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PubMed2002

Do short courses in evidence based medicine improve knowledge and skills? Validation of Berlin questionnaire and before and after study of courses in evidence based medicine.

OBJECTIVE: To develop and validate an instrument for measuring knowledge and skills in evidence based medicine and to investigate whether short courses in evidence based medicine lead to a meaningful increase in knowledge and skills. DESIGN: Development and validation of an assessment instrument and before and after study. SETTING: Various postgraduate short courses in evidence based medicine in Germany. PARTICIPANTS: The instrument was validated with experts in evidence based medicine, postgraduate doctors, and medical students. The effect of courses was assessed by postgraduate doctors from medical and surgical backgrounds. INTERVENTION: Intensive 3 day courses in evidence based medicine delivered through tutor facilitated small groups. MAIN OUTCOME MEASURE: Increase in knowledge and skills. RESULTS: The questionnaire distinguished reliably between groups with different expertise in evidence based medicine. Experts attained a threefold higher average score than students. Postgraduates who had not attended a course performed better than students but significantly worse than experts. Knowledge and skills in evidence based medicine increased after the course by 57% (mean score before course 6.3 (SD 2.9) v 9.9 (SD 2.8), P<0.001). No difference was found among experts or students in absence of an intervention. CONCLUSIONS: The instrument reliably assessed knowledge and skills in evidence based medicine. An intensive 3 day course in evidence based medicine led to a significant increase in knowledge and skills.

Clinical Competence↗
PubMed2002

Knowledge of aspects of acute care in trainee doctors.

Deficiencies in trainees' knowledge, skills, and attitudes have the potential to influence the initial assessment, treatment, and outcome of acutely ill ward patients. Knowledge of basic aspects of acute care were assessed among a group of 185 trainee doctors at six hospitals. Many were unaware of the signs of total airway obstruction, confusing them with those of partial obstruction (pre-registration house officers (PRHOs) 11%, senior house officers (SHOs) 14%) or apnoea (PRHOs 47%, SHOs 26%). Knowledge about the use of non-rebreathing oxygen masks was poor; 23% of trainees could not describe the purpose of the reservoir bag or gave answers that were unclear or incorrect. Seven trainees thought that it was involved in humidification, or carbon dioxide collection or removal. Seventeen per cent of trainees could not quote the maximum deliverable inspired oxygen concentration provided by these masks or gave values below the normal range. Thirty one per cent of trainees thought that the lower end of the normal range for pulse oximetry (S(p)O(2)) was below 95%; nine (5%) believed it to be below 90%. There was also poor knowledge of the factors influencing the function of a pulse oximeter. Similar deficits in knowledge and understanding existed in relation to the normal capillary refill time, minimum hourly urine output, the use of the AVPU scale and the role of blood glucose testing in unconscious adults. Only 22% of PRHOs and 21% of SHOs identified the correct percentage hospital survival for patients who suffer an in-hospital cardiac arrest. Knowledge of aspects of consent was unsatisfactory. It is recommended that all medical schools urgently incorporate training about common aspects of "generic" acute care in their curricula.

Acute Disease↗
PubMed1996

Status of mammography education and knowledge of radiology residents.

PURPOSE: To evaluate breast imaging training and knowledge of radiology residents over a 3-year period. MATERIALS AND METHODS: From 1992 through 1994, the American College of Radiology (ACR) sponsored a 1-day comprehensive breast imaging seminar, which was attended by 2,249 radiology residents at the 6-week radiologic-pathology course of the Armed Forces Institute of Pathology. At each course, the residents were asked to complete a demographics survey and identical pre- and post-tests to assess knowledge before and after the seminar. RESULTS: The majority of residents who attended the Armed Forces Institute of Pathology course were in their 2nd or 3rd year of radiology training, and 75% (1,682 of 2,249 residents) responded that they had training in breast imaging before the ACR seminar. There was an increase in the median residency training time devoted to mammography from 4-6 weeks in 1992 to 8-11 weeks in 1994. There was no statistically significant change in the pretest scores over the 3 years, with persistent weaknesses in knowledge about quality control and mammographic technique. There was improvement in short-term knowledge after the ACR seminar. CONCLUSION: Despite increased time spent in breast imaging training in radiology residency programs from 1992 through 1994, there was no statistically significant improvement in the baseline knowledge of residents who attended this course. This 1-day course improved short-term knowledge of breast imaging.

Educational Measurement↗
PubMedDate not supplied

Virtual reality and written assessments are of potential value to determine knowledge and skill in flexible bronchoscopy.

BACKGROUND: Technically challenging professions such as those of the defense and transportation industries increasingly use computer-based simulation and written self-learning instruments for education and to determine competency. A structured learning curriculum does not exist, however, for flexible bronchoscopy, a minimally invasive diagnostic procedure performed on thousands of patients by respiratory specialists, otolaryngologists, anesthesiologists, and surgeons worldwide. OBJECTIVE: To explore an analogous strategy of measuring theoretical knowledge in flexible bronchoscopy and specific technical skills using written knowledge assessments and a virtual reality bronchoscopy simulator. METHODS: Twelve trainees from a university pulmonary medicine training program were asked to identify and enter five specific bronchial segments on command using a virtual reality bronchoscopy skill station, and to complete a 50-question examination pertaining to bronchoscopy theory. Their performance scores and opinions pertaining to the use of these methods of assessment were then recorded. RESULTS: Trainees correctly identified and entered 71% of the bronchial segments required on command (median 60%, range 40-100%). Fifty percent (3/6) of the trainees who had performed more than 200 flexible bronchoscopies successfully entered all segments required. None (0/6) of those who had performed less than 200 flexible bronchoscopies correctly located, identified and entered all required segments. Despite disparate performance, all trainees believed that technical skills could be improved through practice and instruction using computer-based simulation. On the written assessment, only 51% of questions were answered correctly (median 52%, range 32-60%). No relationship between technical skill and theoretical knowledge was noted. In addition, neither bronchoscopy skill nor theoretical knowledge were associated with years of training or number of bronchoscopies previously performed. CONCLUSIONS: Trainees concluded that (1) bronchoscopy simulation was realistic, (2) simulator-based practice would help improve technical skills, and (3) a written questionnaire would benefit theoretical knowledge acquisition if designed as a learning instrument. The wide variability noted in this study as well as the lack of a relationship between technical skill, knowledge of bronchoscopy theory, extent of training, and bronchoscopy experience suggest that competency should not be assumed based on years of bronchoscopy training or on an arbitrary number of procedures performed.

Bronchoscopy↗
PubMed1981

Changes in cardiovascular health knowledge occurring from childhood to adulthood. A cross-sectional study.

A standardized test of cardiovascular health knowledge was administered to 1367 students, ages 12-18 years, and 562 adults, ages 20-60 years. Mean scores were: ages 12-14 years, 42.5 +/- 0.7% (SEM); 15-18 years, 49.1 +/- 0.1%; 20-40 years, 68.7 +/- 0.7%; 40-60 years, 68.2 +/- 0.7% correct. Cardiovascular health knowledge increased linearly in the student population, averaging 3.08% per year. Increases continued to occur in adults, but plateaued after age 40 years, despite an increasing incidence of cardiovascular disease in this age group. Health knowledge was highly correlated with the highest educational achievement. At all age levels, knowledge of diagnostic tests was highest and knowledge of pathophysiology lowest. A personal or family history of heart disease or history of an elevated serum cholesterol was not a stimulus for increases in health knowledge.

Adolescent↗
PubMed2006

Knowledge about risk factors for stroke: a population-based survey with 28,090 participants.

BACKGROUND AND PURPOSE: Increased knowledge of stroke risk factors in the general population may lead to improved prevention of stroke. The objective of the present study was to assess knowledge of stroke risk factors and to determine factors associated with knowledge. METHODS: In a population-based survey, we sent a questionnaire to randomly selected residents in Berlin who were > or =50 years of age enquiring about knowledge of stroke risk factors. Knowledge was assessed in an open-ended question. In addition, we enquired about the source of participants' information. Sociodemographic factors, including age, sex, educational level, and nationality, were also assessed. RESULTS: A total of 28,090 of 75,720 residents (response rate, 37%) responded to the questionnaire. Of all respondents, 68% were able to name > or =1 correct stroke risk factor, and 13% named 4 correct risk factors. The majority of respondents named mass media as source of information (82%), followed by family/friends (45%) and by general physicians (20%). In multivariable analysis, increased knowledge of stroke risk factors was significantly associated with younger age, a higher educational level, not living alone, a German nationality, and having received any information about stroke during the last year. However, characteristics of respondents using the respective sources of information varied significantly. CONCLUSIONS: Mass media was most frequently named as a source of information about stroke risk factors. Source of information used varied according to population characteristics. Health education programs should take this into account and be adapted accordingly.

Aged↗
PubMed1999

Parental knowledge of attention-deficit hyperactivity disorder and opinions of treatment options: impact on enrollment and adherence to a 12-month treatment trial.

OBJECTIVE: This study examines the relationship between parents' knowledge of attention-deficit hyperactivity disorder (ADHD) and opinions of treatment and their impact on enrolment in and adherence to both pharmacological and nonpharmacological interventions for children with ADHD. METHOD: Participants in the study were the parents of 81 children who reached diagnostic criteria for ADHD and who were referred to a treatment study of ADHD involving stimulant medication and parent groups. The mothers completed a modified version of the ADHD Knowledge and Opinion Scale (AKOS) prior to receiving diagnostic feedback and prior to the families' decisions to participate in a 12-month randomized trial (medication [methylphenidate or placebo] and parent groups [training or support]). Treatment enrolment and adherence were monitored over the 12-month trial, and families who remained in the study at 12 months completed another modified AKOS. RESULTS: A higher level of knowledge of ADHD was found to be related to more favourable opinions of parent groups but not of medication. Moreover, parents who were more knowledgeable about ADHD were more likely to enroll in both pharmacological and nonpharmacological treatments. Adherence to pharmacological and nonpharmacological treatments was not predicted by parental knowledge of ADHD or opinions of the treatment. CONCLUSION: Parents' knowledge of ADHD and opinions of treatments play a significant role in enrollment in treatments for their children with ADHD. Providing information to parents regarding ADHD prior to offering treatment modalities could have a favourable impact on treatment enrollment and hence treatment adherence.

Adult↗
PubMed1992

Breastfeeding knowledge of hospital staff in rural maternity units in Ireland.

Knowledge of breastfeeding is necessary for health workers to adequately assist breastfeeding mothers. This paper examines the level of knowledge concerning breastfeeding in three rural maternity units in Ireland. Health workers responding to a self-report questionnaire felt that they had adequate knowledge, but their answers to the questions did not always bear this out. Health workers felt more staff training in breastfeeding would help to improve breastfeeding rates. Thirty-four percent of respondents had never attended continuing education on infant feeding topics. Manufacturers of artificial infant formula were the main source of continuing education information. The knowledge level of obstetricians did not appear to affect breastfeeding rates. Pediatricians' breastfeeding knowledge was good, but they had little input in the care of healthy babies. Rising breastfeeding rates were found in the unit where midwives were more recently qualified and had higher knowledge scores. The need exists for more breastfeeding education in all the units examined, ideally provided by a staff member with current lactation training.

Breast Feeding↗
PubMed1994

Knowledge for ethical care.

Knowledge needed for ethical care must be constructed in the relationship between professional and patient who strive together to understand what meaning the disease factors have within the experience of the individual patient. Three kinds of knowledge are described. The first two, descriptive knowledge and abstract knowledge, are part of the more comprehensive and complex inherent knowledge. The reality of human experience and meaning is profoundly more complex than the scientific approach of fragmentation for purposes of dissection and diagnosis. In order to develop descriptive, abstract and inherent knowledge as outlined here, three moves need to be made: the move from dominance to collaboration, the move from abstraction to context, and the move from beneficence to nurturance.

Beneficence↗
PubMed2003

Decision support at the point of care: challenges in knowledge representation, management, and patient-specific access.

Many applications in a clinical information system can benefit from the incorporation of medical knowledge to provide patient-specific, point-of-care decision support. These include computer-based provider order entry, referral, clinical result interpretation, consultation, adverse event monitoring, scheduling, shared patient-doctor decision-making, and generation of alerts and reminders, among others. To be executable, knowledge must be represented in the form of rules, constraints, calculations, guidelines, and other logical/algorithmic formats. The main difficulty is that the integration of such knowledge into clinical applications, when it occurs, tends to be very system- and application-specific, often encoded in a programming language, or even in the formating specifications of a user interaction display. Also, the data references and services invoked are highly dependent on the system/platform and electronic medical record implementation. This makes it difficult and time-consuming to encode authoritative evidence-based knowledge, severely limits the ability to disseminate and share successes, and hampers efforts to review and update the logic as medical knowledge changes. Solutions to this problem involve the development of standards-based representations for medical knowledge, and tools for authoring/editing, dissemination, adaptation to local environments, and execution. Numerous approaches are being pursued, all of which will be described in this presentation.

Decision Support Systems, Clinical↗
PubMed2003

Oral health knowledge and behavior among male health sciences college students in Kuwait.

BACKGROUND: Health auxiliary personnel have an important role in oral health promotion when they graduate and start working in the health care system. This study aims to find out oral health knowledge and oral health behavior of male Health Sciences College students. METHODS: A questionnaire was distributed to all students at the male Health Sciences College in Kuwait (N = 153) during the academic year 2001/2002. The students filled the anonymous questionnaire in the class after the lecture. The response rate was 84% (n = 128). The questions consisted information on the general background, oral health behavior and oral health knowledge. RESULTS: Oral health knowledge seemed to be limited and very few background factors were associated with it. More than half of the students had visited a dentist during the previous 12 months, but only one third of students were brushing twice a day or more often. CONCLUSIONS: It may be concluded that the male Health Sciences College students seemed to have appropriate knowledge on some oral health topics, but limited knowledge on the others. Their toothbrushing practices are still far behind the international recommendation (twice a day) and also the knowledge, why it should be done so frequently also very limited.

Journal Article↗
PubMed2005

KAT: a flexible XML-based knowledge authoring environment.

As part of an enterprise effort to develop new clinical information systems at Intermountain Health Care, the authors have built a knowledge authoring tool that facilitates the development and refinement of medical knowledge content. At present, users of the application can compose order sets and an assortment of other structured clinical knowledge documents based on XML schemas. The flexible nature of the application allows the immediate authoring of new types of documents once an appropriate XML schema and accompanying Web form have been developed and stored in a shared repository. The need for a knowledge acquisition tool stems largely from the desire for medical practitioners to be able to write their own content for use within clinical applications. We hypothesize that medical knowledge content for clinical use can be successfully created and maintained through XML-based document frameworks containing structured and coded knowledge.

Artificial Intelligence↗
PubMed2004

Assessment of knowledge and skills in primary health care services: senior medical students' self-evaluation.

BACKGROUND: The responsibility of medical schools is to educate physicians who are able to provide integrated health care services including curative and preventive components to individuals and the community. They should acquire the necessary knowledge and skills for management of health services with a scientific background and necessary skills to conduct research and be able to make plans to improve the health level of the community. PURPOSE: This study aims to examine last-year students in Hacettepe University Medical School and how they assess their knowledge and skills in providing primary health care services. METHODS: The study includes all last-year students in the 2000 to 2001 academic years; 80.4% of the students (n = 313) participated in the survey. The last-year students assessed their own knowledge and skills by using a 5-point scale ranging from 1 (none) to 5 (very good). RESULTS: According to the scoring of the scale, it is found that their level of knowledge is 2.82, and the level of skill is 2.44 for all primary health care services, between low (2) and intermediate (3). A small sample of available students was interviewed regarding these low ratings of their knowledge and skills. CONCLUSIONS: The findings of the study clearly indicate that the curriculum of the medical school does not satisfy the expectations that the newly graduated physicians have the sufficient knowledge and skills necessary for the primary health care services; the graduates have to work just after their graduation from medical school in the health system of Turkey.

Adult↗
PubMed2002

Sex differences in general knowledge, semantic memory and reasoning ability.

This paper has the three objectives of attempting to replicate a previous study in which it was found that males have substantially greater general knowledge in most fields or domains than females, and of determining how far sex differences in general knowledge are a function of differences in either Gf (fluid intelligence), or experience. The results confirmed the previous study to the effect that males have higher means in a general knowledge factor of approximately.50 d (half a standard deviation). It was found further that there was no significant sex difference in Gf measured by Baddeley's Grammatical Reasoning Test, and only a low correlation between general knowledge and Gf. Analysis of covariance showed that differential experience as indicated by 'A'-level points and socio-economic status had only a marginal impact on the observed sex difference. The results are interpreted as showing that sex differences in general knowledge cannot be explained as a function of differences in either Gf or experience. It is proposed further that general knowledge should be regarded as a new second-order factor and designated as semantic memory.

Adolescent↗
PubMed2004

Measuring cancer knowledge: comparing prompted and unprompted recall.

Studies evaluating public knowledge of the warning signs and risk factors associated with cancer have varied in the question format used. Those using a prompted (recognition) format have tended to find higher levels of knowledge than those using an unprompted, recall format. The aim of this study was to quantify the effect of prompting on knowledge of the seven warning signs of cancer, and risk factors for breast and bowel cancer, using data from large representative samples of the UK population. We also tested for demographic differences in the effect of prompting, hypothesizing that prompting would have the greatest impact on groups with least knowledge, specifically men, older and younger people, and those with least education. Analysis of data from four ONS surveys (total n = 5,863) demonstrated significantly higher knowledge of all signs and risk factors in the prompted compared with the unprompted condition. Contrary to our hypothesis, the pattern of interaction of prompting with gender and level of education was inconsistent, and the effect of prompting decreased with increasing age. Implications for future research on cancer knowledge and the most appropriate question format are discussed.

Adolescent↗
PubMed2001

Development and evaluation of a method for evaluating pediatric residents' knowledge and skill in performing physical examinations of the ankle and knee.

BACKGROUND: Pediatric residents need the knowledge and physical examination skills to evaluate common musculoskeletal injuries. The ankle and the knee are the 2 most common sites of musculoskeletal injury in young athletes. Methods for evaluating pediatric residents' knowledge and skills in examining the ankle and knee are needed. OBJECTIVES: 1) To describe the development of a method for evaluating pediatric residents' knowledge and skill in performing physical examinations of the ankle and knee, and 2) to report the reliability of this method. METHODS: A written test and a Clinical Skills Assessment Examination (CSAE) with a rating index were developed by the investigators to evaluate pediatric residents' knowledge and skills in examining the ankle and knee. Fifty-eight pediatric residents completed the written test and examined the ankle and knee of one standardized patient at the beginning of a required 1-month adolescent medicine rotation. Forty-eight residents repeated the evaluation at the end of the month. The investigators rated the residents' performance of the CSAE and then assessed interrater reliability using Cronbach's alpha. Test-retest correlation was calculated to assess the reliability of the written test. RESULTS: Test-retest correlation for the written test was 0.72, establishing its reliability. Interrater reliability for rating the CSAE of the ankle and knee was 0.98 and 0.90, respectively. CONCLUSION: Pediatric residents' knowledge and skills in examining the ankle and knee can be reliably evaluated using the written test and CSAE described in this article. These could be used to assess the effectiveness of current curricula in improving pediatric residents' knowledge and skill in evaluating ankle and knee complaints and to assist in the design of future curricula. musculoskeletal, evaluation methods, resident curriculum.

Adolescent Medicine↗
PubMed2002

Effect of an educational intervention about breastfeeding on the knowledge, confidence, and behaviors of pediatric resident physicians.

OBJECTIVE: Breastfeeding is the preferred nutrition for infants, but many pediatricians report inadequate training to advise mothers who breastfeed. This study was designed to examine the effect of an educational intervention on pediatric residents' knowledge about breastfeeding, their confidence in addressing lactation issues, and their management skills during clinical encounters with breastfeeding mothers. DESIGN: An interactive multimedia curricular intervention was designed for pediatric residents to increase their knowledge about common lactation issues. The residents completed questionnaires before and after the intervention to measure knowledge and confidence. Resident behaviors in the clinical setting were measured before and after the intervention using telephone surveys of breastfeeding mothers after a clinic visit with a pediatric resident. RESULTS: Forty-nine pediatric residents participated in the study. Mean knowledge scores increased from 69% before the intervention to 80% after the intervention. Significant increases in knowledge included advising mothers about low milk supply, mastitis, abscess, or using medication, and in recognizing the benefit of the decreased risk of maternal cancer. Management skills with breastfeeding mothers and infants in the clinical setting improved significantly. Before the intervention residents performed an acceptable number of behaviors 22% of the time, while after the intervention their performance was acceptable 65% of the time. Particular behaviors that showed significant improvement after the intervention included discussing signs of breastfeeding adequacy with the mother and correct management of lactation problems. CONCLUSIONS: These results indicate that not only breastfeeding knowledge and confidence, but most importantly clinical behaviors of pediatric residents can be enhanced through innovative educational opportunities. Appropriate counseling for breastfeeding mothers by pediatricians might contribute to an increase in the duration of breastfeeding.

Adult↗
PubMed1991

Knowledge about AIDS and HIV in the US adult population: influence of the local incidence of AIDS.

BACKGROUND: Accurate information about acquired immunodeficiency syndrome (AIDS) and human immunodeficiency virus (HIV) is important for prevention. This study determined whether AIDS knowledge varied among populations residing in areas with a low, medium, or high incidence of AIDS. METHODS: Respondents to the 1988 National Health Interview Survey of AIDS Knowledge and Attitudes, which is based on a nationally representative sample of 29,659 adults, were rated on their knowledge about modes of HIV transmission, general knowledge about AIDS, and misperceptions about HIV transmission through casual contact. RESULTS: Persons 50 years of age or older, Blacks, Hispanics, and persons with less than a high school education had lower knowledge scores and higher misperception scores. Residents of the high-incidence area had more misperceptions than those who lived in the medium- or low-incidence areas. Sociodemographic determinants of scores were important factors overall and within each AIDS incidence area. CONCLUSIONS: These data suggest that the ability of educational messages to reach and be absorbed by individuals nationwide is less dependent on whether they live in an area with a high incidence of AIDS and more dependent on other demographic variables. New and continued efforts are needed to improve knowledge in older persons, minorities, and the less educated in all parts of the country.

Adolescent↗