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PubMed2004

Computer-aided learning in the real world of medical education: does the quality of interaction with the computer affect student learning?

BACKGROUND: Computerised learning clearly offers exciting potential for improving student learning, either as an aid to or as a replacement for traditional formats, or for the development of innovative approaches. However, rigorous evaluation of the utility of computer-aided learning (CAL) in enhancing student learning can be difficult. Many studies have compared CAL to more traditional learning formats, but there is little evidence to show which style of CAL leads to the best learning outcomes. AIM: This study aimed to test the hypothesis that a CAL tutorial, in which the learner actively interacts with the computer, will result in superior learning (ability to apply and retain knowledge) to that obtained in more passive CAL formats. METHODS: Third year medical undergraduates at Adelaide University, South Australia were randomly assigned to 4 groups. Following a pretest, only students in the "didactic", "problem-based" and "free text" groups had 2 weeks of free access to a neuroradiology CAL tutorial in their assigned format. Tutorial access was denied to all students 2 weeks before post-testing. Learning was quantified by comparing the post- to pretest scores for each of the 4 groups. RESULTS: After active interaction with the computer material, students in the free text group demonstrated a statistically significant improvement in their ability to apply and retain knowledge compared to the control group, but no advantage compared to the didactic group. CONCLUSIONS: While users of an interactive CAL tutorial demonstrated significant learning gains compared to non-CAL users, these gains were not superior to those achieved from non-interactive CAL. When evaluating education interventions such as CAL packages, it is important to use a valid assessment tool to measure learning.

Australia↗
PubMed1997

Why general practitioners and consultants change their clinical practice: a critical incident study.

OBJECTIVE: To describe the complete range of factors which doctors recognise as changing their clinical practice and provide a measure of how often education is involved in change. DESIGN: Interviews using the critical incident technique. SETTING: Primary and secondary care. SUBJECTS: Random sample of 50 general practitioners and 50 consultants. MAIN OUTCOME MEASURES: Categories of reasons for change in clinical practice. RESULTS: Doctors described 361 changes in clinical practice, with an average of 3.0 reasons per change. The three most frequently mentioned reasons were organisational factors, education, and contact with professionals, together accounting for 47.9% of the total number of reasons for change. Education accounted for one sixth (16.9%) of the reasons for change and was involved in one third (37.1%) of the changes. Education was seldom mentioned as a reason for change in referral practice but was more often mentioned in management and prescribing changes. Consultants were influenced by medical journals and scientific conferences, while general practitioners were more influenced by medical newspapers and postgraduate meetings. CONCLUSIONS: Education is involved in about a third of changes in clinical practice. The wide range of other factors affecting changes in practice need to be taken into account in providing and evaluating education. The role of education in the numerous changes in clinical practice that currently have no educational component should also be considered.

Consultants↗
PubMed1983

Behavioral science training in family practice residency education: a first evaluation.

Although behavioral science training is an essential component of family practice residency education, there have been few evaluations of its effects. In this study, selected behaviors of senior residents and their patients in two different family practice residency programs were compared. One program emphasized behavioral science, the other did not. Residents in the more behaviorally oriented program had more positive attitudes toward both social factors in illness and the importance of a warm physician-patient relationship. In addition, these residents claimed to know more about non-pharmacologic treatments for depression and anxiety and felt more confident in their ability to handle them than their less behaviorally trained counterparts. In regard to patient care, patients of residents in the program which emphasized behavioral science were more likely to receive a psychosocial diagnosis and resident counseling or mental health referral than patients of residents in the program which did not. On a patient satisfaction questionnaire, patients of the two programs differed on only one subscale which concerned convenience of care. Although these early results are encouraging, behavioral science training needs continuing clarification and evaluation of its goals and accomplishments.

Behavioral Sciences↗
PubMed2001

Can asthma education improve clinical outcomes? An evaluation of a pediatric asthma education program.

Asthma is a common, costly, and chronic disease that has a significant impact on children, their families, and the health care system. This study investigated whether formal asthma education can reduce asthma severity and morbidity and further questioned whether the method of education is an important factor in this process. Study subjects were recruited from the emergency department of the Royal Children's Hospital, Melbourne (RCHM), and controls were recruited from the neighboring Western Hospital, Sunshine (WHS). Subject parents were randomized to receive face-to-face education, group education, or home-based video education. Controls had similar medical treatment but received no formal asthma education. Subject and control parents were asked to complete questionnaires before the intervention and at 1, 6, and 12 months. These questionnaires measured demographics, the levels of parent asthma knowledge, anxiety, child asthma severity, and morbidity. Results showed that any method of education increased parent asthma knowledge and immediately decreased their anxiety and child asthma morbidity scores. Despite this, asthma severity was reduced only when knowledge was imparted in an interactive, face-to-face setting. When this happened, asthma severity scores were significantly reduced in both the short- and long-term. These findings call into question mass asthma education campaigns and have important implications for the design of future asthma education programs.

Adult↗
PubMedDate not supplied

Training faculty to evaluate the patient education skills of residents.

Nearly 44% of all outpatient visits result in a prescription for medicine; however, little emphasis is generally placed on training or evaluating residents' ability to teach patients about medication. Often faculty themselves have not received training in this subject, nor have they been trained to systematically evaluate patient education skills. As a result, this whole area of communications with patients is commonly overlooked. Even if skills are evaluated, different standards and criteria may be applied resulting in inconsistent feedback to residents' ability to communicate efficiently and effectively with patients about medication prescribed. Faculty participating in the program increased their ability to consistently evaluate resident performance with 80% accuracy. In addition, faculty reported increase in their own ability to communicate more effectively with patients about medication.

Faculty, Medical↗
PubMed2003

Psychosocial training in a palliative care fellowship.

We present a description of a one-year palliative care fellowship training program for physicians at the Massachusetts General Hospital. We provide background information on the Palliative Care Service, and offer an overview of the educational content and methods for fellowship training, focusing especially on psychosocial aspects of care. The medical background and post-training positions of fellows are described. This document is meant to assist other palliative care fellowship programs in developing their curricula and possibly to serve as an initial template for creating educational standards and for identifying outcome measures for educational evaluation of such programs.

Education, Medical, Graduate↗
PubMed1993

Mental wellbeing of nurse educators at work.

The aim of the study was to assess the mental wellbeing of nurse educators at their work by means of self-assessment. Questionnaires were sent to 100 randomly selected trained nurse educators. Data were collected from 83 respondents. The nurse educators evaluated their mental wellbeing as being rather good. There were, however, some contradictions in the answers to questions covering identical work areas but having somewhat different formulation. The disadvantages of being a nurse educator, as listed by the respondents, included: too much work, and especially too many administrative duties, communication breakdowns with the directors of the nursing college, and underestimation by others of the value of teaching as such. As characteristics of the job promoting a sense of wellbeing, the nurse educators mentioned their interaction and relationships with the students. In addition, the demands and challenges of the work were found very interesting and rewarding.

Adult↗
PubMed1993

The Know Your Body program: a review of evaluation studies.

Know Your Body is a comprehensive school health promotion program for kindergarten through six grades, initially developed in the 1970s by the American Health Foundation. The impact of the KYB program has been evaluated in three field trials, the results of which have been reviewed in this article. Across the three studies, at 3-year follow-up, consistent positive intervention effects were reported for systolic blood pressure, diastolic blood pressure, smoking, HDL-cholesterol, and health knowledge. Results for total blood cholesterol, fitness score, heart-healthy snacks, fruit/vegetable intake, whole milk intake, and health attitudes were mixed. For body mass index, triceps skinfold, all remaining dietary variables, self-esteem/self-efficacy, and locus of control no significant effects were observed. Overall, significant treatment effects were reported for 19 of the 40 variables assessed at 3-year follow-up, an effects ratio of 48%. Consistent positive results at 5-year follow-up were reported for smoking and health knowledge. Mixed results were obtained for total blood cholesterol, diastolic blood pressure, and percent kilocalories from saturated fat. Consistent null results were reported for HDL-cholesterol, systolic blood pressure, body mass index, triceps skinfold, fitness score, percentage kilocalories from fat, cholesterol intake, and fiber intake. Overall, significant treatment effects were reported for 7 of 36 variables at 5-year follow-up, an effects ratio of 19%. Although reported program effects were largely mixed, they seem consistent with other health education evaluations. Null results may have been related to insufficient teacher implementation as well as weaknesses in design and assessment. Additional research is needed to determine the effect of the program on a broader range of outcomes, to what degree increasing the "dose" produces larger and more enduring treatment effects, and the relative impact of the various components that comprise the program.

Child↗
PubMed2003

Consumer-oriented evaluation of health education services.

The objective of this study was to evaluate the effect of the presence of formal health education units in health plans on the health education reported by the consumer. The research consisted of interviews with health educators in the Israeli health plans and a random sample of telephone interviews with 793 Israeli residents between the ages of 45 and 75. The interviews with consumers included measures of counseling on smoking, physical activity, weight reduction, hypertension and diabetes. Two of the four Israeli health plans have formal health education units. After adjustment for other variables, however, the quality and quantity of counseling reported by the consumers does not differ, in most subjects, between health plans with or without health education units. The presence of a health education unit within a health plan had little effect on the counseling reported by the consumer. The reasons for and implications of the results are discussed.

Aged↗
PubMed1995

Assessing the quality of the working life of nurse educators in Finland: perceptions of nurse educators and their spouses.

As part of a broader descriptive study of nurse educators' well-being at work in Finland, the quality of working life was assessed by the nurse educators themselves and by their spouses (or another adult living with them). Data were analysed from 477 (68% of 706) educators from 25 institutes throughout Finland and from 409 (58% of 706) spouses. Nurse educators evaluated their working life as being good. Background factors that improved one or several features of working life were: young age, being married, permanent employment in a small institute in the countryside, and highschool education. Lack of freedom to choose the teaching field and tasks at work reduced the quality of working life. Nurse educators estimated that they did an average of 9.6 hours overtime a week; according to their spouses the figure was 12.7 hours. More than moderate amounts of negative stress, derived mainly from work, were reported. Interactions with people at work and the support obtained for their work were generally judged to be good. Participants reported that they were not very satisfied with relationships with college directors, while they were, generally, satisfied with relationships with students. The spouses estimated nurse educators' working life more negatively than did the educators themselves, with the exception of the balance between work and leisure time, which both groups estimated similarly.

Adult↗
PubMed2001

Effects of educational and psychosocial interventions for adolescents with diabetes mellitus: a systematic review.

BACKGROUND: Insulin-dependent diabetes mellitus, also known as type 1 diabetes, is a life-threatening condition and is the third most common chronic illness among young people. As a result of minimal or non-existent insulin production, people with diabetes must take over the normally automatic task of regulation of blood glucose levels. This is achieved by a complex regimen involving multiple, daily administrations of insulin coordinated with dietary intake and energy expenditure and monitored by blood glucose testing. OBJECTIVES: To examine the effectiveness of educational and psychosocial interventions for adolescents with type 1 diabetes designed to improve their diabetes management. Specifically, it addressed the following research questions: (1) Do educational and psychosocial interventions for adolescents with type 1 diabetes have beneficial effects on biological and psychosocial outcomes? (2) Are there types or features of interventions that have been shown to be more effective than others? (3) What evidence is there of the cost-effectiveness of interventions? METHODS: A search strategy was formulated, piloted and refined. Three journals were handsearched, 11 electronic databases were searched and personal contacts, flyers, conferences and websites were used to notify the research community of the review to access further literature. This process generated 10,535 abstracts, which, after screening, resulted in 367 articles identified for retrieval. This number was augmented by hand-searching, personal contact and exploding references, and a final total of 457 articles were scrutinised. Of these, 64 reports describing 62 studies were identified as empirical papers evaluating educational or psychosocial interventions. The relevant data were extracted from the papers and summary tables for each study were prepared. Where possible, effect sizes were computed for outcomes from studies that included a randomised control group (CG) and other relevant information. RESULTS: A descriptive analysis of the 62 studies was undertaken. Most studies (67.7%) were conducted in the USA and 41% were randomised controlled trials (RCTs), none of which were UK-based. Only 48% of the reports provided an explicit theoretical rationale for the intervention. The mean number of participants was 53.8. The studies took place in various settings, evaluated a variety of interventions, involved various interventionists, addressed various components and assessed the effects by a range of outcomes, including measures of metabolic control and psychological and behavioural outcomes. Follow-up assessments were relatively rare. RESULTS - THE EFFECTIVENESS OF INTERVENTIONS: The 25 RCTs were examined in more detail and three of the most effective were described in depth. Effect sizes could be calculated for 14 studies. The mean (pooled) effect size for psychosocial outcomes was 0.37 and 0.33 for glycated haemoglobin with outliers (0.08 without outliers), indicating that these interventions have small to medium beneficial effects on diabetes management outcomes. A narrative review of the 21 pre-post studies with no CG was performed, including evaluations of interventions conducted at summer camps, interventions for poorly controlled patients and educational interventions. All studies reported beneficial effects. RESULTS - COST-EFFECTIVENESS: Few studies addressed economic considerations associated with interventions, and the lack of information on costs and the diversity of outcomes included by investigators impeded cost- effectiveness comparisons. Shorter hospitalisation at diagnosis is at least as effective in achieving control and avoiding complications in adolescence as longer stays. Home care may result in improved outcomes but may not be cheaper than hospital care at diagnosis. Targeting poorly controlled subjects may reduce adverse events and hospitalisations and may be more cost-effective than generic interventions. There is a need for rigorous cost-effectiveness studies of educational and psychosocial interventions for adolescents with type 1 diabetes that include longer-term considerations. CONCLUSIONS: The following conclusions were drawn from this review: (1) Educational and psychosocial interventions have small to medium beneficial effects on various diabetes management outcomes. (2) Well-designed trials of such interventions are needed in the UK (no completed RCTs of educational or psychosocial interventions for adolescents with type 1 diabetes conducted in the UK were found). (3) The evidence, arising primarily from studies in the USA, provides a starting point for the design of interventions in the UK. (4) Quantitative and narrative analysis of the evidence suggested that interventions are more likely to be effective if they demonstrate the inter-relatedness of the various aspects of diabetes management. (ABSTRACT TRUNCATED)

Adolescent↗
PubMed1991

Learning disabilities: an overview.

Children with learning disabilities form a large pool of patients seen by neurologists for help in understanding the disability and deciding which forms of remediation are appropriate. Learning disabilities may accompany a large variety of other neurologic disabilities, but the usual child with such a problem is in excellent health. A thorough office evaluation for possible medical problems is always necessary, but most children do not require laboratory testing. All children with learning disabilities, whether or not they have accompanying neurologic problems, should be seen for psychological and/or educational evaluation. Some children may also benefit from an evaluation by a speech and language pathologist, occupational therapist, or ophthalmologist. The neurologist, alone or in association with a child psychologist, should also investigate the possible association of learning disabilities with attention deficit hyperactivity disorder. It is only for children with this component of learning problems that the possibility of medication arises. Working closely with the family, the child's school system, and other involved professionals becomes an important aspect of providing full and necessary help to children with learning disabilities. A caring physician can be a major help to the child and his family in understanding this disorder and supporting them during a difficult time.

Brain↗
PubMed2000

Gimme 5 fruit, juice, and vegetables for fun and health: outcome evaluation.

A theory-based multicomponent intervention (Gimme 5) was designed and implemented to impact fourth- and fifth-grade children's fruit, juice, and vegetable (FJV) consumption and related psychosocial variables. Gimme 5 was a randomized controlled intervention trial with school (n = 16 elementary) as unit of random assignment and analysis. Participants included the cohort of students who were in the third grade in the winter of 1994 and students who joined them in the fourth and fifth grades. The intervention included a curriculum, newsletters, videotapes, and point-of-purchase education. Evaluation included 7-day food records and psychosocial measures from students, telephone interviews with parents, and observational assessments. Favorable results were observed for consumption of FJV combined, FJV consumed at weekday lunch, eating FJV self-efficacy, social norms, asking behaviors, and knowledge. A theory-based school nutrition education program can help change children's FJV consumption and impact factors at home that predispose to FJV consumption, but changes were small, and their persistence is unknown.

Child↗
PubMed2006

A randomised-controlled trial evaluating a fetal monitoring education programme.

OBJECTIVE: to evaluate the effectiveness of a fetal monitoring education programme on midwives' fetal monitoring knowledge and intrapartum cardiotocograph interpretation skills. DESIGN: two group, before-after, randomised-controlled trial. SETTING: two maternity hospitals in the Republic of Ireland. PARTICIPANTS: 55 midwives were randomly assigned to either the experimental group (n=27) or the control group (n=28). INTERVENTIONS: the experimental group participated in a 1.5 hr fetal monitoring education programme, whereas the control group attended an alternative education programme consisting of a non-fetal-monitoring-related video presentation. MEASUREMENTS: the primary outcomes of interest were fetal monitoring knowledge and intrapartum cardiotocograph interpretation skills test. FINDINGS: in the fetal monitoring knowledge post-test, the median percentage correct responses for the control and experimental groups were 56% (IQR 18.75) and 88% (IQR 12.5), respectively. This difference, 31.2%, was statistically significant (U=78.5, 95.1% CI -31.25 to -18.75, p<0.001). In the intrapartum cardiotocograph interpretation skills post-test, the median percentage correct responses for the control and experimental groups were 55.6% (IQR 16.7) and 66.7% (IQR 22.2), respectively. This difference, of 11.1%, was statistically significant (U=186, 95.2% CI -16.67 to -5.56, p<0.001). KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: attendance at a short (1.5 hr), in-service fetal monitoring education programme can increase midwives' fetal monitoring knowledge and cardiotocograph interpretation skills. The availability of in-service fetal monitoring education programmes is sporadic, often less than recommended, and is a cause for concern.

Adult↗
PubMed1997

Teaching about the female condom.

Reality female condoms became available for over-the-counter purchase in the fall of 1994. Because the female condom is a new sexual barrier device, women need to learn how to use it correctly. Health care providers must also be knowledgeable about the correct use of the female condom so that they can teach women how to use it as a barrier method. To facilitate learning about the female condom, a curriculum was developed that included a quiz on knowledge about the female condom. Content validity was established through a content validity index completed by six content experts. This quiz was used to evaluate educational sessions offered to 42 persons in an urban college setting and 18 women in a community setting. The article describes the female condom along with the curriculum that was developed to teach its correct use and the reactions of potential users of the female condom.

Adult↗
PubMed1987

Role and responsibilities of general practitioner organisers of continuing medical education.

A total of 359 general practitioner organisers of continuing medical education in England and Wales were sent a questionnaire on their role and responsibilities in 1985; 206 with relevant duties replied. The results of the survey showed that they were playing an effective part in planning, organising, and evaluating educational activities at district level, that many were highly qualified and experienced general practitioners, and that many had previously been concerned in vocational training. Less than half had undergone formal training for their continuing education role. Only 105 (51%) were appointed district general practitioner tutors. They were more active in postgraduate centres than in practice based education. Almost a quarter (49) spent three to five hours a week on their educational duties, but 111 (54%) spent fewer hours. Although well provided with educational resources, few had any control over district educational funds, and over half lacked office space. As to remuneration, 161 (78%) received 500 pounds or less a year and almost two thirds received no reimbursement for expenses. Most had no job description. Attention is drawn to the case for appointing general practitioner organisers of continuing medical education ("district general practice tutors") in all districts of England and Wales, to their role in improving the participation of general practitioners in continuing medical education, and to the urgent need for a national agreement on their job description, preparation, support, and remuneration.

Education, Medical, Continuing↗
PubMed2005

Recruitment and retention of emergency medical technicians: a qualitative study.

Emergency medical technicians (EMTs) are critical to out-of-hospital care, but maintaining staff can be difficult. The study objective was to identify factors that contribute to recruitment and retention of EMTs and paramedics. Information was drawn from three focus groups of EMT-Basic, EMT-Intermediate, and EMT-Paramedic personnel recruited from participants at an annual conference. Thoughts and feelings of EMTs and paramedics were investigated using eight questions designed to explore entry into emergency medical services, what it is like to be an EMT or paramedic, and the EMT educational process. Data were analyzed at the group level for common themes using NVivo. For a majority of respondents, emergency medical services was not a primary career path. Most respondents entered the industry as an alternate or replacement for a nursing career or as a second career following military medic service. The majority of respondents believed the job was stressful yet rewarding, and although it negatively affected their personal lives, the occupation gave them a sense of accomplishment and belonging. Respondents expressed a preference for EMT education resulting in college credit or licensure versus professional certification. Job-related stress produced by numerous factors appears to be a likely contributor to low employee retention. Recruitment and retention efforts should address study findings, incorporating key findings into educational, evaluation, and job enhancement programs.

Adolescent↗
PubMed2004

Evaluation framework for nursing education programs: application of the CIPP model.

It is advised that all nursing education programs conduct program evaluations to address accountability requirements and information for planning and guiding the delivery of the programs. Stufflebeam's CIPP Model, supported by triangulation of multiple modes of data collection provides such a theoretical framework for evaluations. This article proposes a total CIPP evaluation framework for nursing education programs. While this evaluation framework is applicable to any nursing evaluation program, it is practically useful for collaborative nursing programs as it allows a full assessment of each partner in its context. Under the direction of this author, the York-Seneca-Georgian-Durham collaborative BScN Program Evaluation Committee in Ontario developed and utilized a CIPP process evaluation.

Education, Nursing↗