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PubMed1984

Evaluation of a new course to teach the principles and clinical applications of epidemiology to medical students.

A new short course to teach clinical medical students the principles of epidemiology and their applications to clinical practice was introduced at St. Thomas's Hospital Medical School. During the first year one half of the students took the new course. All the students also received the previous epidemiological teaching which was performed on the wards in the context of individual patients with a particular disease. In the next year all students were given only the new course. One year after attending these courses, students completed a questionnaire designed to test how well the course objectives had been met. A comparison was made between those who had received the new course and those who had received only ward round teaching. Students exposed to both the ward rounds and the course were more satisfied with the latter and had a greater appreciation of the importance of epidemiology to clinical practice than students receiving only ward rounds. This improvement was maintained in the subsequent year when the ward rounds were dropped. Students who had the new course also performed relatively better than the others in the Community Medicine multiple choice questions in the Medicine Finals examination, and the marks improved in the subsequent year. This evaluation was also useful in identifying those aspects of the course that need further development.

Education, Medical↗
PubMed1996

"My most meaningful patient". Reflective learning on a general medicine service.

OBJECTIVE: To determine the usefulness of critical-incident reports in facilitating reflective learning and the types of experiences that learners found meaningful on a general medicine service. DESIGN: Team members wrote about their most meaningful patient of the month and what was learned from the patient. They shared their narratives during teaching rounds at the end of each month. The written reports were collected and subjected to qualitative thematic analysis. SETTING: General medicine teaching service of an academic medical center. PATIENTS/PARTICIPANTS: Medical students, residents, and attending physicians. MEASUREMENTS AND MAIN RESULTS: Ninety-eight reports were collected over 10 months and subjected to thematic analysis. Reports were coded for six major themes, with a mean of 2.09 themes per narrative. The number of reports containing each theme was 47 for biomedical, 46 for communication with patients and families, 38 for psychosocial, 32 for the physician's role, 30 for personal feelings, and 14 for ethics. Communication issues constituted the theme most frequently reported by third-year students; biomedical and psychosocial themes by interns; biomedical by supervising residents; and the physician's role by attending physicians. Reports from men and women contained a similar mean number (men 2.101; women 2.128) and distribution of themes. CONCLUSIONS: The critical-incident technique promoted reflection on the meaning of clinical experiences. Qualitative thematic analysis revealed the diversity of meaningful experiences on a general medicine service and the high frequency of nonbiomedical themes. This study suggests that reflective exercises can provide a window into the experience of students and residents.

Clinical Medicine↗
PubMed1994

What clinical teachers in medicine need to know.

In order to identify the components of knowledge that effective clinical teachers of medicine need, the author carried out a qualitative study of six distinguished clinical teachers in general internal medicine in 1991. Using data from interviews, a structured task, and observations of each ward team, he identified six domains of knowledge essential to teaching excellence in the context of teaching rounds: clinical knowledge of medicine, patients, and the context of practice, as well as educational knowledge of learners, general principles of teaching and case-based teaching scripts. When combined, these domains of knowledge allow attending physicians to engage in clinical instructional reasoning and to target their teaching to the specific needs of their learners. The results of this investigation are discussed in relation to both prior research on teacher knowledge, reasoning, and action and faculty development in medicine.

Clinical Competence↗
PubMed1997

An approach to teaching ethical, legal, and psychosocial aspects of gynecologic oncology in a residency program.

An approach to teaching ethical, legal, and psychosocial issues in gynecologic oncology has been integrated into an obstetrics and gynecology residency program. Team-teaching is used, involving gynecologic oncology faculty members and a medical ethicist with experience teaching in the clinical setting of obstetrics and gynecology. The teaching takes place as part of ongoing teaching rounds in the division of gynecologic oncology. Articles from clinical journals are used to inform and stimulate discussion of clinical ethical, legal, and psychosocial issues. Integrating the teaching of ethical and legal aspects of gynecologic oncology into residency education is challenging, given the competing demands on the residents' time and the need for teaching to be clinically relevant. The program described in this article illustrates that such teaching can be carried out in a manner that covers main issues and has practical value for residents.

Curriculum↗
PubMed2000

Co-teaching: a faculty development strategy.

It has been stated that faculty development programmes which are closely linked to particular teaching contexts are most likely to be effective. Over the past 10 years we have developed a model of 'co-teaching' for faculty development which is based upon this premise and which can be applied to any clinical rotation. In this paper we describe our model, in which paired physicians focus on developing their teaching skills while sharing the clinical supervision of residents and medical students. Through iterative phases of teaching, debriefing and planning, co-teachers gain experience in analysing teaching encounters and develop skills in self-evaluation. Teaching occurs in the usual clinical settings such as attending (consultant) teaching rounds, clinic precepting, and case conferences. We discuss our model in the context of educational theory and related literature. We support our positive assessment of the co-teaching model through the precepts of collaborative inquiry and case study methodology. Vignettes, taken from the experiences of the authors, are used to demonstrate how the model is used to develop effective solutions to problems and to help in the maturation of one's skill as an educator. Successful implementation of the model is predicated on the development of a truly collaborative process between co-teachers. We share lessons we have learned from our experience of implementing the model in different clinical venues, such as the contrast between teaching on a hospital ward or in the clinic. This collaborative process has been well received by junior and senior faculty participants in our institution for more than a decade.

Education, Medical, Graduate↗
PubMed2006

Patient perceptions of the otolaryngology ward round in a teaching hospital.

OBJECTIVE: This survey assesses patients' perceptions of a daily otolaryngology ward round in a teaching hospital. METHODS: Initial, open-ended questionnaires generated themes from which a structured questionnaire was constructed. Patients' perceptions in a wide range of areas were examined by asking them to indicate on a Likert scale the extent to which they agreed or disagreed with a number of statements concerning various aspects of the ward round. RESULTS: One hundred patients were surveyed. The response rate was 79 per cent. The findings showed overall patient satisfaction with the ward round, particularly in the areas of information-giving regarding diagnosis, treatment and follow-up arrangements. The large size of the ward round appeared to be intimidating and induced anxiety for approximately one-third of patients. Patients wished the roles of staff present to be better defined and to be informed of the presence of medical students. One-third of patients perceived staff to use language that was difficult to understand. CONCLUSIONS: The survey identified some improvement opportunities and will assist our department with its on-going endeavours to improve the ward round experience for both patients and staff.

Hospitals, General↗
PubMed1988

Perinatal law and ethics rounds.

Advances in perinatal medicine have increased the complexity of the clinical decision-making process. Medical education curricula have paid little attention to exploring the ethical and legal aspects of these decisions. In response to this perceived need, we initiated a case-oriented teaching program in perinatal law and ethics. The goals of the program included the following: to develop skills in "moral diagnosis" and analysis (the ability to interpret and analyze clinical cases from a moral point of view); to understand the relevant laws; to appreciate the ethical and legal relationships between the pregnant woman, her fetus, and the professionals; and to encourage open and frank discussion of these important issues. The teaching rounds, led by a lawyer and ethicist, were held monthly, and included all professionals who care for pregnant women and their newborns. A patient was presented in lay language, stressing the ethical or legal issue raised by the case. Cases could be separated into five categories: questions concerning abortion, issues of maternal-fetal conflict, labor management in extreme prematurity or fetal abnormality, innovative therapy, and the psychological concerns of difficult decisions. Careful case analysis with an in-depth discussion of the ethical principles and legal precedents on which decisions are based appears to be an effective and useful educational exercise. This approach to perinatal teaching can prepare professionals to deal with exigent situations that may occur in practice.

Abortion, Induced↗
PubMed1982

Faculty evaluation as a means of faculty development.

Although there is little evidence that evaluation actually helps improve teaching, some conditions increase the likelihood of evaluation leading to improvement, including a combination of student ratings with educational consultation, comparison of student ratings to self-ratings, feedback early enough to provide time for improvement, and linkage of faculty development to the promotion-retention-tenure process. These conditions were built into a family practice faculty development program. The faculty development program was carried out in steps analogous to a medical model with which faculty already were familiar. An educational consultant took an instructor's teaching "history" and conducted a "physical examination" of his teaching. The evaluator collected "laboratory" data regarding the instructor's teaching and made a "diagnosis." He provided "treatment" in terms of educational consultation and "assessed" the changes in the instructor's teaching. A repetition of the data collection and consultative process demonstrated improvement in clinical teaching, particularly with regard to the skill of leading a collaborative group discussion during resident teaching rounds.

Adult↗
PubMed1990

The Century Club: a model for staff-supported medical education.

Osteopathic teaching hospitals are frequently criticized by house staff officers for not being sufficiently didactic or academically oriented. A model for providing academic training for students, interns, and residents as well as continuing medical education for attending staff physicians is described. This model may be administered by a department of medical education at community hospitals. Tax-deductible financial contributions from medical staff physicians and grants from pharmaceutical companies will be adequate to support this model. Benefits include enhancement of teaching rounds, increased medical staff support, improved compliance with CME requirements, and development of a useful recruitment tool.

Education, Medical↗
PubMedDate not supplied

Are you a surgical role model?

PURPOSE: Multiple papers have examined the recent decline in the number of surgical residency applicants. Many have concluded that a lack of role models in surgery is at least partially responsible for this decline. However, to date, the definition of a surgical role model does not exist. This paper defines a surgical role model based on criteria determined by surgery residents. METHODS: Fourth- and fifth-year surgical residents from 1 residency program were asked to collaboratively define 9 characteristics that make a surgical role model. The 9 criteria as defined by the residents were didactic teaching, teaching rounds, attendance at didactic activities, demonstrates skills and decision making in the operating room with confidence and virtuosity, allows [resident] to do procedures according to ability, allows autonomy to make independent decisions, provides feedback, stimulates critical thinking with use of literature, and assists [resident] to find and complete research for publication. Each resident in the program was then given a questionnaire and asked to evaluate each of the 49 teaching attendings on each of the 9 criteria, on a 3-point scale. Finally, residents evaluated each attending based on professionalism and mutual respect on a scale of I Don't Want To Emulate Him/Her, OK, or Role Model. These categories were also assigned a number (1, 2, and 3, respectively). Pearson correlation and stepwise multiple regression were used to determine the relationship between "Role Model" and the 9 criteria. The unit of analysis was the mean rating given each attending on each of the 10 scales. RESULTS: A total of 847 questionnaires were analyzed. Each of the 9 criteria correlated significantly with the Role Model rating (all p < 0.01). The average correlation was 0.73 (range, 0.64 to 0.78). Of the 9 criteria, 4 correlated best with the Role Model, as shown in. The stepwise regression indicates that 3 of the 9 criteria are uniquely associated with the Role Model variable. These 3 criteria are stimulates critical thinking with use of literature, allows autonomy to make independent decisions, and attendance at didactic activities. CONCLUSIONS: All of the 9 criteria are important factors in residents' perception of the Role Model characteristics of attending faculty. A parsimonious, operational definition of the surgical attending role model is one who stimulates the resident to think, gives the resident the opportunity to think and act independently, and is available to the resident.

Attitude of Health Personnel↗
PubMed1990

University-based postresidency training programs in surgical oncology.

The issue of postresidency training in surgical oncology engenders much debate, particularly as it impacts on general surgery training. With the goal of enhancing instruction in surgical oncology in the future, a survey was conducted to assess the role of surgical oncology programs and educational activities within university-based surgery training programs. The results of the study demonstrate an increased emphasis on surgical oncology training over the past five years. The findings also indicate that education activity in surgical oncology in all departments of surgery has increased greatly, as demonstrated by an increased number of specific teaching rounds and conferences. The impact of this increased awareness on the future of surgical oncology training is discussed.

Curriculum↗
PubMed1979

Teacher-student interaction in a medical clerkship.

Seventeen randomly selected clinical teaching sessions in a medical school clerkship were videotaped during a one-month period, including teaching rounds, working rounds, morning report sessions, lectures, patient management conferences, grand rounds, and journal clubs. Using a verbal behavior classification schedule, the investigators analyzed the videotapes in terms of the proportion of talking done by clerkship instructors, medical students, residents, and others. The nature of the verbal interaction was examined by assessing the proportion of time devoted to giving information versus asking questions. The proportions on these dimensions were further analyzed according to the cognitive level of the verbal interaction. The data suggest that the teaching observed was not optimal for promoting problem-solving ability, since students were placed in a very passive role in which they received a preponderance of low-level, factual information.

Communication↗
PubMedDate not supplied

Teaching psychological medicine on hospital rounds: a liaison experiment.

An unusual version of liaison psychiatry is described in which the object of the liaison is the practicing physician in the hospital setting. Hospital work rounds were used as teaching rounds at frequent intervals over a relatively long time span. The paper demonstrates the usefulness and feasibility of such a project. The processes and principles of teaching psychological medicine in this way are described and exemplified.

Attitude of Health Personnel↗
PubMed2003

Randomised controlled trial of clinical decision support tools to improve learning of evidence based medicine in medical students.

OBJECTIVE: To assess the educational effectiveness on learning evidence based medicine of a handheld computer clinical decision support tool compared with a pocket card containing guidelines and a control. DESIGN: Randomised controlled trial. SETTING: University of Hong Kong, 2001. PARTICIPANTS: 169 fourth year medical students. MAIN OUTCOME MEASURES: Factor and individual item scores from a validated questionnaire on five key self reported measures: personal application and current use of evidence based medicine; future use of evidence based medicine; use of evidence during and after clerking patients; frequency of discussing the role of evidence during teaching rounds; and self perceived confidence in clinical decision making. RESULTS: The handheld computer improved participants' educational experience with evidence based medicine the most, with significant improvements in all outcome scores. More modest improvements were found with the pocket card, whereas the control group showed no appreciable changes in any of the key outcomes. No significant deterioration was observed in the improvements even after withdrawal of the handheld computer during an eight week washout period, suggesting at least short term sustainability of effects. CONCLUSIONS: Rapid and convenient access to valid and relevant evidence on a portable computing device can improve learning in evidence based medicine, increase current and future use of evidence, and boost students' confidence in clinical decision making.

Adult↗
PubMedDate not supplied

Effects of organizational change in the medical intensive care unit of a teaching hospital: a comparison of 'open' and 'closed' formats.

OBJECTIVE: To compare the effects of change from an open to a closed intensive care unit (ICU) format on clinical outcomes, resource utilization, teaching, and perceptions regarding quality of care. DESIGN: Prospective cohort study; prospective economic evaluation. SETTING: Medical ICU at a university-based tertiary care center. For the open ICU, primary admitting physicians direct care of patients with input from critical care specialists via consultation. For the closed ICU, critical care specialists direct patient care. PATIENTS: Consecutive samples of 124 patients admitted under an open ICU format and 121 patients admitted after changing to a closed ICU format. Readmissions were excluded. MAIN OUTCOME MEASURES: Comparison of hospital mortality with mortality predicted by the Acute Physiology and Chronic Health Evaluation II (APACHE II) system; duration of mechanical ventilation; length of stay; patient charges for radiology, laboratory, and pharmacy departments; vascular catheter use; number of interruptions of formal teaching rounds; and perceptions of patients, families, physicians, and nurses regarding quality of care and ICU function. RESULTS: Mean +/- SD APACHE II scores were 15.4 +/- 8.3 in the open ICU and 20.6 +/- 8.6 in the closed ICU (P=.001). In the closed ICU, the ratio of actual mortality (31.4 percent) to predicted mortality (40.1 percent) was 0.78. In the open ICU, the ratio of actual mortality (22.6 percent) to predicted mortality (25.2 percent) was 0.90. Mean length of stay for survivors in the open ICU was 3.9 days, and mean length of stay for survivors in the closed ICU was 3.7 days (P=.79). There were no significant differences between periods in patient charges for radiology, laboratory, or pharmacy resources. Nurses were more likely to say that they were very confident in the clinical judgment of the physician primarily responsible for patient care in the closed ICU compared with the open ICU (41 percent vs 7 percent; P<.Ol), and nurses were the group most supportive of changing to a closed ICU format before and after the study. CONCLUSIONS: Based on comparison of actual to predicted mortality, changing from an open to a closed ICU format improved clinical outcome. Although patients in the closed ICU had greater severity of illness, resource utilization did not increase.

APACHE↗
PubMedDate not supplied

Ongoing faculty evaluations: developmental gain or just more pain?

PURPOSE: We continue to increase the amount of evaluations to improve the outcomes of our residency programs. Although ongoing faculty evaluations clearly are an important part of faculty development, their value in terms of improving the program needs to be evaluated. The questions asked were as follows: (1) Do faculty evaluations continue to improve the faculty over the course of successive evaluation periods? (2) Are there groups of faculty who would benefit the most from faculty evaluation feedback? (3) Are there any specific objective categories within the evaluation that carry more value and may help to shorten this form? METHODS: Forty-two faculty members were evaluated by 40 surgical residents with an assessment form developed by surgical residents that assessed faculty members by 10 different criteria. The initial set of data was collected, and attending surgeons were given an intervention in the form of a letter detailing how they had been assessed in each of the 10 categories. The attending surgeons were evaluated again 6 months later and were given an intervention in the form of verbal feedback regarding their evaluations. The attending faculty members were then assessed 1 year after that. One way analyses of variance and Fisher Protected Least Significant Difference (PLSD) were used to analyze the resulting data to determine if there were significant differences in the faculty evaluations. A part-whole correlation was performed that correlated the 10 evaluation criteria against the mean score on each evaluation, and partial eta-squared analysis was used to determine which criterion had the largest effect on the overall means. RESULTS: The means for the 42 faculty members as a whole continued to improve from the first to the final evaluation period, with 30 faculty members increasing their mean score (18 significantly) and 12 decreasing their mean score (4 significantly). Seven of the 10 evaluation criteria's means improved sequentially by feedback session. These were (1) Didactic Teaching, (2) Teaching Rounds, (3) Attendance at Didactic Activities, (4) Allows [Resident] Autonomy to Make Independent Decisions, (5) Provides Feedback, (6) Stimulates Critical Thinking with Use of Literature, and (7) Encourages and Maintains an Atmosphere of Professional Mutual Respect for All Members of Health Care Team (Role Model). The faculty group with the lowest evaluations improved significantly more than those of both the middle and the role model group, with the middle and the role model groups improving, but not significantly differently from each other. Of the criteria that improved, only Provides Feedback improved significantly from the first to second and the second to third evaluation periods. The three criteria with the highest correlation coefficients were Role Model (0.76), Provides Feedback (0.75), and Stimulates Critical Thinking (0.74). The results from the partial eta-squared test showed that the criterion with the largest effect size was Provides Feedback (0.28). These analyses indicate that the criterion Provides Feedback was both highly correlated with the average score on a faculty member's evaluation and was more responsible than any other criteria for the overall improvement in the mean evaluation score of the faculty members. CONCLUSIONS: (1) Ongoing faculty evaluations indeed are a powerful tool to improve the faculty as a whole. (2) The faculty members with the lowest evaluations showed the largest amount of improvement. (3) Providing feedback to the residents seems to be the most valued factor by the residents for faculty evaluations and perhaps could become the basis of the evaluation for the most accomplished faculty.

Faculty, Medical↗
PubMed1993

Postmarketing surveillance: curriculum for the clinical pharmacologist. Part I: Postmarketing surveillance within the continuum of the drug approval process.

This series of two articles on postmarketing safety surveillance has been developed for use in training clinical pharmacologists. It provides a basic overview useful to clinical pharmacologists in a range of occupational functions. These reports can be used as the basis for a lecture or as background reading material for establishing a unit on postmarketing surveillance. For teaching rounds, multiple illustrations and summary tables have been included. These can readily be made into 35-mm slides or transparencies. Table I outlines the curriculum on postmarketing surveillance for the clinical pharmacologist. The first article describes postmarketing surveillance within the continuum of the drug approval process. The relationship of clinical trials to safety surveillance after drug approval are reviewed. The importance of spontaneous adverse drug experience reporting also is discussed. The second article focuses on the regulatory aspects of postmarketing surveillance and discusses the FDA's (Food and Drug Administration) Spontaneous Reporting System. The two types of adverse experience reports in the Spontaneous Reporting System are described: reports voluntarily submitted by health care providers and others, and reports manufacturers are required by regulation to submit. The clinical pharmacologist's role in postmarketing surveillance is defined.

Clinical Trials as Topic↗
PubMed1993

Noise in the ICU.

OBJECTIVE: The growing number of technical devices in ICUs makes noise exposure a major stressor. The purpose of this study was to assess noise levels during routine operation in our ICU. DESIGN: Our ICU is an open ward with four rooms, constructed in the 1960s. During the study period, 4 patients were in the controlled room and were treated by 4 nurses during the day and by 2 at night. A-weighted sound pressure levels (SPL) were measured continuously for 2 days and nights. Also measured were the alarms of various appliances. For gross overall evaluation it is customary to state the Leq, i.e. the energy-averaged level during measurement. The annoyance caused by noise depends more on rare events of high intensity. Therefore, the distribution of SPL values (Ln) over time was also analysed. RESULTS: SPL was roughly the same during the day and at night, with Leq between 60-65 dB(A) and peaks up to 96 dB(A). Most alarms reach an SPL of 60-70 dB(A), but some exceed 80 dB(A). During teaching rounds Leq exceeds 65 dB(A). CONCLUSION: During the day and at night SPL always surpasses the permissible noise exposure for 24 h of 45 db(A) recommended by the US Environmental Protection Agency. Alarms cause the most irritating noise. Hospital management should pay attention to internal noise, and SPL should be measured routinely.

Austria↗