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PubMed2003

The Art of Medicine through the Humanities: an overview of a one-month humanities elective for fourth year students.

BACKGROUND: The purpose of incorporating humanities teaching into medical education is to encourage students to develop into more sensitive and caring doctors who communicate well with their patients and colleagues. CONTENT: A unique 4th year student elective at the Medical College of Wisconsin incorporates reflective and writing activities. Small group sessions are facilitated by faculty with specific interest and expertise in the humanities. EVALUATION: Students keep a journal in which they record their reflections on personal issues, career planning and reactions to classroom discussions. Each student writes a poem and an essay or short story. The course is well received and oversubscribed. CONCLUSIONS: Students increase their understanding of the humanities through readings, small group discussions, journal keeping and formal writing. By incorporating humanism into their professional lives, medical students can learn to care for their patients in a more humane and thoughtful manner.

Attitude of Health Personnel↗
PubMed2004

Facilitating scholarly writing in academic medicine.

Scholarly writing is a critical skill for faculty in academic medicine; however, few faculty receive instruction in the process. We describe the experience of 18 assistant professors who participated in a writing and faculty development program which consisted of 7 monthly 75-minute sessions embedded in a Collaborative Mentoring Program (CMP). Participants identified barriers to writing, developed personal writing strategies, had time to write, and completed monthly writing contracts. Participants provided written responses to open-ended questions about the learning experience, and at the end of the program, participants identified manuscripts submitted for publication, and completed an audiotaped interview. Analysis of qualitative data using data reduction, data display, and conclusion drawing/verification showed that this writing program facilitated the knowledge, skills, and support needed to foster writing productivity. All participants completed at least 1 scholarly manuscript by the end of the CMP. The impact on participants' future academic productivity requires long-term follow-up.

Attitude of Health Personnel↗
PubMed1995

Design and implementation of the Indianapolis Network for Patient Care and Research.

We are creating a health care information network that will link a large community medical record system to three hospital emergency departments, fifty community pharmacies, ten clinics, four health-maintenance organization (HMO) offices, and twelve homeless care sites in Indianapolis, Indiana. This project will test the feasibility of linking care providers across organizational boundaries and measure the benefits of such a network. The network will supply three kinds of information services: a "mini-medical library," patient medical record information, and a citywide prescription database incorporating a computer-based prescription-writing system. The use of medical resources, the cost of care, provider time spent giving care, and providers' opinions of the services will be used as outcomes in randomized clinical trials. Through this project, we hope to expand the information base available to the target care sites; reduce unnecessary testing and increase the efficiency of care in emergency departments; improve emergency department, office, and clinic prescribing patterns; enlarge the consortium of health care providers connected by the network; and develop strategies for successfully implementing a comprehensive city medical record resource.

Ambulatory Care Facilities↗
PubMed2004

[Statement of fair retribution in medical oaths].

BACKGROUND: to determine if Medical Oaths from different times include the statement of the physician to request from patients a fair retribution for his/her medical services. METHODS: Fifty Medical Oaths found in articles and publications were analyzed. In accordance with their corresponding dates, the Oaths were grouped as ancient /medieval (12), and modern/contemporary (38). RESULTS: Of the fifty, only three specifically included the statement of fair retribution. Two of the three were medieval and belonged to the School of Medicine of Montpellier. The other text was modern (Amato Lusitano's Oath). Four writings showed statements regarding medical assistance to the poor. Eleven pledges indirectly stated that no earnings from other activities and/or relations were obtained. CONCLUSIONS: Ancient oaths emphasize fair retribution, no discrimination in medical assistance based on payment possibilities, and gain of honest earnings. Modern oaths generally do not include these topics and very few mention that the medical profession should not be exercised merely for material purposes. Despite the above, physicians should respect the limits of their obligations and should be committed to assist without discriminating, particularly without taking into consideration their patient's financial possibilities. Therefore their fees should not be excessive for the services rendered.

Codes of Ethics↗
PubMed1995

[Qualitative research in health: methodological reflections on the oral report and narrative production in a study about the medical profession].

Qualitative research as applied to Public Health and Social Medicine is studied. The project is based upon research into the historical transformation of medical professional autonomy as medicine shifted from the "liberal" practice to recent "technological" medicine. Field research used unstructured recorded interviews to gather personal testimonies about the professional histories of physicians who graduated between 1930 and 1955. These testimonies are technically classified as "oral accounts" and were registered as free narratives. This study analysis how accounts can express the physicians' self-representations of their daily work and simultaneously write the history of medical practice. Further, the unstructured interview is evaluated as an instrument yielding free narratives and life accounts.

Humans↗
PubMedDate not supplied

A computer-based outpatient medical record for a teaching hospital.

We developed a computer-based outpatient medical record system to facilitate direct physician interaction with the clinical computing system at the Beth Israel Hospital in Boston. During the 2 years since the medical record system was installed, 20 staff physicians, 5 fellows, 64 residents, and 11 nurse practitioners have entered 15,121 active problems and 1996 inactive problems for 3524 patients, as well as 12,651 active medications and 1894 discontinued medications for 3430 patients. Another 20,321 items were entered on health-promotion and disease-prevention screening sheets, and with the help of automatic updating by the computer, an additional 21,897 entries on screening sheets were made for 8686 patients. Clinicians wrote 10.9 +/- 12.8 (mean +/- SD) words per problem when they were working at the computer, as compared with 4.3 +/- 2.5 words per problem when they were writing in the paper medical record. We conclude that physicians will readily enter data directly into a computing system when they are given appropriate tools, and that they consider the computer-based problem list to be a valuable improvement over its paper counterpart. Use of a computer-based medical record system has obvious benefits for data management and patient care.

Ambulatory Care Information Systems↗
PubMed2003

[The problems of alcoholism amongst primary-school pupils as reflected in Polish medical journals of 1923-1938].

During the period between the two World Wars (1918-1939), alcoholism was a fairly common occurrence in Poland among primary-school pupils. Physicians, educators, social workers and central--as well as local-government institutions were involved in combating this disease and, above all, stopping its spread. Polish medical journals of the inter-war period played a dominant role in that struggle. They presented the results of anti-alcohol surveys conducted amongst primary-school children, published reports on the activities of anti-drinking societies and organisations and showed the harmful influence of alcohol on young bodies. They also pointed out methods of preventing the rise of alcoholism amongst children. This article is based on an analysis of numerous writings published in several medical journals dealing with children's alcoholism. It discusses the anti-alcohol tests carried out amongst primary-school children in selected Polish cities and towns from 1923 to 1938. On the basis of the completed questionnaires it shows the reasons for the emergence of alcoholism amongst children and presents the methods used at that time to prevent the disease.

Alcoholism↗
PubMed2003

The first American textbook of surgery.

The first systematic textbook of surgery written in the United States, The Elements of Surgery, was completed in 1813 by John Syng Dorsey, a University of Pennsylvania surgeon. The work thoroughly covered all major clinical areas of surgery of that time in a two-volume, 797-page text. Subsequent editions were published in 1818, 1823, and 1831. It became the standard surgical textbook in this country during that era and was the first American medical text exported abroad for use at the more established European centers of medical education. The reasons for writing the text included a desire to put into print the teachings of Philip Syng Physick (first Chair of the Department of Surgery at the University of Pennsylvania, and Dorsey's uncle), the new American nationalism, and socioeconomic pressures forced on the American publishing industry by the War of 1812 and preceding trade embargoes. In addition to extensive exposure to Physick, Dorsey was also uniquely qualified to write and illustrate this text, as he exhibited an unusually succinct style and was a remarkable medical artist. The book was the forerunner to William Gibson's The Institutes and Practice of Surgery and all American surgical textbooks to follow.

General Surgery↗
PubMed1994

Impact of computerized physician order entry on physician time.

We examined the effect of computerized physician order entry on housestaff time use patterns, using time motion techniques. For both medical and surgical house officers, writing orders on the computer took about twice as long (p < 0.001), or 44 minutes for medical and 73 minutes for surgical house officers. Medical house officers recovered about half this time because some administrative tasks--e.g. looking for charts--were made easier. Within types of orders, sets of stereotyped orders took much less time with order entry, but one-time orders took longer. We have since developed strategies to make it easier to enter one-time orders.

Hospital Information Systems↗
PubMed2006

Forensic report writing.

As the area of specialization of forensic psychology broadens its horizons, it will become increasingly more difficult for clinical psychologists to avoid participating in the forensic arena. As a result, clinical psychologists may be asked to write reports about therapeutic intervention or evaluations in divorce, personal injury, competency, abuse, or criminal proceedings. In this article, the author addresses the issues that the clinical psychologist needs to understand in writing reports that may be utilized in forensic settings. How these reports are affected by the American Psychological Association Ethics Code (APA; 2002), the audience receiving the report, the subject matter of the report, and dissemination of the information are all discussed in this article.

Forensic Psychiatry↗
PubMed2005

Improved patient notes from medical students during web-based teaching using faculty-calibrated peer review and self-assessment.

BACKGROUND: This study examines the effectiveness of Calibrated Peer Review (CPR), a Web-based writing development program, to teach and assess medical students' patient note-writing skills in a standardized fashion. METHOD: At the end of the clerkship year, 67 medical students were divided into three groups, introduced to CPR, and instructed in patient note-writing. Students then wrote notes for three clinical cases, presented in different order to each group. After training on faculty-calibrated standards, students evaluated their peers' notes and their own notes. Trained faculty, blinded to author, order, and group, also graded student notes. RESULTS: Faculty gave lower scores than students, but both groups found students' scores improved significantly from the first to the third note written. CONCLUSIONS: Student-written patient notes improved in quality while using CPR. The program uses approaches valued in medicine (accurate peer review and self-reflection) to enhance performance.

Clinical Competence↗
PubMed2005

'Lost in translation'? Developing assessment criteria that value rural practice.

INTRODUCTION: Rural workforce preparation is often discussed in terms of specific interventions such as rural placements. More technical discussions of education matters seem to belong in the realm of education experts. However, this issues article argues that a focus on quality assessment techniques is important to the rural health agenda. Making connections between the medical education literature and the broader education literature, it explores elements of a qualitative decision-making model as an alternative to narrow competency-based and norm-referenced approaches. In the process it explores assessment techniques that may help educators better translate their intentions to value rural practice into the learning of students. BACKGROUND: Research suggests that, in Australia at least, many university educators have different and conflicting understanding of assessment criteria. At the same time, the literature on the development of assessment criteria is relatively small in a context in which the medical education literature takes a quantitative, reliability-driven approach. This has important implications for how we ensure that rural practice is given enough emphasis at the level of education that most strongly drives student learning-assessment. METHODS: This article explores such matters by examining the steps needed to develop assessment criteria in undergraduate medical education courses. It draws on key writings from the past, as well as current debates, in the medical education and broader education literature. It focuses on the detail of assessment techniques to show how the intention to value rural practice can be 'lost in translation' with narrow norm-referenced and competency-based assessment models. CONCLUSIONS: Rural health has a stake in technical debates about education in health sciences courses. Like other knowledge and skills, the knowledge and skills important to rural practice cannot be valued at the coalface of student learning if our assessment techniques subvert intentions. Developing the quality of assessment techniques involves scrutiny of not only the medical education literature, but also the broader education literature, including writings about working models of criteria-and-standards-based assessment. This scrutiny suggests assessment techniques are not equal in terms of how well they translate intentions. More than that, it suggests the value to rural health education of shifting from narrow norm-referenced models to best practice in criteria-and-standards-based assessment.

Australia↗
PubMed1994

The Consilium ad Calcolum of Alberto de'Zancari.

Zancari was born in 1278 and practised medicine in Ravenna and Bologna. He is mentioned in the Decameron of Boccaccio and in court records of Bologna in connection with 4 of his students who were accused of exhuming a body for medical research. Zancari's writings are found in several manuscript versions and include commentaries on Galen and Consilium ad Calcolum, which deals with renal calculosis. His therapeutic rules are summarized in 74 lines and cover both acute and quiescent calculi and prevention. The treatments prescribed do not differ from those in general use at the time, nor are any new concepts introduced.

History, Medieval↗
PubMed1996

Medical school achievements as predictors of performance in a physical medicine and rehabilitation residency.

PURPOSE: To determine whether medical school achievement is related to or predictive of performance in a physical medicine and rehabilitation (PM&R) residency, performance on PM&R board examinations, and entry into academic PM&R practice. METHOD: In 1994-1995, data were extracted from the files of 205 former residents who trained for at least six months from 1959 to 1991 in the PM&R program at the University of Washington. Associations between medical school and residency and post-residency variables were sought using chi-square analyses, analysis of variance, and linear and logistic regression. RESULTS: Clinical residency performance was predicted by clerkship honors grades (p = .0001). Probation was predicted by failing a basic science course (p = .0001). Written board performance was related to Alpha Omega Alpha status (p = .04). Failing written boards on the first attempt was predicted by failing a basic science course (p = .05). Entry into an academic PM&R practice was predicted by an interest in such a practice in the personal statement of the residency application (p = .002) and by writing a thesis in medical school (p = .03). CONCLUSION: Because medical school achievements were related to performance during and shortly after residency training in PM&R, they can be used as partial predictors of success.

Adult↗
PubMed2003

[Introduction of medical works block-printed by Xiong Zong-li].

Being a famous physician of the Ming dynasty, Xiong Zong-li engaged in the writing, collation, and revision of medical works by combining his medical know-how of his family after his robust age. He published over 20 kinds of medical works and became an expert specialized in publication of medical books which were circulated domestically and abroad. He made great contributions to the development of TCM.

China↗