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1.
Med Educ Online ; 24(1): 1649571, 2019 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-31389770

RESUMEN

Background: Professional identity formation (PIF), a foundational process in becoming a physician, includes establishment of values, moral principles, and self-awareness. The purpose of this report is to examine challenges in establishing the validity of measures of identity fusion as one facet of PIF. Method: Utilizing the modern approach of validity as a unitary concept, the authors generated six hypotheses to examine the evidence for the construct validity of the scores of Physician Professional Identity (PPI) and Identity Integration (IdIn), considering relationships of these measures with each other, year of training and data from a larger survey. Results: Responses from 3473 students at 8 medical schools revealed a weak association between the measures with distributions varying by cohort. PPI had a stronger relationship to cohort and IdIn was moderately associated with students' attitudes relevant to social media use. Responses were independent of response format and evidence supported the interpretation of scores for IdIn as indications of integration of identity. Discussion : Sufficient evidence was found to suggest that these measures assess aspects of PIF. Use of these measures as part of a multidimensional, longitudinal approach to refining understanding of the construct of PIF and developing effective assessment strategies.

2.
MedEdPORTAL ; 15: 10791, 2019 01 04.
Artículo en Inglés | MEDLINE | ID: mdl-30800991

RESUMEN

Introduction: The science of patient safety demonstrates that good communication is essential for effective interprofessional collaboration. Methods: We created a low-stakes, formative assessment with which medical students, pharmacy students, and nursing students could practice several of the Interprofessional Education Collaborative competencies. We aimed to enable students to practice collaborative care, respect for other disciplines, and shared accountability. Senior students from medicine, nursing, and pharmacy worked in teams to disclose a medical error to a standardized patient. The activity began with an icebreaker exercise wherein students learned about each other. Next, each team planned a strategy for error disclosure and collaboratively disclosed the error. Standardized patients evaluated the team's performance. Subsequently, students regrouped for a debriefing. The participating institutions administered a survey to their students. Results: In total, 1,151 students participated: 464 fourth-year students from the University of Houston College of Pharmacy, 450 third- and fourth-year students from Baylor College of Medicine, and 237 fourth-year students from Texas Woman's University Nelda C. Stark College of Nursing, all in Houston, Texas. Postsession survey data showed that students thought they achieved the relevant competencies. Students' understanding of the perspectives of the other two disciplines improved. Students found the simulation encounter and debriefing effective in helping them consider the contributions of other disciplines to patient care. Discussion: This interprofessional standardized patient activity enabled collaborative problem solving. The debriefing discussion broadened students' understanding of the expertise of the other disciplines and promoted shared accountability. Students found this activity engaging and effective.

3.
Healthcare (Basel) ; 5(3)2017 Aug 04.
Artículo en Inglés | MEDLINE | ID: mdl-28777345

RESUMEN

Metaphor helps humans understand complex concepts by "mapping" them onto accessible concepts. The purpose of this study was to investigate the effects of using jazz as a metaphor to teach senior medical students improvisational communication skills, and to understand student learning experiences. The authors designed a month-long course that used jazz to teach improvisational communication. A sample of fourth-year medical students (N = 30) completed the course between 2011 and 2014. Evaluation consisted of quantitative and qualitative data collected pre- and post-course, with comparison to a concurrent control group on some measures. Measures included: (a) Student self-reports of knowledge and ability performing communicative tasks; (b) blinded standardized patient assessment of students' adaptability and quality of listening; and (c) qualitative course evaluation data and open-ended interviews with course students. Compared to control students, course students demonstrated statistically significant and educationally meaningful gains in adaptability and listening behaviors. Students' course experiences suggested that the jazz components led to high engagement and creativity, and provided a model to guide application of improvisational concepts to their own communication behaviors. Metaphor proved to be a powerful tool in this study, partly through enabling increased reflection and decreased resistance to behaviors that, on the surface, tended to run counter to generally accepted norms. The use of jazz as a metaphor to teach improvisational communication warrants further refinement and investigation.

4.
Med Educ Online ; 22(1): 1289315, 2017.
Artículo en Inglés | MEDLINE | ID: mdl-28219315

RESUMEN

BACKGROUND: Accrediting bodies require medical schools to teach patient safety and residents to develop teaching skills in patient safety. We created a patient safety course in the preclinical curriculum and used continuous quality improvement to make changes over time. OBJECTIVE: To assess the impact of resident teaching on student perceptions of a Patient Safety course. DESIGN: Using the Institute for Healthcare Improvement patient safety curriculum as a frame, the course included the seven IHI modules, large group lectures and small group facilitated discussions. Applying a social action methodology, we evaluated the course for four years (Y1-Y4). RESULTS: In Y1, Y2, Y3 and Y4, we distributed a course evaluation to each student (n = 184, 189, 191, and 184, respectively) and the response rate was 96, 97, 95 and 100%, respectively. Overall course quality, clarity of course goals and value of small group discussions increased in Y2 after the introduction of residents as small group facilitators. The value of residents and the overall value of the course increased in Y3 after we provided residents with small group facilitation training. CONCLUSIONS: Preclinical students value the interaction with residents and may perceive the overall value of a course to be improved based on near-peer involvement. Residents gain valuable experience in small group facilitation and leadership.


Asunto(s)
Educación de Pregrado en Medicina/métodos , Seguridad del Paciente , Grupo Paritario , Competencia Clínica , Curriculum , Educación de Pregrado en Medicina/normas , Humanismo , Humanos , Internado y Residencia , Mejoramiento de la Calidad , Rol , Estudiantes de Medicina , Enseñanza
5.
Fam Med ; 48(4): 294-9, 2016 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-27057608

RESUMEN

BACKGROUND AND OBJECTIVES: Reflection after patient encounters is an important aspect of clinical learning. After our medical school instituted a reflection paper assignment for all clerkships, we wanted to learn about the types of encounters that students found meaningful on a family medicine clerkship and how they impacted students' learning. METHODS: Family and Community Medicine Clerkship students completed a reflection paper after the clerkship, based on guidelines that were used for all clerkship reflection papers at our medical school. Two reviewers independently organized student responses into themes and then jointly prioritized common themes and negotiated any initial differences into other themes. RESULTS: A total of 272 reflection papers describing an actual learning moment in patient care were submitted during the study period of January 2011--December 2012. In describing actions performed, students most frequently wrote about aspects of patient-centered care such as listening to the patient, carefully assessing the patient's condition, or giving a detailed explanation to the patient. In describing effects of those actions, students wrote about what they learned about the patient-physician interaction, the trust that patients demonstrated in them, the approval they gained from their preceptors, and the benefits they saw from their actions. CONCLUSIONS: An important contribution of a family medicine clerkship is the opportunity for students to further their skills in patient-centered care and realize the outcomes of providing that type of care.


Asunto(s)
Prácticas Clínicas , Medicina Familiar y Comunitaria/educación , Relaciones Médico-Paciente , Estudiantes de Medicina , Competencia Clínica , Humanos , Aprendizaje , Educación del Paciente como Asunto , Atención Dirigida al Paciente , Estudiantes de Medicina/psicología , Evaluación de Síntomas , Confianza
6.
Med Educ ; 50(3): 320-31, 2016 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-26896017

RESUMEN

CONTEXT: A rich literature describes many innovative uses of the arts in professional education. However, arts-based teaching tends to be idiosyncratic, depending on the interests and enthusiasm of individual teachers, rather than on strategic design decisions. An overarching framework is needed to guide implementation of arts-based teaching in medical education. The objective of this study was to review and synthesise the literature on arts-based education and provide a conceptual model to guide design, evaluation and research of the use of the arts in medical education. METHODS: A systematic literature review using the PubMed and ERIC databases. Search terms included humanism, art, music, literature, teaching, education, learning processes, pedagogy and curriculum. We selected empirical studies and conceptual articles about the use of creative arts, imagery and symbolism in the context of professional education. Data synthesis involved a qualitative content analysis of 49 included articles, identifying themes related to educational characteristics, processes and outcomes in arts-based education. RESULTS: Four common themes were identified describing (i) unique qualities of the arts that promote learning, (ii) particular ways learners engage with art, (iii) documented short- and long-term learning outcomes arising from arts-based teaching and (iv) specific pedagogical considerations for using the arts to teach in professional education contexts. CONCLUSIONS: The arts have unique qualities that can help create novel ways to engage learners. These novel ways of engagement can foster learners' ability to discover and create new meanings about a variety of topics, which in turn can lead to better medical practice. At each of these steps, specific actions by the teacher can enhance the potential for learners to move to the next step. The process can be enhanced when learners participate in the context of a group, and the group itself can undergo transformative change. Future work should focus on using this model to guide process design and outcome measurement in arts-based education.


Asunto(s)
Arte , Educación Médica/métodos , Aprendizaje , Música , Competencia Clínica , Curriculum , Humanismo
7.
Acad Med ; 91(5): 730-42, 2016 05.
Artículo en Inglés | MEDLINE | ID: mdl-26796091

RESUMEN

PURPOSE: Behavioral and social science (BSS) competencies are needed to provide quality health care, but psychometrically validated measures to assess these competencies are difficult to find. Moreover, they have not been mapped to existing frameworks, like those from the Liaison Committee on Medical Education (LCME) and Accreditation Council for Graduate Medical Education (ACGME). This systematic review aimed to identify and evaluate the quality of assessment tools used to measure BSS competencies. METHOD: The authors searched the literature published between January 2002 and March 2014 for articles reporting psychometric or other validity/reliability testing, using OVID, CINAHL, PubMed, ERIC, Research and Development Resource Base, SOCIOFILE, and PsycINFO. They reviewed 5,104 potentially relevant titles and abstracts. To guide their review, they mapped BSS competencies to existing LCME and ACGME frameworks. The final included articles fell into three categories: instrument development, which were of the highest quality; educational research, which were of the second highest quality; and curriculum evaluation, which were of lower quality. RESULTS: Of the 114 included articles, 33 (29%) yielded strong evidence supporting tools to assess communication skills, cultural competence, empathy/compassion, behavioral health counseling, professionalism, and teamwork. Sixty-two (54%) articles yielded moderate evidence and 19 (17%) weak evidence. Articles mapped to all LCME standards and ACGME core competencies; the most common was communication skills. CONCLUSIONS: These findings serve as a valuable resource for medical educators and researchers. More rigorous measurement validation and testing and more robust study designs are needed to understand how educational strategies contribute to BSS competency development.


Asunto(s)
Ciencias de la Conducta/educación , Educación de Postgrado en Medicina/normas , Educación de Pregrado en Medicina/normas , Evaluación Educacional/métodos , Ciencias Sociales/educación , Competencia Clínica/normas , Evaluación Educacional/normas , Humanos , Psicometría , Reproducibilidad de los Resultados , Estados Unidos
8.
J Palliat Med ; 16(11): 1342-9, 2013 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-23937062

RESUMEN

BACKGROUND: Medical education leaders have called for a curriculum that proactively teaches knowledge, skills, and attitudes required for professional practice and have identified professionalism as a competency domain for medical students. Exposure to palliative care (PC), an often deeply moving clinical experience, is an optimal trigger for rich student reflection, and students' reflective writings can be explored for professional attitudes. OBJECTIVE: Our aim was to evaluate the merit of using student reflective writing about a PC clinical experience to teach and assess professionalism. METHODS: After a PC patient visit, students wrote a brief reflective essay. We explored qualitatively if/how evidence of students' professionalism was reflected in their writing. Five essays were randomly chosen to develop a preliminary thematic structure, which then guided analysis of 30 additional, randomly chosen essays. Analysts coded transcripts independently, then collaboratively, developed thematic categories, and selected illustrative quotes for each theme and subtheme. RESULTS: Essays revealed content reflecting more rich information about students' progress toward achieving two professionalism competencies (demonstrating awareness of one's own perspectives and biases; demonstrating caring, compassion, empathy, and respect) than two others (displaying self-awareness of performance; recognizing and taking actions to correct deficiencies in one's own behavior, knowledge, and skill). CONCLUSIONS: Professional attitudes were evident in all essays. The essays had limited use for formal summative assessment of professionalism competencies. However, given the increasing presence of PC clinical experiences at medical schools nationwide, we believe this assessment strategy for professionalism has merit and deserves further investigation.


Asunto(s)
Educación de Pregrado en Medicina , Cuidados Paliativos , Competencia Profesional , Estudiantes de Medicina/psicología , Escritura , Adulto , Curriculum , Empatía , Femenino , Humanos , Masculino
10.
Med Teach ; 35(4): e1082-9, 2013 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-23102159

RESUMEN

BACKGROUND: To reduce cognitive dissonance about one's beliefs or behavior, individuals may compare their behavior to personal and/or normative standards. The details of this reflection process are unclear. AIMS: We examined how medical students compare their behavior or beliefs to standards in discussions about implicit bias, and explored if and how different reflective pathways (preserving vs. reconciling) are associated with each standard. METHODS: Third-year students engaged in a small-group discussion about bias. Some students and group facilitators also participated in a debriefing about the experience. Using qualitative methods, the transcripts from these 11 sessions were analyzed for evidence of student comparison to a standard and of reflection pathways. RESULTS: Of 557 text units, 75.8% could be coded with a standard and/or a path of reflection. Students referenced personal and normative standards about equally, and preserved or reconciled existing beliefs about equally. Uses of normative standards were associated with preservation-type reflection, and uses of personal standards with reconciliation-type reflection. CONCLUSIONS: Normative expectations of physicians are sometimes used to provoke students' consideration of implicit biases about patients. To encourage critical reflection and reconciliation of biased beliefs or behavior, educators should frame reflective activities as a personal exercise rather than as a requirement.


Asunto(s)
Sesgo , Disonancia Cognitiva , Educación de Pregrado en Medicina , Estudiantes de Medicina/psicología , Adulto , Actitud del Personal de Salud , Femenino , Humanos , Masculino
11.
BMC Med Inform Decis Mak ; 12: 152, 2012 Dec 27.
Artículo en Inglés | MEDLINE | ID: mdl-23270422

RESUMEN

BACKGROUND: The purpose of this study is to develop and test reliability, validity, and utility of the Goal-Setting Evaluation Tool for Diabetes (GET-D). The effectiveness of diabetes self-management is predicated on goal-setting and action planning strategies. Evaluation of self-management interventions is hampered by the absence of tools to assess quality of goals and action plans. To address this gap, we developed the GET-D, a criteria-based, observer rating scale that measures the quality of patients' diabetes goals and action plans. METHODS: We conducted 3-stage development of GET-D, including identification of criteria for observer ratings of goals and action plans, rater training and pilot testing; and then performed psychometric testing of the GET-D. RESULTS: Trained raters could effectively rate the quality of patient-generated goals and action plans using the GET-D. Ratings performed by trained evaluators demonstrated good raw agreement (94.4%) and inter-rater reliability (Kappa = 0.66). Scores on the GET-D correlated well with measures theoretically associated with goal-setting, including patient activation (r=.252, P<.05), diabetes specific self-efficacy (r=.376, P<.001) and inverse relationship with depression (r= -.376, P<.01). Significant between group differences (P<.01) in GET-D scores between goal-setting intervention (mean = 7.33, standard deviation = 4.4) and education groups (mean = 4.93, standard deviation = 3.9) confirmed construct validity of the GET-D. CONCLUSIONS: The GET-D can reliably and validly rate the quality of goals and action plans. It holds promise as a measure of intervention fidelity for clinical interventions that promote diabetes self-management behaviors to improve clinical outcomes. TRIAL REGISTRATION: Clinicaltrials.gov Identifier: NCT00481286.


Asunto(s)
Metas , Prioridad del Paciente/psicología , Indicadores de Calidad de la Atención de Salud , Autocuidado , Encuestas y Cuestionarios/normas , Anciano , Anciano de 80 o más Años , Diabetes Mellitus Tipo 2/terapia , Humanos , Persona de Mediana Edad , Psicometría
12.
Implement Sci ; 7: 45, 2012 May 18.
Artículo en Inglés | MEDLINE | ID: mdl-22607640

RESUMEN

BACKGROUND: The Department of Veterans Affairs (VA) has led the industry in measuring facility performance as a critical element in improving quality of care, investing substantial resources to develop and maintain valid and cost-effective measures. The External Peer Review Program (EPRP) of the VA is the official data source for monitoring facility performance, used to prioritize the quality areas needing most attention. Facility performance measurement has significantly improved preventive and chronic care, as well as overall quality; however, much variability still exists in levels of performance across measures and facilities. Audit and feedback (A&F), an important component of effective performance measurement, can help reduce this variability and improve overall performance. Previous research suggests that VA Medical Centers (VAMCs) with high EPRP performance scores tend to use EPRP data as a feedback source. However, the manner in which EPRP data are used as a feedback source by individual providers as well as service line, facility, and network leadership is not well understood. An in-depth understanding of mental models, strategies, and specific feedback process characteristics adopted by high-performing facilities is thus urgently needed.This research compares how leaders of high, low, and moderately performing VAMCs use clinical performance data from the EPRP as a feedback tool to maintain and improve quality of care. METHODS: We will conduct a qualitative, grounded theory analysis of up to 64 interviews using a novel method of sampling primary care, facility, and Veterans Integrated Service Network (VISN) leadership at high-, moderate-, and low-performing facilities. We will analyze interviews for evidence of cross-facility differences in perceptions of performance data usefulness and strategies for disseminating performance data evaluating performance, with particular attention to timeliness, individualization, and punitiveness of feedback delivery. DISCUSSION: Most research examining feedback to improve provider and facility performance lacks a detailed understanding of the elements of effective feedback. This research will highlight the elements most commonly used at high-performing facilities and identify additional features of their successful feedback strategies not previously identified. Armed with this information, practices can implement more effective A&F interventions to improve quality of care.


Asunto(s)
Retroalimentación , Investigación sobre Servicios de Salud/métodos , Difusión de la Información , Auditoría Médica , Revisión por Expertos de la Atención de Salud , Mejoramiento de la Calidad , Humanos , Modelos Teóricos , Motivación , Psicología Industrial , Proyectos de Investigación , Estados Unidos , United States Department of Veterans Affairs
13.
Acad Med ; 87(7): 870-6, 2012 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-22622222

RESUMEN

The authors provide the rationale, design, and description of a unique teaching award that has enhanced Baylor College of Medicine's teaching environment and become highly valued by the promotions and tenure (P&T) committee in determining a faculty member's readiness for promotion. This award is self-nominating and standards based. The primary purpose for development of the award was to provide the Baylor community and the P&T committee a method to understand and value the scholarship of teaching to the same degree that they understand and value the scholarship of discovery.The authors also present results from an internal evaluation of the program that included a survey and interviews. Between the inception of the award in 2001 and the internal review conducted in 2010, the award could have had an influence on the promotion of 130 of the recipients. Of the 130, 88 (65.6%) received this award before gaining their current rank (χ (1) = 16.3, P < .001). Stakeholders, including department chairs and members of the P&T committee, agreed that this award is valuable to those seeking promotion. Individual recipients stated that the award is good for the institution by encouraging reflection on teaching; increasing the recognition, importance, and value of teaching; encouraging the improvement of teaching skills; and providing a better understanding to others about what medical teachers really do. Of the 214 open-ended responses to survey questions of award recipients, more than half the comments were about the value of the award and its positive effect on promotion.


Asunto(s)
Distinciones y Premios , Evaluación del Rendimiento de Empleados/métodos , Docentes Médicos/normas , Revisión por Expertos , Facultades de Medicina/normas , Enseñanza/normas , Actitud , Docentes Médicos/organización & administración , Humanos , Entrevistas como Asunto , Desarrollo de Programa , Evaluación de Programas y Proyectos de Salud , Facultades de Medicina/organización & administración , Encuestas y Cuestionarios , Texas
14.
Med Educ ; 46(1): 80-8, 2012 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-22150199

RESUMEN

CONTEXT: For the last 30 years, developments in cognitive sciences have demonstrated that human behaviour, beliefs and attitudes are shaped by automatic and unconscious cognitive processes. Only recently has much attention been paid to how unconscious biases based on certain patient characteristics may: (i) result in behaviour that is preferential toward or against specific patients; (ii) influence treatment decisions, and (iii) adversely influence the patient-doctor relationship. Partly in response to accreditation requirements, medical educators are now exploring how they might help students and residents to develop awareness of their own potential biases and strategies to mitigate them. METHODS: In this paper, we briefly review key cognition concepts and describe the limited published literature about educational strategies for addressing unconscious bias. DISCUSSION: We propose a developmental model to illustrate how individuals might move from absolute denial of unconscious bias to the integration of strategies to mitigate its influence on their interactions with patients and offer recommendations to educators and education researchers.


Asunto(s)
Educación de Pregrado en Medicina/métodos , Prejuicio , Reconocimiento (Psicología) , Actitud , Diversidad Cultural , Conocimientos, Actitudes y Práctica en Salud , Humanos , Relaciones Médico-Paciente , Valores Sociales , Inconsciente (Psicología)
15.
J Rural Health ; 27(4): 425-32, 2011.
Artículo en Inglés | MEDLINE | ID: mdl-21967387

RESUMEN

CONTEXT: Mental health (MH) providers in community-based outpatient clinics (CBOCs) are important stakeholders in the development of the Veterans Health Administration (VA) telemental health (TMH) system, but their perceptions of these technologies have not been systematically examined. PURPOSE: The purpose of this study was to investigate the attitudes of CBOC providers about TMH services, current utilization of these technologies in their clinics, and sources of knowledge regarding TMH. METHOD: The study employed a mixed-methods design to examine aspects of TMH in CBOCs located in a VA network in the south-central United States. Semistructured, on-site group interviews conducted with 86 CBOC MH providers were followed by in-depth phone surveys with an MH provider identified as a key informant at each of 36 CBOCs in the VA network. FINDINGS: The utilization of TMH services varied widely between CBOCs, and the scope of services provided typically focused on delivery of medication management, with little provision of psychological services. Further, several important barriers to expanded use of TMH were identified, including limited education and training and shortage of dedicated space for TMH encounters. CONCLUSIONS: General attitudes toward TMH were positive, and most CBOC providers indicated that they would like to expand use of TMH in their clinics.


Asunto(s)
Actitud del Personal de Salud , Servicios Comunitarios de Salud Mental/estadística & datos numéricos , Control de Acceso , Telemedicina/estadística & datos numéricos , United States Department of Veterans Affairs , Recolección de Datos , Investigación sobre Servicios de Salud , Humanos , Entrevistas como Asunto , Trastornos Mentales/terapia , Salud Mental , Población Rural , Estados Unidos , Veteranos/psicología
16.
Patient Educ Couns ; 85(3): 383-9, 2011 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-21300516

RESUMEN

OBJECTIVE: To test an active-learning, empowerment approach to teaching patients about the "diabetes ABCs" (hemoglobin A(1)C, systolic blood pressure, and low density lipoprotein cholesterol). METHODS: 84 (97%) diabetic patients who participated in a randomized effectiveness trial of two clinic-based group educational methods and completed a post-intervention assessment. The empowerment arm participated in a group session that incorporated two educational innovations (a conceptual metaphor to foster understanding, and team-based learning methods to foster active learning). The traditional diabetes education arm received a didactic group session focused on self-management and educational materials about the diabetes ABCs. Participants in both arms received individual review of their current ABC values. RESULTS: A questionnaire evaluated knowledge, understanding, and recall of the diabetes ABCs was administered three months after enrollment in the study. At three months, participants in the empowerment group demonstrated greater understanding of the diabetes ABCs (P<0.0001), greater knowledge of their own values (P<0.0001), and greater knowledge of guideline-derived target goals for the ABCs compared with participants in the traditional arm (P<0.0001). CONCLUSION: An active-learning, empowerment-based approach applied to diabetes education can lead to greater understanding and knowledge retention. PRACTICE IMPLICATIONS: An empowerment approach to education can facilitate informed, activated patients and increase performance of self-management behaviors.


Asunto(s)
Diabetes Mellitus/psicología , Conocimientos, Actitudes y Práctica en Salud , Educación del Paciente como Asunto/métodos , Poder (Psicología) , Aprendizaje Basado en Problemas , Autocuidado , Anciano , Anciano de 80 o más Años , LDL-Colesterol/sangre , Diabetes Mellitus/sangre , Femenino , Hemoglobina A Glucada/metabolismo , Hospitales de Veteranos , Humanos , Masculino , Recuerdo Mental , Persona de Mediana Edad , Aprendizaje Basado en Problemas/métodos , Encuestas y Cuestionarios , Estados Unidos
17.
Patient Educ Couns ; 80(3): 345-50, 2010 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-20674240

RESUMEN

OBJECTIVE: Physicians often overlook important contextual clues that patients give during an encounter. The objective of our study was to increase medical students' knowledge and skills in identifying contextual issues. METHODS: Six consecutive learning experiences, including a standardized patient (SP) encounter and activities designed to trigger reflection, were implemented within a first-year Introduction to Clinical Medicine course. Evaluation of the intervention was measured through self-confidence, attitudes, SP history checklist, and student and small group facilitator evaluations. RESULTS: Standardized patient encounters, coupled with activities designed to trigger reflection, can help students identify patients' contextual clues. Students' confidence in eliciting patient clues significantly increased after the intervention. Our results suggest that some contextual clues were more difficult for students to elicit. CONCLUSION: Multi-faceted approaches that include activities to trigger reflection are effective in teaching students to recognize and respond to contextual clues, however, more research is needed. PRACTICE IMPLICATIONS: While students elicited most clues in this study, they struggled with identifying some clues. These results suggest the need for additional research and educational development in this area.


Asunto(s)
Educación de Pregrado en Medicina/métodos , Estudiantes de Medicina , Enseñanza , Conducta Verbal , Comunicación , Evaluación Educacional/métodos , Femenino , Humanos , Masculino , Anamnesis/normas , Pacientes/psicología , Relaciones Médico-Paciente , Enseñanza/métodos
18.
Acad Med ; 85(5): 902-8, 2010 May.
Artículo en Inglés | MEDLINE | ID: mdl-20520048

RESUMEN

PURPOSE: Medical schools are increasingly incorporating opportunities for reflection into their curricula. However, little is known about the cognitive and/or emotional processes that occur when learners participate in activities designed to promote reflection. The purpose of this study was to identify and elucidate those processes. METHOD: In 2008, the authors analyzed qualitative data from focus groups that were originally conducted to evaluate an educational activity designed to promote reflection. These data afforded the opportunity to explore the processes of reflection in detail. Transcripts (94 pages, single-spaced) from four focus groups were analyzed using a narrative framework. The authors spent approximately 40 hours in group and 240 hours in individual coding activities. RESULTS: The authors developed a conceptual model of five major elements in students' reflective processes: the educational activity, the presence or absence of cognitive or emotional dissonance, and two methods of processing dissonance (preservation or reconciliation). The model also incorporates the relationship between the student's internal ideal of what a doctor is or does and the student's perception of the teacher's ideal of what a doctor is or does. The model further identifies points at which educators may be able to influence the processes of reflection and the development of professional ideals. CONCLUSIONS: Students' cognitive and emotional processes have important effects on the success of educational activities intended to stimulate reflection. Although additional research is needed, this model-which incorporates ideals, activities, dissonance, and processing-can guide educators as they plan and implement such activities.


Asunto(s)
Disonancia Cognitiva , Emociones , Modelos Educacionales , Estudiantes de Medicina , Pensamiento , Prácticas Clínicas , Curriculum , Femenino , Grupos Focales , Humanos , Masculino
19.
J Gen Intern Med ; 25 Suppl 2: S115-8, 2010 May.
Artículo en Inglés | MEDLINE | ID: mdl-20352504

RESUMEN

INTRODUCTION/AIMS: Implicit bias can impact physician-patient interactions, alter treatment recommendations, and perpetuate health disparities. Medical educators need methods for raising student awareness about the impact of bias on medical care. SETTING: Seventy-two third-year medical student volunteers participated in facilitated small group discussions about bias. PROGRAM DESCRIPTION: We tested an educational intervention to promote group-based reflection among medical students about implicit bias. PROGRAM EVALUATION: We assessed how the reflective discussion influenced students' identification of strategies for identifying and managing their potential biases regarding patients. 67% of the students (n = 48) identified alternate strategies at post-session. A chi-square analysis demonstrated that the distribution of these strategies changed significantly from pre-session to post-session (chi(2)(11) = 27.93, p < 0.01), including reductions in the use of internal feedback and humanism and corresponding increases in the use of reflection, debriefing and other strategies. DISCUSSION: Group-based reflection sessions, with a provocative trigger to foster engagement, may be effective educational tools for fostering shifts in student reflection about bias in encounters and willingness to discuss potential biases with colleagues, with implications for reducing health disparities.


Asunto(s)
Actitud del Personal de Salud/etnología , Competencia Cultural/psicología , Disparidades en Atención de Salud , Intención , Prejuicio , Estudiantes de Medicina/psicología , Humanos
20.
Patient Educ Couns ; 77(3): 450-5, 2009 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-19850437

RESUMEN

Patient-centered cancer care has become a priority in the oncology field. Increasing efforts to train oncologists in communication skills have led to a growing literature on patient-centered cancer education. In addition, systems approaches have led to an increased emphasis on the concept of teams as an organizing framework for cancer care. In this essay, we examine issues involved in educating teams to provide patient-centered cancer care. In the process, we question the applicability of a tightly coordinated 'team' concept, and suggest the concept of a 'care community' as a more achievable ideal for the way that cancer care is commonly delivered. We discuss the implications that this has for cancer communication education, and propose three principles to guide the development of educational interventions aimed at increasing patient-centeredness in cancer care delivery systems.


Asunto(s)
Comunicación , Neoplasias , Grupo de Atención al Paciente , Atención Dirigida al Paciente , Relaciones Médico-Paciente , Anciano , Femenino , Humanos , Oncología Médica , Oncología por Radiación
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