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PubMed1999

Involving students in question writing: a unique feedback with fringe benefits.

A contest on question writing was organized during the undergraduate medical physiology teaching program. Students were asked to write and submit multiple-choice questions of the assertion-reasoning type (type E) in physiology. The winners were decided after the questions submitted were graded on a six-point scale (0-5) that considered both thematic novelty and construct correctness. Of the 100 students in the class, 37 participated in the contest, and a total of 912 questions was received. The contest encouraged the students to go through their subjects critically. The questions provided the instructor with insight into the learning habits and misconceptions of the students and provided the grist for animated discussions in tutorial classes. Although several types of errors were deciphered in these questions, with suitable modifications the questions helped the faculty build up a sizable question bank.

Education, Medical↗
PubMed2003

Promoting reflection on professionalism: a comparison trial of educational interventions for medical students.

PURPOSE: To determine whether writing, one-on-one interviews with faculty, or a combination of these interventions effectively elicited reflection on professionalism for medical students. METHOD: The study was a randomized trial conducted in 2001 at Harborview Medical Center, Seattle, Washington, with fourth-year medical students on a four-week clinical clerkship in emergency medicine. Three interventions were evaluated: the critical incident report (CIR), the CIR followed by a one-on-one interview with a faculty member, and one-on-one interview with no CIR. Quality and quantity of professional issues raised were addressed. RESULTS: All students (n = 68) agreed to participate; 66 completed the study components. On average, the students addressed significantly more issues of professionalism in their interviews alone than in their CIRs, 15.9 (95% confidence interval [CI] 18.2-13.6) and 7.15 (CI 8.88-5.40) issues respectively (p <.0001). Interviews preceded by CIRs were not significantly different from interviews with no CIR (13.5 versus 15.9 professionalism issues raised, respectively). In-depth explorations, including problem solving and projection to the future, occurred 2.59 times in interviews alone (CI 3.62-1.56) and 0.794 times in CIRs (CI 1.12-0.46) (p <.001). When analyzed as a proportion of total statements, the groups had similar ratios of in-depth statements (11.2% in CIRs and 15.7% in interviews alone). CONCLUSION: Writing did not significantly affect the quantity or quality of reflection in interviews. One-on-one interviews with a faculty mentor most effectively elicited reflection on professionalism. Future studies should examine how reflective exercises such as those evaluated can be used to promote professional development.

Adult↗
PubMed1995

Intervention in elder abuse: a swift blade, or a dull-edged saw?

In spite of a geriatric team's offer to intervene in what was perceived to be a case of psychologic and financial abuse, an elderly patient who was being discharged from hospital chose to remain in her home. Frustration and concern about the victim prompted medical student Kim Curtin to write this essay that considers the issues of judgement, beneficence and medical intervention.

Aged↗
PubMed2004

Writing and publishing case reports: the road to success.

Case reports, by virtue of their simplicity, are ideal for the novice writer. The temptation is to write up anything that is remotely interesting in the hope that you get your name in print. One soon discovers that this is a self-defeating exercise when rejections of a mediocre manuscript come a plenty. Choosing an appropriate case is the difficult first step and getting started remains a challenge for the uninitiated. This article outlines our systematic approach for busy junior doctors to write high-quality and meaningful case reports with relative ease.

Humans↗
PubMed1995

[Astute in vivo observations discover anti-asthma medication].

Will the new reductive biology write the book of revelation of all progress as concerns the pathophysiology and pharmacology of asthma? The early and recent medical history of anti-asthma drugs supports the possibility that exploratory in vivo research involving patients and disease-like test systems may "unexpectedly" provide leap discoveries in pathophysiology and pharmacology. New treatments based on defined molecular disease mechanisms will no doubt emerge. However, the future may also hold novel important anti-asthma drugs where the exact mode of action remains a challenge. Indeed, many aspects of the efficacies of the already long established anti-asthma drug principles have yet to be explained at the end-organ, cellular and molecular levels.

Adrenal Cortex Hormones↗
PubMed2006

[The medical and pharmaceutical profession and the mutual care system in the writings of Jaime Vera (1859-1918)].

This article presents the perspectives of the physician and politician Jaime Vera y López (1859-1918), co-founder of the Spanish Socialist Workers' Party, on the medical profession, medical practice, and healthcare systems. It compares the Report (Informe) that he presented to the Comisión de Reformas Sociales (1884) with his later writings published in the socialist press ("Farmacia y cooperación obrera,, 1914 and "La locura en los niños. Camino del remedio", 1916). We observe the discrepancies between the political-programme documents and the articles centring on professional questions and highlight how his theoretical focus is modified when applied to matters of medical practice.

Delivery of Health Care↗
PubMed2006

Evidence-based medicine: assessment of knowledge of basic epidemiological and research methods among medical doctors.

BACKGROUND: An understanding of statistical methods and basic epidemiology are crucial for the practice of modern medicine. AIMS: To assess (1) the knowledge of basic methods of conducting research and data analysis among residents and practicing doctors and (2) the effect of country of medical school graduation, professional status, medical article reading and writing experience on the level of this knowledge. METHODS: Data were collected by means of a supervised self-administered questionnaire, which was distributed among doctors at Soroka Medical Center, Beer-Sheva, Israel. The questionnaire included 10 multiple-choice questions on basic epidemiology and statistics, and respondent demographical data. RESULTS: Of the 260 eligible doctors, 219 (84.2%) returned completed questionnaires. Of the 219 doctors, 50% graduated more than 8.5 years ago, 39.7% were specialists and the remaining were residents. The most frequent specialty was internal medicine (37.4%). Israel was the most frequent country of graduation (45.7%), followed by the former Soviet Union (Eastern medical education; 38.4%). The median total score of knowledge was 4 of 10 questions (interquartile range 2-6). A higher score was associated with a Western medical education, being a specialist, shorter elapsed time since graduation, higher number of publications and self-reported reading of "methods" and "discussion" sections in scientific articles. CONCLUSION: This study found a low level of knowledge of basic principles of research methods and data analysis among doctors, and this knowledge considerably differed by country of medical school graduation.

Clinical Competence↗
PubMed1995

Writing a PACS program statement.

Medical telecommunications is becoming a necessity for maintaining the quality of care and delivering services on a timely basis in the current environment of cutting services and specialists to reduce costs. (Vanden Brink 1994). Picture archiving and communications systems (PACS) and teleradiology are increasingly viable because there is easier connectivity among modalities and manufacturers. Agreement on the DICOM Standard is one step toward greater connectivity. Two-thirds of the 350 radiology administrators, radiologists, hospital administrators and MIS directors interviewed for the 1994 IMACS/PACS Tracking Study believe that the use of image telecommunication technology is growing. In 1993, Vanderbilt University Medical Center (VUMC) formed a committee to evaluate the need for PACS and to compile a program statement. The principal purpose of the program statement is to provide fundamental information that can be understood easily by individuals outside the radiology department. It outlines the benefits of PACS and includes a financial analysis of the purchase and installation of a system. Key elements of the program statement include a description and analysis of the existing film library system, advantages of PACS, implementation plan, financial proforma and integration with the hospital information system. These and other topics are covered in detail in the following article.

Computer Communication Networks↗
PubMed2005

Thrombotic thrombocytopenic purpura associated with quetiapine.

OBJECTIVE: To report a case of thrombotic thrombocytopenic purpura (TTP) caused by the antipsychotic quetiapine on 2 occasions in the same patient and review the hematologic adverse events associated with quetiapine. CASE SUMMARY: A 25-year-old African American male with a history of bipolar disorder was treated with quetiapine and developed thrombocytopenia, microangiopathic hemolytic anemia, and acute renal failure consistent with a diagnosis of TTP on 2 occasions 2 years apart. On each occasion, TTP was successfully treated with plasmapheresis. DISCUSSION: Many medications, including antibiotics, immunosuppressants, and antineoplastics, have been implicated as causative agents of TTP. Although, as of this writing, a review of the medical literature reveals no previous report of TTP associated with quetiapine, the Food and Drug Administration database of the Adverse Event Reporting System has compiled, as of this writing, 3 cases of TTP occurring in patients on quetiapine as their sole medication. In addition, this database has recorded other common hematologic adverse effects, including neutropenia and thrombocytopenia, that are possibly associated with quetiapine. In our patient, quetiapine-associated TTP presented within a few days after exposure to the drug, with early thrombocytopenia followed by delayed appearance (2-3 days) of microangiopathic hemolysis. CONCLUSIONS: An objective causality assessment suggests that quetiapine was the highly probable cause of TTP in this patient. Early recognition, discontinuation of the drug, and institution of plasmapheresis are paramount for prompt resolution of this life-threatening hematologic disorder.

Adult↗
PubMed1999

The origins and evolution of bioethics: some personal reflections.

Bioethics was officially baptized in 1972, but its birth took place a decade or so before that date. Since its birth, what is known today as bioethics has undergone a complex conceptual metamorphosis. This essay loosely divides that metamorphosis into three stages: an educational, an ethical, and a global stage. In the educational era, bioethics focused on a perceived "dehumanization" of medicine by the rising power of science and technology. Remedies were sought by introducing humanities, ethics, and human "values" into the medical curriculum. Ethics was one among the humanistic disciplines, but not the dominant one. In the second era, ethics assumed a dominant role as ever more complex dilemmas emerged from the rapid pace of biological research. As such dilemmas were applied to medical practice, the need for a more rigorous and more formal analysis of their moral status was clear. Philosophically-trained ethicists had an obvious role. They began to teach, write, and profoundly influence medical education and practice. In the third -- and present -- period, the breadth of problems has become so broad that ethicists must, themselves, draw on disciplines well beyond their expertise -- e.g., law, religion, anthropology, economics, political science, psychology, and the like. The era of bioethics as a global enterprise is upon us. The original hope for humanizing medicine has not been overtly successful; however, much has been accomplished of value to patients, the profession, and society. Medical morality has been transformed into a formal, systematic study of a whole range of issues of the greatest significance to humanity. Now the major challenge is one of identity, or inter-relationships and connections between the theoretical and the practical. Bioethics has outgrown its beginnings.

Academies and Institutes↗
PubMed1994

A controlled trial of a seminar to improve medical student attitudes toward, knowledge about, and use of the medical literature.

OBJECTIVE: To determine whether an interactive seminar could affect medical student knowledge of research design, basic critical appraisal skills, and attitudes toward and clinical use of the medical literature. DESIGN: Controlled, nonrandomized clinical trial. PARTICIPANTS: Third-year clinical clerks (n = 146) during their core medicine clerkship. INTERVENTIONS: Two 90-minute interactive seminars. MEASUREMENTS AND MAIN RESULTS: Pre- and postquestionnaires were used to assess knowledge and attitudes regarding the use of the medical literature among 65 study and 81 control students. Blinded review of write-ups assessed actual use of the medical literature. Overall, 80% of the students subscribed to one or more journals and reported reading three or more journal articles per month. After the intervention, the study students were more likely than the control students to consider: 1) study design important in article selection and 2) use of medical literature critical to patient care decisions. Knowledge scores were significantly improved in the study group (p = 0.0001). The intervention yielded no increase in the actual use of medical literature in patient write-ups over that encouraged by usual clerkship goals. 51% of the study and 48% of the control students cited literature at baseline, and 53% of all the students did so after the intervention. Of these citations, 50% were for journal articles and the remainder were for textbooks. The students infrequently mentioned the quality of the cited literature. CONCLUSIONS: An interactive seminar designed to introduce medical students to critical appraisal improved student knowledge and attitudes but did not increase the actual use of literature in patient write-ups.

Adult↗
PubMed1993

Physician inpatient order writing on microcomputer workstations. Effects on resource utilization.

OBJECTIVE: To assess the effects on health care resource utilization of a network of microcomputer workstations for writing all inpatient orders. DESIGN: Randomized controlled clinical trial. SETTING: Inpatient internal medicine service of an urban public hospital. SUBJECTS: A total of 5219 internal medicine patients and the 68 teams of house officers, medical students, and faculty internists who cared for them. INTERVENTION: Microcomputer workstations, linked to a comprehensive electronic medical record system, for writing all inpatient orders. MAIN OUTCOME MEASURES: Total inpatient charges for each admission and charges for specific categories of orders. A time-motion study of selected interns assessed the ordering system's time consumption. RESULTS: Intervention teams generated charges that were $887 (12.7%) lower per admission than did control teams (P = .02). Significant reductions (P < .05) were demonstrated separately for bed charges, diagnostic test charges, and drug charges. Reductions of similar proportion and statistical significance were found for hospital costs. The mean length of stay was 0.89 day shorter for intervention resident teams (P = .11). Interns in the intervention group spent an average of 33 minutes longer (5.5 minutes per patient) during a 10-hour observation period writing orders than did interns in the control group (P < .0001). CONCLUSIONS: A network of microcomputer workstations for writing all inpatient orders significantly lowered patient charges and hospital costs. This would amount to savings of more than $3 million in charges annually for this hospital's medicine service and potentially tens of billions of dollars nationwide. However, the system required more physician time than did the paper charts. Research at other sites and system advances to reduce time requirements are warranted.

Computer Communication Networks↗
PubMed2005

The effects of violating standard item writing principles on tests and students: the consequences of using flawed test items on achievement examinations in medical education.

The purpose of this research was to study the effects of violations of standard multiple-choice item writing principles on test characteristics, student scores, and pass-fail outcomes. Four basic science examinations, administered to year-one and year-two medical students, were randomly selected for study. Test items were classified as either standard or flawed by three independent raters, blinded to all item performance data. Flawed test questions violated one or more standard principles of effective item writing. Thirty-six to sixty-five percent of the items on the four tests were flawed. Flawed items were 0-15 percentage points more difficult than standard items measuring the same construct. Over all four examinations, 646 (53%) students passed the standard items while 575 (47%) passed the flawed items. The median passing rate difference between flawed and standard items was 3.5 percentage points, but ranged from -1 to 35 percentage points. Item flaws had little effect on test score reliability or other psychometric quality indices. Results showed that flawed multiple-choice test items, which violate well established and evidence-based principles of effective item writing, disadvantage some medical students. Item flaws introduce the systematic error of construct-irrelevant variance to assessments, thereby reducing the validity evidence for examinations and penalizing some examinees.

Choice Behavior↗