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At least 1,189 records · Page 66Linked to original sources
PubMed2001

Making midwives: postmodern conditions and midwifery training in Saint Lucia.

Drawing on material from fieldwork conducted on the island of Saint Lucia, I examine how Saint Lucian nurse-midwives and student midwives negotiate multiple ways of understanding and evaluating their practices and roles in light of contradictory and powerful cultural, historical, and political forces. I argue that, although Saint Lucian nurse-midwives may not qualify as "postmodern" according to the criteria proposed by Davis-Floyd and Davis (1996), they are nonetheless struggling with postmodern conditions as they negotiate between competing healing ideologies. I illustrate the significance of these negotiations through analyzing: (1) the ways nurse-midwives understand and articulate the healing ideologies at play in Saint Lucia, (2) historical and ideological aspects of the Saint Lucian nurse-midwifery training program, and (3) a classroom discussion during which student reported on "bush-midwives."

Attitude of Health Personnel↗
PubMed2004

Evaluation of the continuing professional development scheme of the Institute of Biomedical Science.

As part of a review of the Continuing Professional Development (CPD) scheme of the Institute of Biomedical Science (IBMS), 10 years after it started, a survey was conducted. A questionnaire was distributed to all Institute members in July 2002. By the end of September, replies had been received from 777 biomedical scientists, representing a range of ages, grades and disciplines, and working for a variety of employers throughout the UK and overseas. The majority of respondents (n = 687) were current participants in the IBMS CPD scheme, but 74 replies were received from members who had not previously taken part. Half the respondents who were both scheme participants and Associate members of the IBMS and one-third of participating Fellows had yet to claim a diploma. The results showed that the IBMS CPD scheme was well respected among biomedical scientists, but many reported some difficulties in obtaining study leave and financial support to attend credited activities. Although respondents felt that an individual's own time should not be spent on CPD, activities that are performed when off duty (e.g., journal-based learning) are popular, especially among staff in younger age groups and among junior biomedical scientist grades. Respondents suggested that the scheme could be improved by provision of more resources at departmental level to allow regular participation for individual biomedical scientists. They also recommended inclusion of competency testing within CPD and a simplified diploma system. The IBMS scheme has been well received and has the potential to evolve into a good scheme to serve the profession's needs into the 21st century.

Adult↗
PubMed2002

Interaction in collaborative educational virtual environments.

The collaborative educational virtual environment supposes the active participation of students and teachers, interacting highly and aiming at knowledge exchange and creation of new abilities. The learning becomes a process in which one assists the other to reach the objective, by exchanging experiences, dialogues, discussion of ideas, accomplishments of the group, and individual activities that can be shared with the group, allowing the creation of knowledge based on collective involvement. In this context, this paper describes and discusses the aspects and methods of interaction between students and teachers in collaborative educational virtual environments and presents an application based on the Virtual Teacher Project.

Cooperative Behavior↗
PubMed1997

Media choice in nutrition education of general practitioners.

In the traditional model of communicating information, a general practitioner receives information from his or her teacher (when they choose to give it) and from print media (books and journals) and in turn can pass on the information didactically to patients (whether they asked for it or not). The arrival and development of new electronic media are changing the system and the possibilities. Patients now have access to more information independently (some of it correct, some misleading). GPs cannot trust their own solid body of knowledge any longer. To keep up with new and rising expectations they must become professional information seekers. New media will give opportunities for GPs to look for information by electronic means at the time that they need it, eg, through on-line connections with databases or through use of CD-roms. The role of journals will change from simply providing detailed data; journals can concentrate on the questions behind the questions.

Educational Technology↗
PubMed2002

Use of a high-fidelity simulator to develop testing of the technical performance of novice anaesthetists.

BACKGROUND: We used the Delphi technique to gain a consensus from 26 consultant anaesthetists about technical tasks during general anaesthesia. We then developed a technical scoring system to assess anaesthetists undertaking general anaesthesia with rapid sequence induction. METHODS: We then followed the performance of six novice anaesthetists on five occasions during their first 3 months of training. At each, visit each novice 'anaesthetized' the Human Patient Simulator at Bristol Medical Simulator Centre. For comparison seven post-fellowship anaesthetists were scored on one occasion. RESULTS: Novice scores improved significantly over the 12-week period (P<0.01). A significant difference was also found between the final novice scores and the post-fellowship subjects (P<0.05). CONCLUSIONS: These findings suggest that simulation can be used to observe and quantify technical performance.

Adolescent↗
PubMed1999

A multimedia intervention to support family caregivers.

The lack of choice and predominance of crisis-oriented care in relation to respite and long-term care for family carers and frail older people provided the authors with the rationale for the development, within the European-funded Assisting Carers using Telematic Interventions to meet Older person's Needs (ACTION) project, of two innovative multimedia programs. The key aim of the programs is to provide education, information, and support about respite care and planning for the future for family carers and frail older people in their homes. In this way, it is intended that family carers and frail older people will be able to make informed choices concerning their health and social care needs. The authors describe the conceptual basis of the multimedia programs, the research and development process, the content of the multimedia programs, and the evaluation of the developed product.

Aged↗
PubMed1998

Testing internal consistency and construct validity during evaluation of performance in a patient simulator.

UNLABELLED: The primary goal of this study was to test the items in a rating system developed to evaluate anesthesiologists' performance in a simulated patient environment. A secondary goal was to determine whether the test scores could discriminate between resident and staff anesthesiologists. Two 5-item clinical scenarios included patient evaluation and induction and maintenance of anesthesia. Rating scales were no response to the problem (score = 0), compensating intervention (score = 1), and corrective treatment (score = 2). Internal consistency was estimated using Cronbach's coefficient alpha. Scores between groups were compared using the Cochran-Mantel-Haenszel test. Subjects consisted of 8 anesthesiology residents and 17 university clinical faculty. The Cronbach's coefficient alpha was 0.27 for Scenario A and 0.28 for Scenario B. Two items in each scenario markedly decreased internal consistency. When these four items were eliminated, Cronbach's coefficient alpha for the remaining six items was 0.66. Faculty anesthesiologists scored higher than residents on all six items (P < 0.001). A patient simulator-based evaluation process with acceptable reliability was developed. IMPLICATIONS: The reliability of anesthesia clinical performance in a patient simulation environment was assessed in this study. Of 10 items, 4 were poor in the evaluation process. When these items were removed, the reliability of the instrument improved to a level consistent with other studies. Because faculty scored higher than resident anesthesiologists, the instrument also showed discriminant validity.

Adult↗
PubMed1995

Making a place for teaching about family violence in medical school.

Although family violence is a common cause of patients' problems, it has not yet received sufficient attention in medical school curricula. There are several possible reasons for this delay, including the fact that teaching about family violence is complicated because there are no "quick fix" interventions, the approaches are often complex and multidisciplinary, and there may be limited resources for response in many communities. The author offers a variety of suggestions for incorporating family violence topics in the medical school curriculum, such as: (1) expose students to information about family violence in their preclinical training, and integrate family violence issues into clinical instruction (several examples are given); (2) use problem-based teaching formats when possible, since these lend themselves well to the integration of family violence issues into case presentations; (3) enrich the curriculum by the participation of a variety of non-MD experts who deal with family violence issues, and take students out of the classroom to shelters and other relevant locations; (4) teach a prevention-oriented approach, just as is taught for the areas of smoking, seat belt use, weight control, etc.; (5) use standardized patients, interactive computer-based learning, and other innovative methodologies to help preclinical students perfect their interviewing and examination skills; (6) during the clinical years, include violence as part of the differential diagnosis of common medical complaints; (7) give attention to the education of residents for consistent teaching and reinforcement of principles learned in medical school, and integrate family violence education into the entire continuum of physicians' education; (8) build appropriate expectations into accreditation requirements and into medical licensing and specialty certifying examinations.(ABSTRACT TRUNCATED AT 250 WORDS)

Accreditation↗
PubMed1996

Who should rate candidates in an objective structured clinical examination?

PURPOSE: To determine who is the better rater of history taking in an objective structured clinical examination (OSCE): a physician or a standardized patient (SP). METHOD: During the 1991 pilot administration of an OSCE for the Medical Council of Canada's qualifying examination, five history-taking stations were videotaped. Candidates at these stations were scored by three raters: a physician (MD), an SP observer (SPO), and an SP rating from recall (SPR). To determine the validity of each rater's scores, these scores were compared with a "gold standard", which was the average of videotape ratings by three physicians, each scoring independently. Analysis included both correlations with the standard and a repeated-measures analysis of variance (ANOVA) comparing raters' mean scores on each station with mean scores of the gold standard. RESULTS: Ninety-one videotapes were scored by the "gold-standard" physicians. Correlations with the standard showed no clear preference for MD, SPO, or SPR raters. ANOVAs revealed significant differences from the standard on three stations for the SPR, two stations for the SPO, and one stations for the MD. CONCLUSIONS: An MD rater is less likely to differ from a standard established by a consensus of MD ratings than are SP raters rating from recall. If an MD cannot be used, an SP observer is preferable to an SP rating from recall.

Analysis of Variance↗
PubMed1997

Making a medical practice in an uneasy world: some thoughts from a century ago.

A century ago medical trainees in the United States faced many of the same sorts of issues that confront trainees today. For practical advice in setting up their practices, many of those trainees turned to a book by physician David Cathell called The Physician Himself, which was first published in 1882 and was reprinted many times thereafter. This paper explores the advice Cathell offered in his book as well as parallels with events of the recent past, discussing Cathell's opinions on physician overcrowding, medical education, new technology such as the telephone and the automobile, and the sensitive ethical issues that physicians must deal with. The paper concludes that because being an excellent physician in both Cathell's time and today requires more than good science, Cathell's book helps to remind us of the social world in which medicine is practiced.

Ethics, Medical↗
PubMed1999

Impact of a preceptor education board and computer network to engage community faculty at Dartmouth Medical School.

In 1994, as part of the Generalist Physician Initiative of The Robert Wood Johnson Foundation, Dartmouth Medical School established two programs to support and engage community-based teaching. The Preceptor Education Board and Community Computer Network were established to support a network of community-based preceptors and to facilitate communication between course directors at the school and community-based teachers. The board's mission is to organize, develop, and support a network of community-based primary care faculty, and to create and review community-based curricula. Through the board, community faculty members have made substantial contributions to curriculum, evaluation, faculty development, governance, and financing in community-based teaching. The Community Computer Network provides hardware, software, network systems, and support. Course directors and students have reported improved community-based educational experiences as a direct result of the Network. These two initiatives are dynamic and effective ways to improve the quality of community-based education and preceptors' morale. These efforts have strengthened the community faculty and their connection to the academic medical center.

Computer Communication Networks↗
PubMed1999

Continuing medical education for life: eight principles.

Continuing medical education (CME) is being pressured to change in response to increasing and changing educational needs of practicing physicians, fostered by technical innovations, evolution of practice styles, and the reorganization of health care delivery. Leadership in the reform of CME falls primarily to the medical specialty societies in light of their traditional responsibilities for accrediting CME and maintaining professional standards. To address the need for reform, the American College of Obstetricians and Gynecologists in 1997 organized a conference to assemble CME program administrators from several medical specialties and academicians with expertise in postgraduate learning. At the conference, issues facing CME were examined. The authors, who were conference participants, state and explain eight principles that emerged from conference discussions. (For example: "Educational activities should be supportive of and coordinated with the transition to evidence-based medicine.") The principles reflect the interspecialty and interdisciplinary consensus achieved by the conference participants and can serve as useful guideposts for educators as they work to improve CME in their institutions. The authors conclude by noting the need for a more systematic and rigorously analytic approach, where CME content is determined according to assessed needs and CME is evaluated by measuring outcomes; for this to happen, CME educators and faculty must be brought up to date through training, including the use of problem-based learning. CME must also instill collegiality, interaction, and collaboration into the learning environment instead of being a solitary learning activity. Finally, CME must not only emphasize the acquisition of knowledge but also instruct physicians in the process of decision making to help them better use their knowledge as they make clinical judgments.

Clinical Competence↗
PubMed2001

Critical issues in PhD training for biomedical scientists.

The rapidly changing world of modern biomedical research is raising important new issues for traditional PhD training programs and is creating concern among young PhD scientists about their futures. Specifically, the United States is producing substantially more biomedical PhDs than can be accommodated in professional positions that truly require the PhD as a credential. The "surplus" PhD population is being relegated to poorly paid, unstable, and increasingly unsatisfying jobs. In addition, many current graduate and postdoctoral training programs may not be adequately preparing young scientists for the more complex, more quantitative biological science of the future. Finally, many current graduate training programs are not attracting a sufficient portion of the most talented young people in the nation. To ameliorate these problems in the training and early career paths of basic biomedical scientists, the authors make specific recommendations, such as urging (1) that graduate trainees should be supported exclusively by competitive individual fellowships, training grants, or institutional funds and not by RO1s or similar research awards; (2) that graduate and postdoctoral stipends be increased so that they provide a reasonable living wage; and (3) that research-intensive academic institutions create a career path for biomedical PhDs other than that designed for the traditional tenure-track, grant-funded principal investigator and faculty member. They conclude that it is in the interest of faculty and institutions to make these and other drastic changes because the current system is both inherently unfair and self-destructive.

Biomedical Technology↗
PubMed2005

A simulator-based curriculum to promote comparative and reflective analysis in an internal medicine clerkship.

PURPOSE: To develop and evaluate a novel curricular framework using high-fidelity patient simulation in an internal medicine clerkship. METHOD: Two 90-minute simulator-based modules of ischemic heart failure and hypoxemic respiratory failure were developed from adult and experiential learning principles. Three short simulated cases focused on each pathophysiologic concept were intermixed with two short teaching sessions and a period of comparative analysis. In 2002-03, the program was piloted among 90 third-year medical students at Harvard Medical School assigned to complete their core internal medicine clerk-ship. An entry and two follow-up questionnaires were used to assess the process. The instructors conducted quantitative and qualitative data analysis and directly observed students' performances. RESULTS: Instructors consistently noted students' ability to appropriately extract a history, perform a basic examination, and order appropriate tests. However, students demonstrated repeated errors in the application of knowledge to the clinical circumstance. A final comparative discussion was essential to new learning and students recognized this integrative analysis as the most critical component of the exercise. Every student reported the experience as useful. Ninety-four percent (n = 85) felt the simulator should become a routine part of the clerkship and 68% (n = 71) desired three or more sessions during their internal medicine clerkship. CONCLUSIONS: Simulator-based curricular modules are feasible in an internal medicine clerkship and can successfully complement existing curricula. By comparing similar cases in a compressed time frame, students may achieve enhanced efficiencies in reflective and meta-cognitive learning. As medical simulation is increasingly available, such a curriculum may represent valuable additions to the internal medicine educational environment.

Boston↗