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PubMed2000

Challenges in using rater judgements in medical education.

Changes in the healthcare environment are putting increasing pressure on medical schools to make faculty accountable and to document the quality of the medical education they provide. Faculty's ratings of students' performances and students' ratings of faculty's teaching are important elements in these efforts to document educational quality. This article discusses selected research related to factors affecting raters' judgements, analyses how changes in the health care environment are influencing such judgements, offers some suggestions to moderate some of the effects and links these influences to the system that upholds professional standards. Ratings are known to have a positive bias (generosity error), provide limited discrimination and often fail to document serious deficits. The potential sources of these problems relate to the mechanics of the rating task, the system used to obtain ratings and factors affecting rater judgement. As managed care demands reduce the time faculty have for teaching, as system-wide disincentives to provide negative ratings proliferate and as social engineering challenges, such as the Americans with Disabilities Act, impose differential standards for students, the natural tendency to avoid giving negative ratings becomes even harder to resist. Ultimately, these forces compromise the capability of faculty to uphold the standards of the profession. The author calls for a national effort to stem the erosion of those standards.

Clinical Competence↗
PubMed2001

What issues are raised by evaluating problem-based undergraduate medical curricula? Making healthy connections across the literature.

There have been various waves and ripples of undergraduate medical curricular reform over recent decades. Such programme-wide innovation can attract exceptional suspicion and scrutiny about its worth, fueled by adverse reactions to change. It also raises expectations of what programme evaluation can reveal about the experience, achievements and 'added value' of the medical students or doctors. Problem-based undergraduate medical curricula are expected, for example, to fulfil elusive 'true' (outcome) descriptors of educational quality. The aim here was to explore the rationale, approach and challenges for undergraduate medical programme evaluation, particularly for problem-based curricula. The main focus was on internal, formative evaluation: Why undertake educational evaluation? What is the evaluative context of problem-based learning? What philosophy has guided programme evaluation of innovative undergraduate medical curricula? What can educational, health care and other evaluation frameworks offer? What can be learned from examples of published accounts of problem-based undergraduate medical programme evaluation? Where to from here? Ideally, evaluators of medical education should be explicit about their rationale, highlight local curricular context and special features, balance process-measures with outcome-measures (including unplanned outcomes), and be eclectic in methods. 'Healthier links' with the health care evaluation and educational evaluation literature could be beneficial. It remains to be seen, however, whether the medical educational changes that the General Medical Council's Tomorrow's Doctors triggered in the United Kingdom will stimulate important advances in educational evaluation.

Curriculum↗
PubMed2000

Action research: a suitable method for promoting change in nurse education.

This paper arose from a research study and its follow-up in four schools of nursing and midwifery. The study was concerned with evaluating the extent to which a philosophy of health had been integrated into the educational curricula of nurses, midwives and health visitors. The purpose of the follow-up was to disseminate and implement the study findings in the four centres. The findings showed that the interpretation and implementation of a philosophy of health in nursing had been variable. Health was operationalized as both health education and health promotion ranging from individualized information giving and disease prevention. Action research was chosen as the appropriate methodology for the follow-up because of its emphasis on participation and partnership. As the follow-up study progressed a number of issues emerged which were indicative of the changes taking place in nurse education as its institutional base shifted into higher education. Other issues were associated with the gap between the rhetoric and reality of action research and the expectations and needs of the key partners. The authors conclude that the follow-up study presented both challenges and opportunities to nurse educators in their endeavour to undertaken research and implement educational change.

Curriculum↗
PubMed2002

Nurse education in higher education: understanding cultural barriers to progress.

Nurse education is established in higher education but nurse academics remain concerned about nursing's lack of equal status within the academy. This paper reports findings of a small study of nurse lecturers' views which support other published studies. It argues that cultural factors which contribute to nursing's problems gaining equal status include anti-intellectualism within nursing and academic denigration of practice. These cultural factors are linked to the history of women in higher education, the separation between intellectual education and practical, skill-based training, the low status of caring courses and the resulting mutual denigration of culturally opposed groups. Anti-intellectualism in nursing can be seen as a defensive reaction against an academic culture that defines practical activity as inferior to abstract thinking skills. This can lead to limited educational opportunities to examine the structural and cultural context of nursing. In Freire's view, this is a necessary part of education for freedom. Current cultural change, in nursing and higher education, including an emphasis on learning outcomes and transferable skills, provides new opportunities for nursing to contribute to educational change. Removing cultural barriers to the educated nurse is a responsibility shared by universities and by the nursing profession.

Attitude of Health Personnel↗
PubMed1997

How peer education changed peer sexuality educators' self-esteem, personal development, and sexual behavior.

Despite peer education's having become an extremely common strategy on many college campuses, very few outcome evaluations of these programs, particularly evaluations that focus on the peers themselves, have been performed. In this article, we report on a study that measured changes in self-esteem, personal development, and sexual behavior over 1 academic year in 65 sexuality peer educators from 10 universities in the United States. Objective measures of those traits demonstrated a shift in a positive direction; after analysis, however, the changes were not statistically significant. Qualitative data described increased levels of self-esteem, confidence, and safer sexual behavior as a major outcomes of the program, reinforcing the notion of the positive effects of peer education. Implications for program enhancement and considerations of the importance of evaluation are discussed, and recommendations for future research are offered.

Adolescent↗
PubMed1998

Instructional intranets in graduate medical education.

Changes in medicine, medical education, and technology have influenced graduate medical education (GME) and have altered many traditional concepts of resident training. Three issues in particular have led to changes. The first is the shortage of time that academic and community physicians have to devote to medical teaching because of the demands to bring in revenue through clinical practice. The second is the limited exposure that residents have to various medical conditions due to a shift in training venues from hospitals to ambulatory care settings. Last is residents' lack of training in using information technologies. The resultant deficits the exist in GME make it more difficult for residents to practice medicine in the most efficient manner. Hence, there is a need for health care professionals' education to address the coming demands of the 21st century. Instructional computer technology can be useful in bridging this gap. Intranets, internal organizational networks, are private versions of the World Wide Web that are often available only to members of a particular organization. This paper reviews changes in medicine and medical education, describes how instructional intranets can be incorporated into GME, and discusses the impact intranet and Internet technologies can have on GME.

Computer Communication Networks↗
PubMedDate not supplied

Student perspectives on transitioning to new technologies for distance learning.

This article reports on students' perceptions of their learning experiences when an existing distance-learning master's program transitions to new technologies and new instructional strategies. Unique elements addressed in this article include (1) findings when a program with extensive experience delivering distance education changes to new technologies and (2) findings when a multidimensional format is used to evaluate program delivery. The technology changes involved migrating from a satellite-based technician-supported videoconferencing system to a land-based faculty-operated videoconferencing system and the addition of class Web materials and asynchronous computer conferencing to course delivery. The multidimensional evaluation format examined student experiences within the context of specific interactions among instructional activities, technology applications, and desired learning outcomes. The evaluation process involved (1) open-ended and structured items in course surveys and (2) an end-of-year student focus group discussion. A formative evaluation approach was used; this article reports on efforts to address the problems identified. Findings include (1) program planners should not assume that prior institutional experiences with distance education facilitate a smooth transition to use of different technologies and (2) a formative multidimensional approach to program evaluation is critical for understanding student experiences with technology-mediated distance education.

Adaptation, Psychological↗
PubMedDate not supplied

Quality assurance not equal to quality improvement.

The intent is not to be critical and the misconceptions are easy to understand. The verbiage related to QI and QA sound alike. Quality improvement is not an easy undertaking for any industry. Some industries have tried QI and failed, while others have tried with admirable successes (e.g., Ford, Florida Power and Light, Motorola). The undertaking of the successful programs has not been easy or painless. QI requires extensive education, change of management philosophy and re-evaluation of our organizational structure. For QA professionals this transition will not be easy or painless . We must first accept that the terminology sounds similar but that the definitions are different. We must accept that our prior processes are far from perfect and can improve. As QA professionals, we must accept that the time is here to learn and to improve. We must begin by improving those processes which we own. This effort must coincide with identification of our customers and implementing systematic mechanisms for identifying their needs and expectations. Through energy expenditure and analysis of data over time, we can improve our processes and ultimately improve the output of our efforts. Only after we have learned QI processes, practiced them through daily application, and improved them can we begin to think about applications of QI to clinical process. After we expend the energy to learn about QI and apply it daily, we will be among the informed. QA professionals must prepare for and learn to value this change. Quality improvement and its technology represents a concept which may truly improve America's healthcare.(ABSTRACT TRUNCATED AT 250 WORDS)

Hospital Administration↗
PubMed1995

The Pawtucket Heart Health Program: community changes in cardiovascular risk factors and projected disease risk.

OBJECTIVES: Whether community-wide education changed cardiovascular risk factors and disease risk in Pawtucket, RI, relative to a comparison community was assessed. METHODS: Random-sample, cross-sectional surveys were done of people aged 18 through 64 years at baseline, during, and after education. Baseline cohorts were reexamined. Pawtucket citizens of all ages participated in multilevel education, screening, and counseling programs. RESULTS: The downward trend in smoking was slightly greater in the comparison city. Small, insignificant differences favored Pawtucket in blood cholesterol and blood pressure. In the cross-sectional surveys, body mass index increased significantly in the comparison community; a similar change was not seen in cohort surveys. Projected cardiovascular disease rates were significantly (16%) less in Pawtucket during the education program. This difference lessened to 8% posteducation. CONCLUSIONS: The hypothesis that projected cardiovascular disease risk can be altered by community-based education gains limited support from these data. Achieving cardiovascular risk reduction at the community level was feasible, but maintaining statistically significant differences between cities was not. Accelerating risk factor changes will likely require a sustained community effort with reinforcement from state, regional, and national policies and programs.

Adolescent↗
PubMed1979

Managing the change process.

Change is a normal and expected phenomenon in the 20th century, but how well are health professions educators prepared to deal with necessary educational change? This article presents a conceptual model for the change process, which provides a framework for adopting an innovation. Although a systems model is used, the human factors associated with change are emphasized. The model provides a basis for action, but the limitations of a static, inflexible viewpoint are discussed. The manager of the change process must be sensitive and responsive to human factors. To be successful, the manager must capitalize on his/her intuitive and creative capabilities. The phenomenon of change may be disruptive to an educational organization. The manager of change may not be in a comfortable position, but the manager who perseveres will see innovations adopted, experience personal growth and contribute to the professional development of others.

Faculty↗
PubMed1999

To improve pain management: measure, educate, change habits.

Healthcare organizations that have successfully implemented pain management programs started by unifying their care policies and building pain management into standing orders, protocols and patient charts. The greatest challenge, however, belongs to staff, pharmacists and physicians, who must measure pain routinely and seek effective treatment, see that the most appropriate and effective treatments are ordered and used, and incorporate pain management into the plan for each patient's recovery.

Hospital Administration↗
PubMed2001

[Basic assessment of needs for training in evidence-based medicine in Slovakia].

BACKGROUND: The health care reform in Slovakia produces a desire for greater responsibility for and control of strategic decisions and to be better able to evaluate international knowledge and experience in the specific national social and professional contexts. Evidence based medicine (EBM) provides an increasingly organised and accessible database of international knowledge in health and health care, capable of informing decisions at the macro and micro levels. AIM: The aim of this pilot study was to assess education, training and other capacity building needs in EBM and evidence based health care. METHODS: This study was primarily qualitative and based on a triangular approach, which included: (1) The analysis of the situation in pre- and postgraduate education in Slovakia aiming to the estimation of needs in EBM and critical appraisal skills training; (2) The analysis of questionnaires distributed in a sample of 50 medical doctors and university educated public health workers undergoing a postgraduate training; (3) The discussion in focused groups. RESULTS: The findings and analysis uncovered a gap in knowledge and experience of EBM approaches, particularly of searching for evidence, utilising information technology, of undertaking critical appraisals of the validity and quality of external evidence and of knowledge of English. On the other hand the findings revealed a high access to information including the Internet access at the workplace, an increasing awareness of the need for up-date information, a demand for training and potential opportunities for action. CONCLUSIONS AND RECOMMENDATIONS: The effective implementation introduction of EBM approach would require changes in broader political, cultural and behavioural contexts, including changes in pre- and postgraduate systems of professional and managerial education, changes in professional and managerial attitudes and changes in emphasis in skills and capacity building and improvements in knowledge management systems at the national level.

Education, Medical↗
PubMed1995

Physicians for the 21st century: implications for medical practice, undergraduate preparation, and medical education.

Changes in medical education and the practice of medicine have resulted from the push for both education and health care reforms. Undergraduates planning application to medical school should broaden their preparation to include communications, computers, economics, and multicultural educational experiences. To prepare graduates for medical practice in the new millennium, the University of Kentucky College of Medicine has implemented a new curriculum focusing on integration of basic and clinical sciences, primary care in ambulatory sites, health promotion and disease prevention, and attention to the ethical, social, psychologic, and financial impact of disease upon the patient, family, and society.

Curriculum↗
PubMed1998

Changes in gestational trophoblastic tumors over four decades. A Korean experience.

OBJECTIVE: To review changes that occurred in gestational trophoblastic tumor (GTT) patients treated over four decades and to identify factors leading to the changes. STUDY DESIGN: A retrospective study of 287 cases treated during 1961-1967, 1975-1979, 1980-1986 and 1990-1994. The method of diagnosis, incidence and outcome in each decade and factors that may have had an influence, on incidence, outcome or both, were reviewed. RESULTS: Diagnosis shifted from pathologic (1960s) to clinical (1990s). The incidence per 1,000 births decreased from 4.4 (1960s) to 1.6 (1990s). The incidence showed a 26-fold increase in women aged 40 and over and 13.4-fold increase in women para 3 and over. The obstetric population showed a decrease in the high-risk group of greater age and higher parity. Assessment by the 1983 World Health Organization prognostic score showed an increase in low-risk and decrease in high-risk disease. Prognostic score changes are related to a decrease in GTT in older women, increase in GTT with a short interval and increase in nonmetastatic disease. Overall mortality decreased from 32.6% to 2.6%. CONCLUSION: The decreased incidence and improved outcome of GTT in Korea are related to improved medical care and to social, economic and educational changes.

Adult↗