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1.
BMC Med Educ ; 17(1): 124, 2017 Jul 18.
Artículo en Inglés | MEDLINE | ID: mdl-28720087

RESUMEN

BACKGROUND: The institution of duty hour reforms by the Accreditation Council for Graduate Medical Education in 2003 has created a learning environment where residents are consistently looking for input from attending physicians with regards to balancing duty hour regulations and providing quality patient care. There is a paucity of literature regarding resident perceptions of attending physician actions or attitudes towards work hour restrictions. The purpose of this study was to identify attending physician behaviors that residents perceived as supportive or unsupportive of their compliance with duty hour regulations. METHODS: Focus group interviews were conducted with residents exploring their perceptions of how duty hour regulations impact their interactions with attending physicians. Qualitative analysis identified key themes in residents' experiences interacting with faculty in regard to duty hour regulations. Forty residents from five departments in two hospital systems participated. RESULTS: Discussion of these interactions highlighted that attending physicians demonstrate behaviors that explicitly or implicitly either lend their support and understanding of residents' need to comply with these regulations or imply a lack of support and understanding. Three major themes that contributed to the ease or difficulty in addressing duty hour regulations included attending physicians' explicit communication of expectations, implicit non-verbal and verbal cues and the program's organizational culture. CONCLUSIONS: Resident physicians' perception of attending physicians' explicit and implicit communication and residency programs organization culture has an impact on residents' experience with duty hour restrictions. Residency faculty and programs could benefit from explicitly addressing and supporting the challenges that residents perceive in complying with duty hour restrictions.


Asunto(s)
Internado y Residencia , Cuerpo Médico de Hospitales/psicología , Admisión y Programación de Personal/organización & administración , Médicos/psicología , Calidad de la Atención de Salud/normas , Carga de Trabajo , Actitud del Personal de Salud , Grupos Focales , Humanos , Comunicación Interdisciplinaria , Internado y Residencia/organización & administración , Cultura Organizacional , Admisión y Programación de Personal/normas , Tolerancia al Trabajo Programado/psicología , Carga de Trabajo/psicología
2.
J Prim Care Community Health ; 8(3): 169-175, 2017 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-28606031

RESUMEN

INTRODUCTION: Clinician perceptions of patients with low socioeconomic status (SES) have been shown to affect clinical decision making and health care delivery in this group. However, it is unknown how and if low SES patients perceive clinician bias might affect their health care. METHODS: In-depth interviews with 80 enrollees in a state Medicaid program were analyzed to identify recurrent themes in their perceptions of care. RESULTS: Most subjects perceived that their SES affected their health care. Common themes included treatment provided, access to care, and patient-provider interaction. DISCUSSION: This study highlights complex perceptions patients have around how SES affects their health care. These results offer opportunities to reduce health care disparities through better understanding of their impact on the individual patient-provider relationship. This work may inform interventions that promote health equity via a multifaceted approach, which targets both providers and the health care system as a whole.


Asunto(s)
Actitud Frente a la Salud , Prestación de Atención de Salud , Factores Socioeconómicos , Adulto , Femenino , Accesibilidad a los Servicios de Salud , Disparidades en Atención de Salud , Humanos , Entrevistas como Asunto , Masculino , Persona de Mediana Edad , Relaciones Médico-Paciente , Investigación Cualitativa , Adulto Joven
3.
Patient Educ Couns ; 100(11): 2054-2061, 2017 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-28602566

RESUMEN

The purpose of this paper, based on a 2016 Heidelberg International Conference on Communication in Healthcare (ICCH) plenary presentation, is to examine a key problem in communication skills training for health professional learners. Studies have pointed to a decline in medical students' communication skills and attitudes as they proceed through their education, particularly during their clinical workplace training experiences. This paper explores some of the key factors in this disintegration, drawing on selected literature and highlighting some curriculum efforts and research conducted at the University of Iowa Carver College of Medicine as a case study of these issues. Five key factors contributing to the disintegration of communication skills and attitudes are presented including: 1) lack of formal communication skills training during clinical clerkships; 2) informal workplace teaching failing to explicitly address learner clinical communication skills; 3) emphasizing content over process in relation to clinician-patient interactions; 4) the relationship between ideal communication models and the realities of clinical practice; and 5) clinical teachers' lack of knowledge and skills to effectively teach about communication in the clinical workplace. Within this discussion, potential practical responses by individual clinical teachers and broader curricular and faculty development efforts to address each of these factors are presented.


Asunto(s)
Prácticas Clínicas , Comunicación , Educación de Pregrado en Medicina , Capacitación en Servicio , Aprendizaje , Estudiantes de Medicina/psicología , Lugar de Trabajo , Competencia Clínica , Curriculum , Humanos
4.
Fam Med ; 49(2): 97-105, 2017 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-28218934

RESUMEN

BACKGROUND AND OBJECTIVES: Many medical student-patient encounters occur in the outpatient setting. Conference room staffing (CRS) of student presentations has been the norm in the United States in recent decades. However, this method may not be suitable for outpatient precepting, being inefficient and reducing valuable direct face time between physician and patient. Precepting in the Presence of the Patient (PIPP) has previously been found to be an effective educational model in the outpatient setting but has never been studied in family medicine clinics, nor with non-English speaking patients, nor patients from lower socioeconomic backgrounds with low literacy. METHODS: We used a randomized controlled trial of educational models comparing time spent using PIPP with CRS in two family medicine clinics. Patient, student, and physician satisfaction were also measured using a 5-point Likert scale; total encounter time and time spent precepting were also recorded. RESULTS: PIPP is strongly preferred by attending physicians while patients and students were equally satisfied with either precepting method. PIPP provides an additional 3 minutes of physician-patient face time (17.39 versus 14.08 minutes) in an encounter that is overall shortened by 2 minutes (17.39 versus 19.71 minutes). CONCLUSIONS: PIPP is an effective method for precepting medical students in family medicine clinics, even with non-English speaking patients and those with low literacy. Given the time constraints of family physicians, PIPP should be considered as a preferred, time-efficient method for training medical students that is well received by patients, students, and particularly by physicians.


Asunto(s)
Medicina Familiar y Comunitaria/educación , Preceptoría/métodos , Estudiantes de Medicina/psicología , Adulto , Atención Ambulatoria , Femenino , Humanos , Masculino , Persona de Mediana Edad , Satisfacción del Paciente , Relaciones Médico-Paciente , Médicos de Familia/psicología , Factores de Tiempo , Estados Unidos
5.
Fam Med ; 48(6): 445-51, 2016 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-27272421

RESUMEN

BACKGROUND AND OBJECTIVES: Communication skills are essential to medical training and have lasting effects on patient satisfaction and adherence rates. However, relatively little is reported in the literature identifying how communication is taught in the context of residency education. Our goal was to determine current practices in communication curricula across family medicine residency programs. METHODS: Behavioral scientists and program directors in US family medicine residencies were surveyed via email and professional organization listservs. Questions included whether programs use a standardized communication model, methods used for teaching communication, hours devoted to teaching communication, as well as strengths and areas for improvement in their program. Analysis identified response frequencies and ranges complemented by analysis of narrative comments. RESULTS: A total of 204 programs out of 458 family medicine residency training sites responded (45%), with 48 out of 50 US states represented. The majority of respondents were behavioral scientists. Seventy-five percent of programs identified using a standard communication model; Mauksch's patient-centered observation model (34%) was most often used. Training programs generally dedicated more time to experiential teaching methods (video review, work with simulated patients, role plays, small groups, and direct observation of patient encounters) than to lectures (62% of time and 24% of time, respectively). The amount of time dedicated to communication education varied across programs (average of 25 hours per year). Respondent comments suggest that time dedicated to communication education and having a formal curriculum in place are most valued by educators. CONCLUSIONS: This study provides a picture of how communication skills teaching is conducted in US family medicine residency programs. These findings can provide a comparative reference and rationale for residency programs seeking to evaluate their current approaches to communication skills teaching and develop new or enhanced curricula.


Asunto(s)
Comunicación , Curriculum , Medicina Familiar y Comunitaria/educación , Internado y Residencia , Ciencias de la Conducta/métodos , Educación de Postgrado en Medicina , Humanos , Internet , Relaciones Médico-Paciente , Encuestas y Cuestionarios , Estados Unidos
6.
J Surg Educ ; 73(6): 1072-1076, 2016 Nov - Dec.
Artículo en Inglés | MEDLINE | ID: mdl-27316383

RESUMEN

OBJECTIVE: The purpose of this study was to evaluate surgical preparation methods of medical students, residents, and faculty with special attention to video usage. DESIGN: Following Institutional Review Board approval, anonymous surveys were distributed to participants. Information collected included demographics and surgical preparation methods, focusing on video usage. Participants were questioned regarding frequency and helpfulness of videos, video sources used, and preferred methods between videos, reading, and peer consultation. Statistical analysis was performed using SAS. SETTING: Surveys were distributed to participants in the Department of Surgery at the University of Iowa Hospitals and Clinics, a tertiary care center in Iowa City, Iowa. PARTICIPANTS: Survey participants included fourth-year medical students pursuing general surgery, general surgery residents, and faculty surgeons in the Department of Surgery. A total of 86 surveys were distributed, and 78 surveys were completed. This included 42 learners (33 residents, 9 fourth-year medical students) and 36 faculty. RESULTS: The overall response rate was 91%; 90% of respondents reported using videos for surgical preparation (learners = 95%, faculty = 83%, p = NS). Regarding surgical preparation methods overall, most learners and faculty selected reading (90% versus 78%, p = NS), and fewer respondents reported preferring videos (64% versus 44%, p = NS). Faculty more often use peer consultation (31% versus 50%, p < 0.02). Among respondents who use videos (N = 70), the most used source was YouTube (86%). Learners and faculty use different video sources. Learners use YouTube and Surgical Council on Resident Education (SCORE) Portal more than faculty (YouTube: 95% versus 73%, p < 0.02; SCORE: 25% versus 7%, p < 0.05). Faculty more often use society web pages and commercial videos (society: 67% versus 38%, p < 0.03; commercial: 27% versus 5%, p < 0.02). CONCLUSIONS: Most respondents reported using videos to prepare for surgery. YouTube was the preferred source. Posting surgical videos to YouTube may allow for maximal access to learners who are preparing for surgical cases.


Asunto(s)
Competencia Clínica , Cirugía General/educación , Difusión de la Información/métodos , Medios de Comunicación Sociales/estadística & datos numéricos , Grabación en Video/estadística & datos numéricos , Adulto , Distribución de Chi-Cuadrado , Estudios Transversales , Educación de Postgrado en Medicina/métodos , Educación de Pregrado en Medicina/métodos , Femenino , Humanos , Internado y Residencia/estadística & datos numéricos , Iowa , Masculino , Cuerpo Médico de Hospitales/estadística & datos numéricos , Estudiantes de Medicina/estadística & datos numéricos , Encuestas y Cuestionarios
7.
Acad Med ; 90(1): 94-9, 2015 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-25099242

RESUMEN

PURPOSE: To investigate what criteria medical students would value and use in assessing teaching skills. METHOD: Fourth-year medical students at the University of Iowa Carver College of Medicine enrolled in a teaching elective course are required to design and use an evaluation instrument to assess effective teaching. Each class uses a similar process in developing their instruments. Since the first class in spring 2007, 193 medical students have created 36 different instruments. Three faculty evaluation experts conducted a thematic analysis of the instruments and coded the information according to what was being evaluated and what types of ratings were indicated. The data were submitted to a fourth faculty reviewer, who synthesized the information and adjusted the codes to better capture the data. Common themes and categories were detected. RESULTS: Four themes were identified: content (instructor knowledgeable, teaches at level of learner, practical information), learning environment, teacher personal attributes, and teaching methods. Thirty-two descriptors were distinguished across the 36 instruments. Thirteen descriptors were present in 50% or more of the instruments. The most common rating systems were Likert scales and open comments. CONCLUSIONS: Fourth-year medical students can offer an eclectic resource for evaluating teaching in the classroom and the clinic. Using the descriptors that were identified in greater than 50% of the evaluation instruments will provide effective measures that can be incorporated into medical teacher evaluation instruments.


Asunto(s)
Estudios de Evaluación como Asunto , Docentes Médicos/normas , Estudiantes de Medicina , Enseñanza/normas , Educación de Pregrado en Medicina , Humanos , Iowa
8.
Patient Educ Couns ; 91(1): 85-90, 2013 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-23154147

RESUMEN

OBJECTIVE: In many medical schools, formal training in clinical communication skills (CCS) mainly occurs during pre-clinical training prior to clinical rotations. The current research examined student perceptions of both what and how they learn about CCS during clinical rotations. METHODS: During 2008 and 2009, 4th year medical students were invited to participate in interviews focused on learning of CCS during clinical rotations. Interview transcripts were analyzed to identify salient themes in their discussions of CCS in clinical learning experiences. RESULTS: 107 senior students participated and reported learning CCS during clinical rotations mainly by: (1) observing faculty and residents; (2) conducting interviews themselves; and (3) through feedback on patient presentations. Teacher role modeling tended to not reinforce what they had learned pre-clinically about CCS and clinical teachers rarely discussed CCS. Feedback on patient presentations affected students' communication styles, at times prompting them to omit use of CCS they had learned pre-clinically. CONCLUSIONS: Students reported that clinical learning experiences often do not reinforce the CCS they learn pre-clinically. PRACTICAL IMPLICATIONS: Disconnects between pre-clinical and clinical CCS teaching need to be reconciled through more explicit pedagogical attention to CCS issues during clinical rotations both in the formal and informal curriculum.


Asunto(s)
Conducta de Elección , Encuestas y Cuestionarios , Humanos , Masculino , Escritura
9.
J Med Ethics ; 38(2): 130-2, 2012 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-21947811

RESUMEN

BACKGROUND: Education in ethics and professionalism should reflect the realities medical students encounter in the hospital and clinic. METHOD: We performed content analyses on Case Observation and Assessments (COAs) written by third-year medical students about ethical and professional issues encountered during their internal medicine and paediatrics clinical clerkships. RESULTS: A cohort of 141 third-year medical students wrote 272 COAs. Content analyses identified 35 subcategories of ethical and professional issues within 7 major domains: decisions regarding treatment (31.4%), communication (21.4%), professional duties (18.4%), justice (9.8%), student-specific issues (5.4%), quality of care (3.8%), and miscellaneous (9.8%). CONCLUSIONS: Students encountered a wide variety of ethical and professional issues that can be used to guide pre-clinical and clinical education. Comparison of our findings with results from similar studies suggests that the wording of an assignment (specifying "ethical" issues, "professional" issues, or both) may influence the kinds of issues students identify in their experience-based clinical narratives.


Asunto(s)
Prácticas Clínicas , Ética Médica/educación , Competencia Profesional/normas , Prácticas Clínicas/ética , Estudios de Cohortes , Curriculum , Educación de Pregrado en Medicina/normas , Humanos , Medicina Interna/educación , Estudiantes de Medicina
10.
J Elder Abuse Negl ; 24(1): 17-36, 2012.
Artículo en Inglés | MEDLINE | ID: mdl-22206510

RESUMEN

The purpose of this study was to explore health care professionals' perspectives on elder abuse to achieve a better understanding of the problems of reporting and to generate ideas for improving the detection and reporting process. Through a mailed survey, nurses, physicians, and social workers were invited to participate in an interview. Nine nurses, 8 physicians, and 6 social workers were interviewed, and thematic analysis was used to identify the following core themes: preconceptions, assessment, interpretation, systems, and knowledge and education. Participants suggested a reorganization of the external reporting system. More frequent and pragmatic education is necessary to strengthen practical knowledge about elder abuse.


Asunto(s)
Maltrato al Anciano/diagnóstico , Personal de Salud , Atención Primaria de Salud , Anciano , Maltrato al Anciano/estadística & datos numéricos , Femenino , Encuestas de Atención de la Salud , Humanos , Masculino , Notificación Obligatoria
11.
J Grad Med Educ ; 3(3): 302-8, 2011 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-22942953

RESUMEN

INTRODUCTION: The increased demand for clinician-educators in academic medicine necessitates additional training in educational skills to prepare potential candidates for these positions. Although many teaching skills training programs for residents exist, there is a lack of reports in the literature evaluating similar programs during fellowship training. AIM: To describe the implementation and evaluation of a unique program aimed at enhancing educational knowledge and teaching skills for subspecialty medicine fellows and chief residents. SETTING: Fellows as Clinician-Educators (FACE) program is a 1-year program open to fellows (and chief residents) in the Department of Internal Medicine at the University of Iowa. PROGRAM DESCRIPTION: The course involves interactive monthly meetings held throughout the academic year and has provided training to 48 participants across 11 different subspecialty fellowships between 2004 and 2009. PROGRAM EVALUATION: FACE participants completed a 3-station Objective Structured Teaching Examination using standardized learners, which assessed participants' skills in giving feedback, outpatient precepting, and giving a mini-lecture. Based on reviews of station performance by 2 independent raters, fellows demonstrated statistically significant improvement on overall scores for 2 of the 3 cases. Participants self-assessed their knowledge and teaching skills prior to starting and after completing the program. Analyses of participants' retrospective preassessments and postassessments showed improved perceptions of competence after training. CONCLUSION: The FACE program is a well-received intervention that objectively demonstrates improvement in participants' teaching skills. It offers a model approach to meeting important training skills needs of subspecialty medicine fellows and chief residents in a resource-effective manner.

12.
Teach Learn Med ; 20(3): 218-24, 2008 Jul-Sep.
Artículo en Inglés | MEDLINE | ID: mdl-18615295

RESUMEN

BACKGROUND: This prospective randomized controlled study examined outpatient clinical teaching in the presence of the patient. METHODS: In 2006, patients in ambulatory internal medicine clinics at the University of Iowa were randomized to have faculty-learner presentations either in their presence or in the conference room. Staffing encounters were timed and faculty, learners and patients completed postencounter surveys. RESULTS: Participation included 254 patients and 12 faculty. Comparison of patient encounters randomized to exam room (n = 120) or conference room (n = 134) staffing demonstrated increased time spent with the patient in exam room staffing (91% vs. 54% of total staffing time; p < .0001) but no significant differences in mean total staffing time. Patients, learners, and faculty preferred exam room staffing. CONCLUSIONS: Concerns about time efficiency and patient and learner satisfaction during exam room staffing were not supported. This approach may allow attending physicians to maximize billing levels while increasing learner/patient involvement.


Asunto(s)
Educación Médica/métodos , Medicina Interna/educación , Evaluación de Resultado (Atención de Salud) , Admisión y Programación de Personal , Examen Físico , Atención Ambulatoria , Competencia Clínica , Encuestas de Atención de la Salud , Humanos , Iowa , Satisfacción del Paciente , Relaciones Médico-Paciente , Estudios Prospectivos
13.
J Surg Res ; 147(2): 225-8, 2008 Jun 15.
Artículo en Inglés | MEDLINE | ID: mdl-18440027

RESUMEN

BACKGROUND: Lectures are common in surgical clerkships, although faculty members rarely are trained in this skill. Previous authors have addressed the impact of lecture format, length, etc. on post-test performance, but little work has addressed students' free recall of information. This study was designed to explore what junior surgery students recall in relation to faculty objectives and lecture ratings. METHODS: Prior to surgery clerkship teaching sessions, faculty submitted three to six learning objectives. Immediately following these sessions, students completed lecture evaluations and described three to six concepts they learned. These qualitative data were coded as "general, specific," or "very specific," and categorized according to aspects such as "Treatment, Work-Up, Basic Science," etc. Student-derived themes and session ratings were analyzed relative to faculty objectives. RESULTS: Students provided 16-79 surveys for each of 10 faculty members, whose lecture ratings ranged from 4.9 to 6.1 on a scale of 7. Most of the 1818 statements were "very specific" or "specific" rather than "general" (14.4%). Students commonly recalled concepts related to treatment (28.6%), indications (12.1%), work-up (11.9%), basic science (9.5%), and prognosis/course of disease (9.2%). Four to 10 themes (mean 8, median 7, and mode 7) emerged for each lecture. The percentage of concepts provided by faculty that emerged from student themes (congruence) ranged from 50% to 100%. CONCLUSIONS: Surgery students freely recalled 50% to 100% of faculty teaching objectives, and the degree of congruence was loosely linked to lecture ratings. Future research is warranted regarding what influences congruence between faculty objectives and student recall.


Asunto(s)
Educación de Pregrado en Medicina/estadística & datos numéricos , Cirugía General/educación , Recuerdo Mental , Enseñanza/estadística & datos numéricos
14.
Perm J ; 12(2): 36-41, 2008.
Artículo en Inglés | MEDLINE | ID: mdl-21364810

RESUMEN

INTRODUCTION: This paper examines the use of reflective writing in a preclinical end-of-life curriculum including comparison of the role and outcomes of out-of-class (OC) versus in-class (IC) writing. METHODS: Learners were required to complete one-page essays on their experiences and concerns about death and dying after attending a series of end-of-life care lectures. From 2002-2005, essays were completed OC and in 2006 and 2007 essays were completed during the first ten minutes of small group discussion sessions. Essays were collected and analyzed for salient themes. RESULTS: Between 2002-2007, reflection essays were gathered from 829 learners, including 522 OC essays and 307 IC essays. Essay analysis identified four major themes of student concerns related to caring for dying patients, as well as student reactions to specific curricular components and to the use of reflection. IC essays were shorter and less polished than OC essays but utilized a wider variety of formats including poems and bulleted lists. IC essays tended to react to lecture content immediately preceding the writing exercise whereas OC varied in curricular components upon which they focused. OC essays have the advantage of giving learners more time to choose subject matter, whereas IC essays provide a structured time in which to actively reflect. Both formats served as catalysts for small group discussions. DISCUSSION: Writing exercises can effectively provide an important opportunity and motivation for learners to reflect on past experiences and future expectations related to providing end-of-life care.

15.
Mil Med ; 172(6): 565-71, 2007 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-17615833

RESUMEN

The objective of the study was to examine veterans' perceptions of problems and benefits of outsourcing inpatient care from Veterans Affairs (VA) hospitals to private sector hospitals. Primary data were collected from a cross-section of 42 veterans who were VA users and nonusers using focus groups. Focus group discussion examined reasons patients use VA care, differences between VA and civilian care, positive and negative impacts of outsourcing, and special needs of veterans. Analyses revealed five domains related both to use of VA services and perceptions of outsourcing: costs, access, quality of care, contract (i.e., a covenant between veterans and the U.S. government), veteran milieu, and special needs. Participants identified a variety of potential positive and negative impacts. In general, veterans perceived more advantages than disadvantages to outsourcing VA care but still expressed significant concerns related to outsourcing. These issues should be considered in the development of future policy toward outsourcing VA care to the private sector.


Asunto(s)
Hospitales Privados/estadística & datos numéricos , Hospitales de Veteranos/organización & administración , Servicios Externos , Aceptación de la Atención de Salud , Veteranos/psicología , Adulto , Anciano , Anciano de 80 o más Años , Estudios Transversales , Femenino , Grupos Focales , Accesibilidad a los Servicios de Salud , Hospitales Privados/normas , Hospitales de Veteranos/estadística & datos numéricos , Humanos , Entrevistas como Asunto , Masculino , Persona de Mediana Edad , Calidad de la Atención de Salud , Estados Unidos , United States Department of Veterans Affairs
16.
Acad Med ; 82(5): 508-15, 2007 May.
Artículo en Inglés | MEDLINE | ID: mdl-17457076

RESUMEN

PURPOSE: In 1999, the University of Iowa Roy J. and Lucille A. Carver College of Medicine (UICCOM) established a student management model consisting of four student-style learning communities (LCs), each comprising one quarter of the students from each class, with the goal of fostering student connection, excellence, learning, leadership, and service. The authors present results of a prospective evaluation of medical students' perceptions of emerging LCs and their impact on medical student life at UICCOM. METHOD: A two-page questionnaire, administered in 1999 and again in 2003 to all second-through fourth-year and MD/PhD students, assessed connections among students from different years of study, students' participation in activities, anticipated/perceived benefits of LCs, concerns about LCs, and the impact of LCs on students' perceptions of the learning environment. Questions were open ended or Likert scaled; statistical analyses were descriptive, parametric, and nonparametric. RESULTS: Comparison of results between 1999 and 2003 demonstrated increased connections between students and participation in LC activities, positive perceptions of the overall learning environment, increased access to faculty and staff, and increased involvement in leadership and service activities. Student concerns included continued obstacles to involvement in LCs for third- and fourth-year students. CONCLUSIONS: This prospective evaluation demonstrates that LCs can contribute to more positive perceptions of the learning environment and increased interaction between students throughout medical school. LCs seem to increase student leadership development and engagement in the broader community. Further investigation is needed to determine how these potential benefits of LCs can be maximized and made more accessible to all students.


Asunto(s)
Actitud , Educación de Pregrado en Medicina/métodos , Aprendizaje , Modelos Educacionales , Psicología Social , Facultades de Medicina/normas , Estudiantes de Medicina/psicología , Humanos , Iowa , Liderazgo , Estudios Prospectivos , Medio Social , Identificación Social , Encuestas y Cuestionarios
17.
J Am Med Inform Assoc ; 14(4): 407-14, 2007 Jul-Aug.
Artículo en Inglés | MEDLINE | ID: mdl-17460122

RESUMEN

OBJECTIVE: To describe the characteristics of unanswered clinical questions and propose interventions that could improve the chance of finding answers. DESIGN: In a previous study, investigators observed primary care physicians in their offices and recorded questions that arose during patient care. Questions that were pursued by the physician, but remained unanswered, were grouped into generic types. In the present study, investigators attempted to answer these questions and developed recommendations aimed at improving the success rate of finding answers. MEASUREMENTS: Frequency of unanswered question types and recommendations to increase the chance of finding answers. RESULTS: In an earlier study, 48 physicians asked 1062 questions during 192 half-day office observations. Physicians could not find answers to 237 (41%) of the 585 questions they pursued. The present study grouped the unanswered questions into 19 generic types. Three types accounted for 128 (54%) of the unanswered questions: (1) "Undiagnosed finding" questions asked about the management of abnormal clinical findings, such as symptoms, signs, and test results (What is the approach to finding X?); (2) "Conditional" questions contained qualifying conditions that were appended to otherwise simple questions (What is the management of X, given Y? where "given Y" is the qualifying condition that makes the question difficult.); and (3) "Compound" questions asked about the association between two highly specific elements (Can X cause Y?). The study identified strategies to improve clinical information retrieval, listed below. CONCLUSION: To improve the chance of finding answers, physicians should change their search strategies by rephrasing their questions and searching more clinically oriented resources. Authors of clinical information resources should anticipate questions that may arise in practice, and clinical information systems should provide clearer and more explicit answers.


Asunto(s)
Atención al Paciente , Médicos , Atención Primaria de Salud , Comunicación , Humanos , Almacenamiento y Recuperación de la Información , Obras Médicas de Referencia
18.
Acad Med ; 81(11): 965-8, 2006 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-17065857

RESUMEN

The University of Iowa Teaching Scholars Program was initiated in 1999 at the University of Iowa Carver College of Medicine (CCOM) with the overall goal of promoting leadership in faculty development related to teaching skills. Specific goals of this program are (1) to promote the development of a cadre of faculty members who have the skills to implement faculty development within their departments and the CCOM; (2) to increase departmental involvement in faculty development efforts; (3) to increase resources available for dissemination of college-wide faculty development efforts; and (4) to acknowledge the extra effort faculty put into developing their skills and knowledge in medical education and in providing continuing education to their faculty colleagues. All clinical and basic science departments in the CCOM are given the opportunity to have a faculty member participate in the program. Unlike other programs reported in the literature, competitive decisions for program participation are made at the departmental level. The three-year program combines monthly meetings and other activities to train faculty to provide faculty development in teaching skills. Each scholar develops and implements a project to address departmental faculty development needs as well as needs of other departments in the CCOM. To date (2006), 50 faculty members from 19 different departments have participated in the program with an average of 12 scholars per class. The program has resulted in a substantial increase in departmental and college-wide faculty development programming and has had a positive impact on individual scholars' teaching skills and leadership roles.


Asunto(s)
Educación de Postgrado en Medicina/métodos , Docentes Médicos/normas , Becas , Liderazgo , Desarrollo de Programa , Facultades de Medicina/organización & administración , Desarrollo de Personal/métodos , Curriculum , Docentes Médicos/provisión & distribución , Humanos , Iowa , Estudios de Casos Organizacionales , Competencia Profesional , Evaluación de Programas y Proyectos de Salud , Gestión de la Calidad Total
19.
Fam Med ; 38(7): 476-82, 2006 Jul-Aug.
Artículo en Inglés | MEDLINE | ID: mdl-16823672

RESUMEN

BACKGROUND AND OBJECTIVES: Effective management of patients with medically unexplained symptoms may be influenced by physicians' goals. This study's objective was to identify physicians' goals for managing primary care patients with unexplained symptoms. METHODS: This was a qualitative study of patients and clinicians from primary care clinics in Iowa and Illinois. Interviews were conducted with 47 patients who had unexplained symptoms and the 36 primary care clinicians who managed them. The interviews were transcribed and coded independently by two investigators. Categories for coding responses were derived from the data and the literature. RESULTS: Eleven goals were identified and grouped into four classes based on whether they were disease centered, patient centered, society centered, or clinician centered. The three goals most commonly held by patients were patient centered: clinician support (62%), functional improvement (45%), and patient coping (43%). The most common clinician goals were symptom alleviation (38%), patient coping (32%), and functional improvement (30%). Only one clinician (2%) cited making the patient feel supported as a goal. CONCLUSIONS: The goals of clinician support and patient coping appear to have value to patients beyond being means for achieving symptom alleviation. Although receiving physician support is an important goal for patients, it was not a commonly recognized goal by physicians. Clearly identified management goals may improve the care of patients with medically unexplained symptoms and help clinicians achieve greater satisfaction with the management of these patients.


Asunto(s)
Metas , Médicos de Familia , Atención Primaria de Salud/métodos , Adaptación Psicológica , Adulto , Anciano , Anciano de 80 o más Años , Instituciones de Atención Ambulatoria , Femenino , Humanos , Entrevistas como Asunto , Iowa , Masculino , Persona de Mediana Edad , Satisfacción del Paciente , Atención Dirigida al Paciente
20.
Med Teach ; 28(2): 180-2, 2006 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-16707301

RESUMEN

Responding to patients' emotions has been identified as a core skill in medical interviewing. To give medical students realistic practice in responding to patients' emotions, an exercise was initiated in which simulated patient (SP) cases were developed in collaboration with SPs. Small groups were visited by two SPs, who portray emotional scenarios based on symptoms for which they had previously sought a doctor's care or considered seeking care. SPs also identified circumstances that would provoke emotional reactions for their case. Students and facilitators rated this activity highly. Benefits included more realistic case portrayals, less training time for SPs and more efficient use of SPs.


Asunto(s)
Educación de Pregrado en Medicina/métodos , Emociones , Entrevistas como Asunto , Simulación de Paciente , Pacientes/psicología , Estudiantes de Medicina , Retroalimentación , Procesos de Grupo , Humanos
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