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School Health Education Evaluation. The impact of instructional experience and the effects of cumulative instruction.

Two substudies were conducted within the School Health Education Evaluation (SHEE) to assess implementation practices and cumulative effects. In both studies, special samples were identified that permitted independent analysis of contributing factors. For the implementation study, teachers who had taught only one year were assessed in their second year to determine what changes they made during implementation and how those changes were related to classroom performance. Teachers taught significantly fewer hours, fewer components of the curriculum, and made more changes. However, the classroom performance, compared with the first year, improved for both knowledge and attitude with a marginal trend toward improvement in self-reported practices. These results suggest that teachers became both more efficient and effective in the second iteration. The cumulative effects study tracked children through different levels of exposure to health instruction across two consecutive grade levels. Using partial classrooms as the unit of analysis, the results revealed that for knowledge, attitudes, and self-reported practices, exposure to two units of School Health Curriculum Project (SHCP) were more effective than one which was, in turn, more effective than no exposure. Analysis of self-reported smoking practices indicated cumulative program effectiveness in reducing both current smoking and future intent to smoke.

Attitude to Health↗

Development and application of the student test used in the School Health Education Evaluation.

To accurately assess the health knowledge, attitudes, and practices of students in grades four-seven, the staff of the School Health Education Evaluation (SHEE) project devoted extensive effort to identify a test appropriate for such assessment. An extensive literature review failed to produce an instrument sufficiently comprehensive or psychometrically sound that could be employed. In this paper, the philosophic orientation and the detailed processes followed in developing a noncurriculum specific, psychometrically sound evaluation instrument for use in the study is described. Included are the bases for the test framework, test objective development, test item review, the various measures constructed using the test blueprint, student performance on the test battery, the psychometric qualities of the test, and suggestions for appropriate use of the final test in other school health education settings.

Attitude to Health↗

Design of the School Health Education Evaluation.

The Center for Health Promotion and Education, Centers for Disease Control, and the Office of Disease Prevention and Health Promotion, US Dept. of Health and Human Services, contracted with Abt Associates, Inc., to evaluate the School Health Curriculum Project as compared with three other approaches to school health education. Background on the reasons for initiating this project, a summary of the original design, and highlights of the main features of the actual implementation of the School Health Education Evaluation (SHEE) are detailed.

Adolescent↗

The Medical Education Evaluation Program of the state of Ohio.

In October 1988, seven foreign medical graduates participated in the first administration of the examination devised by the Medical Education Evaluation Program (MEEP) mandated by the State Medical Board of Ohio. The MEEP was established to provide an objective evaluation of an applicant's clinical competencies; passing the MEEP examination was intended to certify that the applicant's clinical skills were comparable to those of a medical student graduating from a school accredited by the Liaison Committee on Medical Education. An applicant who successfully passed the MEEP examination and fulfilled the other Ohio licensure requirements would be eligible to take the Federation Licensing Examination (FLEX) and apply for an unrestricted license to practice medicine in Ohio. The paper describes the origin and development of the MEEP examination and the testing modalities selected (multiple-choice examinations and the use of standardized patients). Four fundamental areas were tested; these are named and described, along with the method for calculating scores for each area and the criteria for passing the different components of the examination. Although the small sample size prohibited meaningful data analysis for the performance of the first group of MEEP candidates, the MEEP examination appears to meet psychometric standards of certifying and licensing examinations, based on data from comparable tests taken by beginning fourth-year medical students in New England and NBME Part III examination examinees. Some potential pitfalls of the MEEP examination are mentioned, as well as the fact that it presents a challenge to boards of medical examiners of other states to implement performance-based assessments of physicians who graduate from non-accredited medical schools.

Clinical Competence↗

School Health Education Evaluation. Methodological and substantive significance.

As two of the consultants on the team that advised on design and execution of the School Health Education Evaluation (SHEE), the authors offer retrospective comments on the accomplishments and significance of the study. Comments are divided into three parts. First, the authors point out why many evaluators would argue a priori that the design of the study would not be feasible. Second, the authors discuss why the study did work and what makes it exemplary. Finally, the authors point out the several substantive findings of the study that have broad significance in education beyond health education alone.

Child↗

A secondary analysis of the School Health Education Evaluation data base.

This secondary analysis examined variables directly related to teacher training not fully examined in the School Health Education Evaluation (SHEE). The problem was to determine the effect of School Health Curriculum Project (SHCP) teacher training and curriculum implementation variables on overall student health knowledge, attitude, and self-reported practice scores in SHCP grades four-six. The major variables of interest had no statistically significant interactive effects on student scores in the knowledge, attitude, and practice domains. The teacher implementation variable had significant (p less than or equal to .05) main effects on student scores within attitude and practice domains in addition to statistically significant effects on related subscores within categorical item areas. Design flaws, which represent serious threats to internal and external validity of the primary analysis, may have effected results associated with this project.

Curriculum↗

Correlation between EEG spectral parameters and an educational evaluation.

EEG spectral parameters were computed in a group of children with different degrees of difficulty in learning to read and write. For statistical analyses, Z-transformed values according to normative age-regression equations were used to control the age effects. Canonical Correlation Analysis between absolute power in different bands and the categories of the educational evaluation (good, regular, poor and very poor) showed that more delta was probably related to a poor evaluation and more alpha in occipital areas to a good one. MONOVA also showed highly significant differences in the absolute power in many leads between children with different evaluations. As children with a poor evaluation very frequently had antecedents of risk factors related to brain damage and were from a low socioeconomic status, and both factors have been shown to affect absolute power, it may be that the differences observed were due to these causes. However, relative power correlated more with the learning problems. Children with minor difficulties, with no antecedents and with good socioeconomic status had more theta in almost all leads than children with a good evaluation and with the same characteristics. Children with a poor, or very poor, evaluation had more delta in left frontal and temporal areas (F3, F7 and T3) which may reflect underlying cerebral dysfunction of these regions directly involved in reading and writing processes.

Child↗

Assessment of a continuing education evaluation framework.

This study analyzes a systems model for evaluation research of continuing education (CE) and reports on the result of a quasi-experimental study of a stoma care CE program. Holzemer's conceptual framework for evaluating CE consisting of the learner, setting, and program along with a systems model was used as an organizing framework. A quasi-experimental design (n = 24 experimental group and n = 27 control group) was used to evaluate the impact of the CE program. Pre- and post-tests of participants' knowledge and skills of stoma care were evaluated. Participants' satisfaction with the course was surveyed by questionnaire during the course, on completion and four months after the course. No significant differences were found between the two groups. The revised framework included the concept of needs assessment and the impact of the CE program on patient care.

Adult↗

Patient education - evaluation of a complex intervention.

Diabetes education or self-management programmes are complex interventions. Their evaluation is difficult because of problems in identifying and separately assessing the effect of the various components of the intervention. A phased approach defining sequential stages of a continuum of increasing evidence has been proposed as a framework for the design and evaluation of such complex interventions. As an example we present the available evidence for diabetes treatment and teaching programmes implemented in Germany. Evidence is compiled for structured group treatment and teaching programmes for Type I diabetes, non-insulin dependent Type II diabetes, and hypertension according to the following sequential stages of increasing evidence: (i) preclinical or theoretical phase; (ii) modelling the components of the intervention; (iii) exploratory trials; (iv) randomized controlled trials; (v) phase of implementation including replication and transfer to different settings. Evidence for most of these phases has been generated for the three programmes, although individual studies do not fulfill all important quality criteria by today's standards. The time span for gathering the evidence from the theoretical phase to surveillance after implementation was about 20 years. It can only be speculated which parts of the programmes are the most active ones. The presentation of a continuum of increasing evidence for diabetes education or self-management programmes could provide useful information for the appraisal of such complex interventions. Since this evidence cannot be readily extracted from databases we suggest that other research groups present their data in a similar way.

Diabetes Mellitus, Type 1↗

Interdisciplinary education: evaluation of a palliative care training intervention for pre-professionals.

PURPOSE: Medical education inadequately prepares students for interdisciplinary collaboration, an essential component of palliative care and numerous other areas of clinical practice. This study developed and evaluated an innovative interdisciplinary educational program in palliative care designed to promote interdisciplinary exchange and understanding. METHOD: The study used a quasi-experimental longitudinal design. Thirty-three medical students (third and fourth year) and 38 social work students (second year of masters degree) were recruited. The intervention group students (21 medical and 24 social work students) participated in a series of four training sessions over four weeks while the control group students received written materials after the study. The curriculum and teaching methods were based on theories of professional socialization and experiential learning. The intervention included experiential methods to promote interdisciplinary interaction to foster communication, exchange of perspectives, and the building of mutual trust and respect. Both groups completed assessments of perceived role understanding, a primary component of effective interdisciplinary teamwork, in palliative care. Self-administered surveys were completed at baseline, intervention completion, and three months later. The intervention group also completed an anonymous evaluation about the interdisciplinary education. RESULTS: The intervention group demonstrated a significant increase in perceived role understanding compared with the control group. Three-month follow-up data suggested that intervention group subjects maintained gains in perceived role understanding. CONCLUSION: An interdisciplinary educational intervention improves role understanding early in the process of professional socialization in a pilot program. Further implementation of interdisciplinary education should evaluate the effect on subsequent interdisciplinary practice and the quality of patient care.

Adult↗