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Prevalence and determinants of physician participation in conducting pharmaceutical-sponsored clinical trials and lectures.

BACKGROUND: The relationship between physicians and the pharmaceutical industry is controversial because of the potential for conflicts of interest. However, little empirical evidence exists on the extent of physician participation in activities sponsored by pharmaceutical companies. OBJECTIVES: To determine the prevalence of participation of internal medicine physicians in clinical trials and lectures sponsored by pharmaceutical companies and to describe factors that are associated with such participation. DESIGN, SETTING, AND PARTICIPANTS: We conducted a cross-sectional regional survey of 1,000 Maryland internal medicine physicians between February 2000 and January 2001 in order to measure the prevalence of physician participation in pharmaceutical-sponsored clinical trials and lectures. We also collected economic and demographic information to examine potential associations between physician characteristics and engagement in such activities. RESULTS: Of 835 eligible physicians 444 (53%) responded, of whom 37% reported engaging in pharmaceutical-sponsored clinical trials and/or lectures to supplement their incomes. In our multivariable analysis, subspecialists versus generalist physicians (odds ratio [OR], 1.85; 95% confidence interval [CI], 1.14 to 2.99), physicians in private group-single specialty and academic practice versus physicians in solo practice (OR, 2.30; 95% CI, 1.19 to 4.44 and OR, 2.56; 95% CI, 1.17 to 5.61, respectively), and physicians with higher versus lower annual incomes (OR, 1.22; 95% CI, 1.04 to 1.44) had a greater odds of participation in these activities. Additionally, physicians dissatisfied with their income had a 140% greater odds of participation (OR, 2.36; 95% CI, 1.45 to 3.83) than those who were satisfied with their income. CONCLUSIONS: A substantial number of internists engage in pharmaceutical industry-sponsored clinical trials and/or lectures in an effort to supplement their incomes. Physician dissatisfaction with income appears to partially explain such participation.

Clinical Trials as Topic↗

Lectures in physiology: a three-phase evaluation plan.

The initial phase of a voluntarily implemented multiphasic plan for improving faculty lectures was completed in 1988 and reported in 1989 [Am. J. Physiol. 256 (Adv. Physiol. Educ. 1): S3-S8, 1989]. That phase, conducted by a teaching consultant, included analysis of the teaching practices of each of seven faculty members. Following lecture observations, each faculty member received a written critique of his/her teaching, and individual as well as departmental strengths and weaknesses were identified. In the 1989 follow-up phase, faculty reviewed the feedback provided in their critiques and attended a seminar on developing effective lectures. Each faculty member was again observed during the presentation of a lecture; the same observation instrument was used in the follow-up phase as was used in the initial phase. A comparative analysis of the 1988 and 1989 teaching behaviors was completed for each faculty member and for the whole department. Results indicate that definitive changes had occurred in teaching methods employed since the initiation of the plan. Additional recommendations were made and specific target areas for ongoing improvement were identified.

Alabama↗

Combination of didactic lecture with problem-based learning sessions in physiology teaching in a developing medical college in Nepal.

Physiology teaching as an essential part of medical education faces tremendous criticism regarding curriculum design, methods of implementation, and application of knowledge in clinical practice. In the traditional method of medical education, physiology is taught in the first year and involves little interdisciplinary interaction. The Manipal College of Medical Sciences, Pokhara, Nepal (affiliated with the Kathmandu Univ.) started in 1994 and adopted an integrated curriculum drawn along the lines of the student-centered, problem-based, integrated, community-based, elective-oriented, and systematic (SPICES) medical curriculum. Here, physiology is taught for the first 2 yr of the 4.5-yr Bachelor of Medicine, Bachelor of Surgery course. Methodology adopted is as follows. For a particular topic, objectives are clearly defined and priority content areas are identified. An overview is given in a didactic lecture class to the entire batch of 100 students. Tutorial classes are conducted thereafter with smaller groups of students (25/batch) divided further into five subgroups of five students each. In these sessions, a problem is presented to the students as a focus for learning or as an example of what has just been taught. Each problem was accompanied with relevant questions to streamline the students' thought processes. A tutor is present throughout the session not as an instructor but as a facilitator of the learning process. A questionnaire sought students' opinion on the usefulness of this approach, relevance of the combination of problem-based learning (PBL) sessions and didactic lectures in understanding a particular topic and relating clinical conditions to basic mechanisms, and improvement of performance on the university final examination. The majority of the students opined that the combination of didactic lectures and PBL sessions was definitely beneficial regarding all the above-mentioned aspects of learning. The university results corroborated their opinion. Thus it may be considered that a judicious mixture of didactic lectures and PBL sessions is beneficial as a teaching module of physiology in medical schools.

Clinical Competence↗

Teaching more by lecturing less.

We carried out an experiment to determine whether student learning gains in a large, traditionally taught, upper-division lecture course in developmental biology could be increased by partially changing to a more interactive classroom format. In two successive semesters, we presented the same course syllabus using different teaching styles: in fall 2003, the traditional lecture format; and in spring 2004, decreased lecturing and addition of student participation and cooperative problem solving during class time, including frequent in-class assessment of understanding. We used performance on pretests and posttests, and on homework problems to estimate and compare student learning gains between the two semesters. Our results indicated significantly higher learning gains and better conceptual understanding in the more interactive course. To assess reproducibility of these effects, we repeated the interactive course in spring 2005 with similar results. Our findings parallel results of similar teaching-style comparisons made in other disciplines. On the basis of this evidence, we propose a general model for teaching large biology courses that incorporates interactive engagement and cooperative work in place of some lecturing, while retaining course content by demanding greater student responsibility for learning outside of class.

Attitude↗

The physical examination of patients with abdominal pain: the long-term effect of adding standardized patients and small-group feedback to a lecture presentation.

BACKGROUND: One of the most effective methods for teaching physical diagnosis may be standardized patient instructors. PURPOSE: To determine if a lecture plus standardized patient instructors with small-group sessions is more effective than a lecture alone for teaching the evaluation of patients with abdominal pain. METHODS: Control (class of 2001) and intervention (class of 2002) groups both attended a lecture on the abdominal examination. The intervention group then underwent an exercise with standardized patient instructors and a review session with surgical faculty. An evaluation 18 months later used standardized patient instructors to complete evaluations assessing history-taking and physical examination skills. RESULTS: The intervention group performed significantly better than the control group on both the history and the physical examination subscales. CONCLUSION: It is possible to have an important, measurable, and lasting effect on physical examination skills by adding standardized patient instructors and small-group discussion to a lecture presentation.

Abdominal Pain↗

How can the clinical credibility of nurse lecturers be improved?

The last 10 years has seen a surge in the development of academic pre- and postregistration courses. With the movement of colleges of nursing and midwifery into higher education it has become difficult for lecturers of nursing to remain engaged in clinical practice. However, the professional bodies, the students themselves and their employers expect lecturers of nursing to be clinically able, clinically credible and knowledgeable about contemporary practice in order to produce practitioners who are 'fit for purpose'. This article outlines one innovative approach employed by an educational organization to enable lecturers of postregistration specialist nursing programmes to achieve clinical credibility by undertaking a minimum of 300 contracted hours of clinical experience. This approach was found to be beneficial to the lecturers, the students and the ongoing relationships between the trusts and the department of nursing.

Clinical Competence↗

Educational leave for lecturers to regain clinical competence: 1.

The clinical credibility and clinical competence of nurse lecturers have presented interesting debate for some years in nursing. While some argue that being clinically competent is an unavoidable necessity for nurse lecturers, others are either ambivalent or believe that they do not have to be clinically competent, being clinically credible should suffice. This article distinguishes between the two terms and presents an analysis of how the latter can be developed through the use of paid educational leave. Such leave, known also as a sabbatical, is one of the possible benefits of being a nurse lecturer within higher education in the UK, and it can be used opportunely as a means of regaining and further developing one's clinical skills and knowledge, if this is perceived as a need. If nurse lecturers value the retention and development of one's own clinical skills and knowledge, then some mechanism should be in place for them to achieve this aim. Johns' (1998) model of structured reflection is used for reflecting on one such experience. The article is in two parts.

Clinical Competence↗

Using active learning in lecture: best of "both worlds".

Many creative teaching strategies have been developed in recent years in nursing and other fields to promote active learning. These strategies foster development of problem solving, critical thinking, and communication skills, and they encourage students to work collaboratively with peers. However, in nurse educators' rush to embrace active learning, lecture has been viewed negatively by some faculty. Rather than positioning active learning against lecture, another approach is to integrate active learning within lecture, gaining the benefits of both methods. An integrated approach also takes into consideration the situation of teaching large groups of students. This article examines benefits of an integrated approach to teaching and presents strategies for active learning intended for use with lecture.

Communication↗

Background sound pressure fluctuations (5 DB) from overhead ventilation systems increase subjective fatigue of university students during three-hour lectures.

During each of four successive sessions (once per week), 21 university students attended 3-hr. lectures. During alternative weeks the fans of the room's ventilation system were either on or off. When operating, they generated an average sound pressure that varied continuously between 60 and 65 dB. The dominant frequency of this 5-dB amplitude modulation of sound pressure was within the electroencephalographic range (5 Hz to 25 Hz). At the end of each hour of the lecture for each session each student estimated on 7-point summated rating scales fatigue (none to maximum) and concentration (poor to excellent). As a group, the students reported more fatigue during lectures when the fans were operating relative to lectures when the fans were not operating. This environmental effect explained about 30% of the variance in fatigue ratings and may be sufficient to affect adversely the attention of students within these settings.

Adult↗

Use of teaching methods within the lecture format.

A survey was carried out at Dorset House School of Occupational Therapy, Oxford, into the perceived effectiveness of different teaching methods used within the lecture format in the Human Biology Courses for Year 1 and Year 2. Results showed that the traditional, didactic lecture was perceived by the students as the least effective method used, yet by involving the students actively within the lecture time the format was enhanced and was regarded as a more effective teaching/learning tool. Experimental tasks and learning packages used within the lecture format were also perceived by the students as effective. Some trends were noted relating to the age of students and the different perceptions of effectiveness of teaching methods. The implication of these results on the planning and financing of courses is discussed.

Adult↗

Evaluation of a Web-based introductory psychology course: I. Learning and satisfaction in on-line versus lecture courses.

We offered introductory psychology on the World-Wide Web (WWW) and evaluated the on-line format relative to the traditional lecture-test format, using a pretest-posttest nonequivalent control group design. Multiple sections of the introductory course were offered each semester; on-line and lecture sections were taught by the same instructor, the same textbook was used, and the same in-class examinations were taken. For on-line sections, mastery quizzes, interactive individual exercises, and weekly laboratory meetings replaced lectures. Increased content knowledge was greater for the students in the Web sections, as was in-class examination performance. Use of the WWW and computers for academic purposes increased more in the on-line sections, and the on-line students showed a greater decrease in computer anxiety. The students in the on-line sections expressed appreciation for course components and the convenience of the course, but the lecture sections received higher ratings on course evaluations than did the on-line sections. Learning and course satisfaction were dissociated in the two course formats.

Analysis of Variance↗

A comparison of lecture-discussion and self-study methods in nursing education.

Three groups of students in a Nurse Practitioner Program were subjected to a multiple-choice test based upon two articles from the Nurse Practitioner. Prior to testing, one group read and studied the articles for one hour with no discussion permitted. The other two groups did not read the articles but participated in a lecture-discussion on their contents. The testing followed each learning session. Overall, the results support strongly the hypothesis that the Lecture-Discussion method is superior to the Reading Only method. The fact that the Lecture-Discussion method utilized two different instructors suggests that this finding is not based on some unique personality characteristic of one particular faculty member. Naturally, these findings are limited to this particular subject matter with nurse practitioner students. It is possible that the Reading Only method would be equal to or superior to the Lecture-Discussion method with other topics or with other student bodies. In any case, the present results run counter to the current wave of enthusiasm for the Self-study method in nursing education. These results suggest that caution be employed in a wholesale shift to autotutorial results. As Hogan states: "Self-instructional materials are not replacements for . . . teacher-centered instruction. Instead they are supplements that encourage individual initiative, autonomy, and responsibility for students who can use and wish to use them."

Education, Nursing, Continuing↗

Comparing the learning outcomes of lecture and self-instruction methods in a senior clinical laboratory science course.

OBJECTIVE: To compare the relative effectiveness of lecture and self-instruction methods of instruction in a senior clinical laboratory science course. DESIGN: Posttest repeated measures design or within subject design. SETTING: The Department of Medical Technology in the School of Allied Health Professions, Louisiana State University Medical Center, New Orleans. PARTICIPANTS: Clinical laboratory science students (27) enrolled in clinical parasitology agreed to participate, which was a sample of convenience. There were 16 females and 11 males; 70% Caucasian, 23% Asian, and 7% African-American. The 2 students who did not sign a consent form were excluded from the study. INTERVENTION: Subjects were taught clinical parasitology course material by 2 different methods of instruction, lecture and self-instruction. All subjects received both treatments. MAIN OUTCOME MEASURE: Examination scores from each half of the course were compared using descriptive statistics and a paired t-test to determine the effectiveness of each instructional format. RESULTS: Results showed no statistically significant difference in learning outcomes between the 2 instructional formats (a = 0.05, p = 0.13). CONCLUSION: The results of the study generally support the hypothesis that the self-instruction method is as effective as the lecture method in teaching clinical parasitology. By incorporating self-instruction into a clinical laboratory science curriculum, many hours of lecture can be eliminated, and students can learn the material at their own pace. Students comprehend the material effectively, and are relieved from some of the intensity of the didactic approach to instruction that dominates clinical laboratory science curricula.

Educational Measurement↗

A comparison of a multi-media instructional module with a traditional lecture format for geriatric pharmacy training.

The purpose of this study was to develop, produce, and test the effectiveness of a multi-media instructional module versus a traditional lecture format. The subject selected was geriatric care in relation to pharmacy practice. A pretest/posttest control group design was used, differing only in the method of presentation of the material. The control group received four fifty-minute traditional lectures, and the treatment group utilized the module for the acquisition of the information. An evaluation of the pretest scores showed that the groups were equal in knowledge (no significant difference at P = 0.05) before exposure to the information. A comparison of the posttest scores of the two groups showed that the module was as effective a learning strategy as the traditional lectures (no significant difference at P = 0.05). The comparison of the pretest and posttest scores within each group showed that significant improvement occurred following the utilization of both methods of instruction at P less than 0.05. The results of this project indicated that the module is an effective learning strategy when compared to a traditional lecture format. It was also evident that the multi-media module can be used as an instructional alternative in the education of pharmacy students.

Analysis of Variance↗

[Lectures from the tutorial courses at NATO--Advanced Study Institute pt. "Human biomonitoring after environmental and occupational exposure to chemical and physical agents" (Turkey, 9/23-10/3/1999)].

The NATO Science Programme joining in the celebration of 50th Anniversary of Founding of the NATO by organisation of NATO Advanced Study Institute "Human Monitoring after Environmental and Occupational Exposure to Chemical and Physical Agents", which was held in Tekirova-Antalya (Turkey), September 23-October 3, 1999. The director of ASI was dr Diana Anderson from TNO-BIBRA (UK). The members of Scientific Organizing Committee were also dr R. Sram (Czech Republik), dr A. Karakaya (Turkey), Dr P. O'Neill (USA), dr R. Bos (Netherlands), dr M. Lotti (Italy). It was a high-level tutorial course for scientists at the post-doctoral level from NATO countries and from NATO Cooperation Partner countries. NATO-ASI attended about 100 scientists from about 30 countries. There were 40 lectures, 20 oral presentations and 43 posters presented, 19 authors of posters were invited to additional short oral presentations. Subject of course concerned undesirable effects of chemical and physical agents on human health. The aim of NATO-Advanced Study Institute was the meeting of scientists working in different fields of science to present and discuss the knowledge and recent developments in the field of human monitoring. The majority of lectures concerned about biomonitoring of people exposed to genotoxic agents at work place and environment. Dr A. Autio (Switzerland) presented definitions of different kinds of bimarkers proposed by the Committee on Biological Markers in Environmental Health of USA Academy of Science/National Research Council. Dr D. Anderson (UK) introduced history of biomonitoring. The main lecturers on this topic were dr W. Au (USA), dr R. Sram (Czech Republik), dr M. Lotti (Italy), dr J. Timbell (USA), Dr E. Moustacchi (France). The following group of lectures presented by dr D. Anderson (UK), dr A. Wyrobek (USA), dr J. Bonde (Dennmark), dr H. Norppa (Finland) was regarded to male-mediated mutagenic effect in offspring induced by genotoxic physical and chemical agents. This part of course was the most interesting to the author of this report. She has presented the poster "Male-mediated F1 effects in mice subchronic exposed to low doses of X-rays". The author of this report found NATO-ASI as very fruitful initiative for scientific view-exchange between scientists from NATO countries and for NATO Cooperation Partner countries.

Animals↗

[The lecture in the system of teaching pathology].

The material of lectures on pathology in 75 higher medical schools of the country is analyzed. The types of lectures, their optimal planning are indicated. Recommendations to enhance their efficiency taking into consideration the motivation of their learning are given. Optimal form for the lecture is considered a problem lecture.

Education, Medical↗

Comparing the effectiveness of the mini-lecture technique to role-playing in a dental psychology course.

The array of instructional methods utilized in teaching behavioral sciences to dental students has included both teacher-centered and student-centered approaches. The purpose of this study was to evaluate the effectiveness of two small-group treatments, mini-lecture and role-playing, in teaching dental psychology. Freshman dental students were randomly assigned to 12 groups. Groups were then assigned to one of six dentist-pyschologist teaching teams so that each team taught one mini-lecture and one role-playing group. Teaching teams taught seven sessions in which each mini-lecture/role-playing pair of groups received parallel subject matter. Following instruction, two outcome measures were administered: (1) an achievement post-test measuring factual recall, and (2) a measure of facilitative communication. Results indicated that mini-lectures were more effective than role-playing in effecting student mastery of factual information. There were no significant differences between the instructional treatments in teaching facilitative communication skills.

Curriculum↗

The 20th Kellersberger Memorial Lecture, 1994. Leprosy and tuberculosis combined programmes: an uneasy partnership?

One of the purposes of this memorial lecture is to relate progress and difficulties in the field of leprosy to work in other fields. Tuberculosis is a disease closely related to leprosy and in 1982 the Kellersberger lecture was given by Dr. Styblo, someone whose name is synonymous with the development of effective Tuberculosis Control Programme in Africa. His title was "Tuberculosis and its control: lessons to be learned from past experience, and implications for leprosy control programme" (1). Many countries in Africa, including Ethiopia, have adopted the strategy of a combined leprosy and TB control programme. In this lecture then, I will examine more closely the strategy of combining the two programmes. I want to look at some of the problems that may arise and then draw out the ways in which each side of the partnership can contribute to the other, so that the combination can be more effective than either programme could hope to be on its own. This lecture will focus mainly on management issues, which are currently the most important barriers to effective control of both diseases, but the socio-economic aspects of disease, so much a part of Dr. Kellersberger's working life, will also be prominent.

Cost-Benefit Analysis↗