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1.
Med Teach ; 45(1): 73-79, 2023 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-35914521

RESUMO

PURPOSE: Leadership development programs often use institutional projects to activate learning. We explored how project work shaped leadership identity formation in senior women leaders from one academic health science center who enrolled in The Hedwig von Ameringen Executive Leadership in Academic Medicine (ELAM®) program. MATERIALS AND METHODS: We interviewed ELAM Fellows and conducted a qualitative analysis of transcripts. Our primary analysis focused on the influences of projects on Fellows and institutions. Leadership identity formation emerged as a distinct pattern, so this narrative content was separated for secondary analysis. All authors approved the final assignment of themes and codes. RESULTS: Participants described a multi-dimensional process for developing a leadership identity. Themes encompassed participants' View of Self and One's Image as a Leader, Interpersonal Relationships, and Commitment to a Value-based Goal. These internal factors grounded external influences, such as interactions with colleagues and institutional leaders, and the world beyond the institution. CONCLUSIONS: We examined the process of leadership identity formation from the perspective of women leaders in academic health sciences who completed an institutional project during a leadership development program. Findings illustrate how internal and external forces, experienced in the context of project work, combine to influence leadership identity formation in women.


Assuntos
Instalações de Saúde , Liderança , Humanos , Feminino , Aprendizagem , Relações Interpessoais , Motivação
3.
Fam Syst Health ; 40(4): 472-483, 2022 12.
Artigo em Inglês | MEDLINE | ID: mdl-36508618

RESUMO

INTRODUCTION: Novel teaching curricula using simulated patients (SP) and a team-based approach are needed to teach pediatric residents how to approach behavioral health (BH) conditions in an integrated care setting. METHOD: This mixed-methods study evaluated a pilot curriculum on BH integration in pediatric primary care. Two 1-hour didactic sessions and 3 hours of SP encounters focused on attention-deficit/hyperactivity disorder (ADHD) and anxiety, followed by facilitated debriefings that included interdisciplinary team members. Residents completed pre- and postcurriculum surveys on self-efficacy in patient assessment and management. A subset of residents participated in semistructured interviews, reviewing video recordings of their SP encounters to facilitate reflection on their learning. We conducted qualitative analysis of interview transcripts until we reached thematic saturation. RESULTS: Residents (n = 31) reported significantly improved self-efficacy in the majority of BH skills (p ≤ .05 to p ≤ .0001), including assessing and discussing concerns with families, using screening tools, developing management plans, prescribing medications, and performing warm handoffs with BH clinicians. In analysis of 15 interviews, four themes emerged: shared experiences, mutual engagement, contextual meaning, and behavioral change, which aligned with the components of the communities of practice framework. Sharing experiences within an integrated BH-pediatric primary care learning community enhanced activated, self-reflective learning and consequent behavioral change that contributed to identity formation. DISCUSSION: Resident participation in the integrated BH-pediatric curriculum improved self-efficacy in patient care for anxiety and ADHD. Curricula implemented in integrated learning communities could help promote reflection and improve integrated pediatric-BH care, including warm handoffs from pediatric to BH providers. (PsycInfo Database Record (c) 2022 APA, all rights reserved).


Assuntos
Currículo , Internato e Residência , Humanos , Criança , Inquéritos e Questionários , Atenção Primária à Saúde , Educação em Saúde
4.
Pediatrics ; 149(3)2022 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-35165742

RESUMO

OBJECTIVES: Health professionals need training to provide trauma-informed care (TIC) for children with adverse childhood experiences (ACEs), which can affect short- and long-term health. We summarize and evaluate published curricula for health professionals on ACEs and TIC. METHODS: We searched PubMed, Embase, Web of Science, CINAHL, Cochrane Central Register of Controlled Trials, PsychInfo, and MedEdPORTAL through January 2021. Studies meeting the following criteria were included: Described teaching interventions on ACEs, TIC, and child abuse and maltreatment; included health care providers or trainees as learners; were written in English; included an abstract; and described a curriculum and evaluation. We reviewed 2264 abstracts, abstracted data from 79 studies, and selected 51 studies for qualitative synthesis. RESULTS: Studies focused on ACEs/TIC (27), child abuse (14), domestic/intimate partner violence (6), and child maltreatment/parental physical punishment (4). Among these 51 studies, 43 were published since 2010. Learners included a mix of health professionals (34) and students (17). Duration, content, and quality of the 51 curricula were highly variable. An analysis of 10 exemplar curricula on ACEs and/or TIC revealed high and very high quality for methods and moderate to very high quality for curriculum evaluation, suggesting that they may be good models for other educational programs. Four of the 10 exemplars used randomized controlled trials to evaluate efficacy. Studies were limited to English language and subject to publication bias. CONCLUSIONS: ACEs and TIC are increasingly relevant to teaching health professionals, especially pediatricians, and related teaching curricula offer good examples for other programs.


Assuntos
Experiências Adversas da Infância , Maus-Tratos Infantis , Violência por Parceiro Íntimo , Criança , Maus-Tratos Infantis/terapia , Currículo , Pessoal de Saúde , Humanos
5.
J Hum Lact ; 38(1): 64-74, 2022 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33823702

RESUMO

BACKGROUND: Breastfeeding rates for United States women with lower incomes fall below the government's Healthy People 2020 Goals. Breastfeeding recommendations combined with support from providers and peer counselors help women decide to begin and sustain breastfeeding, but peer counselor uptake is low. RESEARCH AIM: To evaluate changes in referrals to Women, Infants, and Children's Supplemental Nutrition Program peer counselors, reported prenatal provider education and support, and breastfeeding outcomes (intention, initiation, 1-month duration of any and exclusive breastfeeding) after a prenatal breastfeeding promotion intervention. METHOD: In this pre-post intervention study (2015-2016; upstate New York), providers implemented a Toolkit to discuss infant feeding recommendations and initiate peer counselor referral. We surveyed women pre- and post-implementation (after delivery; 1 month postpartum) about prenatal breastfeeding intentions, provider support, and breastfeeding outcomes. Analyses controlled for secular trends. RESULTS: Pre-intervention (n = 71) and post-intervention (n = 70) participants were 49% Black, 61% publicly insured, and 16% uninsured. More post-intervention participants had > 1 Toolkit use (76%), peer counselor program referrals (60.0% post vs. 36.6% pre, p < .01), reported any breastfeeding intention (89% vs. 72%, p = .013), and intended to breastfeed for > 1 year (31% vs. 14%, p = .014). Post-intervention breastfeeding initiation and exclusivity were higher, but not significantly different. Post-intervention participants reported better prenatal breastfeeding support. CONCLUSIONS: Implementing a prenatal Breastfeeding Toolkit, including facilitating peer counselor referral, was associated with increases in provider counseling, participants' breastfeeding intentions, and uptake of peer counselors. Replicating this approach may reinforce efforts to support breastfeeding in similar practices serving women with lower incomes.


Assuntos
Aleitamento Materno , Intenção , Aleitamento Materno/psicologia , Criança , Aconselhamento/métodos , Feminino , Humanos , Lactente , Grupo Associado , Cuidado Pós-Natal , Gravidez
6.
Acad Pediatr ; 21(7): 1253-1261, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33862289

RESUMO

OBJECTIVE: Patients with a new diagnosis of attention-deficit/hyperactivity disorder (ADHD) who are prescribed stimulant medication need regular follow-up. Guidelines recommend follow-up within 30 days of stimulant initiation or change but this goal is seldom achieved. This quality improvement (QI) study in an urban academic outpatient practice aimed to: 1) assess whether use of school-based telemedicine increases rates of follow-up within 30 days and decreases the number of days to follow-up for ADHD, and 2) compare rates of 30-day follow-up via in-person vs telemedicine visits. METHODS: We performed three Plan-Do-Study-Act cycles over a 12-month period: QI interventions included clinic wide education, paper prompts for clinicians, and creation of a database to track ADHD patients. We measured days from the index visit to the follow-up visit, and the mode of both visits (in-person or telemedicine). Data were collected for 6 months pre-intervention and 12 months post-intervention. RESULTS: Follow-up within 30 days increased from 19% (of 191 visits) to 33% (of 661 visits) (P < .001). The time to follow-up decreased from 67 to 34 days (P < .001). Follow up visits by telemedicine were more also more likely to be within 30 days (62% vs. 32%, P < .001). DISCUSSION: A QI intervention for ADHD care increased rates of follow-up within 30 days, particularly when telemedicine was used, and decreased the number of days to follow-up. This intervention could serve as a model to improve follow-up for ADHD in other settings.


Assuntos
Transtorno do Deficit de Atenção com Hiperatividade , Telemedicina , Transtorno do Deficit de Atenção com Hiperatividade/diagnóstico , Transtorno do Deficit de Atenção com Hiperatividade/terapia , Seguimentos , Humanos , Melhoria de Qualidade , Instituições Acadêmicas
7.
J Contin Educ Health Prof ; 41(1): 75-81, 2021 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-33433127

RESUMO

INTRODUCTION: The Hedwig von Ameringen Executive Leadership in Academic Medicine program (ELAM) is a national professional development program for women that includes institutional action projects (IAPs). Although benefits of ELAM participation are well documented, the value of the IAPs has not been specifically evaluated. We explored the experience of ELAM Fellows and leaders from one institution to elucidate how institutional factors influence project implementation and outcomes. METHODS: Fellows and deans participated in semistructured interviews. We analyzed the transcripts qualitatively to develop themes and describe factors that influenced IAP implementation and outcomes. We used the New World Kirkpatrick Model, an updated version of the widely used Kirkpatrick model of educational program evaluation, as a framework to elucidate how participants applied their leadership learning through project work, and to analyze early results of projects that indicated institutional impact. RESULTS: Project work had bidirectional impact on the fellows in the program and on the institution itself. Project enablers included: focusing projects on institutional priorities, obtaining sustainable support, and navigating institutional complexity. Leading indicators of institutional outcomes included contributions to institutional leadership and culture, and mutual enhancement of the reputation of the fellow and of the institution. DISCUSSION: By examining enablers and barriers for institutionally based projects conducted in a national leadership development program, we identified the drivers that facilitated application of leadership learning. Leading indicators of project outcomes reflected bidirectional impact on fellows and the institution, demonstrating outcomes at the highest levels of the New World Kirkpatrick Model.


Assuntos
Educação Continuada/normas , Liderança , Desenvolvimento de Pessoal/métodos , Educação Continuada/métodos , Humanos , Desenvolvimento de Programas/métodos , Avaliação de Programas e Projetos de Saúde/métodos , Desenvolvimento de Pessoal/tendências
8.
J Pediatr Adolesc Gynecol ; 33(5): 529-535, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32544517

RESUMO

STUDY OBJECTIVE: To examine associations between provider counseling about specific contraceptive methods and method choices reported by adolescents. DESIGN: A cross-sectional, secondary analysis of the local 2015 Youth Risk Behavior Survey, to which we added 2 new/modified questions about long-acting reversible contraception (LARC). SETTING: Rochester, New York. PARTICIPANTS: Female students in 9th-12th grade in the Rochester City School District. INTERVENTIONS: An anonymous, standardized survey was administered to collect data. MAIN OUTCOME MEASURES: We studied associations between students' reported contraceptive use and counseling (LARC, short-acting contraception [SAC], neither), health care factors, and potential risk/protective factors. Data were analyzed using bivariate and multivariate methods. RESULTS: Among 730 sexually active female respondents, 353/730 (49%) were African American and 182/730 (25%) were Other/Mixed race. 416/730 (57%) used no hormonal method at last sex, and 95/730 (13%) used LARC. 210/730 (29%) of participants recalled any LARC-specific counseling, and 265/730 (36%) any counseling on SAC. Recall of LARC and SAC counseling and use were significantly associated with speaking privately with a provider, but were not related to personal risk/protective factors. Multivariate analyses showed that recollection of LARC counseling was significantly associated with higher odds of using either LARC (adjusted odds ratio, 14.3; P < .001) or SAC (adjusted odds ratio, 2.1; P = .007). Recollection of either LARC or SAC counseling was associated with significantly lower odds of using no contraception. CONCLUSION: Adolescents' use of LARC was only 13%, but those who recalled contraceptive counseling had higher odds of using some hormonal method. Efforts are needed to improve provider counseling, maintain confidentiality, and identify effective methods to engage adolescents in meaningful, memorable discussions of LARC.


Assuntos
Comportamento Contraceptivo/estatística & dados numéricos , Serviços de Planejamento Familiar/estatística & dados numéricos , Contracepção Reversível de Longo Prazo/estatística & dados numéricos , Adolescente , Adulto , Estudos Transversais , Feminino , Humanos , New York , Autorrelato , Estudantes/psicologia
9.
J Adolesc Health ; 65(6): 812-814, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31383391

RESUMO

PURPOSE: Among diverse, low-income urban adolescents with persistent asthma, we examined whether attention-deficit/hyperactivity disorder (ADHD) comorbidity, compared with asthma alone, was associated with clinical outcomes, healthcare utilization, and responsibility for self-management. METHODS: We conducted a secondary analysis of data from a large school-based study of adolescents with asthma in Rochester, NY. Adolescents reported asthma symptoms over 2 weeks and primary care and hospital admissions over 1 year. We assessed shared responsibility for asthma management between caregivers and adolescents. RESULTS: ADHD comorbidity was common (28%) in this sample of 370 adolescents. Adolescents with ADHD had more primary care utilization and hospitalizations than those without, despite having similar asthma symptoms. Caregivers and adolescents with ADHD reported that adolescents had less shared responsibility for nine asthma management tasks. CONCLUSIONS: Adolescents with ADHD share less responsibility for asthma self-management. These teens' increased healthcare use might provide opportunities for clinicians to provide extra self-management support.


Assuntos
Asma/epidemiologia , Transtorno do Deficit de Atenção com Hiperatividade/epidemiologia , Gerenciamento Clínico , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Adolescente , Cuidadores/estatística & dados numéricos , Comorbidade , Feminino , Humanos , Masculino , Ensaios Clínicos Controlados Aleatórios como Assunto , Instituições Acadêmicas , Estados Unidos
10.
Psychiatr Serv ; 70(1): 68-70, 2019 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-30332926

RESUMO

Reports on the behavioral health workforce highlight the need to enhance evidence-based capacity; evidence-based interventions incorporated into pre-service graduate curricula (coursework and fieldwork) are needed to meet this goal. Improving educational practices across pre-service settings will require understanding of and careful attention to the contextual factors that exert pressure on curricula. The authors believe efforts to change educational practices can be enhanced by application of implementation science principles. This Open Forum delineates the key contextual factors that influence pre-service education, highlights gaps in the literature, and proposes an agenda for future research at the intersection of behavioral health workforce development and implementation science.


Assuntos
Prestação Integrada de Cuidados de Saúde/métodos , Prática Clínica Baseada em Evidências , Mão de Obra em Saúde , Ciência da Implementação , Desenvolvimento de Pessoal/métodos , Humanos , Psiquiatria
11.
J Palliat Med ; 21(9): 1221-1233, 2018 09.
Artigo em Inglês | MEDLINE | ID: mdl-29768072

RESUMO

BACKGROUND: While palliative care (PC) competencies for medical school graduates have been defined, the lack of established curriculum models and assessment tools hampers curricular evaluation. OBJECTIVE: To describe the scope and content of the University of Rochester's longitudinal, integrated four-year PC curriculum after 17 years of implementation, review student evaluative responses, and compare the curriculum to national competency standards. DESIGN AND SETTING: Combining and reorganizing a published PC curriculum assessment tool and a list of medical school PC competencies, we created a novel nine-topic framework to assess the content coverage of our curriculum. We queried our electronic medical school curriculum database and surveyed course and clerkship directors, as well as PC, pain, ethics, and humanities faculty, to locate where and when PC topics are taught and to collate student responses to these experiences. RESULTS: We present a comprehensive list of PC curricular activities over a four-year medical school experience. The curriculum covers all nine PC topics longitudinally in multiple formats. Five in-depth activities cover multiple PC topics in a format that integrates biological, psychological, and social dimensions; these activities have survived and evolved over 17 years in our setting. A majority of year 3 University of Rochester students feel "well" or "extremely well" trained in PC. CONCLUSIONS: Our four-year PC curriculum provides robust and developmentally appropriate training that addresses all nine evidence-based core topics for PC education. Medical student feedback and their Association of American Medical Colleges (AAMC) survey responses suggest that they find their PC learning experiences rewarding. This curriculum could serve as a model for other schools.


Assuntos
Currículo , Educação de Graduação em Medicina , Medicina Paliativa/educação , Humanos , Estudos Longitudinais , Modelos Educacionais , New York
12.
Acad Med ; 92(8): 1105-1113, 2017 08.
Artigo em Inglês | MEDLINE | ID: mdl-28746133

RESUMO

A sizeable literature describes the effectiveness of institution-based faculty development programs in nurturing faculty educators as scholars, but national programs are less common and seldom evaluated. To fill this role, the Educational Scholars Program (ESP) was created within the Academic Pediatric Association (APA) in 2006. It is a national, three-year, cohort-based certification program focused on fostering educational scholarship. This article describes the development and outcomes of an innovative program embedded within the framework of a national professional organization, and offers a model for potential adaptation by similar organizations to enhance their support of educators.After 10 years, 171 scholars have enrolled in the ESP, and 50 faculty have participated. Scholars are assigned a faculty advisor and participate in three full-day sessions at a national meeting; online, interactive learning modules; and a mentored, scholarly project. The program receives support from the APA in four organizational frames: structural, human resource, political, and symbolic. The self-perceived scholarly proficiency of the scholars in Cohort 1 increased significantly over time, and their productivity and collaborations increased during and after the program. Scholars wrote enthusiastically about their experience in yearly and postprogram evaluations. In interviews, eight past APA presidents explained that the ESP strengthened the APA's mission, created new leaders, and provided a new model for other APA programs. Outcomes of the ESP suggest that a longitudinal faculty development program embedded within a national professional organization can create a social enterprise not only within the organization but also within the broader national community of educator-scholars.


Assuntos
Currículo , Educação Médica/organização & administração , Docentes de Medicina/educação , Pediatria/educação , Faculdades de Medicina/organização & administração , Sociedades Médicas/organização & administração , Desenvolvimento de Pessoal/organização & administração , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Avaliação de Programas e Projetos de Saúde , Estados Unidos
13.
Teach Learn Med ; 29(3): 337-350, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28632010

RESUMO

PROBLEM: Clinical educators at U.S. academic health centers are frequently disadvantaged in the academic promotion system, lacking needed faculty development, mentoring, and networking support. INTERVENTION: In 2006, we implemented the national Educational Scholars Program to offer faculty development in educational scholarship for early career educators in pediatrics. We aimed to provide them with skills, experience, and initial success in educational scholarship and dissemination. The 3-year curriculum is delivered in interactive sessions at the annual pediatric academic meetings and online intersession modules. Curriculum content progresses from educational scholarship and implementing scholarly projects to dissemination and professional networking. Intersession modules address project planning, building an educator portfolio, reviewing the literature, using technology, authorship, and peer review. Concurrently, all scholars must complete a mentored educational project and demonstrate national dissemination of a peer-reviewed product to obtain a Certificate of Excellence in Educational Scholarship. CONTEXT: The setting of this study was a national, longitudinal, cohort-based faculty development program built within the Academic Pediatric Association, a 2,000-member professional organization. OUTCOME: In 10 years, the Educational Scholars Program has enrolled 172 scholars in 8 cohorts; 94 have graduated so far. We describe how formative evaluation guided curriculum refinement and process improvement. Summative evaluations show that faculty and scholars were satisfied with the program. Participant outcomes from Cohort 1, assessed at Kirkpatrick's four levels of evaluation, demonstrate increases in scholarly productivity, leadership activities, and academic promotions. LESSONS LEARNED: Curriculum building is a dynamic process of ongoing evaluation and modification. Our program benefited from designing an integrated and focused curriculum, developing educational principles to guide program improvements, creating curricular tools to help learners organize and document their efforts, supporting project-based learning with expert mentoring, and facilitating peer and faculty networking and collaboration. A national, longitudinal faculty development program can support growth in academic knowledge and skills, promote professional networking, and thereby enrich educators' career opportunities.


Assuntos
Currículo , Docentes de Medicina , Avaliação de Programas e Projetos de Saúde , Desenvolvimento de Pessoal , Feminino , Humanos , Masculino , Desenvolvimento de Programas , Inquéritos e Questionários
14.
J Contin Educ Health Prof ; 37(2): 106-115, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28562499

RESUMO

INTRODUCTION: Multisite and national professional development (PD) programs for educators are challenging to establish. Use of implementation science (IS) frameworks designed to convert evidence-based intervention methods into effective health care practice may help PD developers translate proven educational methods and models into successful, well-run programs. Implementation of the national Educational Scholars Program (ESP) is used to illustrate the value of the IS model. METHODS: Four adaptable elements of IS are described: (1) replication of an evidence-based model, (2) systematic stages of implementation, (3) management of implementation using three implementation drivers, and (4) demonstration of program success through measures of fidelity to proven models and sustainability. RESULTS: Implementation of the ESP was grounded on five established principles and methods for successful PD. The process was conducted in four IS stages over 10 years: Exploration, Installation, Initial Implementation, and Full Implementation. To ensure effective and efficient processes, attention to IS implementation drivers helped to manage organizational relationships, build competence in faculty and scholars, and address leadership challenges. We describe the ESP's fidelity to evidence-based structures and methods, and offer three examples of sustainability efforts that enabled achievement of targeted program outcomes, including academic productivity, strong networking, and career advancement of scholars. DISCUSSION: Application of IS frameworks to program implementation may help other PD programs to translate evidence-based methods into interventions with enhanced impact. A PD program can follow systematic developmental stages and be operationalized by practical implementation drivers, thereby creating successful and sustainable interventions that promote the academic vitality of health professions educators.


Assuntos
Avaliação de Programas e Projetos de Saúde/métodos , Desenvolvimento de Pessoal/métodos , Pesquisa Translacional Biomédica/métodos , Medicina Baseada em Evidências/métodos , Medicina Baseada em Evidências/normas , Humanos , Liderança , Desenvolvimento de Programas , Avaliação de Programas e Projetos de Saúde/normas , Ensino/normas
15.
Acad Pediatr ; 17(4): 424-430, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28137673

RESUMO

OBJECTIVE: Resident mental health (MH) problems can be associated with reduced empathy and increased medical errors. The Accreditation Council for Graduate Medical Education mandates resident MH support services, but it is unknown if these services are accessible and meet resident needs. We sought to describe the prevalence of anxiety and depression in current pediatric residents in New York State (NYS), and their self-reported use of and barriers to support services. METHODS: We developed an online survey and distributed it to all categorical pediatric residents in 9 NYS programs. Items addressing self-concern for clinical anxiety and depression and use of MH services were pilot tested for content and construct validity. The validated Patient Health Questionnaire-2 (PHQ-2) measured depressive symptoms. Analyses used descriptive and chi-square tests. RESULTS: Respondents included 227 residents (54% response rate) distributed across training levels and programs. Many reported "often" or "almost always" feeling stress (52%), physical exhaustion (41%), and mental exhaustion (35%); 11% had PHQ-2-defined depressive symptoms. Some thought that their stress levels raised concern for clinical depression (25%) or anxiety (28%); among these, only 44% and 39%, respectively, had sought care. More women reported physical exhaustion (P < .05). Only 45% of residents reported educational offerings on resident MH; 66% wanted to know more about available resources. Barriers to receipt of services included inflexible schedules (82%), guilt about burdening colleagues (65%), fear of confidentiality breach (46%), and difficulty identifying services (44%). CONCLUSIONS: Pediatric residents frequently experience MH symptoms, but many do not know about or use support services. Programs should enhance MH support by overcoming barriers and increasing resident awareness of services.


Assuntos
Transtornos de Ansiedade/psicologia , Transtorno Depressivo/psicologia , Acessibilidade aos Serviços de Saúde , Internato e Residência , Fadiga Mental/psicologia , Serviços de Saúde Mental , Pediatria/educação , Estresse Psicológico/psicologia , Adulto , Confidencialidade , Depressão/psicologia , Emoções , Fadiga , Feminino , Humanos , Masculino , Saúde Mental , New York , Apoio Social
16.
MedEdPORTAL ; 13: 10547, 2017 Mar 03.
Artigo em Inglês | MEDLINE | ID: mdl-30800749

RESUMO

INTRODUCTION: Child abuse is a ubiquitous problem with personal, interpersonal, and social consequences. Risk factors are well established, and preventive strategies have been effective in decreasing abusive parenting behaviors and child maltreatment incident reports. Curriculum tools are needed to incorporate these strategies into training programs so physicians are adequately trained to identify and prevent child maltreatment at the earliest opportunity. METHODS: A literature review established the core content for the curriculum. Resident learning needs were assessed with an online survey sent to graduating residents and teaching faculty. Curriculum objectives were composed to target core content and to address learning needs. Adult learning theories were applied to design interactive, case-based workshops to meet the curriculum objectives. A qualitative assessment tool was distributed to participating residents pre- and postcurriculum. Evaluators were blinded to pre/post status. Follow-up surveys distributed 3 months after the curriculum evaluated for retention of content and application to clinical practice. RESULTS: After workshop participation, residents showed a greater tendency to associate somatic and behavioral complaints with potential toxic stress or abuse and demonstrated understanding of ongoing needs and risks in affected families. On follow-up surveys, most residents self-reported progress toward incorporating discussion of risk factors, stress, and abuse into routine well-child visits. DISCUSSION: Resident physicians who attended the child abuse prevention workshop acquired knowledge and skills relevant to secondary and tertiary child abuse prevention and indicated progress toward primary prevention goals during the subsequent 3 months.

17.
J Career Assess ; 24(1): 182-196, 2016 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-26924920

RESUMO

Competency in forms of scientific communication, both written and spoken, is essential for success in academic science. This study examined the psychometric properties of three new measures, based on social cognitive career theory, that are relevant to assessment of skill and perseverance in scientific communication. Pre- and postdoctoral trainees in biomedical science (N = 411) completed online questionnaires assessing self-efficacy in scientific communication, career outcome expectations, and interest in performing tasks in scientific writing, oral presentation, and impromptu scientific discourse. Structural equation modeling was used to evaluate factor structures and model relations. Confirmatory factor analysis supported a 22-item, 3-factor measure of self-efficacy, an 11-item, 2-factor measure of outcome expectations, and a 12-item, 3-factor measure of interest in scientific communication activities. Construct validity was further demonstrated by theory-consistent inter-factor relations and relations with typical communications performance behaviors (e.g., writing manuscripts, abstracts, presenting at national meetings).

19.
J Adolesc Health ; 58(3): 284-9, 2016 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-26903428

RESUMO

PURPOSE: Few studies have evaluated the use of etonogestrel subdermal implants (ESI) by U.S. adolescents. We assessed several factors, including continuation rates, the association of implant removal with postimplant management of nuisance bleeding, and the relation between bleeding and body mass index. METHODS: We reviewed 116 charts from all adolescent females with ESI placement in our adolescent medicine clinic from January 2010 to August 2013. Data were obtained from follow-up encounters up to 36 months after insertion. RESULTS: Of the 116 adolescents, 94% were nulliparous. Follow-up data were available for 81% (n = 94). Early ESI removal was defined as removal <32 months. ESI continuation rates at 12, 24, and 32 months were 78%, 50%, and 40%, respectively; this represents an early removal rate of 35% (33 of 94). Nuisance bleeding occurred in 48% (45 of 94). Of those complaining of bleeding, 63% (25 of 40) received medication management. Resolution of bleeding occurred in 25% of those in the early removal group versus 15% in the full retention group. Early implant removal due to nuisance bleeding occurred in 18% (17 of 94). There was no significant association between body mass index, nuisance bleeding, and early ESI removal. CONCLUSIONS: Implant continuation rates were quite high at 12 and 24 months, with 40% of patients reaching 32 months retention, providing a significant period of pregnancy prevention. Treatments for nuisance bleeding were often not prescribed and when they were, medication regimens varied among providers. An evidence-based protocol for medication management, combined with more routine use of appropriate medications and preventive or long-term therapies, may help improve continuation of ESI.


Assuntos
Anticoncepcionais Femininos , Desogestrel , Satisfação do Paciente , Hemorragia Uterina/etiologia , Adolescente , Anticoncepcionais Femininos/efeitos adversos , Desogestrel/efeitos adversos , Remoção de Dispositivo , Feminino , Humanos , Gravidez , Gravidez na Adolescência/prevenção & controle , Estudos Retrospectivos , Adulto Jovem
20.
CBE Life Sci Educ ; 14(4): ar46, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-26628562

RESUMO

Scientific communication (SciComm) skills are indispensable for success in biomedical research, but many trainees may not have fully considered the necessity of regular writing and speaking for research career progression. Our purpose was to investigate the relationship between SciComm skill acquisition and research trainees' intentions to remain in research careers. We used social cognitive career theory (SCCT) to test a model of the relationship of SciComm skills to SciComm-related cognitive variables in explaining career intentions. A sample of 510 graduate students and postdoctoral fellows at major academic health science centers in the Texas Medical Center, Houston, Texas, were surveyed online. Results suggested that interest in performing SciComm tasks, SciComm outcome expectations (SCOEs), and SciComm productivity predicted intention to remain in a research career, while SciComm self-efficacy did not directly predict career intention. SCOEs also predicted interest in performing SciComm tasks. As in other SCCT studies, SciComm self-efficacy predicted SCOEs. We conclude that social cognitive factors of SciComm skill acquisition and SciComm productivity significantly predict biomedical trainees' intentions to pursue research careers whether within or outside academia. While further studies are needed, these findings may lead to evidence-based interventions to help trainees remain in their chosen career paths.


Assuntos
Pesquisa Biomédica/educação , Escolha da Profissão , Comunicação , Autoeficácia , Habilidades Sociais , Cognição , Feminino , Humanos , Comunicação Interdisciplinar , Masculino , Pesquisadores/estatística & dados numéricos
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