Participant perceptions of the influences of the NLM-sponsored Woods Hole medical informatics course.

This report provides an evaluation of the National Library of Medicine-sponsored Woods Hole Medical Informatics (WHMI) course and the extent to which the objectives of the program are achieved. Two studies were conducted to examine the participants' perceptions of both the short-term (spring 2002) and the long-term influences (1993 through 2002) on knowledge, skills, and behavior. Data were collected through the use of questionnaires, semistructured telephone interviews, and participant observation methods to provide both quantitative and qualitative assessment. The participants of the spring 2002 course considered the course to be an excellent opportunity to increase their knowledge and understanding of the field of medical informatics as well as to meet and interact with other professionals in the field to establish future collaborations. Past participants remained highly satisfied with their experience at Woods Hole and its influence on their professional careers and their involvement in a broad range of activities related to medical informatics. This group considered their knowledge and understanding of medical informatics to be of greater quality, had increased their networking with other professionals, and were more confident and motivated to work in the field. Many of the participants feel and show evidence of becoming effective agents of change in their institutions in the area of medical informatics, which is one of the objectives of the program.

Errors in interpreting quantities as procedures: the case of pharmaceutical labels.

The purpose of this study is to investigate and characterize the errors in cognitive processes deployed in the comprehension of procedural texts found on pharmaceutical labels by subjects of different cultural and educational backgrounds. In this study, participants were asked to read and interpret three pharmaceutical labels related to children's medications of varying complexity: oral rehydration therapy (ORT); over-the-counter cough medicine; and over-the-counter fever medicine. Results indicate that: (1) all groups of participants had considerable difficulty in interpreting the instructions; (2), cultural and educational background appeared to be only weakly related to the accuracy of dosage and administration; and (3) errors of comprehension were related to three features of the texts: situation-representational complexity, inherent quantification complexity, and conformity with intuitive models of therapy based on prior knowledge. The results are discussed in terms of the role of multiple representations (boundary objects) and theories of text comprehension to facilitate the reduction of errors.

Relationship between small group problem-solving activity and lectures in health science curricula.

Components of problem-based education, such as small group teaching, are being implemented in diverse health curricula. Implementation, however, is often motivated by the intuitive appeal of many problem-based learning components, when what is needed is the detailed examination of how these components support students' integration of knowledge as well as continuity of their learning experiences. This study presents an investigation of the relationship between lecture and small group teaching (SGT) in a medical curriculum. Four problem-oriented SGT sessions representing diverse topics in the first-year curriculum and their corresponding lectures were videotaped and analyzed using techniques of concept mapping, where the broad concepts from the lectures were identified and matched to the case-specific concepts in the small group sessions. The results show that lectures function as an anchor for the students' discussion of issues relevant to clinical problem-solving and interventions in small group sessions. These discussions extended to contextual aspects of clinical practice that were not dealt with in the lectures, such as ethical/cultural issues around the treatment of patients. Furthermore, small group environments were found to promote discussions that allowed the integration of information from different sources and encompassed concepts across a number of disciplines. These results suggest that carefully designed small group sessions serve the purposes of 1) illustrating broader concepts in lectures to case-specific, clinically relevant problem-solving and 2) promoting knowledge integration from diverse sources of information. The implications of these results for learning and reasoning in health science curricula are discussed.

Shaping understanding of HIV through negotiation and conflict resolution during peer group discussion.

High-risk behavior in youths related to HIV transmission continues to occur despite large-scale efforts to disseminate information about safe sexual practices through education. Our study examined the relationships among knowledge, decision-making strategies, and risk assessment about HIV by youths during peer group focused discussions. Two focus groups with first-year college students were conducted, with a series of questions about risk for HIV transmission as prompts. All group interactions were recorded, transcribed and analyzed using methods of discourse analysis to characterize a detailed description of the interactions. The results indicated that youths negotiated their perspectives with the use of justification and elaboration to support alternative opinions and positions. They used concrete experiential examples to further explain and illustrate their positions, Opposing views or arguments met with requests for clarification and further negotiation. This cycle of clarification-negotiation shaped their understanding of HIV-related concepts. The use of strategies, such as justification of alternative positions and the use of examples as support for arguments to clarify and negotiate various perspectives, could be used as a tool for designing educational programs to improve understanding of health related issues, such as HIV transmission and prevention.

Public awareness about depression: the effectiveness of a patient guideline.

OBJECTIVE: To evaluate the effectiveness of a patient guideline for educating the public in the recognition and treatment of depression. METHOD: Lay subjects were interviewed regarding their knowledge and beliefs about depression through the use of a semi-structured questionnaire. They were asked to "think aloud" while evaluating two clinical scenarios about depression, both with and without the use of a patient guideline. All interviews were audio taped, transcribed, and analyzed for subjects' thought processes and accuracy of responses in the presence and absence of the guideline. RESULTS: Subjects with no prior history of depression identified fewer symptoms of depression listed in the patient guideline than did subjects with a history of depression. In the absence of the guideline, only 50% and 38% of subjects provided accurate diagnosis of depression for the simple and complex problems respectively. In the presence of the guideline, 92% and 83% of subjects provided an accurate diagnosis of depression for the simple and complex problems respectively. CONCLUSIONS: Lay people have a limited knowledge of depression and its treatment, and are less able to recognize symptoms of depression without the help of patient guideline. The guideline primes lay people to better recognize these symptoms and their relationship to diagnosis. This level of understanding about depression by lay people will facilitate improved communication between physicians and their patients.