Multimedia to teach urology to medical students

OBJECTIVES: To test the hypothesis that an interactive multimedia-based computer application may be used to teach urology to undergraduate medical students. METHODS: Third-year medical students rotating on their urology clerkship were studied. Student knowledge was measured with a multiple choice test administered in a pretest-post-test experimental design. The educational intervention was a multimedia-based application that presented a clinical module on hematuria, using natural language-like entries. Student attitudes toward the multimedia application were assessed by a survey. RESULTS: Twenty-three consecutive third-year medical students participated. Mean pretest and post-test scores +/- standard deviation were 35%+/-11% versus 74%+/-17%, respectively, P<0.0001. Student questionnaire responses indicated highly positive opinions that the multimedia-based module was easy to use, was fun, provided natural patient responses, had clear exercises, provided immediate feedback, was educational, and had a nonthreatening format, and that the multiple choice questions were clear and fair. CONCLUSIONS: Multimedia-based education may be used to teach urology to undergraduate medical students.     

Australian and South African undergraduates' HIV-related knowledge, attitudes, and behaviors

To understand safe sex behavior in two countries which have been differentially affected by the HIV/AIDS epidemic, the present study compared the AIDS-related knowledge, attitudes, and behaviors of 920 heterosexual undergraduate students in Australia and 228 heterosexual undergraduate students in South Africa. South African students were found to have significantly less knowledge about HIV/AIDS, and significantly less favorable attitudes toward safe sex behavior than their Australian counterparts. They were also more likely to report that they have avoided various groups of people for fear of contracting AIDS. Experience from Australia over the period 1986-1995 suggests that significant improvements in the AIDS-related knowledge, attitudes, and behaviors of South African undergraduates are achievable.     

Addressing a state''s physician workforce priorities through the funding of graduate medical education: the TennCare model

OBJECTIVE: To investigate differences in second-, third-, and fourth-year medical students' knowledge of bloodborne pathogen exposure risks, as well as their attitudes toward, and intentions to comply with, Universal Precautions (UP). DESIGN: Cross-sectional survey. PARTICIPANTS AND SETTING: Surveys about students' knowledge, attitudes, and intentions to comply with UP were completed by 111 second-year (preclinical), 80 third-year, and 60 fourth-year medical students at Washington University School of Medicine in the spring of 1996. RESULTS: Preclinical students knew more than clinical students about the efficacy of hepatitis B vaccine, use of antiretroviral therapy after occupational exposure to human immunodeficiency virus, and nonvaccinated healthcare workers' risk of infection from needlestick injuries (P<.001). Students' perceived risk of occupational exposure to bloodborne pathogens and attitudes toward hepatitis B vaccine did not differ, but preclinical students agreed more strongly that they should double glove for all invasive procedures with sharps (P<.001). Clinical students agreed more strongly with reporting only high-risk needlestick injuries (P=.057) and with rationalizations against using UP (P=.008). Preclinical students more frequently reported contemplating or preparing to comply with double gloving, wearing protective eyewear, reporting all exposures, and safely disposing of sharps, whereas students with clinical experience were more likely to report compliance. Clinical students also were more likely to report having "no plans" to practice the first three of these precautions (P<.001). CONCLUSIONS: Differences in knowledge, attitudes, and intentions to comply with UP between students with and without clinical experience may have important implications for the timing and content of interventions designed to improve compliance with UP.     

Knowledge of and interest in geropsychology among psychology trainees.

Given the increasing number of older people in the U.S. population, how well prepared are graduate students to deliver services to older adults? Do graduate students want to see older adults in clinical practice? Ninety-four psychology externs and interns were surveyed about their knowledge of and attitudes toward older people. Although trainees evidenced gaps in knowledge, they indicated interest in expanding that knowledge. They also reported favorable attitudes toward the aged and interest in practice with them. This article summarizes geropsychology resources for graduate program directors, students, and practitioners who want to expand practice to include older adults. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

General practitioner teaching in the community: a study of their teaching experience and interest in undergraduate teaching in the future

BACKGROUND: In line with the General Medical Council (GMC) recommendations for undergraduate teaching, many medical schools are implementing new programmes of community-based teaching. Little is known about the enthusiasm of general practitioners (GPs) for, or their ability to undertake, an additional teaching role. AIM: To assess the reservoir of teaching experience among GPs and, in particular, their undergraduate teaching experience, their views on the rewards and problems of teaching, their interest in teaching in the future, and their needs for support. METHOD: Postal questionnaire sent to all 417 GP principals with Lambeth, Southwark, and Lewisham family health service authorities (FHSAs) in January 1995. RESULTS: We achieved a 74% (310/417) response rate. A total of 86% (261/303) of GPs have some sort of teaching experience in their current practice. A large number of medical and non-medical subjects are already being taught. Overall, 75% (228/303) of GPs had experience of undergraduate teaching. Only 13% (41/303) had no teaching experience of any kind. Very few responders felt that teaching was best done in hospital. Different rewards and problems of teaching were perceived by undergraduate teaching GPs and other GPs. There was a high level of interest in undergraduate teaching in the future and a demand for a variety of support measures from medical schools. CONCLUSIONS: New community-based programmes are likely to receive support from GPs, but the vital issues of time, adequate financial reward, and teacher training must be addressed by medical schools if large-scale changes in undergraduate teaching are to be achieved.     

Performance characteristics of a new synthetic APTT reagent

The question of whether the use of a teaching strategy employing simulation influences attitudes toward disabled persons over time was addressed in this quasi-experimental intervention study. The experimental group participated in "Sensitivity Day" which incorporated a simulation activity. A total of 77 undergraduate baccalaureate nursing students completed the Attitudes Toward Disabled Persons scale four times: presimulation, immediate postsimulation, six week delayed postsimulation and six month delayed postsimulation. In general, the nursing students had relatively positive scores on the Attitudes Toward Disabled Persons scale in each testing period. The best indicator of postsimulation attitude scores was the presimulation attitude score. Personal and prior nursing experience had no statistical effects on attitude. Improvement that was significant at p = .07 level was noted in the experimental group at the six weeks delayed postsimulation when compared with the presimulation attitude scores. This study supplies data that is useful in constructing learning activities and contributes to the body of knowledge about simulation and attitudes toward persons with disabilities.     

Referrals for alternative therapies

BACKGROUND: The purpose of this study was to examine how allopathic physicians participate in the decision to refer patients for alternative therapies. METHODS: A pretested, self-administered, structured questionnaire was distributed simultaneously to all area physicians at community locations in Washington State, New Mexico, and southern Israel. The primary outcome measures were monthly and yearly rates of referral to alternative therapies. RESULTS: More than 60% of all physicians made referrals to alternative providers at least once in the preceding year and 38% in the preceding month. Referrals were generally based on patient requests, synergy between the alternative therapy and the patients' cultural beliefs, failure of conventional treatment, and the belief that patients have "nonorganic" or "psychological" disease. There was no relationship between the rate of referral and the referring physician's level of knowledge about, beliefs about the effectiveness of, or familiarity with alternative therapies. CONCLUSIONS: Primary care physicians are more likely than other medical specialists to be knowledgeable about, personally subscribe to, and refer patients for alternative therapies. Physicians who use alternative techniques for themselves and their families or who adopt complementary therapies into their practices have higher rates of referrals. Referral rates and patterns were similar between sites despite considerable cross-cultural and health system differences. Given the high rate of referral and the absence of an apparent internal logic for such recommendations, guidelines and physician education may be advisable.     

Expression of thyrotropin receptor on clonal osteoblast-like rat osteosarcoma cells

OBJECTIVE: To assess (1) pediatricians' attitudes toward and practice of complementary and alternative medicine (CAM) for their patients; (2) their knowledge, experience, and referral patterns for selected CAM therapies; and (3) their desire for continuing medical education courses on CAM therapies. METHOD: An anonymous, self-report, 25-item questionnaire was mailed to fellows of the Michigan chapter of the American Academy of Pediatrics. RESULTS: Of 860 pediatricians, 348 (40.5%) responded; their median age ranged from 35 to 45 years, 54.3% were men, 67.6% were white, 67.9% were general pediatricians, and 65.2% were trained in the United States. Of the respondents, 83.5% believed their patients use CAM therapies, but 55.1% believed this constituted less than 10% of patients. Of the pediatricians who talked about CAM (53.8%), 84.7% said the discussion was initiated generally by the patient's family. More than half of the physicians (55.2%) said they would use CAM therapies personally, and 50.3% would refer for CAM therapies. Therapies referred for were biofeedback (23.6%), self-help groups (23.3%), relaxation (14.9%), hypnosis (13.8%), and acupuncture or acupressure (10.9%). Of the physicians who responded, 54.1% were interested in continuing medical education courses on CAM therapies. White respondents, US medical school graduates, and general pediatricians were most likely to believe their patients use CAM and discuss or refer for CAM therapies (P<.01). Female pediatricians were most likely to discuss or refer for CAM and to want more continuing medical education on CAM therapies (P<.05). CONCLUSIONS: A majority of pediatricians sampled believed a small percentage of their patients were seeking alternatives to conventional medicine. Half would consider referring patients for CAM, and most were interested in continuing medical education courses on CAM. Larger studies surveying pediatricians, along with more education and research on CAM therapies, need to be considered for the future.     

Clinical teachers as humanistic caregivers and educators: perceptions of senior clerks and second-year residents

BACKGROUND: The acquisition and nurturing of humanistic skills and attitudes constitute an important aim of medical education. In order to assess how conducive the physician-learning environment is to the acquisition of these skills, the authors determined the extent to which clinical teachers are perceived by their trainees as humanistic with patients and students, and they explored whether undergraduate and graduate students share the same perceptions. METHODS: A mail survey was conducted in 1994/95 of all senior clerks and second-year residents at Laval University, University of Montreal and University of Sherbrooke medical schools. Of 774 trainees, 259 senior clerks and 238 second-year residents returned the questionnaire, for an overall response rate of 64%. Students' perceptions of their teachers were measured on a 6-point Likert scale applied to statements about teachers' attitudes toward the patient (5 items) and toward the student (5 items). RESULTS: On average, only 46% of the senior clerks agreed that their teachers displayed the humanistic characteristics of interest. They were especially critical of their teachers' apparent lack of sensitivity, with as many as 3 out of 4 declaring that their teachers seemed to be unconcerned about how patients adapt psychologically to their illnesses (75% of clerks) and that their teachers did not try to understand students' difficulties (78%) or to support students who have difficulties (77%). Compared with the clerks, the second-year residents were significantly less critical, those with negative perceptions varying from 27% to 58%, 40% on average. Except for this difference, their pattern of responses from one item to another was similar. INTERPRETATION: This study suggests the existence of a substantial gap between what medical trainees are expected to learn and what they actually experience over the course of their training. Because such a gap could represent a significant barrier to the acquisition of important skills, more and urgent research is needed to understand better the factors influencing students' perceptions.     

Reflections on the therapeutic relationship. Who will be the patient of tomorrow?

CONTEXT: The purpose of this study was to gain a better understanding of the use of complementary therapies among patients with inflammatory bowel disease. OBJECTIVE: To examine factors influencing the use of complementary therapies, to explore patient-physician communication concerning those therapies, and to assess the effect of combining qualitative with quantitative research. DESIGN: In-depth qualitative interviews. PARTICIPANTS: Fourteen patients were selected from a quantitative study in which the use of complementary therapies among patients with inflammatory bowel disease was assessed. RESULTS: Patients reported using complementary therapies because of the serious side effects of medical treatment, because they felt conventional treatments did not help, and because complementary therapies were thought to be safe. Psychological and social factors for using complementary therapies must be considered and understood. Patients cited many reasons for not discussing the use of complementary therapies with their doctors. Adding qualitative data to quantitative research greatly increased the authors' understanding of factors that contribute to complementary therapy use. CONCLUSIONS: Multiple factors contribute to the decision to use complementary therapies among those with inflammatory bowel disease. Identifying these factors is important for educating physicians regarding their patients' use of complementary therapies and may contribute to improved patient-physician communication.     

The impact of geropsychology training.

What effect does a geropsychology practicum placement have on graduate students' knowledge of and attitudes toward older adults? Ninety psychology externs and interns were surveyed at the beginning of the training year and then 9 months later. About half of the trainees provided services in settings that served older adults, whereas the remainder did not. At the end of training, those with a geropsychology placement maintained higher interest in geropsychology, had lower negative attitudes toward older people, and had greater knowledge of mental health and aging than trainees without a geropsychology placement. There were no differences between the two placement groups in knowledge of general facts on aging and positive attitudes toward the aged. The implications of the findings for graduate program directors, training psychologists, and graduate students are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Validation of computer-mediated open-ended standardized patient assessments

Quantitative information regarding the development of students' clinical reasoning skills is valuable in assessing third- and fourth-year medical students' clinical knowledge. Standardized patient cases are often used to obtain this quantified information. These cases typically involve a post-patient examination consisting of a series of closed-ended multiple-choice questions. Many medical educators question whether the results from the closed-ended multiple-choice questions truly reflect students' clinical knowledge and reasoning proficiency. Since 1995, the Kirksville College of Osteopathic Medicine (KCOM) has used a computer program, SOAP Note Plus, for standardized patient assessment of students to automate the post-encounter documentation and evaluation. This paper describes the development of the SOAP Note Plus program and a validation study which was conducted to determine the empirical association between the computer-mediated closed-ended and open-ended post-encounter standardized patient assessments. Correlation and GENOVA statistics were used in the analysis of the performance of third-year medical students on the closed-ended and the open-ended assessments following standardized patient encounters and the relationship to their undergraduate GPA, first 2-year medical school GPA and the actual clinical rotation evaluations. The initial results show the positive relationship between the open-ended assessment and the actual clinical rotation evaluations. undergraduate GPA and the first two-years of medical school GPA.     

Improving undergraduate nursing research education: the effectiveness of collecting and analyzing oral histories

Nine oral histories of retired RNs (age range from 60 to 77) were collected by trained senior nursing students in their nursing research class. Attitudes toward nursing research of the 18 undergraduate baccalaureate nursing students participating in the collection and analysis of oral histories were compared with 20 students who did not participate. Both groups of students completed a pretest and posttest Attitudes Toward Nursing Research Questionnaire. The participating students had significantly positive changes in their attitudes toward nursing research. The nonparticipating group did not. While reminiscing about their careers, the retired RNs related historical events that influenced their nursing practice. Three themes emerged: World War II, technology, and intensive care units. Through an open-ended, written questionnaire following the interview, the nurses expressed positive benefits of participation. The collection and analysis of oral histories was an effective experiential learning strategy with positive outcomes for the students and the retired nurses who were interviewed.     

Unconventional therapy in Pennsylvania practices

The public's interest in "alternative" medicine is well documented, and recent attempts to integrate unconventional therapies into conventional medical practices have been widely publicized Pennsylvania physicians have reacted cautiously but are showing increasing interest. This article summarizes the perspectives of physicians who employ at least some of what they prefer to call "complementary" or "adjunctive" therapies-including acupuncture, hypnosis, and herbal remedies.     

Organ donation from the viewpoint of the medical students

A questionnaire survey was carried out to examine the attitudes of 125 medical students, aged 19-37 years, toward organ donation. 73 of them were in their first semester and 52 senior students in their last year of the study. A return rate of 88% (senior students: 58%) was achieved. Although 59% (71%) expressed willingness to donate their organs, only 30% (50%) had signed an organ donor card. Concerns regarding definition and declaration of death, benefit of organ donation and feelings of the donor's family were identified in 51% (38%) of the students. 71% (79%) had already discussed this issue with their families. In summary, results of the study indicate that more intensified interdisciplinary discussion and information during the study of medicine could bring about an even more positive attitude toward organ donation.     

Rewards of entering podiatric medicine and attitudes toward older adults

This study examined the relationships between social and demographic characteristics (ie, gender, race, year in school, desired residency choice, and socioeconomic background), motivations for entering the profession of podiatric medicine (extrinsic and intrinsic rewards), and negative attitudes toward treating elderly patients. The study used ordinary least squares multiple regression models to analyze data from a random, national sample of 448 podiatric medical students. In particular, the ordinary least squares models were developed to determine the independent effect of intrinsic and extrinsic rewards on negative attitudes toward treating elderly patients. Consistent with the study hypotheses, after adjusting for social and demographic characteristics, the study found extrinsic rewards to have strong positive relationships with negative attitudes toward treating elderly patients, and intrinsic rewards to have strong negative relationships with negative attitudes toward treating elderly patients. The authors discussed the implications of the findings for podiatric physicians and educators training podiatric medical students.     

Interrelationship of knowledge, interest, and recall: Assessing a model of domain learning.

Two experiments examined the interrelationship of subject-matter knowledge, interest, and recall in the field of human immunology/human biology and assessed cross-domain performance in the field of physics. Framed by a stage model of domain learning, cluster-analytic methods were used to group individuals on the basis of their performance on cognitive and affective measures in immunology. Results using cluster profiles were compared with prediction expected from the stage model. Performance for students in these clusters was compared with their performance on similar measures in the field of physics. In Experiment 1, 30 premedical students and 17 graduate students in educational psychology served as participants. Results revealed 3 unique clusters of students that tended to conform to prediction of the domain learning model. Individuals' knowledge, interest, and recall of immunology generally paralleled their performance in the domain of physics. Experiment 2 sought to test and extend the findings of the initial experiment. Participants were 78 undergraduate students in education. Although 4 clusters emerged, patterns in knowledge, interest, and recall were similar to those revealed in Experiment 1. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychosocial factors in sunbathing and sunscreen use.

Interviewed 120 sunbathing and nonsunbathing beachgoers about their health practices, knowledge about skin cancer, moods, and social rewards obtained through sunbathing. Ss also completed personality questionnaires. Data were considered using a theoretical perspective combining aspects of health belief, social influence, social learning, and risk-taking models. Results indicate that sunbathing was related to having a positive attitude toward risk taking, having little knowledge about skin cancer, reporting a relaxed mood, having friends who sunbathe, and engaging in activities related to maintaining a positive physical appearance. Sunscreen use was related to sex, having knowledge about skin cancer, knowing people who have had cancer, and reporting high levels of anxiety. (PsycINFO Database Record (c) 2010 APA, all rights reserved)