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BMC Med Educ ; 18(1): 321, 2018 Dec 27.
Artículo en Inglés | MEDLINE | ID: mdl-30591050


BACKGROUND: Point-of-care-ultrasound (POCUS) training is expanding in undergraduate and graduate medical education, but lack of trained faculty is a major barrier. Two strategies that may help mitigate this obstacle are interprofessional education (IPE) and near-peer teaching. The objective of this study was to evaluate a POCUS course in which diagnostic medical sonography (DMS) students served as near-peer teachers for internal medicine residents (IMR) learning to perform abdominal sonography. METHODS: Prior to the IPE workshop, DMS students participated in a train-the-trainer session to practice teaching and communication skills via case-based simulation. DMS students then coached first-year IMR to perform POCUS examinations of the kidney, bladder, and gallbladder on live models. A mixed-methods evaluation of the interprofessional workshop included an objective structured clinical exam (OSCE), course evaluation, and qualitative analysis of focus group interviews. RESULTS: Twenty-four of 24 (100%) IMR completed the OSCE, averaging 97.7/107 points (91.3%) (SD 5.2). Course evaluations from IMR and DMS students were globally positive. Twenty three of 24 residents (96%) and 6/6 DMS students (100%) participated in focus group interviews. Qualitative analysis identified themes related to the learning environment, scanning technique, and suggestions for improvement. IMR felt the interprofessional training fostered a positive learning environment and that the experience complimented traditional faculty-led workshops. Both groups noted the importance of establishing mutual understanding of expectations and suggested future workshops have more dedicated time for DMS student demonstration of scanning technique. CONCLUSION: An interprofessional, near-peer workshop was an effective strategy for teaching POCUS to IMR. This approach may allow broader adoption of POCUS in medical education, especially when faculty expertise is limited.

Medicina Interna/educación , Sistemas de Atención de Punto , Enseñanza , Ultrasonografía , Abdomen/diagnóstico por imagen , Educación Médica/métodos , Humanos , Grupo Paritario , Estudiantes de Medicina
J Interprof Care ; 30(6): 726-731, 2016 11.
Artículo en Inglés | MEDLINE | ID: mdl-27797633


Effective interprofessional practice requires interprofessional education that facilitates learners' achievement of competency in the interprofessional domains. Unfortunately, educators currently have a limited number of tools to identify the level of competency of their learners. Previous investigations by some of the authors described the initial characteristics of a tool based on the Competencies for Interprofessional Collaborative Practice. Building on this work, this study describes a multi-institutional, three-part study refining this tool. The series of studies further established the validity, reliability, and usability of the assessment tool. Based on the data derived from this study, we created a shorter, more easily utilised version of the tool that retains previous psychometric strengths. This article describes a tool that consists of two domains, one linked to interprofessional interaction and one linked to interprofessional values. It is believed that this assessment tool may help educators define competence in interprofessional practice and guide assessment of both programmes and learners.

Conducta Cooperativa , Personal de Salud/educación , Relaciones Interprofesionales , Humanos , Psicometría , Reproducibilidad de los Resultados , Autoevaluación , Encuestas y Cuestionarios
J Parasitol ; 99(3): 573-5, 2013 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-23339344


Protozoans of the family Opalinidae are intestinal commensals in amphibians. To test the hypothesis that these organisms are susceptible to the antiprotozoal antibiotic metronidazole, we randomly assigned 60 juvenile Woodhouse's toads ( Bufo woodhousii ) to receive a single oral dose of metronidazole or water. In pilot trials, the prevalence of opalinids in untreated members of this population was over 70%. One-third of the study population was dissected at each of 3 time points: 18 hr, 1 wk, and 2 wk post-treatment. An examiner blinded to the toad's treatment history determined the presence or absence of opalinids using a dissecting microscope. Opalinids were found in 3/10 toads in the treatment group and 9/10 in the control group after 18 hr (P < 0.02), in none of the treatment group and 8/10 in the control group after 1 wk (P < 0.001), and in none of the treatment group and 10/10 in the control group after 2 wk (P < 0.0001). These results suggest that a single-dose of metronidazole quickly and reliably clears opalinids from juvenile Woodhouse's toads with no evidence of short-term recurrence. The treatment was well tolerated, with no apparent morbidity and no mortality in either group. Future exploration of opalinid-related host fitness consequences may be facilitated by this simple method of developing a protozoan-free host population.

Antiprotozoarios/uso terapéutico , Bufonidae/parasitología , Metronidazol/uso terapéutico , Enfermedades Parasitarias en Animales/tratamiento farmacológico , Estramenopilos/efectos de los fármacos , Administración Oral , Animales , Antiprotozoarios/administración & dosificación , Antiprotozoarios/farmacología , Metronidazol/administración & dosificación , Metronidazol/farmacología , Enfermedades Parasitarias en Animales/parasitología , Estramenopilos/fisiología , Resultado del Tratamiento
J Gen Intern Med ; 23(10): 1615-20, 2008 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-18622651


BACKGROUND: Overuse of antibiotics in the treatment of acute respiratory tract infection (ARI) contributes to the growing problem of antibiotic-resistant infections. OBJECTIVE: To identify factors that influence community practitioners to prescribe antibiotics and examine how they differ from the recommendations of the Centers for Disease Control and Prevention (CDC) guideline for treatment of ARI. DESIGN: Paper case vignette study using a fractional factorial design. PARTICIPANTS: One hundred one community practitioners and eight faculty members. MAIN MEASUREMENTS: We asked community practitioners to estimate how likely they would be to prescribe antibiotics in each of 20 cases of ARI and then used multiple regression to infer the importance weights of each of nine clinical findings. We then compared practitioners' weights with those of a panel of eight faculty physicians who evaluated the cases following the CDC guidelines rather than their own judgments. MAIN RESULTS: Practitioners prescribed antibiotics in 44.5% of cases, over twice the percentage treated by the panel using the CDC guidelines (20%). In deciding to prescribe antibiotic treatment, practitioners gave little or no weight to patient factors such as whether the patients wanted antibiotics. Although weighting patterns differed among practitioners, the majority (72%) gave the greatest weight to duration of illness. When illness duration was short, the rate of prescribing (20.1%) was the same as the rate of the faculty panel (20%). CONCLUSIONS: Based on hypothetical cases of ARI, community practitioners prescribed antibiotics at twice the rate of faculty following CDC practice guidelines. Practitioners were most strongly influenced by duration of illness. The effect of duration was strongest when accompanied by fever or productive cough, suggesting that these situations would be important areas for practitioner education and further clinical studies.

Antibacterianos/uso terapéutico , Toma de Decisiones , Prescripciones de Medicamentos , Medicina Familiar y Comunitaria/métodos , Personal de Salud , Infecciones del Sistema Respiratorio/tratamiento farmacológico , Enfermedad Aguda , Adulto , Antibacterianos/efectos adversos , Prescripciones de Medicamentos/normas , Medicina Familiar y Comunitaria/tendencias , Femenino , Personal de Salud/tendencias , Humanos , Masculino , Médicos de Familia/tendencias , Guías de Práctica Clínica como Asunto/normas , Infecciones del Sistema Respiratorio/diagnóstico
Gend Med ; 5(2): 186-93, 2008 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-18573485


BACKGROUND: Men and women communicate differently, but it is unclear whether this influences health care outcomes. OBJECTIVE: Because women patients frequently choose women health care providers, we examined whether this preference was affected by communication styles. We focused on communication of disease-specific symptoms, hypothesizing that symptom agreement between women patients and women health care providers would be greater than between other patient-provider gender combinations. METHODS: Patients attending outpatient clinics were recruited as part of a study of respiratory illness at 7 university-affiliated sites during 3 consecutive influenza seasons (2000-2003). Individuals aged > or = 19 years were offered enrollment if they sought care for cold or flu symptoms at a participating study site. Patients were eligible to participate in the study if they reported any 1 of 6 symptoms: cough, runny nose, fever (subjective), muscle aches, sore throat, and/or exhaustion. Using separate questionnaires, patients and their health care providers recorded the patients' respiratory symptoms (as present or absent). Patients recorded their symptoms before visiting their health care provider, and providers recorded patient symptoms after the visit. Symptom agreement was compared using general estimating equations across all gender combinations. RESULTS: A total of 327 patients (220 women, 107 men) and 84 health care providers (37 women, 47 men) participated in the study. Overall symptom agreement for all patient-provider gender combinations was 81.9% (95% CI, 79.6%-84.2%). For each symptom, the observed agreement significantly exceeded the agreement expected by chance alone (P < 0.001 for all symptoms except "no energy," which was P = 0.023). The male-male pairing of patient and provider was more likely to agree on a symptom than were the other gender combinations, although not statistically significantly more so than the female-female pairing. CONCLUSIONS: In this survey of patients with respiratory illness, there was no significant difference in symptom agreement for most symptoms between the male-male and female-female patient-provider combinations. Based on these findings, symptom agreement alone does not explain why women patients select women health care providers.

Comunicación , Satisfacción del Paciente , Relaciones Médico-Paciente , Infecciones del Sistema Respiratorio/diagnóstico , Infecciones del Sistema Respiratorio/psicología , Encuestas y Cuestionarios , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Atención Primaria de Salud/estadística & datos numéricos , Infecciones del Sistema Respiratorio/epidemiología , Factores Sexuales