Description and student self-evaluation of a pilot integrated small group learning and simulation programme for medical students in the first clinical year.

BACKGROUND: Contemporary education for medical students should be student-centred, integrated and contextualised. Small group learning promotes clinical reasoning and skills for lifelong learning. Simulation can provide experiential learning in a safe and controlled environment. We developed a weekly integrated problem-based learning and simulation programme (IPS) over two semesters in the first clinical year to augment clinical placement experience and contextualise theory into work-relevant practice. AIM: To evaluate the new programme at Kirkpatrick level 1. METHODS: An anonymous survey of participating students. RESULTS: The programme was well liked. Students found the programme relevant and that they had a better understanding of patient safety and the assessment of the deteriorating patient. They felt it contributed to integration of theory and practice, clinical reasoning and the acquisition of non-technical skills, particularly affective and communication elements. CONCLUSION: This IPS programme in the first clinical year can deliver a student-centred curriculum to complement clinical placement that delivers the important requirements of contemporary medical student education.

Tracking the phonological status of /l/ in Newfoundland English: Experiments in articulation and acoustics.

This paper investigates patterning of /l/ in Newfoundland English. Using acoustic and ultrasound methods, the reported displacement of the traditional Irish pattern of word-final light /l/ is assessed. Acoustic results show darker /l/'s in word-final position in both phrases and compounds. Although the standard allophonic pattern is widespread in Newfoundland English, dialectal variation arising from early settlement patterns continues to influence speech patterns with less distinction between initial and final /l/ in Irish-settled areas. Men show relatively less distinction between initial and final /l/, consistent with sociolinguistic patterns in which men retain local variants. Last, light /l/ in final position may be resurfacing among younger speakers. Ultrasound imaging also shows variable rates of distinction between word-final and initial /l/, but without significant main effects of region or gender. Articulatory analysis reveals a small effect of age, with older speakers being less likely to have significant differences in articulation across positions. An interaction between region and gender shows males from an Irish-settled community are less likely to employ distinct lingual shapes across positions. While some articulatory findings complement the acoustic results, it is suggested that differences between these domains result from lateralization or other aspects of articulation not captured in ultrasound imaging.

Inside the physician's black bag: critical ingredients of brief alcohol interventions.

Brief primary care interventions structured around patient workbooks have been shown to be effective in modifying hazardous drinking behavior. However, the critical ingredients of such interventions are not well understood, possibly contributing to their underutilization. Seventeen campus-based clinicians trained in a brief, workbook-based alcohol intervention participated in a qualitative study to identify the most promising clinician-patient interaction components within this shared approach, utilizing a focus group with the clinicians and ranking of the 24 workbook ingredients. Based on the clinicians' collective experience, consensus emerged around the perceived strength of 5 main components: (1) providing a summary of the patient's drinking level, (2) discussing drinking likes and dislikes, (3) discussing life goals, (4) encouraging a risk-reduction agreement, and (5) asking patients to track their drinking (on cards provided for this purpose). This is the first paper to examine primary care physician perspectives on potentially critical components of effective brief alcohol intervention.

A Public Health Service-Learning Capstone: Ideal for Students, Academia and Community.

Undergraduate public health degree programs strive to educate students to improve the health of communities. As such we have an obligation to develop curricula that push students to think critically about their perspectives, examine assumptions, and provide supported opportunities to apply their academic learning. In addition, curricula ideally develop and nurture students' sense of civic responsibility. Community-engaged learning provides opportunities for students to interact with populations with a range of needs and different perspectives. Students need to be prepared to engage ethically and respectfully, while thinking critically about and reflecting on their roles in these communities. Service-learning is a high-impact practice that combines community service with structured academic learning, including preparation, and reflection. In line with public health community-based work, a key aspect of service-learning is the intentional development of community partnerships to ensure that students are filling the needs defined by the communities themselves. Accreditation criteria may guide what is taught but say little about how it should be taught. However, how we teach matters. Service-learning is a high impact practice that not only aligns well with the goals and objectives of an accreditation required culminating senior experience but shares many of the values of the discipline of public health. This paper analyzes the use of service-learning in the development and delivery of the University of Washington School of Public Health undergraduate Public Health-Global Health majors' culminating experience. We describe the course learning objectives, structure, and assessment tools. In addition, we present quantitative and qualitative results on the impact of the course. We argue that it is feasible, sustainable, and beneficial to students and communities when the high impact practice of service-learning is used in delivery of a culminating senior experience.

Framing Undergraduate Public Health Education as Liberal Education: Who Are We Training Our Students To Be and How Do We Do That?

The rapid development of the undergraduate major in public health over the past 15 years has led to a debate about the most appropriate framing for the degree. Should it be viewed as a liberal education degree (akin to academic disciplines such as psychology and political science) or as a professional training degree (akin to disciplines such as nursing and management)? This paper presents an overview of both the liberal education and the professional training degree approaches to the undergraduate public health degree. The reality of public health work in the modern era and the constraints on undergraduate-level training lead to our conclusion that the liberal education framing is a more optimal way to design the degree program. Such a framework optimizes career opportunities, especially long-term opportunities, for graduates, acknowledges the reality of the complex and diverse career paths that one can take under the general umbrella of public health, and accounts for the important role of critical thinking skills in undergraduate education. Ultimately, the distinction between liberal education and professional training may be fuzzier than the debate often highlights-an intentional, well-designed, and thoughtfully implemented undergraduate public health curriculum can address the range of student needs underlying both the liberal education and professional training approaches to the degree, thus optimizing both learning goals and career outcomes for undergraduate public health students.

Should external short courses be a compulsory part of ACEM specialty training? No.

I am proud to be a product of an excellent training system that builds trainees and fellows with an ongoing desire to learn. Dogmatic incorporation of external courses into training would be incongruent with medical education best practice principles upon which the new curriculum is founded. I am confident that our junior colleagues can ­ as we were ­ be trusted for generations to come to fashion their own learning paths, identifying and addressing their own knowledge gaps, using whatever media engages them best.

Computer-facilitated rapid HIV testing in emergency care settings: provider and patient usability and acceptability.

Providers in emergency care settings (ECSs) often face barriers to expanded HIV testing. We undertook formative research to understand the potential utility of a computer tool, "CARE," to facilitate rapid HIV testing in ECSs. Computer tool usability and acceptability were assessed among 35 adult patients, and provider focus groups were held, in two ECSs in Washington State and Maryland. The computer tool was usable by patients of varying computer literacy. Patients appreciated the tool's privacy and lack of judgment and their ability to reflect on HIV risks and create risk reduction plans. Staff voiced concerns regarding ECS-based HIV testing generally, including resources for follow-up of newly diagnosed people. Computer-delivered HIV testing support was acceptable and usable among low-literacy populations in two ECSs. Such tools may help circumvent some practical barriers associated with routine HIV testing in busy settings though linkages to care will still be needed.

Depression and suicide ideation among students accessing campus health care.

Depression and suicide are of increasing concern on college campuses. This article presents data from the College Health Intervention Projects on the frequency of depression and suicide ideation among 1,622 college students who accessed primary care services in 4 university clinics in the Midwest, Northwest, and Canada. Students completed the Beck Depression Inventory and other measures related to exercise patterns, alcohol use, sensation seeking, and violence. The frequency of depression was similar for men (25%) and women (26%). Thought of suicide was higher for men (13%) than women (10%). Tobacco use, emotional abuse, and unwanted sexual encounters were all associated with screening positive for depression. "Days of exercise per week" was inversely associated with screening positive for depression. Because the majority of students access campus-based student health centers, medical providers can serve a key role in early identification and intervention. With every 4th student reporting symptoms of depression and every 10th student having suicidal thoughts, such interventions are needed.

Patient and staff perspectives on the use of a computer counseling tool for HIV and sexually transmitted infection risk reduction.

PURPOSE: To explore use of an interactive health communication tool--"Computer Assessment and Risk Reduction Education (CARE) for STIs/HIV." METHODS: This was a mixed method study utilizing participant observation and in-depth interviews with patients (n = 43), and focus groups with staff (5 focus groups, n = 41) from 5 clinics in 3 states (1 Planned Parenthood, 1 Teen, 2 STD, and 1 mobile van clinic). Data were managed using Atlas.ti. Inter-rater reliability of qualitative coding was .90. RESULTS: Users were 58% nonwhite with mean age 24.7 years (74% < 25). Patients could use CARE with minimal to no assistance. Time for session completion averaged 29.6 minutes. CARE usefulness was rated an average of 8.2 on an ascending utility scale of 0 to 10. Patient themes raised as strengths were novelty, simplicity, confidentiality, personalization, and plan development, increased willingness to be honest, lack of judgment, and a unique opportunity for self-evaluation. Staff themes raised as strengths were enhanced data collection, handout customization, education standardization, behavioral priming, and expansion of services. Patient limitation themes included limited responses and lack of personal touch. Staff limitation themes were selecting users, cost, patient-provider role, privacy, and time for use. CONCLUSIONS: CARE was well-received and easily usable by most (especially 18-25-year-olds). Patient and staff perceptions support the use of CARE as an adjunct to usual practice and as a method to expand services. Honesty, reduced time constraints, and lack of judgment associated with CARE appeared to enhance self-evaluation, which may prove an important component in moving patients forward in the behavior change process.