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PubMed1997

Problem-based medical education: development of a theoretical foundation and a science-based professional attitude.

Problem-based learning, combined with early patient contact, integration between different subject areas, elements of multiprofessional education, and special emphasis on the development of communications skills has become the basis for the medical curriculum at the Faculty of Health Sciences in Linköping. Critics have questioned the depth of the scientific and theoretical aspects of the curriculum. Through a series of specific measures in the organization of the curriculum and examinations, and due to the pedagogical principles involved per se, our claim is that students graduating at Linköping do possess the required theoretical knowledge and a scientific attitude to the practice of medicine, at least equivalent to that obtained in a more conventional medical curriculum. One such specific measure is that all students perform one field study and two scientific studies during the course of the curriculum. An investigation of student opinions regarding the value of performing scientific projects of their own have shown that these projects have had a positive impact on the students' general scientific attitude and their willingness to engage in future scientific work. The specific skills acquired, as confirmed by oral examinations, were largely determined by the scientific nature of the chosen field of study. Our graduates have not yet progressed far enough in their careers for comparisons to be made on the basis of the Swedish Licensing Board Internship Examinations, but continuing evaluations of students, graduates and licensed doctors emerging from the curriculum will provide future evidence as to whether our present evaluation is correct.

Attitude of Health Personnel↗
PubMed1998

Clinical teachers' perceptions of medical students' English language proficiency.

Medical educators from the Faculty of Medicine at the University of Adelaide, South Australia, have expressed reservations about the adequacy of some undergraduate medical students' English language proficiency for satisfactory academic and clinical performance. This study explores the occurrence and nature of the comments made in writing by clinical teachers about the English language proficiency of 568 students over a period of 4 years. The frequency and nature of the comments made by clinicians have important implications for the planning and implementation of pedagogical strategies to support non-English-speaking background medical students experiencing difficulties with their course due to language. Although the University of Adelaide has introduced initiatives in response to some of the problems that have been identified, it is recommended that any teaching interventions require careful evaluation through a longitudinal research design to ensure that their aims are being achieved.

Australia↗
PubMed2003

Putting your course on the Web: lessons from a case study and systematic literature review.

BACKGROUND: Education via the Internet offers enormous potential, but many online courses are pedagogically or technically weak and many good projects are never mainstreamed. METHOD: In drawing up our recommendations to address the issues around putting a course on the web, we drew on 3 main sources of data: an extensive in-depth course evaluation; a systematic review of the literature, and questions raised by participants on our training-the-trainers courses. RECOMMENDATIONS: For any web-based course to succeed, 10 overlapping and iterative areas of activity must be addressed. These are: the market for the course; course aims and intended learning outcomes; choice of software platform; staff training needs; writing high quality study materials; design features for active learning; technical and administrative challenges; evaluation and quality improvement; mainstreaming the course within the institution, and financial viability.

Computer-Assisted Instruction↗
PubMed1998

Disciplinary power and its influence on the administration and supply of medications by nurses in rural areas of Australia.

This paper reports on aspects of a larger study into rural nursing practice in Australia, 1991-94 (D. Hegney, unpublished data, 1996). Using a Foucauldian framework for analysis of the rural nursing discourses, it presents an interpretation of the statements regarding the administration and supply of medications in rural nursing practice. In particular, it focuses on the supply and administration of medications by rural nurses working in small rural health services. It explains that there are particular issues regarding telephone medication orders and the consequent verification of these orders. It suggests that rural medical practitioners use the power of legislation with regard to the administration and supply of medications to subjugate rural nursing practice. It argues that the nursing profession itself has used, through its silence on the inadequacy of the current Poison Acts and their Regulations, disciplinary power to ensure that rural nursing practice is normalised to metropolitan nursing practice. Further, the lack of educational preparation for this rural nursing role, can be seen as a pedagogical control of rural nursing practice. This paper recommends that the Statute Law regarding the administration and supply of medications be changed to reflect the reality of rural nursing practice, and that rural nurses are prepared adequately for this aspect of rural nursing practice.

Attitude of Health Personnel↗
PubMed2003

Undergraduate nursing student experience.

The purpose of the present qualitative study was to describe and explicate the experience of being a nursing student. A convenience sample of 12 nursing students from a variety of backgrounds at a public university were interviewed using an interview guide with open-ended questions. Their stories provided an insight into the satisfactions, challenges and stresses faced by students. Four major theme clusters emerged from the data: (i) meeting conflicting demands; (ii) feeling overworked; (iii) feeling unprepared and; (iv) seeking respect and support from one's faculty. These identified themes corroborate the findings of other researchers who have studied the student experience. Student's stories provide insights into the current educational environment, which can assist faculties to understand the impact of their pedagogical approaches. This information is particularly important in light of the current worldwide nursing shortage.

Adaptation, Psychological↗
PubMedDate not supplied

Interaction in graduate nursing Web-based instruction.

This article describes interaction and communication methods and issues in the context of two Web-based graduate nursing courses, a theory course and a research course. A conceptual model for graduate nursing Web-based instruction is presented in which learner-centered pedagogic philosophies and interaction techniques are combined to produce active learning at each phase of the Web-based courses. The focus is on asynchronous communication techniques because these represent the dominant communication form in the two courses. Asynchronous communication is interaction in which teacher and student activities are not occurring at the same time and/or place (Berge, 1999). Outcomes of the courses are examined briefly. J Prof Nurs 17:128-134, 2001.

Adult↗
PubMedDate not supplied

Using standardized patients in advanced practice nursing education.

Standardized patient encounters, a pedagogic approach to helping students develop appropriate clinical skills, are widely used in medical education and are being adopted by advanced practice nursing programs. Two types, simulated clinical encounters, in which students complete an episodic or comprehensive visit, and objective structured clinical experiences, multiple stations each presenting a different clinical problem, are used for formative and summative evaluation. Graduating adult and pediatric nurse practitioner students (N = 26) completed a simulated clinical encounter for an episodic visit. Students' performance on the simulated clinical encounter did not reflect their performance on other clinical evaluation measures or their performance on national certifying examinations. This one-time simulated clinical encounter was shown to lack the necessary reliability and validity to appropriately evaluate the clinical skills of nurse practitioner students. Videotaped, simulated patient encounters are useful, however as formative learning experiences. This reinforced our position that multiple site visits by faculty to students and their preceptors at all their clinical sites are necessary to accurately evaluate students' clinical performance.

Clinical Competence↗
PubMed2000

Repetitive self-injurious behavior: a neuropsychiatric perspective and review of pharmacologic treatments.

The phenomenology, pathophysiology, and psychopharmacology of repetitive self-injurious behavior (rSIB) are reviewed. Although numerous neurotransmitter systems are thought to be involved in the initiation and maintenance of rSIB, the majority of clinical studies attend to the role of serotonin or endogenous opioids. This focus has emerged from a conceptualization of rSIB as a problem of impulse control (primarily mediated by serotonin) and/or as a maladaptive pain-related behavior (ultimately mediated by opioids). A developmental perspective of rSIB is emphasized, highlighting the biased prevalence of rSIB among patients with mental retardation and severe personality disorders and the significance of critical developmental events leading to pathology in "pedagogical" neural circuits. A novel typology is offered in an effort to better match interventions with rSIB subtypes. Achievement of this ultimate goal however, must await further research.

Adult↗
PubMed2001

Determinants of the revival of dissection of the human body in the Middle Ages.

The author reviews the causes of the rebirth of human dissection in the Middle Ages after a hiatus of 1500 years, that is, after the practice was abandoned in the time following Herophilus of Alexandria in the third century BC. It is concluded that three main factors determined the rebirth: the removal of obstacles (i.e., the devaluation of the body), the stimulus to proceed (i.e., the resuming of the slow progress of medicine toward the scientific mode), and the different value attributed to cadavers of different people, that is, the correspondence between life deeds and the importance of the cadaver (which made the corpses of executed criminals available and pedagogical dissection possible).

Dissection↗
PubMed1999

Student nurses' conceptions of internationalization: a phenomenographic study.

A phenomenographic approach was used when analysing and interpreting interviews with 25 student nurses in order to describe their conceptions of internationalization. The results are presented in five categories and various subcategories, forming an outcome space. The categories describe forms of understanding, or ways of thinking about internationalization, which, in relation to internationalization as a whole, were either atomistic or holistic in character. The data revealed that nursing students shared some aspects of meaning when thinking of internationalization. These aspects seemed to be understood in a similar way by all students, whereas, when students thought about internationalization as a whole, they assigned it different meanings. In two of the categories aspects of meaning were fragmentarily related to each other, and represented only one perspective. These two categories are to be compared to the other three categories which were more complex and holistic in character, since they contained more than one perspective as well as more aspects of meaning, and related in several different ways. From a pedagogical point of view, the findings point to the importance of teachers trying, in an active way, to confront students with as many existing variations of conceptualized wholes related to internationalization as possible, by using forms of understanding originating from a holistic approach.

Adult↗
PubMed2002

The issue of death and dying: employing problem-based learning in nursing education.

Caring for dying patients can be an emotionally painful, distressing and sometimes threatening experience for nurses as the illness is incurable and death is imminent. The avoidance of discussion of dying in the presence of patients in Chinese culture further increases nurses' anxiety. The purpose of this article is to provide an example of how nurses can be helped when caring for dying patients by using a problem-based learning (PBL) approach in Hong Kong. The process and value of using PBL is discussed from the students' perspective. Students went through the PBL process and documented their learning throughout the course in journals. A total of 96 sets of journals were collected and analysed. The case analysis explored the perception of learning in the process of PBL. Three themes, related to nurses' attitudes and caring behaviours towards death and dying, have been derived from the findings. They were (a) increased self-awareness (b) positive attitudes towards death (c) providing culturally sensitive care. Problem-based learning as a pedagogical strategy for achieving learning in death and dying was well received. Problem-based learning was found to be a highly satisfactory method for enabling nurses to reflect on their own attitudes towards death and understanding of the emotional aspects of death and dying. Independent finding of information not only prompted nurses to find information from books and journals, but nurses also interviewed experts and patients for updated and experiential knowledge. Tutorials serve as a safe environment for discussion and sharing of feelings and information. The results definitely support PBL as an effective teaching strategy for nursing educators in the area of death education.

Attitude of Health Personnel↗
PubMed2002

[Information programs for patients during gastroenterological rehabilitation].

Patient education especially groups for patients with inflammatory bowel disease belong to the typical tasks of Reha-medicine. In the Reha-Clinic "Ob der Tauber", Bad Mergentheim these patients are informed in special Colitis/Crohn-groups for eleven years now. Normally approximately ten patients with IBD are treated in our house at the same time. These patients participate in a nearly closed group in which they are taught in three weeks blocks. Three hours a week the patients are informed by doctors, one hour a week a diet assistant teaches the participants. The psychotherapeutic group takes place regularly once a week. The aim of the patient information or health education is to reach a mostly complete information of the patients about inflammatory bowel disease, that means to inform them about all diagnostic and therapeutic possibilities. Another important purpose of team work is the support of dynamic group processes like reduction of anxiety and the influence on the patients for developing an active positive attitude towards their disease. The participating therapist (doctors, psychotherapist, diet-assistant) have created a structured concept which was modified during the last years. Resulting from the interactive work between therapist and patients this concept is improved continuously. This development however is delayed by the shortcomming of bad personal capacities and the lack of possibilities for the therapist to improve their pedagogic and psychotherapeutic abilities. At the moment their education is based on autodidactic methods and empathy. For a standardization of the program including all hospitals the extended curriculum of the GRVS is useful. An evaluation concerning the therapeutic benefit of patient information has not been done yet.

Adaptation, Psychological↗
PubMed2002

[Health situation of homeless in a health care home in Hannover].

BACKGROUND AND AIM: Extension of the medical health care system for social fringe groups by means of a special 'Health Care Apartment' for homeless people with an ambulatory nursing service. Between 55-70 % of the homeless people in Germany are in-patients for medical treatment nearly once a year. Only 10-20 % have a family doctor. METHOD: : The pilot experiment of a special Health Care Apartment for homeless people was scientifically evaluated for approximately one and a half year under socio-medical and socio-economic viewpoints. Every patient passes a standardized interview at admission and discharged with one validated systematic setup and one specifically developed questionnaire. RESULTS: : The mean age of the 36 investigated persons was 48.7. 36.1 % (13) of the patients lived in divorce. About 86.1 % (31) of the patients had secondary school qualifications, 69.4 % (25) had learnt a profession. All were unemployed. Two-thirds of them stated they had been found guilty of a criminal offence within the last few years. 44.5 % (16) had been homeless for 3 or more years. Approximately x of the homeless were addicted to alcohol, according to the employees entrusted with looking after the inmates. The main reasons for the average 8-week stay in the medical department were diseases of the skin and skeletal system, which had caused several hospital admissions in the past. The satisfaction of their own health status improved by 66 % from the day of their admission to the day of their discharge. 72.2 % (26) said they could get easier medical support in the Health Care Apartment. Supported by intensive socio-pedagogical care, 55.5 % (20) of the homeless people could be discharged from the special Health Care Apartment to other arrangements for homeless people, respectively to own apartments. CONCLUSION: : The pilot study of the special Health Care Apartment for homeless people in Hannover closes a gap in the provision of medical care which exists in many major cities. Moreover, hospital admissions for homeless people can be prevented and their social reintegration promoted.

Alcoholism↗
PubMed2002

[Quality control of sonography courses in advanced training of physicians: analysis of present status and potential for improvement].

AIM: Since 1995 sonography represents the diagnostic imaging procedure most commonly applied (52 %) by physicians working in the public health sector. On the account of the high cost of sonography (around 2,5 billion DM in 1998) it seems justified to intensify the quality control of advanced sonography training courses for physicians. This study was set out to evaluate the learning efficiency and teaching quality of sonography training courses for doctors. We also aimed at testing, evaluating and carefully optimising modern concepts for sonography training based on recognised didactic criteria. METHODS: 34 courses in B-mode sonography and colour-Doppler sonography of 5 regional and national institutions were evaluated on the basis of standardised questionnaires by observers taking part in the courses incognito. The control group was formed by 332 physicians taking part in ten sonography courses which were structured in the way of alternating training modules with practical final exams based on OSCE criteria. With the help of modern imaging media it was intended to make these courses as illustrative as possible, including practical exercises in small groups of up to five people. Subsequent evaluation was based on standardised questionnaires. The attendance quota of the participants served as an additional comparative value for the acceptance of different teaching concepts. RESULTS: We observed significant deficits in the didactic concepts of numerous ultrasound courses offered externally: there was a high prevalence of extended frontal teaching with noticeably tiring effects as well as unstructured practical exercises in large groups which resulted in high numbers of absenteeism of the participants. The evaluation of the newly drawn up course concepts, however, demonstrated highly significant and unquestionable advantages of alternating teaching in small groups. DISCUSSION: Background information from the field of pedagogical psychology is supplied and the application of current learning theories to new concepts of ultrasound courses is demonstrated. CONCLUSION: Instructors of sonography courses need to be well trained in modern teaching methods. This study shows a variety of current concepts and provides a list of easily applicable didactic quality criteria for the conception of ultrasound courses.

Curriculum↗
PubMed2003

[Initial examination for school attendance in Mannheim: language development at initial school entry level].

INTRODUCTION: In autumn 2001 the initial examination for school attendance in Mannheim has been fundamentally reorganised. The individual examination elements had been widely standardized, the results can be evaluated by regions and a diagnosis for the early detection of legasthenia has been developed. METHODS: The testing involved repeating sentences, numbers and artificial words. This has been developed by the Pedagogical University Heidelberg. In pre-examinations in Heidelberg the results relate significantly to the subsequent results in reading and writing. PROBANDS: A total of 2,744 children (46.1% girls, 53.9% boys) aged of 5 to 7 years was seen. 71.5% of the children were German nationality. Most non-German nationalities were Turkish (15.4%) and Italian (3.6%) children. Besides the nationality the mother tongue has been also recorded. More than 96% of the children had been attending a kindergarten. For judgement of the social strata the frequency of social welfare receivers has been recorded. RESULTS: The testing results are significantly influenced by the native language and the social strata of the children. The results of children with German as native language are above those of non-Germans. Within the migrant children there are significant differences between the several nationalities. Children from a lower social strata achieved lower results. A positive effect to the language development is attributed to the attendance of a kindergarten. CONCLUSION: These results are the basis for language- and general health supporting projects in Mannheim. For the examination for school attendance in the current year the diagnostic for language development has been extended by some more aspects.

Child↗
PubMed2003

[Care structures for drug dependent children and adolescents].

Children and adolescents abusing drugs present a special challenge for our health system. Special risks for the development of drug dependence are psychic diseases of parents, familial addiction or multiply burdened families. The treatment of drug-addicted children and adolescents in child and youth psychiatry requires a highly individualised therapy programme as well as a pedagogic and therapeutic setting corresponding to age. 745 patients were examined in a retrospective study between 1998 and 2001. The results are shown below. 68% of the patients had a relevant psychiatric second diagnosis, 39 Patients of the examined drug addicted children and adolescents were diagnosed with an additional psychotic disturbance. A study of children and youth psychiatry clinics in the fall of 2001 showed that sufficient clinical care for drug-addicted children and adolescents is still lacking.

Adolescent↗
PubMed2006

[New forms of management in dermatology. Integrated in-patient-out-patient prevention of severe occupational dermatoses: cornerstones for an effective integrated management in clinics and practices].

Occupational dermatoses (OD) are the most frequent occupational diseases in Germany and amount to more than 25% of all suspected occupational diseases. Preventive measures have proven to be very effective in recent years, especially measures of primary and secondary prevention as components of a complex hierarchical prevention concept in wet work occupations. If employees are in danger of loosing their job due to a severe OD, intensive interdisciplinary measures of tertiary individual prevention (TIP) are required. TIP comprises 2-3 weeks of in-patient treatment plus intensive health-pedagogic counselling, followed by 3 consecutive weeks (or longer) of out-patient treatment by the local dermatologists ("Osnabrueck model"). Each patient will stay off work for a total of at least 6 weeks to allow full barrier-recovery. It could be shown that 2/3 of the patients successfully remained in their workplaces because of TIP. TIP reveals remarkable pertinent options for interdisciplinary disease management in severe OD in all risk professions. In Germany recently, a multi-centre study was started which will further standardise such preventive measures and evaluate their long-term success.

Ambulatory Care↗