An exploratory study of nursing and medical students health promotion counselling self-efficacy.

Self-efficacy of nursing and medical students for client health promotion counselling was examined in an exploratory study using Bandura's (1977) self-efficacy theoretical perspective. Third-year nursing students (n = 41) and fourth-year medical students (n = 60) were compared on their self-efficacy for engaging in clients health promotion activities within 5 areas: smoking, exercise, nutrition, sexually-transmitted diseases and injuries. Their self-efficacy about their knowledge levels in the same 5 areas of health was also compared along with their perceptions of the relative impact of various curricular learning experiences on building health promotion counselling self efficacy. Self-efficacy scores were high for both groups. Nursing students scored significantly higher on both knowledge and ability to counsel patients in the areas of exercise, nutrition and injury prevention. In both groups, confidence in knowledge for health promotion activities was higher than ability to counsel patients. Learning specific health promotion strategies in class and actual practice were strongly associated with nursing students' self-efficacy while practice, feedback on performance, and role modelling were strongest for medical students.

Educating residents for managed care: report on a multidisciplinary conference.

A growing number of residency programs are preparing their graduates for the realities of managed care practice. In 1996, The Cleveland Clinic Foundation, a private, nonprofit academic medical center, hosted a two-day conference on managed care education to develop innovative instructional and evaluative approaches that, where appropriate, would build on existing expertise. The conference was attended by invited national experts who had a stake in residents' education: clinical faculty, residents, medical educators, executives of managed care organizations, and representatives of other interested organizations. Participants spent much of their time in four small break out groups, each focusing on one of the following topics that were judged particularly relevant to managed care: preventive and population-based medicine, appropriate utilization of resources, clinician-patient communication, and interdisciplinary team practice. Participants shared existing materials, discussed teaching goals and objectives, and generated ideas for teaching methods, teaching materials, and evaluative methods for their respective topics. The authors summarize the recommendations from the four groups, with an overview of the issues that emerged during the conference concerning curriculum development, integration of managed care topics into existing curricula, staging of the curriculum, experiential teaching methods, negative attitudes and resistance, evaluation of trainees and profiling, program assessment, faculty development, and cooperation between academic medical centers and managed care organizations.

Characteristics, importance, and implications of comprehensive drug therapy management.

Ideas and opinions about comprehensive drug therapy management (CDTM) were gathered from an expert panel representing health care practitioners, educators, and consumers. A qualitative method of inquiry, the Delphi technique, was used to aggregate opinions of an expert panel of health care professionals, health care educators, and consumer representatives. The 66 experts who agreed to participate in the study consisted of 10 from pharmacy education, 10 from pharmacy professional associations, 20 from managed care, 19 from primary care, and 7 consumers (public members of health care regulatory and governing boards). Each participant was sent a questionnaire designed to evaluate a preliminary definition of CDTM and gather opinions on related topics. A second questionnaire was sent to the participants to determine the extent of their agreement with each statement generated by the first questionnaire. A third questionnaire was sent, asking participants to reconsider their ratings in light of the group's responses and to choose the most important elements. The response rates were 83% for the first questionnaire, 70% for the second, and 76% for the third. The panel reached a high level of agreement on a definition of CDTM. Panel members also identified many critical aspects of CDTM, including what makes it worthwhile, barriers to and facilitators of engaging in CDTM, key participants, ways in which responsibility for CDTM may be shared, and the competencies needed for CDTM. An expert panel of health care leaders and future leaders, within and outside the pharmacy profession, reached a high level of agreement on a definition of CDTM and identified many critical aspects of this concept.

Teaching an integrated approach to health care: lessons from five schools.

Medical education has excelled in bringing a sound biomedical base to the practice of medicine; however, there is now growing interest in helping students and residents learn an integrated approach to health care that addresses the complex interaction of many factors influencing health and illness. The authors' purpose was to learn about how some medical schools teach students a more integrated approach to health care. They used a qualitative, multiple-case-study design and collected data through document review and interviews with faculty, administrators, students, and residents at five U.S. and Canadian medical schools, chosen for their reputed excellence in addressing an integrated approach to care. Visits to the schools were made in the spring of 1993. Data analysis focussed on the institutional factors associated with teaching such an approach and the ways in which the schools help students and residents learn about this approach. The interviewees described the strong presence of an institutional mission or philosophy that is unique to each school but that generally has a service-oriented, patient-centered perspective. They reported that the primary means for learning about an integrated approach was the attention, woven into the curriculum, to four relationships; physician-patient, physician-community, physician-other practitioners, and faculty-student. A broad-based shared mission or philosophy was important in focusing attention on the integration of biomedical and non-biomedical concerns and promoting a perspective that focuses outward toward the community and its people. The pervasive attention to the four relationships suggests that such attention is intimately related to each school's underlying mission or philosophy.(ABSTRACT TRUNCATED AT 250 WORDS)

An integrated health care model in medical education: interviews with faculty and administrators.

PURPOSE: To broaden the understanding of how medical schools can help students learn an approach to health care that reflects the integration of psychosocial and biomedical factors in health and illness. METHOD: A qualitative research design was used, with data collected through document review and semi-structured interviews conducted in the spring and summer of 1992 with 22 faculty and administrators from 17 U.S. and Canadian medical schools. The interviewees represented the following disciplines: internal medicine, family medicine, pediatrics, psychiatry, and preventive/behavioral medicine. An analytic framework was developed, within which the constant comparative method was used on a continuous basis during and after data collection. Category development focused on (1) defining the scope and character of an integrated perspective, (2) delineating various ways to incorporate such a perspective in medical education, and (3) identifying barriers to and facilitative factors for incorporating such a perspective in medical education. Validity was assessed by having the interviewees and three other faculty members review the analyses and preliminary results. RESULTS: The interviewees' conceptions of an integrated perspective on health care focused on the theoretical need for a broader scientific model and on the practical need for more inclusive approaches to medical practice. The interviewees described patient-level and community-level approaches as equally important. The ideal curricula envisioned by the interviewees were patient-centered, integrated, developmental, and population-based. In addition to naming many barriers to integration (e.g., negative attitudes of faculty and administrators, diffuse organization of medical schools, ignorance of appropriate curriculum design and implementation), the interviewees identified certain facilitative factors (e.g., strong leaders, faculty development programs, and reform of the faculty reward system). CONCLUSION: The interviewees envisioned an integrated model of health care that suggests that medical curricula should address the development of physicians' knowledge, attitudes, and skills regarding physicians' relationships with both patients and community.