An alternative approach to defining the role of the clinical teacher

BACKGROUND: A number of studies have attempted to identify the components of the clinical teacher role by examining learners' numerical ratings of items on researcher-generated lists. Some of these studies have also compared different groups' perceptions of clinical teaching, but have not directly compared the perceptions of first- and third-year residents. This study addressed two questions: (1) What do residents consider important components of the clinical teacher role? (2) Do first- and third-year residents perceive this role similarly? METHOD: A content analysis was performed on the comments written on evaluation forms by 268 residents about 490 clinical teachers over a five-year period (1980-81 through 1984-85) at a large family practice residency. Of 5,664 forms completed by the residents, 2,388 (42%) contained written comments; comments were on 1,024 (46%) of the first-year resident's forms, 701 (41%) of the second-year residents' forms, and 663 (39%) of the third-year residents' forms. Themes in these comments were coded into a coding dictionary of 157 categories, within 37 clusters, within four roles. RESULTS: The ten highest-ranked categories (Global; Teaching: General; Knowledgeable; Gives Resident Responsibility; Supportive; Miscellaneous; Interested in Teaching; Clinical Competence; Makes Effort to Teach; and Gives Resident Opportunity to Do Procedures) accounted for 41% of the themes coded. The first- and third-year residents differed in the clusters they used to describe their clinical teachers on evaluation forms (chi 2 = 149.86, df = 36, p < .0001). CONCLUSION: The results suggest that content analysis can be used to validly and reliably study residents' written evaluative comments about their teachers. This study contributes to the definition of the clinical teacher role, showing the relative importances of its components, and also supports Stritter's Learning Vector theory, finding the anticipated differences between the comments made by first- and third-year residents.     

Analysis of the effectiveness of an endoscopy education program in improving residents' laparoscopic skills

OBJECTIVE: To evaluate the effectiveness of a gynecologic endoscopy education program in enhancing residents' proficiency in laparoscopic surgery. METHODS: The program was designed to provide residents with the knowledge and skills necessary for laparoscopic surgery, before entering the operating room, in a cost-effective manner that honored the principles of adult education. The 7-week program included didactic sessions to provide conceptual learning but focused on practical skills enhancement through practice in both pelvic trainer and animal laboratory settings. The program design included dominant, nondominant, and two-handed skills as well as models for laparoscopic dissection, hemostasis, and suturing. The evaluation of the program is based on timing of laparoscopic skills as well as resident and faculty evaluation of laparoscopic proficiency at the beginning and end of the program. RESULTS: Prior to the program, 48% of residents and 75% of faculty were satisfied with laparoscopic training. All residents improved operating times in pelvic trainer skills after the program, with first-year residents improving by 68%, third-year residents by 58%, and fourth-year residents by 72%. The residents self-assessment of competence in 14 laparoscopic skills revealed an increase in all skills following the program. The faculty assessment showed an upward trend in skills competence. At the conclusion of the program, 100% of residents and 92% of faculty were satisfied with the laparoscopic training. CONCLUSION: A structured program emphasizing skills enhancement is an effective approach to improve residents' performance in laparoscopic surgery.     

Nursing home residents functional ability and perceptions of choice

1. Nursing home residents have the right to be involved in decision making relative to their care, which researchers have demonstrated has a positive effect on residents. 2. The authors designed a study to explore discrepancies between residents' perceptions of choice and the amount of choice preferred and their relationship to self-care abilities and functional abilities in nursing home residents. 3. The results indicate that residents desired more choice than they felt they were given, but that this difference was not related to their perceptions of their self-care abilities. As residents' functional abilities increased, actual choice as well as desired choice increased slightly. 4. Nurses should structure the nursing home's approach to residents so that choice is maximized within the constraints of the institution.     

Measuring quality of nursing home service: residents' perspective

An inventory was developed to measure residents' perceptions of the quality of nursing home service. The content domain and dimensions of the inventory were derived from actual comments of nursing home residents. Independent studies employing a multiple-facility sample of 103 residents and 194 residents from a single institution supported a four-factor structure of the quality of nursing home service--Staff and Environmental Responsiveness, Dependability and Trust, Food-related Services and Resources, and Personal Control. The data provide preliminary support for the measure's reliability and validity so it may be used to study the antecedents and consequences of quality in nursing home service from the residents' perspective.     

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.     

Unethical and unprofessional conduct observed by residents during their first year of training

PURPOSE: To present residents' personal observations of unethical and unprofessional conduct in medicine during their first year of training. METHOD: Eight hundred and fifty-seven second-year residents who had previously participated in a study of perceived mistreatment as senior medical students were resurveyed by a three-tiered mail process concerning their experiences during their first postgraduate year, including their personal observations of four types of unethical and unprofessional conduct. RESULTS: Surveys were returned by 571 residents, for a response rate of 67%. Personal observations of falsification of patient records by others on at least one occasion were reported by 44.5% of the responding residents, while 73.8% reported direct observations of mistreatment of patients. Nearly half of the residents (46.7%) reported that others had taken credit for their work, and 72.8% said they had observed colleagues working in an impaired condition at least once during their first year of training. Over one fourth of the residents (28.6%) stated that they had been required to do something during the year that they believed was immoral, unethical, or personally unacceptable. There was an inverse relationship between the residents' observations of unethical and unprofessional conduct and their overall satisfaction with their first year of training (p < .001). CONCLUSIONS: The residents reported observing several types of unethical and unprofessional conduct among their colleagues and superiors. These findings confirm similar reports among medical students and residents and raise questions about the possible effect of such observations on the ethical principles and behavior of physicians-in-training.     

Increasing clinical prevention efforts in a family practice residency program through CQI methods

BACKGROUND: As primary care physicians develop ongoing relationships with their patients, each contact provides another opportunity for primary, secondary, or tertiary prevention activities. In 1991 an interdisciplinary prevention project team using continuous quality improvement (CQI) principles was established to improve family practice residents' provision of such services. DIAGNOSTIC JOURNEY: For a random sample of 60 patient charts, abstractors looked for documentation of 23 clinical preventive services, including nursing screens, physician on-site and off-site implemented services, lifestyle education (diet, tobacco use), and self-screening education. After the chart review, the physicians, nurses, residents, and clinical staff used a fishbone analysis to identify physician-, clinic system-, and patient-centered factors contributing to the lack of conformance with clinical prevention guidelines. REMADIAL JOURNEY: The residency program began a series of didactic sessions on clinical prevention and instituted a procedures rotation to teach prevention procedure skills such as flexible sigmoidoscopy, stress testing, and colposcopy. On the CQI team's recommendation, a checklist developed by physicians and staff which itemized age- and gender-specific clinical prevention services was placed at the front of all patient charts. Clinic-system and patient factors were also addressed. HOLDING THE GAINS--MONITORING PERFORMANCE: The 1993 postintervention chart review showed significant improvements for 17 (81%) of the 21 targeted services. DISCUSSION: Providing educational sessions on prevention, permitting residents to select the areas of prevention on which to focus, and giving feedback on resident and staff performance through ongoing, nonpunitive monitoring resulted in increased provision of clinical prevention services in a family practice residency training center.     

Review of the regulations on quality control of human albumin

PURPOSE: To assess medical students' perceptions of the ethical environment across four years of medical school. METHOD: In the spring of 1996, the authors distributed a questionnaire to all four classes at the Wake Forest University School of Medicine. The students provided demographic information and information about their exposures to or participation in unethical situations. Results were analyzed using multiple analysis of variance, univariate analysis of variance, Pearson correlation, and cross-tabulations. RESULTS: The response rate was 71%. The students reported that exposures to unethical behavior started early and continued to increase with each year in school. For example, 35% of the first-year students reported observing unethical conduct by residents or attending physicians. This percentage rose to 90% of the fourth-year students. The authors found no significant relationship between demographic variables other than the year in school and the ethical dilemma variables. CONCLUSION: Medical students face perceived ethical dilemmas beginning as early as the first year of medical school. Thus ethics instruction must begin in the freshman year. In addition, there must be changes to the environment in which clinical education is conducted to enhance the positive enculturation of students into the medical profession.     

A strategy for improving patient satisfaction by the intensive training of residents in psychosocial medicine: a controlled, randomized study

PURPOSE: To use a controlled, randomized design to assess the effect on patient satisfaction of an intensive psychosocial training program for residents. METHOD: Twenty-six first-year residents, in two internal medicine and family practice community-based programs affiliated with the Michigan State University College of Human Medicine, were randomly assigned during 1991 and 1992 to a control group or a one-month intensive training program. Experiential teaching focused on many psychosocial skills required in primary care. A 29-item questionnaire administered before and after the residents' training evaluated their patients' satisfaction regarding patient disclosure, physician empathy, confidence in physician, general satisfaction, and comparison of the physician with other physicians. Analyses of covariance with groups and gender as factors and pre-training patient satisfaction scores as the covariate evaluated the effect of the training. RESULTS: The patients of the trained residents expressed more confidence in their physicians (p = .01) and more general satisfaction (p = .02) than did the patients of controls. The effect of training on patient satisfaction with patient disclosure (p < .01) and physician empathy (p < .05) was greater for female than for male residents. CONCLUSION: The intensive psychosocial training program for residents improved their patients' satisfaction.     

Genomic organization of six tomato polygalacturonases and 5'' upstream sequence identity with tap1 and win2 genes

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.     

Resident and faculty perceptions of effective clinical teaching in family practice

Increasing interest in clinical teaching has led to the realization that the unique subset of skills which characterizes effective clinical teaching needs to be identified. Such identification will lead to development of these skills and improvement in the quality of clinical teaching. Family practice faculty are vitally concerned with improving their clinical teaching skills, since clinical teaching is the core of education in family medicine and since many family physicians who become preceptors have had no formal training as teachers. In this investigation of effective clinical teaching behaviors, faculty and residents generally agree in their perceptions of the helpfulness of 58 clinical teaching behaviors. Neither group felt that emphasis on references and research is as important a factor in effective clinical teaching as are residents' active participation in the learning situation and positive preceptor attitudes toward teaching and residents. It was perceived that the ineffective clinical teacher has a negative attitude toward residents, is inaccessible, and lacks skills in providing feedback, while the effective clinical teacher has skills in two-way communication, creates an educational environment that facilitates learning, and provides constructive feedback to residents.     

The properties of simian coronavirus

OBJECTIVE: To determine the effect of a unique educational program in critical care medicine on the attitudes, knowledge, and skills of general internists who care for critically ill patients. DESIGN: Comparison of objective assessments and self-assessments obtained before and after the one-year educational program. SETTING/PARTICIPANTS: Eighteen general internists practicing in a 350-bed university-affiliated community teaching hospital. RESULTS: After the program, the internists felt significantly more competent in, knowledgeable about, comfortable with, and satisfied with caring for critically ill patients than they did when completing the precourse self-assessments (p < 0.05). Participants felt particularly more comfortable with managing ventilator patients and leading the advanced cardiac life-support team (p < 0.05). Comfort levels for other commonly performed critical care procedures did not vary. No significant change in knowledge test scores was noted from before to after the one-year program (61% vs 60%). Residents and nurses rated the internists' overall ability in critical care medicine to be the same as that of senior medical residents. They also favorably rated the internists on humanism, teaching skills, and interpersonal interactions. Residents also appreciated the decrease in their night call because of the program. CONCLUSIONS: This unique educational program increased comfort and satisfaction of general internists caring for critically ill patients. The program was well accepted by residents and nurses because of favorable interaction with the internists and a decrease in resident night-call responsibility. This curriculum is recommended to other teaching hospitals.     

An evaluation of a family visit education program

OBJECTIVES: This study was designed to examine the impact of the Family Visit Education Program (FVEP) on family members, nursing staff, and nursing home residents with dementia. DESIGN: The study employed a 2 x 3 single-blind, randomized control group design with two study conditions, FVEP or usual care (UC), and three times of measurement, baseline, 3-months, and 6-months. SETTING: The study was conducted in five skilled-care nursing homes that ranged in size from 120 to 300 beds. PARTICIPANTS: Sixty-six residents with dementia and their primary visitor were randomly assigned to FVEP (n = 32) or UC (n = 34). MEASUREMENTS: Residents were assessed for (1) psychosocial functioning, (2) depression, (3) agitated behavior, and (4) degree of positive social interaction. Nursing staff were assessed for changes in the time and methods used to manage problem behaviors. Visitors were assessed for (1) dementia management skills, (2) extent of perceived caregiving hassles, and (3) visit satisfaction. RESULTS: FVEP was effective for reducing residents' problem behaviors and for decreasing their symptoms of depression and irritability. It was also effective for improving the way family members and other visitors communicated with residents, but, with the exception of reducing the use of mechanical restraints, it was not effective in changing nurses' management of residents' behavior problems. CONCLUSIONS: It is possible to educate family members to communicate and interact more effectively with nursing home residents with dementia. This has beneficial effects on residents but not on nursing staff's management of problem behaviors.     

Attitude of psychiatric residents toward patient requests

The authors assessed residents' comfort in dealing with 14 previously identified types of patient requests in inpatient, outpatient, and acute service settings. First-year residents expressed significantly more discomfort than more experienced residents on 11 categories. They were also significantly less comfortable in the acute service than the inpatient setting. All residents expressed more comfort dealing with dynamic, psychological, and "nonsevere" requests. These findings suggest a need to teach residents specific therapeutic responses to various categories of requests and to evaluate the desirability of starting the residency experience on an acute service.     

Effects of viral respiratory disease education and surveillance on antibiotic prescribing

BACKGROUND AND OBJECTIVES: We describe a partnership between family practice residency clinics and a state public health virology laboratory that has produced comprehensive viral respiratory disease education and surveillance. Family practice residents have been provided with education on respiratory viruses and the results of ongoing viral surveillance. The preliminary effects of this program on antibiotic prescribing by senior residents are evaluated in this paper. METHODS: We used a questionnaire to assess the acceptance by family practice residents of the educational component and the utility of ongoing viral surveillance. We used chart review to evaluate rates of antibiotic prescribing and the number of patients diagnosed per year with acute upper respiratory infection and acute bronchitis by senior residents in 1992 (preexposure) and 1996 (postexposure). RESULTS: By the third year of training, most residents (79%) reported receiving adequate training regarding common viral respiratory diseases. Moreover, residents reported that they were less likely to prescribe antibiotics to patients presenting with respiratory infections when provided with specific information on circulating viral pathogens. Antibiotic prescribing in the postexposure group was 68% lower for upper respiratory infection (URI) and 45% lower for a composite of URI and bronchitis. CONCLUSIONS: Education and monitoring of circulating respiratory viruses can result in familiarity with common disorders in primary care and reduce unnecessary antibiotic use.     

Hospital system in society--with special reference to the development of team functions as a mode of work

BACKGROUND: Student clinical and work-related experiences are available at many healthcare organizations, but little is known about how these experiences contribute to the employer/nurse work relationship that begins after graduation. This study examined the relationship of senior BSN students' past employer experience in describing first-year employer commitment and turnover. METHODS: The sample was 63 senior BSN students. Experience factors measured included job selection factors, pre- and one-year commitment, organizational climate, employer support, and first-year turnover. RESULTS: Organizational climate was the experience-related factor most important in explaining first-year commitment. CONCLUSION: Findings suggest the importance of supportive work environments to new nurses both before and after accepting the first graduate nurse position.     

Preferences of older adults and experts for policies and services in group living facilities.

The Policy and Program Information Form—Ideal Form (POLIF—I) was developed to assess preferences of older adults for the policies and services of group living facilities. Compared with older community residents (n?=?205), congregate apartment residents (n?=?229) prefer facilities that have higher behavioral standards, deemphasize supportive services and formal avenues for resident influence, and emphasize privacy. In contrast to older respondents, experts (n?=?44) prefer settings with lower behavioral standards, more supportive services, more resident input, and more privacy. Sociodemographic characteristics (marital status, occupation, education, age, gender) and functional ability are weakly associated with the policy and service preferences of older respondents. The POLIF—I has several applications, including examination of the congruence between residents' preferences and the actual policies and services of group living facilities. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Breast cancer screening knowledge and skills of students upon entering and exiting a medical school

PURPOSE: To assess needs for breast cancer screening education by comparing medical students' training and knowledge of breast cancer screening upon their entry to and exit from medical school. METHOD: Seventy-seven medical students at one medical school completed questionnaires as first-year students (in 1992) and again as fourth-year students (in 1996) that assessed their breast cancer screening knowledge. The fourth-year questionnaire included additional questions about the students' clinical training in breast cancer screening skills and their perceptions of needs for further training. RESULTS: Although the students performed significantly better on the knowledge-based questions in their fourth year than they did in their first year, considerable room for improvement remained. The students reported learning the most from surgery rotations and more from standardized patients than from faculty. Women medical students performed significantly more clinical breast examinations than did men students. CONCLUSIONS: Most of the medical students reported needing additional training in clinical breast examination. More curricular time devoted to education about breast cancer screening is needed.