension weights for individual students were then correlated with their final examination scores. RESULTS: A four-dimensional MDS solution provided the best structural fit to the pairwise concept-similarity data. Dimension 1 ranges from control of breathing to lung gas exchange. Dimension 2 ranges from control of breathing to respiratory mechanics. Dimension 3 separates perfusion from diffusion. Dimension 4 addresses ventilatory control. Hierarchical concept clusters are located within this framework. However, indexes of structural learning did not correlate with other measures of knowledge about the same concepts. CONCLUSION: The study outcomes, in contrast to research in other fields, suggest that structural knowledge in this domain differs from knowledge assessed by standard examinations. Further research involving other basic science or clinical concept sets is needed to verify or refute this finding.

Education, Medical↗
PubMed2000

Quantitative concept mapping in pulmonary physiology: comparison of student and faculty knowledge structures.

Quantitative concept mapping, in contrast with qualitative approaches, is rigorous scientifically and permits statistical analyses of data about concept learning. This study extends past quantitative research on the structure of student concept learning in pulmonary physiology. Pathfinder scaling is used to derive concept maps for medical and veterinary students and their physiology instructors at Northwestern University and the University of Wisconsin, respectively. The concept maps are evaluated for coherence (internal consistency), student-instructor similarity, and correlation of similarity with final examination scores. Results show that student and instructor concept maps are coherent and that student concept maps become increasingly similar to instructors' concept maps from pre- to postinstruction, but that student-instructor concept map similarity does not correlate with examination performance. Research outcomes are discussed concerning possible sources of variation in student and faculty knowledge structures.

Data Collection↗
PubMed1999

Simulation technology for health care professional skills training and assessment.

Changes in medical practice that limit instruction time and patient availability, the expanding options for diagnosis and management, and advances in technology are contributing to greater use of simulation technology in medical education. Four areas of high-technology simulations currently being used are laparoscopic techniques, which provide surgeons with an opportunity to enhance their motor skills without risk to patients; a cardiovascular disease simulator, which can be used to simulate cardiac conditions; multimedia computer systems, which includes patient-centered, case-based programs that constitute a generalist curriculum in cardiology; and anesthesia simulators, which have controlled responses that vary according to numerous possible scenarios. Some benefits of simulation technology include improvements in certain surgical technical skills, in cardiovascular examination skills, and in acquisition and retention of knowledge compared with traditional lectures. These systems help to address the problem of poor skills training and proficiency and may provide a method for physicians to become self-directed lifelong learners.

Anesthesiology↗
PubMed1999

Implementation of a four-year multimedia computer curriculum in cardiology at six medical schools.

The pressures of a changing health care system are making inroads on the commitment and effort that both basic science and clinical faculty can give to medical education. A tool that has the potential to compensate for decreased faculty time and thereby to improve medical education is multimedia computer instruction that is applicable at all levels of medical education, developed according to instructional design principles, and supported by evidence of effectiveness. The authors describe the experiences of six medical schools in implementing a comprehensive computer-based four-year curriculum in bedside cardiology developed by a consortium of university cardiologists and educational professionals. The curriculum consisted of ten interactive, patient-centered, case-based modules focused on the history, physical examination, laboratory data, diagnosis, and treatment. While an optimal implementation plan was recommended, each institution determined its own strategy. Major goals of the project, which took place from July 1996 to June 1997, were to identify and solve problems of implementation and to assess learners' and instructors' acceptance of the system and their views of its value. A total of 1,586 students used individual modules of the curriculum 6,131 times. Over 80% of students rated all aspects of the system highly, especially its clarity and educational value compared with traditional lectures. The authors discuss the aspects of the curriculum that worked, problems that occurred (such as difficulties in scheduling use of the modules in the third year), barriers to change and ways to overcome them (such as the type of team needed to win acceptance for and oversee implementation of this type of curriculum), and the need in succeeding years to formally assess the educational effectiveness of this and similar kinds of computer-based curricula.

Attitude to Computers↗
PubMed1996

Smoking history-taking skills: a simple guide to teach medical students.

Many doctors rate themselves as ineffective smoking cessation counsellors. It is logical to initiate training efforts with medical students. We incorporated smoking history-taking in the physical diagnosis course at the University of North Carolina at Chapel Hill using a simple method to teach smoking history-taking skills and to assess its effectiveness as an educational intervention. The principal intervention was the distribution of a one-sheet Smoking-History Taking and Counseling Guide, adapted from the American Lung Association's Freedom From Smoking for You and Your Family self-help manual. The second intervention was a single prompt for 50% of the course preceptors. Students' smoking history-taking skills were evaluated in the Objective Structured Clinical Examination (OSCE) at the end of the course. Students who received the guide did significantly better on the OSCE, even after controlling for having discussed taking a smoking history with their preceptors. A simple guide combined with a one-time prompting of preceptors has a positive effect on the acquisition of smoking history-taking skills by the medical students. This strategy may also be useful for teaching and evaluating smoking-cessation counselling skills, for which good smoking history-taking is a necessary basis.

Clinical Competence↗
PubMed1995

Adherence to screening mammography recommendations in a university general medicine clinic.

OBJECTIVE: To determine factors predicting adherence to a health care provider's screening mammography recommendation in a general internal medicine practice. DESIGN: Prospective observational study. SETTING: An urban academic general internal medicine practice. PATIENTS: Three hundred forty-nine asymptomatic women, aged 50 years and older, without prior history of breast cancer, who received a health care provider's recommendation for screening mammography. MEASUREMENT: Independent variables were: patient age, race, insurance type, educational level, and duration of affiliation with the practice; visit type; and health care provider gender and level of training. Dependent variables were acceptance of the recommendation and adherence, defined as undergoing mammography within three months of the recommendation. RESULTS: Overall, 193 (55%) of the women underwent the recommended mammography. Two hundred ninety-eight (85%) initially agreed to the recommendation, and of these, 190 (64%) completed mammography within three months. By univariate analysis, acceptance of the recommendation decreased significantly with increasing age (p < 0.01), and by race (African-Americans 89% vs whites 82%, p = 0.05). Only age remained independently predictive of acceptance in a multiple variable analysis. Among women who accepted the recommendation, adherence varied significantly according to race (white 70% vs nonwhite 59%, p = 0.05), insurance type [Medicare as only insurance 45%, Medicaid 66%, non-health maintenance organization (non-HMO) private 62%, HMO 73%, p = 0.03], and health care provider training (attending physicians 73%, residents 58%, nurse practitioners 47%, p = 0.02). In a logistic regression analysis, insurance type and health care provider training remained independently predictive of adherence. CONCLUSION: Acceptance of screening mammography recommendations decreases with age. Among the women who agreed to the recommendation for screening mammography, insurance type and health care provider level of training best predicted adherence.

Age Factors↗
PubMed1995

Development of a measure of medical faculty attitudes toward clinical evaluation of students.

PURPOSE: This research involved the development, and in particular the evaluation of the reliability, of scales to measure medical faculty attitudes toward clinical evaluation (ACE) of medical students. The intent was to create measures that yield reliable data and have practical utility in medical education research and faculty development. METHOD: A systematic, eight-step scale development protocol was used to create the instrument. In early 1993 factor analysis was used on data from 217 clinical faculty at four medical schools to refine the measures. Internal consistency and test-retest reliability analyses were performed. Analyses were also done to determine whether the attitude scores were influenced by such faculty demographic attributes as employing medical school, gender, age, tenure track status, academic rank, or academic department. RESULTS: An initial pool of 52 items was reduced to 30 items based on iterative reliability studies. Factor analysis on the 30 items yielded two scales: (1) Quality of Evaluation Procedures, 12 items, alpha = .81; and (2) Content of Departmental Evaluations, eight items, alpha = .85. Test-retest reliabilities (12 weeks) for the scales were .67 and .74, respectively. Faculty demographics did not influence attitudes about the quality of evaluation procedures. However, family physicians showed a slightly more positive attitude toward the content of departmental evaluations than did physicians in five other medical specialties. CONCLUSION: The goal of developing reliable measures of faculty attitudes toward clinical evaluation of medical students has been achieved. With baseline reliabilities established, future research should assess the validity and utility of the scales, especially in the context of clinical practice examinations.

Analysis of Variance↗