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Sample records for medical curricular improvement

  1. Medical student mental health 3.0: improving student wellness through curricular changes.

    PubMed

    Slavin, Stuart J; Schindler, Debra L; Chibnall, John T

    2014-04-01

    Medical education can have significant negative effects on the well-being of medical students. To date, efforts to improve student mental health have focused largely on improving access to mental health providers, reducing the stigma and other barriers to mental health treatment, and implementing ancillary wellness programs. Still, new and innovative models that build on these efforts by directly addressing the root causes of stress that lie within the curriculum itself are needed to properly promote student wellness. In this article, the authors present a new paradigm for improving medical student mental health, by describing an integrated, multifaceted, preclinical curricular change program implemented through the Office of Curricular Affairs at the Saint Louis University School of Medicine starting in the 2009-2010 academic year. The authors found that significant but efficient changes to course content, contact hours, scheduling, grading, electives, learning communities, and required resilience/mindfulness experiences were associated with significantly lower levels of depression symptoms, anxiety symptoms, and stress, and significantly higher levels of community cohesion, in medical students who participated in the expanded wellness program compared with those who preceded its implementation. The authors discuss the utility and relevance of such curricular changes as an overlooked component of change models for improving medical student mental health.

  2. Medical Student Mental Health 3.0: Improving Student Wellness Through Curricular Changes

    PubMed Central

    Schindler, Debra L.; Chibnall, John T.

    2014-01-01

    Medical education can have significant negative effects on the well-being of medical students. To date, efforts to improve student mental health have focused largely on improving access to mental health providers, reducing the stigma and other barriers to mental health treatment, and implementing ancillary wellness programs. Still, new and innovative models that build on these efforts by directly addressing the root causes of stress that lie within the curriculum itself are needed to properly promote student wellness. In this article, the authors present a new paradigm for improving medical student mental health, by describing an integrated, multifaceted, preclinical curricular change program implemented through the Office of Curricular Affairs at the Saint Louis University School of Medicine starting in the 2009–2010 academic year. The authors found that significant but efficient changes to course content, contact hours, scheduling, grading, electives, learning communities, and required resilience/mindfulness experiences were associated with significantly lower levels of depression symptoms, anxiety symptoms, and stress, and significantly higher levels of community cohesion, in medical students who participated in the expanded wellness program compared with those who preceded its implementation. The authors discuss the utility and relevance of such curricular changes as an overlooked component of change models for improving medical student mental health. PMID:24556765

  3. Effects of "minimally invasive curricular surgery" - a pilot intervention study to improve the quality of bedside teaching in medical education.

    PubMed

    Raupach, Tobias; Anders, Sven; Pukrop, Tobias; Hasenfuss, Gerd; Harendza, Sigrid

    2009-09-01

    Bedside teaching is an important element of undergraduate medical education. However, the impact of curricular course structure on student outcome needs to be determined. This study assessed changes in fourth-year medical students' evaluations of clinical teaching sessions before and after the introduction of a new course format. The curricular structure of bedside teaching sessions in cardiology was modified without changing the amount of teaching time. Clinical teachers were instructed about the new teaching format and learning objectives. The new format implemented for adult but not paediatric cardiology sessions was piloted with 143 students in winter 2007/08. By computing effect sizes, evaluation results were compared to data obtained from 185 students before the intervention. Significant rating increases were observed for adult cardiology teaching sessions (Cohen's d = 0.66) but not paediatric cardiology sessions (d = 0.22). In addition to improving the structure and organization of the course, the intervention significantly impacted on students' perceptions of their learning outcome regarding practical skills (d = 0.69). Minimal curricular changes combined with basic faculty development measures significantly increase students' perception of learning outcome. Curricular structure needs to be considered when planning bedside teaching sessions in medical undergraduate training.

  4. Improvement in attitudes toward influenza vaccination in medical students following an integrated curricular intervention.

    PubMed

    Afonso, Nelia; Kavanagh, Maurice; Swanberg, Stephanie

    2014-01-16

    Vaccination of health care workers (HCW) reduces transmission of influenza among patients, yet uptake of vaccination remains low. If vaccination education is integrated into the early medical school curriculum, will student attitudes toward the vaccine change? The objectives of the study were to: (1) Determine influenza vaccination rates among entering medical students; (2) Assess the attitudes toward influenza vaccination; (3) Evaluate the effects of a multifaceted educational intervention on attitudes to vaccination. Entering medical students were surveyed before and after an intervention at the beginning of the influenza season. This intervention provided by an inter-professional team, included education about influenza, importance of vaccination for HCWs, followed by vaccination administration practice, and ended with students vaccinating consenting classmates. The pre-intervention surveys and intervention were completed by 124 of 125 (99%) students. Pre-intervention survey revealed 60 (48%) of students had been previously vaccinated. Of the vaccinated students 91% had been recommended vaccination by their healthcare provider compared to 43% of non-vaccinated students. More positive attitudes were noted in the vaccinated students compared to non-vaccinated students: importance of vaccination (p<0.01); HCWs should be vaccinated (p<0.01); recommendation of vaccine to family and friends (p<0.01). 97 (78%) students completed post-intervention surveys. Significant improvement in these attitudes was noted post-intervention compared to pre-intervention: importance of vaccination 93% versus 71% (p<0.01); HCWs should be vaccinated 95% versus 83% (p<0.01); recommendation to family and friends 93% versus 73% (p<0.01); comfort with vaccine counseling 92% versus 41%; comfort with vaccine administration 84% versus 22% (p<0.01). Educating medical students and promoting the importance of vaccination early in a medical student's career using such an intervention is relatively

  5. Coupling Admissions and Curricular Data to Predict Medical Student Outcomes

    ERIC Educational Resources Information Center

    Sesate, Diana B.; Milem, Jeffrey F.; McIntosh, Kadian L.; Bryan, W. Patrick

    2017-01-01

    The relative impact of admissions factors and curricular measures on the first medical licensing exam (United States Medical Licensing Exam [USMLE] Step 1) scores is examined. The inclusion of first-year and second-year curricular measures nearly doubled the variance explained in Step 1 scores from the amount explained by the combination of…

  6. Managing curricular change in the UWI medical schools.

    PubMed

    Uchegbu, B O

    2001-12-01

    The ideal operational curriculum is dynamic. It is alive, constantly responding to changes within the social milieu served by its programmes. The medical curriculum of the University of the West Indies (UWI) has not been readily responsive to its catchment society's changing needs. This lack of resilience has created both curricular and administrative problems that have remained unsolved. Now, at the threshold of the twenty-first century, many more fundamental curricular changes are imperative in the UWI medical programme if the Faculty of Medical Sciences (FMS) is to be able to withstand the territorial invasions imminent from the global digital institutions of the new age. The new changes that will place the medical curriculum in line with the demands of the new Information Age will also remove the obnoxious effects of the 'dual curriculum' question and related issues. The Change Formula (Ch = V x P x D > C) that has worked the corporate transformations and realignments of the late twentieth century is applied to the thoughts of a reformed management of the UWI medical curriculum, and its ability to break down walls of resistance to change and liberate the curriculum to full dynamism is discussed.

  7. Curricular reform may improve students' performance on externally administered comprehensive examinations.

    PubMed

    Damjanov, Ivan; Fenderson, Bruce A; Hojat, Mohammadreza; Rubin, Emanuel

    2005-06-01

    To determine whether changes in the format of teaching pathology and the introduction of active learning principles can improve medical students' performance on external examinations and enhance clinical skills. The sophomore Pathology Course at Jefferson Medical College (JMC) in Philadelphia, Pennsylvania, USA, was completely restructured in 1986, with greater emphasis placed on independent study, small group teaching, and case study discussion. We used the scores of JMC medical students on the National Board of Medical Examiners (NBME) Part I Examination to compare the performance of JMC students who completed their medical education before curricular change (entering classes 1982-1984) with the performance of subsequent generations of students who were taught according to the reformed curriculum (entering classes 1985-1988). The two groups of students were comparable in terms of standard social and psychometric parameters, such as mean age at matriculation, female/male ratio, ratio of minority students in the class, premedical college grade point averages, and mean scores on the preadmission Medical College Admissions Test. JMC students who studied pathology prior to the curricular reform received on the pathology subsection of the NBME Part I Examination reform scores that were close to the national average. In contrast, mean scores for students who studied pathology after curricular changes were significantly higher than the national average (P<0.001). Based on their pathology subscores, the number of JMC students scoring below the cutoff line for passing (380 points) decreased significantly after the curricular reform, whereas the number of high-scoring students whose scores ranked them in the 90th percentile nationally increased. Curricular reform was also associated with an increase in overall student satisfaction. Curricular changes that include an emphasis on active learning can improve the performance of medical students on externally administered

  8. Reflective writing by final year medical students: lessons for curricular change.

    PubMed

    Ganesh, Alka; Ganesh, Gayatri

    2010-01-01

    Reflective writinghas been used in undergraduate medical curricula to inculcate empathetic attitudes in medical students. Journal writing has been used to enhance reflection in a confidential space. We aimed to introduce our medical students to reflective writing of their daily experiences, both to enhance empathetic attitudes as well as to use the entries to Inform curricular changes. We invited 16 final year medical students posted in the Department of Medicine to record their emotional experiences during a 6-week posting. Freedom to abstain without prejudice was emphasized, yet all 16 students complied. According to the principle of grounded theory, the entries were grouped into 8 themes: (i) doctor-patient relationship; (ii) personal inadequacy; (iii) empathy; (iv) communication skills; (v) doctor's competence; (vi) patient behaviour; (vii) hospital practices; and (viii) personal feelings. There were 179 entries which were evaluable under the above categories, with no significant gender differences. Based on the entries, the following curricular suggestions were made: (i) use of diaries by medical students to express their emotional reactions and make value judgements, followed by guided discussion by experienced facilitators; (ii) introduction of communication skills courses at appropriate points to enhance Interview skills, empathetic listening, conflict resolution and breaking bad news; (iii) encourage reflection on healthcare delivery and its inequities and suggest methods of dealing with individual patients; and (iv) use of positive feedback and encouragement by faculty. Conclusions. Reflective journal writing by medical students in India gives valuable insights into improving communication skills and professionalism. Appropriate curricular changes should be made to meet the challenges posed by the existing healthcare system.

  9. EVIDENCE-BASED CURRICULAR CONTENT IMPROVES STUDENT KNOWLEDGE AND CHANGES ATTITUDES TOWARDS TRANSGENDER MEDICINE.

    PubMed

    Eriksson, Sven E S; Safer, Joshua D

    2016-07-01

    Previous studies have demonstrated that the addition of transgender medicine content to a medical school curriculum increased students' comfort and willingness to treat transgender patients. We aimed to demonstrate that (1) evidence-based curricular content would improve knowledge of and change attitudes towards transgender medicine, and (2) students would consider cross-sex hormone therapy a legitimate treatment option for transgender patients. Curricular content with a focus on the biologic evidence for the durability of gender identity was added to the first-year medical program at Boston University School of Medicine. Immediately before and after exposure to the content, students were presented with an assessment of their knowledge of the etiology of gender identity. Immediately following exposure to the content, a significant number of students changed their answer regarding the etiology of gender identity so that the number of correct responses increased from 63% (n = 56) to 93% (n = 121) (P<.001). For transgender treatment, the number of correct responses increased from 20% (n = 56) before exposure to the content to 50% (n = 121) following exposure (P<.001). The addition of transgender medicine content to a medical school curriculum with a focus on the biologic evidence for a durable gender identity is an effective means of educating students about the etiology of gender identity and the appropriateness of cross-sex hormone therapy as a treatment for transgender patients.

  10. Health Systems Science Curricula in Undergraduate Medical Education: Identifying and Defining a Potential Curricular Framework.

    PubMed

    Gonzalo, Jed D; Dekhtyar, Michael; Starr, Stephanie R; Borkan, Jeffrey; Brunett, Patrick; Fancher, Tonya; Green, Jennifer; Grethlein, Sara Jo; Lai, Cindy; Lawson, Luan; Monrad, Seetha; O'Sullivan, Patricia; Schwartz, Mark D; Skochelak, Susan

    2017-01-01

    The authors performed a review of 30 Accelerating Change in Medical Education full grant submissions and an analysis of the health systems science (HSS)-related curricula at the 11 grant recipient schools to develop a potential comprehensive HSS curricular framework with domains and subcategories. In phase 1, to identify domains, grant submissions were analyzed and coded using constant comparative analysis. In phase 2, a detailed review of all existing and planned syllabi and curriculum documents at the grantee schools was performed, and content in the core curricular domains was coded into subcategories. The lead investigators reviewed and discussed drafts of the categorization scheme, collapsed and combined domains and subcategories, and resolved disagreements via group discussion. Analysis yielded three types of domains: core, cross-cutting, and linking. Core domains included health care structures and processes; health care policy, economics, and management; clinical informatics and health information technology; population and public health; value-based care; and health system improvement. Cross-cutting domains included leadership and change agency; teamwork and interprofessional education; evidence-based medicine and practice; professionalism and ethics; and scholarship. One linking domain was identified: systems thinking. This broad framework aims to build on the traditional definition of systems-based practice and highlight the need for medical and other health professions schools to better align education programs with the anticipated needs of the systems in which students will practice. HSS will require a critical investigation into existing curricula to determine the most efficient methods for integration with the basic and clinical sciences.

  11. The medical humanities and the perils of curricular integration.

    PubMed

    Chiavaroli, Neville; Ellwood, Constance

    2012-12-01

    The advent of integration as a feature of contemporary medical curricula can be seen as an advantage for the medical humanities in that it provides a clear implementation strategy for the inclusion of medical humanities content and/or perspectives, while also making its relevance to medical education more apparent. This paper discusses an example of integration of humanities content into a graduate medical course, raises questions about the desirability of an exclusively integrated approach, and argues for the value of retaining a discrete and coherent disciplinary presence for the medical humanities in medical curricula.

  12. Clerkship curricular revision based on the Ambulatory Pediatric Association and the Council on Medical Student Education in Pediatrics guidelines: does it make a difference?

    PubMed

    Kuo, A A; Slavin, S J

    1999-04-01

    To compare general pediatric knowledge acquisition and clinical problem-solving skills by students pre- and postcurricular reform based on the 1994 Ambulatory Pediatric Association and the Council on Medical Student Education in Pediatrics (APA-COMSEP) curricular guidelines. A large, urban academic medical center. Third-year medical students on a required clerkship in Pediatrics. Pre- and postcurricular revision, the students were given both the National Board of Medical Examiners (NBME) Pediatric Subject Examination and an objective examination, which was developed in-house, based on the APA-COMSEP guidelines (Pediatric Clerkship Examination [PCE]). Baseline data before curricular revision were obtained on 52 students from May 1995 to May 1996. After curricular redesign in May 1996, data were obtained on 42 students from May 1996 to May 1997. Curricular revision focused on the following: defining educational principles, selecting teaching strategies, defining learning objectives, implementing the curriculum, and evaluating the students with an examination. Before curricular revision, the average NBME score was 521 +/- 122. The average PCE score was 53.7% +/- 10.1%. After curricular revision, the average NBME score was 520 +/- 109, and the average PCE score was 67.7% +/- 8.4%. Content areas showing the greatest improvement were fluids and electrolytes, issues pertaining to the newborn, and health supervision. Our baseline data indicate that despite spending two thirds of the clerkship in the ambulatory setting, students did not acquire adequate general pediatric knowledge or clinical problem-solving ability. After broad clerkship revision based on the APA-COMSEP Core Curriculum, students' acquisition of general pediatric knowledge and clinical problem-solving improved significantly, as measured by the PCE. The overall NBME Pediatric Subject Examination scores did not reflect this increased acquisition of general pediatric knowledge.

  13. Integrating Quality Improvement Education into the Nephrology Curricular Milestones Framework and the Clinical Learning Environment Review.

    PubMed

    Prince, Lisa K; Little, Dustin J; Schexneider, Katherine I; Yuan, Christina M

    2017-02-07

    The Accreditation Council for Graduate Medical Education requires that trainees show progressive milestone attainment in the practice-based learning and systems-based practice competencies. As part of the Clinical Learning Environment Review, sponsoring hospitals must educate trainees in health care quality improvement, provide them with specialty-specific quality data, and ensure trainee participation in quality improvement activities and committees. Subspecialty-specific quality improvement curricula in nephrology training programs have not been reported, although considerable curricular and assessment material exists for specialty residencies, including tools for assessing trainee and faculty competence. Nephrology-specific didactic material exists to assist nephrology fellows and faculty mentors in designing and implementing quality improvement projects. Nephrology is notable among internal medicine subspecialties for the emphasis placed on adherence to quality thresholds-specifically for chronic RRT shown by the Centers for Medicare and Medicaid Services Quality Incentive Program. We have developed a nephrology-specific curriculum that meets Accreditation Council for Graduate Medical Education and Clinical Learning Environment Review requirements, acknowledges regulatory quality improvement requirements, integrates with ongoing divisional quality improvement activities, and has improved clinical care and the training program. In addition to didactic training in quality improvement, we track trainee compliance with Kidney Disease Improving Global Outcomes CKD and ESRD quality indicators (emphasizing Quality Improvement Program indicators), and fellows collaborate on a yearly multidisciplinary quality improvement project. Over the past 6 years, each fellowship class has, on the basis of a successful quality improvement project, shown milestone achievement in Systems-Based Practice and Practice-Based Learning. Fellow quality improvement projects have improved

  14. Curricular integration of social medicine: a prospective for medical educators.

    PubMed

    Vanderbilt, Allison A; Baugh, Reginald F; Hogue, Patricia A; Brennan, Julie A; Ali, Imran I

    2016-01-01

    In the United States, the health of a community falls on a continuum ranging from healthy to unhealthy and fluctuates based on several variables. Research policy and public health practice literature report substantial disparities in life expectancy, morbidity, risk factors, and quality of life, as well as persistence of these disparities among segments of the population. One such way to close this gap is to streamline medical education to better prepare our future physicians for our patients in underserved communities. Medical schools have the potential to close the gap when training future physicians by providing them with the principles of social medicine that can contribute to the reduction of health disparities. Curriculum reform and systematic formative assessment and evaluative measures can be developed to match social medicine and health disparities curricula for individual medical schools, thus assuring that future physicians are being properly prepared for residency and the workforce to decrease health inequities in the United States. We propose that curriculum reform includes an ongoing social medicine component for medical students. Continued exposure, practice, and education related to social medicine across medical school will enhance the awareness and knowledge for our students. This will result in better preparation for the zero mile stone residency set forth by the Accreditation Council of Graduate Medical Education and will eventually lead to the outcome of higher quality physicians in the United States to treat diverse populations.

  15. The patient handoff: a comprehensive curricular blueprint for resident education to improve continuity of care.

    PubMed

    Wohlauer, Max V; Arora, Vineet M; Horwitz, Leora I; Bass, Ellen J; Mahar, Sean E; Philibert, Ingrid

    2012-04-01

    In 2010, the Accreditation Council for Graduate Medical Education released its resident duty hours restrictions, requiring that faculty monitor their residents' patient handoffs to ensure that residents are competent in handoff communications. Although studies have reported the need to improve the effectiveness of the handoff and a variety of curricula have been suggested and implemented, a common method for teaching and evaluating handoff skills has not been developed. Also in 2010, engineers, informaticians, and physicians interested in patient handoffs attended a symposium in Savannah, Georgia, hosted by the Association for Computing Machinery, entitled Handovers and Handoffs: Collaborating in Turns. As a result of this symposium, a workgroup formed to develop practical and readily implementable educational materials for medical educators involved in teaching patient handoffs to residents. In this article, the result of that yearlong collaboration, the authors aim to provide clarity on the definition of the patient handoff, to review the barriers to performing effective handoffs in academic health centers, to identify available solutions to improve handoffs, and to provide a structured approach to educating residents on handoffs via a curricular blueprint. The authors' blueprint was developed to guide educators in customizing handoff education programs to fit their specific, local needs. Hopefully, it also will provide a starting point for future research into improving the patient handoff. Increasingly complex patient care environments require both innovations in handoff education and improvements in patient care systems to improve continuity of care.

  16. The Patient Handoff: A Comprehensive Curricular Blueprint for Resident Education to Improve Continuity of Care

    PubMed Central

    Wohlauer, Max V.; Arora, Vineet M.; Horwitz, Leora I.; Bass, Ellen J.; Mahar, Sean E.; Philibert, Ingrid

    2012-01-01

    In 2010, the Accreditation Council for Graduate Medical Education released its resident duty hours restrictions, requiring that faculty monitor their residents’ patient handoffs to ensure that residents are competent in handoff communications. Although studies have reported the need to improve the effectiveness of the handoff and a variety of curricula have been suggested and implemented, a common method for teaching and evaluating handoff skills has not been developed. Also in 2010, engineers, informaticians, and physicians interested in patient handoffs attended a symposium in Savannah, Georgia, hosted by the Association for Computing Machinery, entitled Handovers and Handoffs: Collaborating in Turns. As a result of this symposium, a workgroup formed to develop practical and readily implementable educational materials for medical educators involved in teaching patient handoffs to residents. In this article, the result of that yearlong collaboration, the authors aim to provide clarity on the definition of the patient handoff, to review the barriers to performing effective handoffs in academic health centers, to identify available solutions to improve handoffs, and to provide a structured approach to educating residents on handoffs via a curricular blueprint. The authors’ blueprint was developed to guide educators in customizing handoff education programs to fit their specific, local needs. Hopefully, it also will provide a starting point for future research into improving the patient handoff. Increasingly complex patient care environments require both innovations in handoff education and improvements in patient care systems to improve continuity of care. PMID:22361791

  17. Curricular priorities for business ethics in medical practice and research: recommendations from Delphi consensus panels.

    PubMed

    DuBois, James M; Kraus, Elena M; Gursahani, Kamal; Mikulec, Anthony; Bakanas, Erin

    2014-11-15

    No published curricula in the area of medical business ethics exist. This is surprising given that physicians wrestle daily with business decisions and that professional associations, the Institute of Medicine, Health and Human Services, Congress, and industry have issued related guidelines over the past 5 years. To fill this gap, the authors aimed (1) to identify the full range of medical business ethics topics that experts consider important to teach, and (2) to establish curricular priorities through expert consensus. In spring 2012, the authors conducted an online Delphi survey with two heterogeneous panels of experts recruited in the United States. One panel focused on business ethics in medical practice (n = 14), and 1 focused on business ethics in medical research (n = 12). Panel 1 generated an initial list of 14 major topics related to business ethics in medical practice, and subsequently rated 6 topics as very important or essential to teach. Panel 2 generated an initial list of 10 major topics related to business ethics in medical research, and subsequently rated 5 as very important or essential. In both domains, the panel strongly recommended addressing problems that conflicts of interest can cause, legal guidelines, and the goals or ideals of the profession. The Bander Center for Medical Business Ethics at Saint Louis University will use the results of the Delphi panel to develop online curricular resources for each of the highest rated topics.

  18. A Process for Curricular Improvement Based on Evaluation of Student Performance on Milestone Examinations

    PubMed Central

    Hylton, Ann C.; Justice, Michael

    2016-01-01

    Objective. To identify and address areas for curricular improvement by evaluating student achievement of expected learning outcomes and competencies on annual milestone examinations. Design. Students were tested each professional year with a comprehensive milestone examination designed to evaluate student achievement of learning outcomes and professional competencies using a combination of multiple-choice questions, standardized patient assessments (SPAs), and objective structured clinical examination (OSCE) questions. Assessment. Based on student performance on milestone examinations, curricular changes were instituted, including an increased emphasis on graded comprehensive cases, OSCE skills days, and use of patient simulation in lecture and laboratory courses. After making these changes, significant improvements were observed in second and third-year pharmacy students’ grades for the therapeutic case and physician interaction/errors and omissions components of the milestone examinations. Conclusion. Results from milestone examinations can be used to identify specific areas in which curricular improvements are needed to foster student achievement of learning outcomes and professional competencies. PMID:28090108

  19. Using POSTDOC to recognize biomedical concepts in medical school curricular documents.

    PubMed

    Kanter, S L; Miller, R A; Tan, M; Schwartz, J

    1994-07-01

    Recognition of the biomedical concepts in a document is prerequisite to further processing of the document: medical educators examine curricular documents to discover the coverage of certain topics, detect unwanted redundancies, integrate new content, and delete old content; and clinicians are concerned with terms in patient medical records for purposes ranging from creation of an electronic medical record to identification of medical literature relevant to a particular case. POSTDOC (POSTprocessor of DOCuments) is a computer application that (1) accepts as input a free-text, ASCII-formatted document and uses the Unified Medical Language System (UMLS) Metathesaurus to recognize relevant main concept terms; (2) provides term co-occurrence data and thus is able to identify potentially increasing correlations among concepts within the document; and (3) retrieves references from MEDLINE files based on user identification of relevant subjects. This paper describes a formative evaluation of POSTDOC's ability to recognize UMLS Metathesaurus biomedical concepts in medical school lecture outlines. The "precision" and "recall" varied over a wide range and were deemed not yet acceptable for automated creation of a database of concepts from curricular documents. However, results were good enough to warrant further study and continued system development.

  20. From Curricular Justice to Educational Improvement: What Is the Role of Schools' Self-Evaluation?

    ERIC Educational Resources Information Center

    Sampaio, Marta; Leite, Carlinda

    2017-01-01

    This article presents a study that aimed to understand the contributions of self-evaluation (SE) processes towards the development of curricular and social justice and educational improvement. The study focuses on data collected from the schools' external evaluation (SEE) process and from the TEIP programme (Educational Territories of Priority…

  1. Curricular reform of the 4th year of medical school: the colleges model.

    PubMed

    Slavin, Stuart J; Wilkes, Michael S; Usatine, Richard P; Hoffman, Jerome R

    2003-01-01

    The practice of medicine has changed dramatically over the last 3 decades. Medical education has struggled to keep up with these changes, with only limited success. The 4th year of medical school offers a tremendous opportunity for curricular innovation, but little change has occurred in the past 30 years. This article traces the history of the 4th year, from the Flexnerian era in which the classic preclinical-clinical model for medical education was developed, through the 1970s, when virtually every medical school adopted a largely elective 4th year, to the present. Although the classic 4th-year curriculum has a number of strengths such as flexibility and relative autonomy of scheduling for students, it also has significant weaknesses. A major educational initiative for the 4th year-the "College Phase"-has been implemented at the David Geffen School of Medicine at UCLA. It is designed to remedy many of the weaknesses of the 4th-year curriculum while preserving the benefits. Five colleges have been created: acute care, applied anatomy, medical science, primary care, and urban underserved. Students participate in a number of different college-specific activities that are hoped to produce a more engaging, rigorous, and enriching experience for students and faculty alike

  2. Students’ Perceptions of Peer-Organized Extra-Curricular Research Course during Medical School: A Qualitative Study

    PubMed Central

    Nazha, Bassel; Salloum, Rony H.; Fahed, Akl C.; Nabulsi, Mona

    2015-01-01

    Early integration of research education into medical curricula is crucial for evidence-based practice. Yet, many medical students are graduating with no research experience due to the lack of such integration in their medical school programs. The purpose of this study was to explore the impact of a peer-organized, extra-curricular research methodology course on the attitudes of medical students towards research and future academic careers. Twenty one medical students who participated in a peer-organized research course were enrolled in three focus group discussions to explore their experiences, perceptions and attitudes towards research after the course. Discussions were conducted using a semi-structured interview guide, and were transcribed and thematically analyzed for major and minor themes identification. Our findings indicate that students’ perceptions of research changed after the course from being difficult initially to becoming possible. Participants felt that their research skills and critical thinking were enhanced and that they would develop research proposals and abstracts successfully. Students praised the peer-assisted teaching approach as being successful in enhancing the learning environment and filling the curricular gap. In conclusion, peer-organized extra-curricular research courses may be a useful option to promote research interest and skills of medical students when gaps in research education in medical curricula exist. PMID:25764441

  3. Students' perceptions of peer-organized extra-curricular research course during medical school: a qualitative study.

    PubMed

    Nazha, Bassel; Salloum, Rony H; Fahed, Akl C; Nabulsi, Mona

    2015-01-01

    Early integration of research education into medical curricula is crucial for evidence-based practice. Yet, many medical students are graduating with no research experience due to the lack of such integration in their medical school programs. The purpose of this study was to explore the impact of a peer-organized, extra-curricular research methodology course on the attitudes of medical students towards research and future academic careers. Twenty one medical students who participated in a peer-organized research course were enrolled in three focus group discussions to explore their experiences, perceptions and attitudes towards research after the course. Discussions were conducted using a semi-structured interview guide, and were transcribed and thematically analyzed for major and minor themes identification. Our findings indicate that students' perceptions of research changed after the course from being difficult initially to becoming possible. Participants felt that their research skills and critical thinking were enhanced and that they would develop research proposals and abstracts successfully. Students praised the peer-assisted teaching approach as being successful in enhancing the learning environment and filling the curricular gap. In conclusion, peer-organized extra-curricular research courses may be a useful option to promote research interest and skills of medical students when gaps in research education in medical curricula exist.

  4. Sex and Gender Medical Education Summit: a roadmap for curricular innovation.

    PubMed

    Chin, Eliza L; Hoggatt, Marley; McGregor, Alyson J; Rojek, Mary K; Templeton, Kimberly; Casanova, Robert; Klein, Wendy S; Miller, Virginia M; Jenkins, Marjorie

    2016-01-01

    The Sex and Gender Medical Education Summit: a roadmap for curricular innovation was a collaborative initiative of the American Medical Women's Association, Laura W. Bush Institute for Women's Health, Mayo Clinic, and Society for Women's Health Research (www.sgbmeducationsummit.com). It was held on October 18-19, 2015 to provide a unique venue for collaboration among nationally and internationally renowned experts in developing a roadmap for the incorporation of sex and gender based concepts into medical education curricula. The Summit engaged 148 in-person attendees for the 1 1/2-day program. Pre- and post-Summit surveys assessed the impact of the Summit, and workshop discussions provided a framework for informal consensus building. Sixty-one percent of attendees indicated that the Summit had increased their awareness of the importance of sex and gender specific medicine. Other comments indicate that the Summit had a significant impact for motivating a call to action among attendees and provided resources to initiate change in curricula within their home institutions. These educational efforts will help to ensure a sex and gender basis for delivery of health care in the future.

  5. Challenges of the e-Health curricular education in bio-medical engineering and in medicine.

    PubMed

    Pinciroli, Francesco; Bonacina, Stefano; Marceglia, Sara; Ferrante, Simona; Mazzola, Luca

    2012-01-01

    Curricular recommendations coming from highly respectable associations are highly useful. Nevertheless, they show fatigue in keeping the pace of any fast evolution, as in the ICT happens. So we do the attempt to disclose the emerging challenges affecting e-Health curricular education.

  6. Corporate influence and conflicts of interest: assessment of veterinary medical curricular changes and student perceptions.

    PubMed

    Dowers, Kristy L; Schoenfeld-Tacher, Regina M; Hellyer, Peter W; Kogan, Lori R

    2015-01-01

    The ethics document of the Association of American Veterinary Medical Colleges provides guiding principles for veterinary schools to develop conflict of interest policies. These policies regulate faculty and student interactions with industry, potentially reducing the influence companies have on students' perceptions and future prescribing practices. This paper examines the implementation of a conflict of interest policy and related instructional activities at one veterinary college in the US. To inform policy and curricular development, survey data were collected regarding veterinary students' attitudes toward pharmaceutical marketing, including their perceptions of their own susceptibility to bias in therapeutic decisions. Responses from this group of students later served as control data for assessing the effectiveness of educational programs in the content area. A conflict of interest policy was then implemented and presented to subsequent classes of entering students. Classroom instruction and relevant readings were provided on ethics, ethical decision making, corporate influences, and the issue of corporate influence in medical student training. Within seven days of completing a learning program on conflict of interest issues, another cohort of veterinary students (the treatment group) were administered the same survey that had been administered to the control group. When compared with the control group who received no instruction, survey results for the treatment group showed moderate shifts in opinion, with more students questioning the practice of industry-sponsored events and use of corporate funds to reduce tuition. However, many veterinary students in the treatment group still reported they would not be personally influenced by corporate gifts.

  7. Characteristics and Core Curricular Elements of Medical Simulation Fellowships in North America.

    PubMed

    Ahmed, Rami A; Frey, Jennifer; Gardner, Aimee K; Gordon, James A; Yudkowsky, Rachel; Tekian, Ara

    2016-05-01

    Background In the past few years, there has been rapid growth in the number of simulation fellowships for physicians in the United States and Canada, with the objective of producing faculty with expertise and leadership training in medical simulation. Relatively little is known about the collective content and structure of these new fellowship opportunities. Objective We sought to identify a common set of core curricular elements among existing simulation fellowships and to obtain demographic background information on participants and leadership. Methods We designed a web-based survey and circulated it to simulation fellowship directors in the United States and Canada. The questions explored aspects of the fellowship curriculum. A grounded theory approach was used to qualitatively analyze fellowship goals and objectives. Results Of the 29 program directors surveyed, 23 responded (79%). The most commonly listed goals and objectives were to increase skills in simulation curriculum development, simulation operations and training environment setup, research, educational theory, administration, and debriefing. The majority of the responding fellowship directors (17 of 22, 77%) indicated that a set of consensus national guidelines would benefit their fellowship program. Conclusions Simulation fellowships are experiencing a period of rapid growth. Development of a common set of program guidelines is a widely shared objective among fellowship directors.

  8. Characteristics and Core Curricular Elements of Medical Simulation Fellowships in North America

    PubMed Central

    Ahmed, Rami A.; Frey, Jennifer; Gardner, Aimee K.; Gordon, James A.; Yudkowsky, Rachel; Tekian, Ara

    2016-01-01

    Background In the past few years, there has been rapid growth in the number of simulation fellowships for physicians in the United States and Canada, with the objective of producing faculty with expertise and leadership training in medical simulation. Relatively little is known about the collective content and structure of these new fellowship opportunities. Objective We sought to identify a common set of core curricular elements among existing simulation fellowships and to obtain demographic background information on participants and leadership. Methods We designed a web-based survey and circulated it to simulation fellowship directors in the United States and Canada. The questions explored aspects of the fellowship curriculum. A grounded theory approach was used to qualitatively analyze fellowship goals and objectives. Results Of the 29 program directors surveyed, 23 responded (79%). The most commonly listed goals and objectives were to increase skills in simulation curriculum development, simulation operations and training environment setup, research, educational theory, administration, and debriefing. The majority of the responding fellowship directors (17 of 22, 77%) indicated that a set of consensus national guidelines would benefit their fellowship program. Conclusions Simulation fellowships are experiencing a period of rapid growth. Development of a common set of program guidelines is a widely shared objective among fellowship directors. PMID:27168898

  9. Introducing a curricular program culminating in a certificate for training peer tutors in medical education.

    PubMed

    Fellmer-Drüg, Erika; Drude, Nina; Sator, Marlene; Schultz, Jobst-Hendrik; Irniger, Erika; Chur, Dietmar; Neumann, Boris; Resch, Franz; Jünger, Jana

    2014-01-01

    Student tutorials are now firmly anchored in medical education. However, to date there have only been isolated efforts to establish structured teacher training for peer tutors in medicine. To close this gap, a centralized tutor training program for students, culminating in an academic certificate, was implemented at Heidelberg University Medical School. The program also counts within the scope of the post-graduate Baden-Württemberg Certificate in Academic Teaching (Baden-Württemberg Zertifikat für Hochschuldidaktik). Based on a needs assessment, a modular program comprised of four modules and a total of 200 curricular units was developed in cooperation with the Department for Key Competencies and Higher Education at Heidelberg University and implemented during the 2010 summer semester. This program covers not only topic-specific training sessions, but also independent teaching and an integrated evaluation of the learning process that is communicated to the graduates in the form of structured feedback. In addition, to evaluate the overall concept, semi-structured interviews (N=18) were conducted with the program graduates. To date, 495 tutors have been trained in the basic module on teaching medicine, which is rated with a mean overall grade of 1.7 (SW: 0.6) and has served as Module I of the program since 2010. A total of 17% (N=83) of these tutors have gone on to enroll in the subsequent training modules of the program; 27 of them (m=12, f=15) have already successfully completed them. Based on qualitative analyses, it is evident that the training program certificate and its applicability toward the advanced teacher training for university instructors pose a major incentive for the graduates. For successful program realization, central coordination, extensive coordination within the medical school, and the evaluation of the attained skills have proven to be of particular importance. The training program contributes sustainably to both quality assurance and

  10. Introducing a curricular program culminating in a certificate for training peer tutors in medical education

    PubMed Central

    Fellmer-Drüg, Erika; Drude, Nina; Sator, Marlene; Schultz, Jobst-Hendrik; Irniger, Erika; Chur, Dietmar; Neumann, Boris; Resch, Franz; Jünger, Jana

    2014-01-01

    Aim: Student tutorials are now firmly anchored in medical education. However, to date there have only been isolated efforts to establish structured teacher training for peer tutors in medicine. To close this gap, a centralized tutor training program for students, culminating in an academic certificate, was implemented at Heidelberg University Medical School. The program also counts within the scope of the post-graduate Baden-Württemberg Certificate in Academic Teaching (Baden-Württemberg Zertifikat für Hochschuldidaktik). Method: Based on a needs assessment, a modular program comprised of four modules and a total of 200 curricular units was developed in cooperation with the Department for Key Competencies and Higher Education at Heidelberg University and implemented during the 2010 summer semester. This program covers not only topic-specific training sessions, but also independent teaching and an integrated evaluation of the learning process that is communicated to the graduates in the form of structured feedback. In addition, to evaluate the overall concept, semi-structured interviews (N=18) were conducted with the program graduates. Results: To date, 495 tutors have been trained in the basic module on teaching medicine, which is rated with a mean overall grade of 1.7 (SW: 0.6) and has served as Module I of the program since 2010. A total of 17% (N=83) of these tutors have gone on to enroll in the subsequent training modules of the program; 27 of them (m=12, f=15) have already successfully completed them. Based on qualitative analyses, it is evident that the training program certificate and its applicability toward the advanced teacher training for university instructors pose a major incentive for the graduates. For successful program realization, central coordination, extensive coordination within the medical school, and the evaluation of the attained skills have proven to be of particular importance. Conclusion: The training program contributes sustainably to

  11. Use of Curricular and Extracurricular Assessments to Predict Performance on the United States Medical Licensing Examination (USMLE) Step 1: A Multi-Year Study

    ERIC Educational Resources Information Center

    Gandy, Robyn A.; Herial, Nabeel A.; Khuder, Sadik A.; Metting, Patricia J.

    2008-01-01

    This paper studies student performance predictions based on the United States Medical Licensure Exam (USMLE) Step 1. Subjects were second-year medical students from academic years of 2002 through 2006 (n = 711). Three measures of basic science knowledge (two curricular and one extracurricular) were evaluated as predictors of USMLE Step 1 scores.…

  12. Using complementary and alternative medicine curricular elements to foster medical student self-awareness.

    PubMed

    Elder, Willam; Rakel, David; Heitkemper, Margaret; Hustedde, Carol; Harazduk, Nancy; Gerik, Susie; Haramati, Aviad

    2007-10-01

    To determine the value that the National Center for Complementary and Alternative Medicine (NCCAM)-funded Education Project leaders placed on self-awareness objectives among their curricular activities, to identify projects' rationales for inclusion of self-awareness activities, and to describe curricular elements used to teach self-awareness. A survey was distributed to the NCCAM Education Project grantees in October 2006. Survey items sought to identify project directors' perceived importance of self-awareness activities in complementary and alternative medicine (CAM) curricula, rationales for inclusion of self-awareness activities, and activities to foster self-awareness. Invited reports described in more depth the specific activities in three of the projects. Fourteen of 15 reporting NCCAM educational projects rated activities to promote self-awareness as highly or very highly valued components, and all projects incorporated numerous strategies to enhance self-awareness. Learning objectives ranged from basic knowledge about mind-body relationships and psychoneuroimmunology, to evidence and indications for mind-body interventions, to training in self-application, to training for intervention with patients. Specific strategies that increase students' self-awareness included evidence-based CAM activities to help students recognize personal biases that may impair critical thinking; personal health experiences to expand definition of health beliefs; and mind-body medicine skills groups to personally integrate the use of mind-body techniques for wellness and stress management. Incorporating some of these CAM curricular activities, didactically or experientially, may be a unique way to foster student self-awareness and personal growth.

  13. Evaluation of medical and veterinary students' attitudes toward a one health interprofessional curricular exercise.

    PubMed

    Winer, Jenna Nicole; Nakagawa, Keisuke; Conrad, Patricia A; Brown, Lauren; Wilkes, Michael

    2015-01-01

    This study evaluates whether medical and veterinary students' attitudes toward "One Health" and interprofessional education changed after participating in a joint small group learning exercise focused on risk factors associated with zoonotic disease. A survey was distributed to third-year medical students (n = 98) and second-year veterinary students (n = 140), each with a 95% response rate. Overall, 92% of veterinary students and 73% of medical students agreed or strongly agreed that "One Health" was relevant to their desired specialty. Students from both schools largely agreed that interprofessional education should be a goal of the curriculum for their school, and that interprofessional approaches strengthen their overall education. Students reported increased confidence in their communication skills and improved ability to contribute to One Health collaborative teams. This educational intervention, built around a patient case, focused on a variety of learning objectives including skills (such as communication), knowledge (of zoonotic toxoplasmosis) and attitudes (toward collaborative learning and practice). By sparking an interest in One Health during their early professional education, we sought to encourage a new generation of physicians and veterinarians to adopt a more collaborative spirit to their clinical practice, which will ultimately benefit human, animal and environmental health.

  14. [Is it Possible to Arouse Interest in a Career in Traumatology with a Curricular Course in Medical School?

    PubMed

    Meder, A; Lammerding-Köppel, M; Zundel, S; Stöckle, U; Bahrs, C; Gonser, C

    2016-12-01

    Background: There is a serious lack of young doctors in trauma surgery, which has intensified in recent years. The reasons are complex. Studies have shown that the interest in starting a career in surgery significantly decreases during medical school. To counteract the lack of young talent in the clinic, interest in the subject should be aroused in medical school. The aim of the present study was to evaluate current teaching at our university, where trauma surgery is a curricular subject with mandatory attendance for all medical students. Material and Methods: The current curriculum is intended for medicine students in their fifth year. The curriculum comprises lectures, practical courses and observation modules held in small groups. Students are provided with an experienced surgeon as teacher and mentor for the whole week. A teaching and training centre is available for the practical courses. In an anonymised questionnaire, students were asked about their overall assessment and the training success of practical and theory-oriented modules, as well as their specific interest in traumatology. Results: The evaluated curriculum gave very good results, with an overall rating of 1.53 (average) on a 6-point Likert scale in the overall assessment. It could be shown that students previously not interested in starting a career in trauma surgery showed significantly more interest in the subject after the curriculum. The practical parts scored best in the individual assessment. Conclusion: We showed that intensive teaching can arouse interest in traumatology in students who had been indifferent to orthopaedics and traumatology.

  15. Approaches and Study Skills of Veterinary Medical Students: Effects of a Curricular Revision.

    PubMed

    Zamor, Eliza; Chigerwe, Munashe; Boudreaux, Karen A; Ilkiw, Jan E

    2017-01-01

    The objective of this study was to determine if a revised, recently implemented curriculum, embracing an integrated block design with a focus on student-centered, inquiry-based learning, had a different effect on veterinary medical students' approaches to studying than the previous curriculum. A total of 577 students completed a questionnaire consisting of the short version of the Approaches and Study Skills Inventory for Students (ASSIST). It included questions relating to conceptions about learning, approaches to studying, and preferences for different types of courses and teaching. In addition, students were asked to respond to general questions regarding the design of the revised curriculum. The scores for the deep and strategic learning approaches were higher for students studying under the previous curriculum compared to the revised curriculum, despite the fact that the revised curriculum was specifically designed to foster deep learning. The scores for the surface learning approach were lower in the students studying the revised curriculum compared to students studying under the previous curriculum. We identified the following factors affecting student learning: alteration of learning activities, such as problem-based learning, from the recommended models; a lack of instructor support for the revised curriculum; assessments that were not aligned to encourage critical thinking; and directed self-learning activities that were too comprehensive to complete in the allotted time. The results of this study can be used to improve the implementation of student-centered and inquiry-based curricula by identifying potential problems that could prevent a deep learning approach in veterinary medical students.

  16. [Anaesthesiology as a compulsory subject in the new German medical school curriculum. Evaluation of a curricular model at the University Hospital Aachen].

    PubMed

    Beckers, S K; Sopka, S; Fries, M; Skorning, M H; Kuhlen, R; Rossaint, R

    2007-06-01

    Since October 2003 new regulations for qualifications to practice medicine in Germany now require compulsory courses in anaesthesiology. Therefore, existing curricular activities had to be changed from facultative courses for a small number of interested students to compulsory activities for all students. Previous data of the department of anaesthesiology at the University Hospital Aachen (Germany) were collected and taken into consideration for the development of a new curriculum: The result was a course consisting of a tutorial with integrated "basic skill training", practical training in the operating theatre and a simulation-based session, in addition to two series of lectures. An evaluation by the students was carried out using EvaLuna as a tool for web-based on-line evaluation and faculty members had to fill out a standardized questionnaire. The different parts of the curriculum received the highest scores of all courses in the undergraduate medical school curriculum. Best results were achieved by the anaesthesia-simulation session followed by the tutorial and the practical training. The feedback of faculty members as well as the results of students' evaluation approved the developed concept of integrating anaesthesia-relevant issues into the formal medical school curriculum. Nevertheless, the on-line evaluation system EvaLuna provided additional suggestions for future improvements in the newly created curriculum.

  17. The Impact of Curricular Changes on the Geriatrics Knowledge, Attitudes and Skills of Medical Students

    ERIC Educational Resources Information Center

    Nagoshi, Michael H.; Tanabe, Marianne K. G.; Sakai, Damon H.; Masaki, Kamal H.; Kasuya, Richard T.; Blanchette, Patricia L.

    2008-01-01

    We redesigned our medical school's Problem-Based Learning (PBL) curriculum to include a substantial increase in required geriatrics content. Innovations included new PBL health care problems and standardized patients (SPs) throughout the first three years and a new required four-week, fourth-year rotation. We used data from the AAMC Medical School…

  18. The Psychiatry Major: A Curricular Innovation to Improve Undergraduate Psychiatry Education in China.

    PubMed

    Jing, Ling; Chang, Wing Chung; Rohrbaugh, Robert; Ouyang, Xuan; Chen, Eric; Liu, Zhening; Hu, Xinran

    2017-06-02

    In China, a psychiatry major curriculum (PMC) has been implemented in select medical schools to improve the quality of undergraduate psychiatry education (UPE). Our aim was to describe this PMC and compare it with UPE in the standard Chinese clinical medicine curriculum (CMC). We also benchmarked PMC to UPE programs in the Hong Kong Special Administrative Region of China and the United States of America (USA) to determine how well it met standards of well-established programs and to highlight areas for improvement. Based on archival information, relevant literature, and communication with key informants, we described PMC and CMC in a Chinese school with both curriculums. We then compared PMC to UPE curriculums in Hong Kong and the USA. PMC provides substantially more comprehensive exposure to psychiatry than CMC, with more preclinical experiences and psychiatry clerkship course hours, greater diversity of clinical sites, and exploration of subspecialties. PMC employs a variety of teaching methods and offers mentoring for students. PMC has similar UPE preclinical content and course hours as programs in Hong Kong and the USA. PMC also provides more clinical exposure than programs in Hong Kong or the USA, although there is less variety in clinical settings. We recommend implementation of concrete measures to improve UPE in Chinese medical schools, using the PMC curriculum as a model that has been successfully implemented in China. We also recommend improvements to PMC based on comparisons with existing programs outside Mainland China.

  19. [Strategies to improve medication adherence].

    PubMed

    Laufs, U; Böhm, M; Kroemer, H K; Schüssel, K; Griese, N; Schulz, M

    2011-08-01

    Up to 50 % of patients with chronic diseases do not take their medication regularly. Poor adherence to drug therapy is associated with higher morbidity and mortality. A selective literature search using the terms adherence, compliance, concordance, persistence, medication management, and pharmaceutical care was performed. Evidence for improving adherence has been provided for the following principles: individual counselling of patients and care givers, medication management including simplifying dosing and use of combination tablets as well as the use of individual unit doses, e. g. blister cards. The effectiveness has only been shown for the duration of the interventions. The improvement of medication adherence represents an area of research with high impact on outcomes and cost. Measures to improve adherence may be as important as the development of novel therapies. However, prospective clinical evaluations with clinical endpoints are missing especially for the German health care system in order to develop recommendations for clinical practice. Joint efforts of physicians and pharmacists are needed.

  20. Faculty and students' perceptions of student experiences in a medical school undergoing curricular transition in the United arab emirates.

    PubMed

    Shehnaz, Syed I; Sreedharan, Jayadevan; Gomathi, Kadayam G

    2012-02-01

    In 2008, the Gulf Medical College in the United Arab Emirates underwent a curricular change from a discipline-based to an organ-system-based integrated curriculum. In this context, this study aimed to compare the faculty and students' perceptions of the student experiences with the new curriculum. Data were collected from faculty and second-year students in the integrated curriculum using the Dundee Ready Education Environment Measure (DREEM). Data collected were transferred to Predictive Analytics Software, Version 18. Global and domain scores were assessed with the Wilcoxon Rank-Sum Test. Percentage agreement, disagreement and uncertainty were assessed by the z-test for proportion. There were no significant differences between the total DREEM scores of faculty (139/200) and students (135/200). The faculty perceived that the students were experiencing significantly more positive learning as indicated by the domain score of "Students' Perceptions of Learning". Proportions of agreement between faculty and students showed that more faculty members than students perceived the need for increased feedback to students and a greater emphasis on long term learning. The study showed that the faculty and students had similar perceptions about the student experiences in the integrated curriculum. Areas necessitating remedial measures were the need for faculty to learn constructive feedback techniques and an emphasis on long term learning in the new curriculum.

  1. Faculty and Students’ Perceptions of Student Experiences in a Medical School Undergoing Curricular Transition in the United Arab Emirates

    PubMed Central

    Shehnaz, Syed I; Sreedharan, Jayadevan; Gomathi, Kadayam G

    2012-01-01

    Objectives: In 2008, the Gulf Medical College in the United Arab Emirates underwent a curricular change from a discipline-based to an organ-system-based integrated curriculum. In this context, this study aimed to compare the faculty and students’ perceptions of the student experiences with the new curriculum. Methods: Data were collected from faculty and second-year students in the integrated curriculum using the Dundee Ready Education Environment Measure (DREEM). Data collected were transferred to Predictive Analytics Software, Version 18. Global and domain scores were assessed with the Wilcoxon Rank-Sum Test. Percentage agreement, disagreement and uncertainty were assessed by the z-test for proportion. Results: There were no significant differences between the total DREEM scores of faculty (139/200) and students (135/200). The faculty perceived that the students were experiencing significantly more positive learning as indicated by the domain score of “Students’ Perceptions of Learning”. Proportions of agreement between faculty and students showed that more faculty members than students perceived the need for increased feedback to students and a greater emphasis on long term learning. Conclusion: The study showed that the faculty and students had similar perceptions about the student experiences in the integrated curriculum. Areas necessitating remedial measures were the need for faculty to learn constructive feedback techniques and an emphasis on long term learning in the new curriculum. PMID:22375262

  2. Leadership, management and teamwork learning through an extra-curricular project for medical students: descriptive study.

    PubMed

    Jorge, Maria Lucia da Silva Germano; Coelho, Izabel Cristina Meister; Paraizo, Mariana Martins; Paciornik, Ester Fogel

    2014-01-01

    Professionalism in medicine requires preparation for the globalized world. Our objective was to describe a project that introduces medical students to the community, hospital and laboratory activities, thereby allowing them to gain experience in people management, leadership and teamwork. Descriptive study of the process applied at a philanthropic medical school in Curitiba, Paraná. Inclusion of management and leadership practices as part of the medical degree program. The study groups consisted of fifteen students. After six months, any of the participants could be elected as a subcoordinator, with responsibility for managing tasks and representing the team in hospital departments and the community. The activities required increasing levels of responsibility. In medical schools, students' involvement in practical activities is often limited to observation. They are not required to take responsibilities or to interact with other students and stakeholders. However, they will become accountable, which thus has an adverse effect on all involved. The learning space described here aims to fill this gap by bringing students closer to the daily lives and experiences of healthcare professionals. Being a physician requires not only management and leadership, but also transferrable competencies, communication and critical thinking. These attributes can be acquired through experience of teamwork, under qualified supervision from teaching staff. Students are thus expected to develop skills to deal with and resolve conflicts, learn to share leadership, prepare others to help and replace them, adopt an approach based on mutual responsibility and discuss their performance.

  3. Improving the medical 'take sheet'.

    PubMed

    Reed, Oliver

    2014-01-01

    The GMC states that "Trainees in hospital posts must have well organised handover arrangements, ensuring continuity of patient care[1]". In the Belfast City Hospital throughout the day there can be multiple new medical admissions. These can be via the GP Unit, transfers for tertiary care, and transfers due to bed shortages in other hospitals. Over the course of 24 hours there can be up to four medical SHOs and three registrars that fill in the take sheet. Due to the variety of admission routes and number of doctors looking after the medical take information can be lost during handover between SHOs. In the current format there is little room to write and key and relevant information on the medical take sheet about new and transferring patients. I felt that this handover sheet could be improved. An initial questionnaire demonstrated that 47% found the old proforma easy to use and 28.2% felt that it allowed them to identify sick patients. 100% of SHOs and Registrars surveyed felt that it could be improved from its current form. From feedback from my colleagues I created a new template and trialled it in the hospital. A repeat questionnaire demonstrated that 92.3% of responders felt the new format had improved medical handover and that 92.6% felt that it allowed safe handover most of the time/always. The success of this new proforma resulted in it being implemented on a permanent basis for new medical admissions and transfers to the hospital.

  4. The Medical Humanities at the Northeastern Ohio Universities College of Medicine: historical, theoretical, and curricular perspectives.

    PubMed

    Wear, Delese

    2003-10-01

    The Human Values in Medicine Program (HVM) at the Northeastern Ohio Universities College of Medicine is composed of 120 required hours in medical humanities, social sciences, and behavioral sciences. In addition to a required HVM month in the fourth year when the bulk of the course work is completed, students can also choose from lectures, seminars, and short courses during the first, second, and third years. The broad goal of the HVM program as originally conceived was for students to use the content and skills of the humanities disciplines to reflect on their own and others' values, and to appraise their role in the patient-physician relationship, both in the community and in the larger culture. During the past several years, a cultural studies orientation has also been included, particularly the practice of critical analysis aimed at identifying the inequities and injustices within the doctor-patient relationship, in medical training, and in health care access and delivery in the U.S. and beyond. Current program development includes standardizing a bioethics curriculum for all students and developing a required fourth-year course that all students take during their HVM elective month.

  5. Mainstreaming alternatives in veterinary medical education: resource development and curricular reform.

    PubMed

    Hart, Lynette A; Wood, Mary W; Weng, Hsin-Yi

    2005-01-01

    Veterinary medical educators are charged with preparing students to enter practice in veterinary medicine during a four-year, intensive, professional education program. This requires giving students in laboratory training that involves dead, anesthetized, or conscious animals, so that they become proficient in the expected range of veterinary knowledge, skills, and abilities. Undeniably, experience with animals is essential to prepare students for a profession in which animals comprise the total domain. However, the consumptive use of animals for teaching students, especially in laboratories, is increasingly subject to regulatory requirements, while also being scrutinized by animal protection groups, and has become a common focus of contention among veterinary students. Not surprisingly, the use of animals in teaching has sharply declined over the past few decades, as new teaching resources and methods, involving less consumptive use of animals, have been incorporated. This change in veterinary medical education has occurred on such a wide scale, in almost all veterinary schools and colleges, that the educational approach can serve as a model for further developments within the veterinary educational community and, indeed, for animal-related material in secondary schools and undergraduate higher education. This article highlights examples of the leadership provided by veterinary educators in developing alternative teaching resources and methods, while maintaining the high level of proficiency expected from traditional educational approaches.

  6. Problem based learning as a curricular strategy for medical undergraduates: a tutor's experience.

    PubMed

    Luthra, K; Das, N

    1998-12-01

    This article focuses on the experiences and role of a tutor while conducting a problem based learning (PBL) exercise to facilitate the learning of biochemistry and molecular biology. A case presentation of sickle cell anemia was used to frame a module. The objective of this experimental exercise was to assess the suitability and effectiveness of problem based learning in the first year of undergraduate medical course and to practice self-assessment by tutors in this new role of a facilitator of learning through small group discussion. A tutor during such a learning session encouraged the students to apply their reasoning to analyze the problem and to develop self-directed learning skills in acquiring the knowledge appropriate to their perceived needs to work on a problem. The tutors ensured that they apply this knowledge in their work with other similar problems that they would encounter later in life.

  7. Effective Utilization of Computerized Curricular Assistive Tools in Improving NCLEX-RN Pass Rates for a Baccalaureate Nursing Program.

    PubMed

    Shoemaker, Joy R; Chavez, Ruth A; Keane, Patricia; Butz, Susan; Yowler, Susan K

    2016-11-10

    Achieving satisfactory first-time pass rates on the national nursing licensure examination represents a challenge for nursing programs across the United States. The consequences of examination failure for first-time test takers can be devastating, both emotionally and financially. Nursing programs are evaluated by national higher-education credentialing bodies and state boards of nursing based on the first-time pass rate of their students. One Midwestern nursing program faced unsatisfactory first-time pass rates and developed strategies for improving first-time pass rates over a 3-year period. The nursing program utilized several strategies documented in the literature but found implementing computerized curricular assistive tools that complemented the nursing program's curriculum to be most effective. In addition, changing faculty and student culture on preparation for the national licensure examination was beneficial to all involved in the process.

  8. A National Radiation Oncology Medical Student Clerkship Survey: Didactic Curricular Components Increase Confidence in Clinical Competency

    SciTech Connect

    Jagadeesan, Vikrant S.; Raleigh, David R.; Koshy, Matthew; Howard, Andrew R.; Chmura, Steven J.; Golden, Daniel W.

    2014-01-01

    Purpose: Students applying to radiation oncology residency programs complete 1 or more radiation oncology clerkships. This study assesses student experiences and perspectives during radiation oncology clerkships. The impact of didactic components and number of clerkship experiences in relation to confidence in clinical competency and preparation to function as a first-year radiation oncology resident are evaluated. Methods and Materials: An anonymous, Internet-based survey was sent via direct e-mail to all applicants to a single radiation oncology residency program during the 2012-2013 academic year. The survey was composed of 3 main sections including questions regarding baseline demographic information and prior radiation oncology experience, rotation experiences, and ideal clerkship curriculum content. Results: The survey response rate was 37% (70 of 188). Respondents reported 191 unique clerkship experiences. Of the respondents, 27% (19 of 70) completed at least 1 clerkship with a didactic component geared towards their level of training. Completing a clerkship with a didactic component was significantly associated with a respondent's confidence to function as a first-year radiation oncology resident (Wilcoxon rank–sum P=.03). However, the total number of clerkships completed did not correlate with confidence to pursue radiation oncology as a specialty (Spearman ρ P=.48) or confidence to function as a first year resident (Spearman ρ P=.43). Conclusions: Based on responses to this survey, rotating students perceive that the majority of radiation oncology clerkships do not have formal didactic curricula. Survey respondents who completed a clerkship with a didactic curriculum reported feeling more prepared to function as a radiation oncology resident. However, completing an increasing number of clerkships does not appear to improve confidence in the decision to pursue radiation oncology as a career or to function as a radiation oncology resident. These results

  9. Improving Patient's Primary Medication Adherence

    PubMed Central

    Leguelinel-Blache, Géraldine; Dubois, Florent; Bouvet, Sophie; Roux-Marson, Clarisse; Arnaud, Fabrice; Castelli, Christel; Ray, Valérie; Kinowski, Jean-Marie; Sotto, Albert

    2015-01-01

    Abstract Quality of transitions of care is one of the first concerns in patient safety. Redesigning the discharge process to incorporate clinical pharmacy activities could reduce the incidence of postdischarge adverse events by improving medication adherence. The present study investigated the value of pharmacist counseling sessions on primary medication adherence after hospital discharge. This study was conducted in a 1844-bed hospital in France. It was divided in an observational period and an interventional period of 3 months each. In both periods, ward-based clinical pharmacists performed medication reconciliation and inpatient follow-up. In interventional period, initial counseling and discharge counseling sessions were added to pharmaceutical care. The primary medication adherence was assessed by calling community pharmacists 7 days after patient discharge. We compared the measure of adherence between the patients from the observational period (n = 201) and the interventional period (n = 193). The rate of patients who were adherent increased from 51.0% to 66.7% between both periods (P < 0.01). When discharge counseling was performed (n = 78), this rate rose to 79.7% (P < 0.001). The multivariate regression performed on data from both periods showed that age of at least 78 years old, and 3 or less new medications on discharge order were predictive factors of adherence. New medications ordered at discharge represented 42.0% (n = 1018/2426) of all medications on discharge order. The rate of unfilled new medications decreased from 50.2% in the observational period to 32.5% in the interventional period (P < 10−7). However, patients included in the observational period were not significantly more often readmitted or visited the emergency department than the patients who experienced discharge counseling during the interventional period (45.3% vs. 46.2%; P = 0.89). This study highlights that discharge counseling sessions are

  10. The Association Between Premedical Curricular and Admission Requirements and Medical School Performance and Residency Placement: A Study of Two Admission Routes at The Warren Alpert Medical School of Brown University

    PubMed Central

    George, Paul; Park, Yoon Soo; Ip, Julianne; Gruppuso, Philip A.; Adashi, Eli Y.

    2015-01-01

    Purpose The curricular elements of undergraduate premedical education are the subject of an ongoing debate. The Warren Alpert Medical School of Brown University (AMS) matriculates students via the traditional premedical route (TPM) and an eight-year baccalaureate/MD program—the Program in Liberal Medical Education (PLME)—which provides students with a broad and liberal education. Using the juxtaposition of these two admission routes, the authors aimed to determine whether there is an association between highly distinct premedical curricular and admission requirements and medical school performance and residency placement. Method The cohorts studied included all of the PLME (n = 295) and TPM (n = 215) students who graduated from the AMS between 2010 and 2015. Outcome variables consisted of multiple measures of medical school performance, including standardized multiple-choice examination scores and honors grades, and residency placement. The authors employed unadjusted tests of averages and proportions (independent t tests and chi-squared tests) to compare variables. Results The TPM students attained marginally, but statistically significantly, higher average scores on standardized multiple-choice examinations than their PLME counterparts. The number of undergraduate premedical science courses completed by PLME students accounted for less than 4% of the variance in key metrics of medical school performance. The residency placement record of the PLME and TPM cohorts proved comparable. Conclusions These findings suggest that the association between medical school performance and residency placement and undergraduate premedical curricular and admission requirements is weak. Further study is needed to determine the optimal premedical preparation of students. PMID:26422591

  11. Building the Foundation for Improved Student Performance: The Pre-Curricular Phase of Project GRAD Newark.

    ERIC Educational Resources Information Center

    Ham, Sandra; Doolittle, Fred C.; Holton, Glee Ivory; Ventura, Ana Maria; Jackson, Rochanda

    This report is the first in a series on Project GRAD (Graduation Really Achieves Dreams) in the Newark, New Jersey Public Schools. Project GRAD is an education initiative that combines several proven or promising reforms with the goals of increasing reading and math achievement test scores, improving classroom behavior, reducing dropout rates, and…

  12. Curricular Reforms That Improve Students' Attitudes and Problem-Solving Performance

    ERIC Educational Resources Information Center

    Teodorescu, Raluca E.; Bennhold, Cornelius; Feldman, Gerald; Medsker, Larry

    2014-01-01

    We present the most recent steps undertaken to reform the introductory algebra-based course at The George Washington University. The reform sought to help students improve their problem-solving performance. Our pedagogy relies on didactic constructs such as the" GW-ACCESS problem-solving protocol," "instructional sequences" and…

  13. Academic Teams Promote Cross-Curricular Applications that Improve Learning Outcomes

    ERIC Educational Resources Information Center

    Reed, Deborah K.; Groth, Cori

    2009-01-01

    The middle school team project described in this article was part of a larger district initiative, started in 2001 by the Southwest Educational Development Laboratory (SEDL) to create a systemic model of school improvement for increasing student achievement in low-performing schools. Academic teams were established as the conduit for ensuring that…

  14. Do Extra-Curricular Activities in Schools Improve Educational Outcomes? A Critical Review and Meta-Analysis of the Literature

    ERIC Educational Resources Information Center

    Shulruf, Boaz

    2010-01-01

    Secondary schools tend to sponsor a large number of extra-curricular activities (ECA) yet little is known about their contribution to students' educational outcomes. This meta-analysis aims to determine what it is about ECA participation that supports positive educational outcomes. Furthermore, this study challenges the theoretical assumptions…

  15. Software process improvement for the medical industry.

    PubMed

    McCaffery, Fergal; Donnelly, Peter; McFall, Donald; Wilkie, Frederick George

    2005-01-01

    This chapter describes a software process improvement framework, structured to ensure regulatory compliance for the software developed in medical devices. Software is becoming an increasingly important aspect of medical devices and medical device regulation. Medical devices can only be marketed if compliance and approval from the appropriate regulatory bodies of the Food and Drug Administration (US requirement), and the European Commission under its Medical Device Directives (CE marking requirement) is achieved.

  16. Does curricular change improve faculty perceptions of student experiences with the educational environment? A preliminary study in an institution undergoing curricular change

    PubMed Central

    2014-01-01

    Purpose: College of Medicine, Gulf Medical University, United Arab Emirates, underwent a major curriculum change from a discipline-based to an organ system-based integrated curriculum. However, it was not known how the faculty perceived the changes in the educational environment as experienced by the students. In this context, we aimed to compare the faculty perceptions of the student experiences in the discipline-based curriculum with those in the organ system-based integrated curriculum. Methods: The Dundee Ready Education Environment Measure (DREEM) questionnaire was modified to assess faculty perceptions of the student experiences, pilot-tested, and administered to all faculty members (n=28) involved in the discipline-based curriculum (FDC) in January 2009. In the subsequent year, data were collected from the same faculty involved in the new integrated curriculum (FIC). Collected data were transferred to Predictive Analytics Software version 18. Total, domain, and individual statement scores were assessed with the Wilcoxon signed rank test. Percentage agreement, disagreement, and uncertainty were assessed by the McNemar’s test for proportion. Results: The mean total DREEM score was significantly higher (P<0.001) for FIC (139/200) as compared to FDC (119/200). The FIC perceived significantly more positive student experiences with the educational environment as indicated by the domain scores and statement scores. The differences in proportions of agreement between FIC and FDC also reinforced that the FIC perceived more positive student experiences with the educational environment. Conclusion: The study showed that the faculty perceived the organ system-based integrated curriculum as providing a better educational environment for the students than the discipline based curriculum. PMID:24781357

  17. Medical Interpreting: Improving Communication with Your Patients.

    ERIC Educational Resources Information Center

    Tebble, Helen

    The guide is designed for physicians and other medical practitioners who need to work with medical interpreters to improve communication with patients. Special attention is given to the Australian context. An introductory section discusses the need for medical interpreters and explains the guide's organization. Subsequent sections address these…

  18. Total quality management approach improves medication replacement.

    PubMed

    Anderson, L K

    1994-07-01

    Total quality management (TQM) is based on understanding customer needs, improving key processes that affect customer satisfaction, and creating cross-functional teams to resolve process problems. This article describes application of TQM principles and problem-solving processes to improve one OR's medication exchange system. The problem was excessive monthly pharmacy medication replacement costs. The goal was to reduce the monthly medication replacement costs by 50%. Within four months, monthly medication replacement charges decreased from $656 to $302, and by one year, monthly charges decreased to $160. The new process had fewer steps, fewer staff members involved, and fewer delays in medication replacement.

  19. Mobile Applications to Improve Medication Adherence.

    PubMed

    Haase, Jamie; Farris, Karen B; Dorsch, Michael P

    2017-02-01

    Background and Introduction: Mobile applications are useful tools to improve medication adherence. As developers continue to improve the features of existing mobile applications, pharmacists should be aware of the current features that are available to patients. There are limited studies available that discuss which applications have the most desirable features. The aim of this study was to compare available mobile applications and identify ideal application features used to improve medication adherence. As of September 5, 2014, the search terms "medication adherence" and "medication reminder" generated a total of 225 hits. Ideal application features were used to create an Application Score Card to identify applications with the highest number of ideal features. We identified 30 applications that were written in English, medication related, last updated in 2014, and did not meet any exclusion criteria. The top five applications RxNetwork, Mango Health, MyMeds, C3HealthLink, and HuCare are discussed in detail. There are numerous studies looking at medication adherence. However, current literature regarding mobile applications to improve medication adherence is lacking. This article will provide pharmacists with a brief overview of the available mobile applications and features that could be used to improve patient adherence to medications. Existing mobile applications to improve medication adherence have ideal features that could help patients take medication as prescribed. Once further research is performed to establish their efficacy, pharmacists could begin to recommend mobile applications to their patients.

  20. Positive changes in the medical educational environment following introduction of a new systems-based curriculum: DREEM or reality? Curricular change and the Environment.

    PubMed

    Finn, Y; Avalos, G; Dunne, F

    2014-06-01

    Evaluation of a new systems-based curriculum in an undergraduate Irish Medical School was carried out with the validated Dundee Ready Educational Environment (DREEM) inventory. Comparison was made with the results from a previous DREEM study in the old curriculum. DREEM was administered to 225 medical students enrolled in the new curriculum. Data analysis was carried out using SPSS 17.0 and the Student unpaired t test. Increased mean scores supported greater satisfaction with the educational environment in the new curriculum. Students perceived better opportunities to develop interpersonal skills, ask questions and learn about empathy. Areas of concern included timetabling, support for stressed students and provision of feedback. Clinical students perceived their overall environment more positively. Pre-clinical students were more confident about passing exams and felt better prepared for clinical practice. Male students were more positive about the environment and found the teaching more stimulating. Female students perceived greater development of their problem-solving skills. Non-Irish students no longer perceived the atmosphere and their social self-perceptions more negative than Irish students, as was the case in the old curriculum. DREEM is a valuable tool in evaluating the educational environment and monitoring the impact of curricular change.

  1. Implementation of nephrology subspecialty curricular milestones.

    PubMed

    Yuan, Christina M; Prince, Lisa K; Oliver, James D; Abbott, Kevin C; Nee, Robert

    2015-07-01

    Beginning in the 2014-2015 training year, the US Accreditation Council for Graduate Medical Education (ACGME) required that nephrology Clinical Competency Committees assess fellows' progress toward 23 subcompetency "context nonspecific" internal medicine subspecialty milestones. Fellows' advancement toward the "ready for unsupervised practice" target milestone now is tracked in each of the 6 competencies: Patient Care, Medical Knowledge, Professionalism, Interpersonal Communication Skills, Practice-Based Learning and Improvement, and Systems-Based Practice. Nephrology program directors and subspecialty societies must define nephrology-specific "curricular milestones," mapped to the nonspecific ACGME milestones. Although the ACGME goal is to produce data that can discriminate between successful and underperforming training programs, the approach is at risk to produce biased, inaccurate, and unhelpful information. We map the ACGME internal medicine subspecialty milestones to our previously published nephrology-specific milestone schema and describe entrustable professional activities and other objective assessment tools that inform milestone decisions. Mapping our schema onto the ACGME subspecialty milestone reporting form allows comparison with the ACGME subspecialty milestones and the curricular milestones developed by the American Society of Nephrology Program Directors. Clinical Competency Committees may easily adapt and directly translate milestone decisions reached using our schema onto the ACGME internal medicine subspecialty competency milestone-reporting format.

  2. Teaching ultrasound in a curricular course according to certified EFSUMB standards during undergraduate medical education: a prospective study.

    PubMed

    Heinzow, Hauke S; Friederichs, Hendrik; Lenz, Philipp; Schmedt, Andre; Becker, Jan C; Hengst, Karin; Marschall, Bernhard; Domagk, Dirk

    2013-06-11

    As a non-invasive and readily available diagnostic tool, ultrasound is one of the most important imaging techniques in medicine. Ultrasound is usually trained during residency preferable according to German Society of Ultrasound in Medicine (DEGUM) standards. Our curriculum calls for undergraduate training in ultrasound of medical students in their 4th year of undergraduate education. An explorative pilot study evaluated the acceptance of this teaching method, and compared it to other practical activities in medical education at Muenster University. 240 medical students in their 4th year of undergraduate medical education participated in the training and completed a pre- and post-questionnaire for self-assessment of technical knowledge, self-assurance of the procedure, and motivation in performing ultrasound using a Likert scale. Moreover, students were asked about their interest in pursuing a career in internal medicine. To compare this training to other educational activities a standardized online evaluation tool was used. A direct observation of procedural skills assessment (DOPS) for the first time applied on ultrasound aimed to independently assess the success of our teaching method. There was a significant increase in technical knowledge and self-assurance (p < 0.001) of the students' self-assessments. The clinical relevance and self-motivation of the teaching were evaluated positively. The students' DOPS results demonstrated proficiency in the understanding of anatomic structures shown in ultrasonographic images, including terminology, machine settings, and transducer frequencies. Training ultrasound according to certified DEGUM standards was successful and should be offered in undergraduate medical education. The evaluation of the course affirmed the necessity, quality and clinical relevance of the course with a top ranking score of hands-on training courses within the educational activities of the Medical Faculty of Muenster.

  3. Improving the pedagogical effectiveness of medical videos.

    PubMed

    Iorio-Morin, Christian; Brisebois, Simon; Becotte, Annick; Mior, Frédéric

    2017-07-01

    Videos are often employed in medical cursus, yet few guidelines are available to help with their production. Mayer's cognitive theory of multimedia learning is the most cited evidence-based framework for improving pedagogical effectiveness of multimedia content. Based on this framework, we identified four workflow interventions to improve the effectiveness of video content in the context of medical education: (1) choosing appropriate content; (2) optimizing the voiceover; (3) optimizing the supporting visuals and (4) planning the shooting schedule in advance. Content creators should think about pedagogical effectiveness and aim to improve their work by applying evidence-based principles.

  4. [Quality improvement of medical diagnostic laboratories].

    PubMed

    Horváth, Andrea Rita; Endröczi, Elemér; Mikó, Tivadar

    2003-07-13

    Service quality in medical laboratories is influenced by a number of variables. Medical laboratories have long recognized the need for total quality management that incorporates the continuous improvement of all stages, such as the pre-analytical, analytical and post-analytical phases, of the diagnostic process, in addition to the traditional internal and external quality control of analytical procedures. Based on national and international experience, continuous improvement of quality and its external assessment are of high priority in order to guarantee a reliable, effective and cost-effective diagnostic service. Certification of health care services, according to ISO 9001 standards in Hungarian hospitals, is not sufficient to prove professional competence of medical laboratories, which called for a system of laboratory accreditation. Accreditation is an external professional audit by which an independent accreditation body gives formal recognition that the medical laboratory is competent to provide high quality services that are compliant with rigorous professional standards of best practice. The primary aim of accreditation is the improvement of the quality of diagnostic services by voluntary participation, professional peer review, continuous training and education and compliance with professional standards. In vitro medical laboratories have pioneered quality control and quality assurance in health care. Based on these strengths and traditions, the introduction of the accreditation program of medical laboratories in Hungary is one of the key professional and ethical responsibilities of diagnostic professions, in order to improve the quality, efficiency and effectiveness of laboratory services during the course of Hungary's accession to the European Union.

  5. Improving medical literature sourcing by first-year medical students in problem-based learning: outcomes of early interventions.

    PubMed

    Krasne, Sally; Stevens, Carl D; Wilkerson, LuAnn

    2014-07-01

    To describe and report outcomes of interventions implemented in the preclerkship curriculum at the David Geffen School of Medicine at UCLA to guide students toward use of high-quality information sources and build a foundation for developing fluency in applying primary medical literature to answer clinical questions. The authors introduced three phases of change to instruction in literature searching and sourcing for beginning medical students writing learning issue essays: in phase 1 (2003-2006), students were introduced to online resources during orientation week and received a lecture on high-yield literature searching midway through their first curricular block; in phase 2 (2007-2008), the high-yield lecture shifted to orientation week, and a resource matrix and librarian-guided workshop on locating authoritative sources were added; and in phase 3 (2009), peer evaluation and collaboration were implemented. To track changes in sourcing skills, the authors analyzed 3,199 references from 665 essays written by 465 first-year students for two problem-based learning (PBL) cases during the first block of one representative year per phase (2006, 2008, 2009). Over the study period, the authors found significantly increased citations to peer-reviewed journal articles and guidelines and decreased citations to general public Web sites and highly abstracted resources. Peer feedback and collaboration in phase 3 were associated with maintenance of these gains. Early introduction of instruction on medical literature searching and sourcing, a librarian-guided workshop, and peer collaboration and feedback improved the quality of references cited by students in PBL essays during their first curricular block.

  6. Improving Defense Health Program Medical Research Processes

    DTIC Science & Technology

    2017-08-08

    solutions that protect, treat, and optimize the health and performance of the total force; 2) improve the quality of patient care in the MHS by improving... Quality and Safety. 60 Improving Defense Health Program Medical Research Processes 13 Defense Health Board Navy The Navy Surgeon General, also...in how the MHS is approaching health care administration, such as the movement toward value-based health care, adoption of core quality performance

  7. [Communication in medicine: a new and much needed curricular alternative].

    PubMed

    Halac, Eduardo; Quiroga, Daniel; Olmas, Josè M; Trucchia, Silvina M

    2016-01-01

    Medical education must emphasize communication practices mostly for undergraduate medical students. To introduce an approach for teaching and learning communication in medicine. An approach for developing communicational practices for both undergraduate and post graduate students is presented. Medical communication is not taught adequately in modern medical schools and is allotted a brief curricular space.. This curricular time must be widened in order to support communication's central role.

  8. Student centered curricular elements are associated with a healthier educational environment and lower depressive symptoms in medical students.

    PubMed

    AlFaris, Eiad Abdelmohsen; Naeem, Naghma; Irfan, Farhana; Qureshi, Riaz; van der Vleuten, Cees

    2014-09-17

    Any curriculum change is essentially an environmental change; therefore there is a need to assess the impact of any change in the curriculum on the students' perception of the Educational Environment (EE) and psychological well-being. The objectives of the current study are to (i) compare the EE perceptions of medical students studying in a System Based Curriculum (SBC) with those studying in a traditional curriculum (ii) compare the rate of depressive symptoms among the same students studying in both types of curricula (iii) determine whether there is a difference in the EE perception and depressive symptoms based on gender and year of study. A cross sectional survey was conducted in a Saudi Medical School from 2007-2011, a period in which the school transitioned from a traditional to a SBC. A bilingual version of the Dundee Ready Educational Environment Measure (DREEM) inventory was used for measuring the EE; the Beck Depression Inventory (BDI II) was used for screening of depressive symptoms. A separate demographic questionnaire was also used. Mean scores and percentages were calculated. Continuous variables were summarized as means and standard deviation. For comparison of means, the effect size and student t test (with significance level of <0.05) were used. The percentages of the categorical data were compared using chi square test. The mean total DREEM score of positive perception of the EE in the SBC students was significantly higher (better) than the traditional curriculum students (p < 0.01) with an effect size of 0.472. The mean total score on the BDI-II inventory for depressive symptoms was higher (sicker) 21.3 among the female traditional curriculum students than 16.7 among the male traditional curriculum students and the difference was statistically significant (p = 0.001). The BDI score of the female SBC students (14.7) was significantly lower (healthier) than the female traditional curriculum students (21.3). No similar change was noted for

  9. Continued Variation Amid Standardization: The Effects of School Program Improvement Status and of Participation in the South Coast Writing Project (SCWriP) on Teachers' Curricular Sensemaking and Enactment

    ERIC Educational Resources Information Center

    Null, Suzanne Y.

    2010-01-01

    Recent school reforms such as NCLB have focused on standardizing learning outcomes, and in the process have stimulated many schools to standardize curricular content, particularly if those schools are in Program Improvement (PI) status as a result of not meeting testing targets. But these attempts at standardization have ignored the fact that…

  10. English for Specific Purposes: Building a Curricular Bridge between English as a Second Language and Vocational/Business Office Systems. A Carl D. Perkins Vocational and Applied Technology Education Program Improvement Grant. Final Report.

    ERIC Educational Resources Information Center

    Austin Community Coll., TX.

    This 11-page report describes a project wherein a Carl D. Perkins Vocational and Applied Technology Program Improvement Grant was used to develop a curricular bridge between the academic English-as-a-Second-Language (ESL) area and the vocational-technical business/office systems area of Austin Community College (ACC). The following project…

  11. Exploring medical student learning in the large group teaching environment: examining current practice to inform curricular development.

    PubMed

    Luscombe, Ciara; Montgomery, Julia

    2016-07-19

    Lectures continue to be an efficient and standardised way to deliver information to large groups of students. It has been well documented that students prefer interactive lectures, based on active learning principles, to didactic teaching in the large group setting. Despite this, it is often the case than many students do not engage with active learning tasks and attempts at interaction. By exploring student experiences, expectations and how they use lectures in their learning we will provide recommendations for faculty to support student learning both in the lecture theatre and during personal study time. This research employed a hermeneutic phenomenological approach. Three focus groups, consisting of 19 students in total, were used to explore the experiences of second year medical students in large group teaching sessions. Using generic thematic data analysis, these accounts have been developed into a meaningful account of experience. This study found there to be a well-established learning culture amongst students and with it, expectations as to the format of teaching sessions. Furthermore, there were set perceptions about the student role within the learning environment which had many implications, including the way that innovative teaching methods were received. Student learning was perceived to take place outside the lecture theatre, with a large emphasis placed on creating resources that can be taken away to use in personal study time. Presented here is a constructive review of reasons for student participation, interaction and engagement in large group teaching sessions. Based on this are recommendations constructed with the view to aid educators in engaging students within this setting. Short term, educators can implement strategies that monopolise on the established learning culture of students to encourage engagement with active learning strategies. Long term, it would be beneficial for educators to consider ways to shift the current student learning

  12. Using evaluation research to improve medical education.

    PubMed

    Tavakol, Mohsen; Gruppen, Larry D; Torabi, Sima

    2010-09-01

    Evaluation research is a form of applied research that scrutinises how well a particular programme, practice, procedure or policy is operating. Evaluation researchers use both quantitative and qualitative research data to construct a collective picture of the programme under evaluation. Medical educators need to provide information about a particular programme using the methods of evaluation research in order to make a decision on the potential adoption, improvements and refinements of the programme. Improving curricula and pedagogical methods using these methods may enhance health care education. We provide an overview of the methods of evaluation research in the context of medical education. We discuss the application, general methodology, methods of collecting data and analysis for each type of evaluation research. The methods of evaluation research described in this article enable medical educators to gain a comprehensive understanding of evaluation research in the context of medical education. The use of evaluation research findings helps medical educators to make informed decisions regarding a programme and any future actions related to it. © Blackwell Publishing Ltd 2010.

  13. Can claudication be improved with medication?

    PubMed

    Conners, Michael S; Money, Samuel R

    2002-12-01

    Intermittent claudication is a common disabling condition that affects approximately 5% to 15% of patients with atherosclerotic disease. Recommended treatment involves lifestyle modification and physical conditioning through the adoption of a regular exercise program. These methods of treatment often have been unsuccessful in the past because of noncompliance, in large part related to the relatively minor degree of improvement experienced by the patient. However, some recent trials have resulted in greater relative improvements in both pain-free and maximal walking distances in some patients treated with medication. Surgical and endovascular options offer greater degrees of improvement but also greater morbidity and should be reserved as treatment for severe claudication. The efficacies, as well as common adverse reactions associated with current medications used to treat patients with intermittent claudication are reviewed.

  14. Improving the medical ‘take sheet’

    PubMed Central

    Reed, Oliver

    2014-01-01

    The GMC states that “Trainees in hospital posts must have well organised handover arrangements, ensuring continuity of patient care[1]”. In the Belfast City Hospital throughout the day there can be multiple new medical admissions. These can be via the GP Unit, transfers for tertiary care, and transfers due to bed shortages in other hospitals. Over the course of 24 hours there can be up to four medical SHOs and three registrars that fill in the take sheet. Due to the variety of admission routes and number of doctors looking after the medical take information can be lost during handover between SHOs. In the current format there is little room to write and key and relevant information on the medical take sheet about new and transferring patients. I felt that this handover sheet could be improved. An initial questionnaire demonstrated that 47% found the old proforma easy to use and 28.2% felt that it allowed them to identify sick patients. 100% of SHOs and Registrars surveyed felt that it could be improved from its current form. From feedback from my colleagues I created a new template and trialled it in the hospital. A repeat questionnaire demonstrated that 92.3% of responders felt the new format had improved medical handover and that 92.6% felt that it allowed safe handover most of the time/always. The success of this new proforma resulted in it being implemented on a permanent basis for new medical admissions and transfers to the hospital. PMID:26734303

  15. Interventions to improve medication adherence in schizophrenia.

    PubMed

    Zygmunt, Annette; Olfson, Mark; Boyer, Carol A; Mechanic, David

    2002-10-01

    Although nonadherence with the antipsychotic medication regimen is a common barrier to the effective treatment for schizophrenia, knowledge is limited about how to improve medication adherence. This systematic literature review examined psychosocial interventions for improving medication adherence, focusing on promising initiatives, reasonable standards for conducting research in this area, and implications for clinical practice. Studies were identified by computerized searches of MEDLINE and PsychLIT for the years between 1980 and 2000 and by manual searches of relevant bibliographies and conference proceedings. Key articles were summarized. Thirteen (33%) of 39 identified studies reported significant intervention effects. Although interventions and family therapy programs relying on psychoeducation were common in clinical practice, they were typically ineffective. Concrete problem solving or motivational techniques were common features of successful programs. Interventions targeted specifically to problems of nonadherence were more likely to be effective (55%) than were more broadly based treatment interventions (26%). One-half (four of eight) of the successful interventions not specifically focused on nonadherence involved an array of supportive and rehabilitative community-based services. Psychoeducational interventions without accompanying behavioral components and supportive services are not likely to be effective in improving medication adherence in schizophrenia. Models of community care such as assertive community treatment and interventions based on principles of motivational interviewing are promising. Providing patients with concrete instructions and problem-solving strategies, such as reminders, self-monitoring tools, cues, and reinforcements, is useful. Problems in adherence are recurring, and booster sessions are needed to reinforce and consolidate gains.

  16. A comprehensive model to build improvement capability in a pediatric academic medical center.

    PubMed

    Kaminski, Gerry M; Schoettker, Pamela J; Alessandrini, Evaline A; Luzader, Carolyn; Kotagal, Uma

    2014-01-01

    Cincinnati Children's Hospital Medical Center developed a comprehensive model to build quality improvement (QI) capability to support its goal to transform its delivery system through a series of training courses. Two online modules orient staff to basic concepts and terminology and prepare them to participate more effectively in QI teams. The basic program (Rapid Cycle Improvement Collaborative, RCIC) is focused on developing the capability to use basic QI tools and complete a narrow-scoped project in approximately 120 days. The Intermediate Improvement Science Series (I(2)S(2)) program is a leadership course focusing on improvement skills and developing a broader and deeper understanding of QI in the context of the organization and external environment. The Advanced Improvement Methods (AIM) course and Quality Scholars Program stimulate the use of more sophisticated methods and prepare Cincinnati Children's Hospital Medical Center (CCHMC) and external faculty to undertake QI research. The Advanced Improvement Leadership Systems (AILS) sessions enable interprofessional care delivery system leadership teams to effectively lead a system of care, manage a portfolio of projects, and to deliver on CCHMC's strategic plan. Implementing these programs has shown us that 1) a multilevel curricular approach to building improvement capability is pragmatic and effective, 2) an interprofessional learning environment is critical to shifting mental models, 3) repetition of project experience with coaching and feedback solidifies critical skills, knowledge and behaviors, and 4) focusing first on developing capable interprofessional improvement leaders, versus engaging in broad general QI training across the whole organization, is effective.

  17. Improving medical personnel selection and appointment processes.

    PubMed

    Bassett, Mark L; Ramsey, Wayne P; Chan, Christopher C A

    2012-01-01

    This paper seeks to argue that processes for selecting and appointing medically qualified personnel in some healthcare organizations may be limited, especially those that emphasize qualifications rather than expanding the criteria to include practice scope, person-organization fit and capability to function within a healthcare team. The paper is based on the authors' experiences and a literature review. Selection based purely on academic merit, advanced clinical training, skills and professional achievements may not address other essential selection criteria. Medical personnel need to possess competencies such as ability to give high quality care and work constructively in a clinical team; communication skills; willingness to actively participate in quality and safety programs; teaching ability; management and leadership skills; and support institutional values and corporate aims. These attributes are often over-looked and cannot be assumed from academic merit and achievements. The study's conclusions are based on the authors' experiences and literature review. Future studies may wish to examine selection technique efficacy and outcomes empirically. Better medical personnel selection and appointment processes are likely to reduce unnecessary costs associated with poorly-made appointments, improve patient outcomes and may have a formative role encouraging medical personnel to take a broader view of their healthcare organization roles. The authors challenge selection panel members to consider non-traditional with normal selection criteria for medical appointments. Nine recommendations for enhancing selection processes are provided.

  18. Improving medical work experience for students.

    PubMed

    Hunter, Neil; Shah, Alexander; Bollina, Prasad; Bollina, Harsha

    2010-12-01

    This exploratory piece details the development of the programme Medic Insight, which was established in 2007 in Lothian. This is an aptly-named unique organisation that provides an insight into life as a doctor for school students. We believe that the provision of work experience needs to be improved for both students and doctors. Securing work experience in medicine has historically been biased: individuals that have family or friends who work as doctors are able to organise shadowing placements with greater ease. Shadowing experiences are of questionable value, and frequently offer exposure to only one field, and administrators struggle to match doctors' working schedules with those of students. Medic Insight has been developed to address these key problems. It provides a free, application-based shadowing experience for 15-16-year olds, in addition to interactive seminars for younger students. Over the course of the 5-day shadowing experience (Medic Insight Week), students rotate through a variety of specialties, meeting doctors of all grades. Doctors agree to act as mentors prior to the shadowing weeks and post their availability online. Data from our pilot in 2008 has been encouraging. All students who answered our questionnaire found the experience to be either useful or very useful, and ongoing data collection is proving this to be an enjoyable and effective programme. We are confident that Medic Insight will help all suitably enthusiastic and able school students make informed decisions to apply to study medicine. © Blackwell Publishing Ltd 2010.

  19. Improving Learner Handovers in Medical Education.

    PubMed

    Warm, Eric J; Englander, Robert; Pereira, Anne; Barach, Paul

    2017-07-01

    Multiple studies have demonstrated that the information included in the Medical Student Performance Evaluation fails to reliably predict medical students' future performance. This faulty transfer of information can lead to harm when poorly prepared students fail out of residency or, worse, are shuttled through the medical education system without an honest accounting of their performance. Such poor learner handovers likely arise from two root causes: (1) the absence of agreed-on outcomes of training and/or accepted assessments of those outcomes, and (2) the lack of standardized ways to communicate the results of those assessments. To improve the current learner handover situation, an authentic, shared mental model of competency is needed; high-quality tools to assess that competency must be developed and tested; and transparent, reliable, and safe ways to communicate this information must be created.To achieve these goals, the authors propose using a learner handover process modeled after a patient handover process. The CLASS model includes a description of the learner's Competency attainment, a summary of the Learner's performance, an Action list and statement of Situational awareness, and Synthesis by the receiving program. This model also includes coaching oriented towards improvement along the continuum of education and care. Just as studies have evaluated patient handover models using metrics that matter most to patients, studies must evaluate this learner handover model using metrics that matter most to providers, patients, and learners.

  20. The Time is Now: Improving Substance Abuse Training in Medical Schools.

    PubMed

    Ram, Anita; Chisolm, Margaret S

    2016-06-01

    This commentary highlights the growing demand for substance abuse prevention and treatment, summarizes the literature regarding the current insufficiencies in substance abuse training in medical schools, and suggests strategies to address this gap in physician education. The authors describe how the combination of mandated coverage for substance abuse services and expanding treatment needs means that more physicians, regardless of their patient populations, will be faced with addressing the problem of substance use. The authors review the literature on substance abuse training in medical schools, which indicates insufficient exposure to this topic. The authors describe how current substance abuse training at medical schools is focused on transmitting scientific knowledge with relatively little education or training in attitudes and skills central to effective prevention and treatment. Given the gap between clinical need and physician education, the authors suggest several strategies for medical schools to increase training in substance abuse knowledge, attitudes, and skills, which will enhance the practice of evidence-based care. The authors posit that medical curricular reform, combined with initiatives to change clinical culture around substance abuse, will translate into improved rates of screening, shorter overall length of treatment, effective referrals for continued treatment, and increased access to care for individuals who use substances and so reduce the morbidity and mortality associated with substance use.

  1. Improved Interactive Medical-Imaging System

    NASA Technical Reports Server (NTRS)

    Ross, Muriel D.; Twombly, Ian A.; Senger, Steven

    2003-01-01

    An improved computational-simulation system for interactive medical imaging has been invented. The system displays high-resolution, three-dimensional-appearing images of anatomical objects based on data acquired by such techniques as computed tomography (CT) and magnetic-resonance imaging (MRI). The system enables users to manipulate the data to obtain a variety of views for example, to display cross sections in specified planes or to rotate images about specified axes. Relative to prior such systems, this system offers enhanced capabilities for synthesizing images of surgical cuts and for collaboration by users at multiple, remote computing sites.

  2. Improving the transition from medical school to internship - evaluation of a preparation for internship course.

    PubMed

    Scicluna, Helen A; Grimm, Michael C; Jones, Philip D; Pilotto, Louis S; McNeil, H Patrick

    2014-02-03

    This study evaluates the impact of a new 'Preparation for Internship' (PRINT) course, which was developed to facilitate the transition of University of New South Wales (UNSW) medical graduates from Medical School to Internship. During a period of major curricular reform, the 2007 (old program) and 2009 (new program) cohorts of UNSW final year students completed the Clinical Capability Questionnaire (CCQ) prior to and after undertaking the PRINT course. Clinical supervisors' ratings and self-ratings of UNSW 2009 medical graduates were obtained from the Hospital-based Prevocational Progress Review Form. Prior to PRINT, students from both cohorts perceived they had good clinical skills, with lower ratings for capability in procedural skills, operational management, and administrative tasks. After completing PRINT, students from both cohorts perceived significant improvement in their capability in procedural skills, operational management, and administrative tasks. Although PRINT also improved student-perceived capability in confidence, interpersonal skills and collaboration in both cohorts, curriculum reform to a new outcomes-based program was far more influential in improving self-perceptions in these facets of preparedness for hospital practice than PRINT. The PRINT course was most effective in improving students' perceptions of their capability in procedural skills, operational management and administrative tasks, indicating that student-to-intern transition courses should be clinically orientated, address relevant skills, use experiential learning, and focus on practical tasks. Other aspects that are important in preparation of medical students for hospital practice cannot be addressed in a PRINT course, but major improvements are achievable by program-wide curriculum reform.

  3. Improving the transition from medical school to internship – evaluation of a preparation for internship course

    PubMed Central

    2014-01-01

    Background This study evaluates the impact of a new 'Preparation for Internship’ (PRINT) course, which was developed to facilitate the transition of University of New South Wales (UNSW) medical graduates from Medical School to Internship. Methods During a period of major curricular reform, the 2007 (old program) and 2009 (new program) cohorts of UNSW final year students completed the Clinical Capability Questionnaire (CCQ) prior to and after undertaking the PRINT course. Clinical supervisors’ ratings and self-ratings of UNSW 2009 medical graduates were obtained from the Hospital-based Prevocational Progress Review Form. Results Prior to PRINT, students from both cohorts perceived they had good clinical skills, with lower ratings for capability in procedural skills, operational management, and administrative tasks. After completing PRINT, students from both cohorts perceived significant improvement in their capability in procedural skills, operational management, and administrative tasks. Although PRINT also improved student-perceived capability in confidence, interpersonal skills and collaboration in both cohorts, curriculum reform to a new outcomes-based program was far more influential in improving self-perceptions in these facets of preparedness for hospital practice than PRINT. Conclusions The PRINT course was most effective in improving students’ perceptions of their capability in procedural skills, operational management and administrative tasks, indicating that student-to-intern transition courses should be clinically orientated, address relevant skills, use experiential learning, and focus on practical tasks. Other aspects that are important in preparation of medical students for hospital practice cannot be addressed in a PRINT course, but major improvements are achievable by program-wide curriculum reform. PMID:24485072

  4. Reshaping Curricular Culture.

    ERIC Educational Resources Information Center

    Kaufman, Cathy

    Curricular goals that traditionally focused on the delivery of the teaching rather than the outcomes of the learning are in a state of major transition. Implementation of academic standards requires the application of content and not merely its delivery. As a result, colleges of education must prepare anew genre of teacher leaders equipped to…

  5. Curricular Guidelines for Neuroanatomy.

    ERIC Educational Resources Information Center

    Journal of Dental Education, 1981

    1981-01-01

    Presented are the curricular guidelines for Neuroanatomy developed by the Section on Anatomical Sciences of the American Association of Dental Schools for use by individual educational institutions as curriculum development aids. Included are recommendations for primary educational goals, prerequisites, scope, content, behavioral objectives,…

  6. Curricular Guidelines in Biochemistry.

    ERIC Educational Resources Information Center

    Adams, A. Birk; And Others

    1981-01-01

    Curricular guidelines for biochemistry are presented, developed by the Section on Biochemistry and Nutrition and the Section on Oral Diagnosis and Oral Medicine of the American Association of Dental Schools for use by individual educational institutions as curriculum development aids. (MLW)

  7. Overview of Curricular Approaches

    ERIC Educational Resources Information Center

    Hartz, Cameo V.; Parker, Jill

    2012-01-01

    Institutions of higher education address the transition from after-college life in a variety of curricular approaches. Articulation agreements provide greater transferability of courses from one college to another, thereby easing the transition for students. Career courses, which are typically taught by career center staff, are a common offering…

  8. Improving medical handover at the weekend: a quality improvement project

    PubMed Central

    Michael, Emma; Patel, Chandni

    2015-01-01

    In recent years medical handover has been identified as an increasingly important area for hospitals to improve upon, in light of the changes in shift patterns for doctors. Significant changes to weekday handover had recently been successfully introduced at Broomfield hospital. Weekend handover remained a concern, with an electronic and paper system being used simultaneously. Our objectives were to introduce a new electronic handover system for weekend handover at Broomfield Hospital and improve the organisation of the weekend handover meeting to promote patient safety. Doctors involved in weekend handover were surveyed using a questionnaire, to establish insufficiencies in the weekend handover process; where both the electronic ExtraMed system and paper were being used inconsistently. A new weekend handover system was introduced together with a new user-friendly electronic handover database, addressing the identified difficulties in the current system. These changes met the medical handover guidelines set by the Royal College of Physicians. Three months after the launch of the new system, doctors were re-surveyed using a modified questionnaire to assess the impact our changes had made. Before changes were implemented only 12% of doctors surveyed used the electronic system for weekend. Eighty-nine percent found sorting through jobs time consuming and 67% were handed jobs to them meant for a different grade of doctor. Only 41% were aware who to hand weekend discharges to. Subjective assessment of safety was 3.18 out of 5. The electronic system was felt to be time consuming and complicated. After execution of the new weekend handover process, 100% of doctors reported using the electronic system for weekend handover. Only 47% of doctors felt sorting through jobs was time consuming and 89% of doctors were aware who to handover weekend discharges to. Subjective assessment of the safety of weekend handover improved to 3.84 out of 5. Informal interviews on the ward

  9. Improving medical handover at the weekend: a quality improvement project.

    PubMed

    Michael, Emma; Patel, Chandni

    2015-01-01

    In recent years medical handover has been identified as an increasingly important area for hospitals to improve upon, in light of the changes in shift patterns for doctors. Significant changes to weekday handover had recently been successfully introduced at Broomfield hospital. Weekend handover remained a concern, with an electronic and paper system being used simultaneously. Our objectives were to introduce a new electronic handover system for weekend handover at Broomfield Hospital and improve the organisation of the weekend handover meeting to promote patient safety. Doctors involved in weekend handover were surveyed using a questionnaire, to establish insufficiencies in the weekend handover process; where both the electronic ExtraMed system and paper were being used inconsistently. A new weekend handover system was introduced together with a new user-friendly electronic handover database, addressing the identified difficulties in the current system. These changes met the medical handover guidelines set by the Royal College of Physicians. Three months after the launch of the new system, doctors were re-surveyed using a modified questionnaire to assess the impact our changes had made. Before changes were implemented only 12% of doctors surveyed used the electronic system for weekend. Eighty-nine percent found sorting through jobs time consuming and 67% were handed jobs to them meant for a different grade of doctor. Only 41% were aware who to hand weekend discharges to. Subjective assessment of safety was 3.18 out of 5. The electronic system was felt to be time consuming and complicated. After execution of the new weekend handover process, 100% of doctors reported using the electronic system for weekend handover. Only 47% of doctors felt sorting through jobs was time consuming and 89% of doctors were aware who to handover weekend discharges to. Subjective assessment of the safety of weekend handover improved to 3.84 out of 5. Informal interviews on the ward

  10. Parental Influence on Psychological Value Perception of Co-Curricular Activities: Its Links with Improving Personality Traits of Higher Secondary Students

    ERIC Educational Resources Information Center

    Kumar, G. N. Sunith; Arockiasamy, S.

    2012-01-01

    Co-curricular activities provide prospects for better youth development and growth experiences. These activities are particularly good at providing opportunities for students to work in teams, to exercise leadership, and to take the initiative themselves. The active participation of the students is required to reap out maximum benefits out of such…

  11. Improving oversight of the graduate medical education enterprise: one institution's strategies and tools.

    PubMed

    Afrin, Lawrence B; Arana, George W; Medio, Franklin J; Ybarra, Angela F N; Clarke, Harry S

    2006-05-01

    Accreditation organizations, financial stakeholders, legal systems, and regulatory agencies have increased the need for accountability in educational processes and curricular outcomes of graduate medical education. This demand for greater programmatic monitoring has placed pressure on institutions with graduate medical education (GME) programs to develop greater oversight of these programs. Meeting these challenges requires development of new GME management strategies and tools for institutional GME administrators to scrutinize programs, while still allowing these programs the autonomy to develop and implement educational methods to meet their unique training needs. At the Medical University of South Carolina (MUSC), senior administrators in the college of medicine felt electronic information management was a critical strategy for success and thus proceeded to carefully select an electronic residency management system (ERMS) to provide functionality for both individual programs and the GME enterprise as a whole. Initial plans in 2002 for a phased deployment had to be changed to a much more rapid deployment due to regulatory issues. Extensive communication and cooperation among MUSC's GME leaders resulted in a successful deployment in 2003. Evaluation completion rates have substantially improved, duty hours are carefully monitored, patient safety has improved through more careful oversight of residents' procedural privileges, regulators have been pleased, and central GME administrative visibility of program performance has dramatically improved. The system is now being expanded to MUSC's medical school and other health professions colleges. The authors discuss lessons learned and opportunities and challenges ahead, which include improving tracking of development of procedural competency, establishing and monitoring program performance standards, and integrating the ERMS with GME reimbursement systems.

  12. Managing the medical workforce: time for improvements?

    PubMed

    Maynard, A; Walker, A

    1995-01-01

    There has been a regular cycle of Government committees in Britain that have forecast 'shortages' and 'surpluses' in medical manpower. It is remarkable how little change there has been in the methods used in these forecasts despite criticism of their methods and the move towards competitive markets in the delivery of health care. The practice of medical manpower planning was criticised in the 1960s because of the failure to explore the implications of alternative skill mixes and incentives. Whilst these criticisms were ignored, the forecasters now pay more regard to budget constraints and produce more regular estimates. The 1992 forecast could be improved by sensitivity analysis (e.g. for GP/population ratios). However, unless the issue of scope (forecasting for all health care staff, not just for doctors alone) and the implications of skill mix and incentives identified in the 1960s are addressed effectively, the current recommendations may produce doctor 'surpluses' in the early twenty-first century. The Government's analysis should be challenged at the level of principle and practice, and this implies that the research activity proposed in the 1960s is carried out in the 1990s to facilitate efficiency in the twenty-first century. Furthermore, the issue of policy priorities and their ranking needs to be spelt out explicitly: does the Government want a competitive NHS internal market, and if it does, what is the role of central manpower planning? One implication of current policy choice and the maintenance of manpower planning is that cost containment is of more importance to policy makers than the internal market.

  13. Metacognitive awareness and self-regulated learning skills of medical students in different medical curricula.

    PubMed

    Turan, Sevgi; Demirel, Ozcan; Sayek, Iskender

    2009-10-01

    The aim of this study was to investigate the acquisition of metacognitive awareness and self-regulated learning skills in medical schools using different curricular models. The study was carried out in four medical schools implementing different curricular models. Eight hundred and sixty two medical students took part in the study and two scales (self-regulated learning perception scale--SRLPS and metacognitive awareness inventory--MAI) were used. Cronbach's alpha was 0.93 for the MAI, and 0.88, 0.91, 0.83, and 0.76 for the four dimensions of the SRLPS. There were no statistically significant differences in MAI scores according to gender, curricular language, or previous exposure or not to a learner-centered method during secondary school, but the differences in scores according to the phase and curricular model were found to be significant. With regard to SRLPS total scores, no difference was found according to gender, but significant differences were found according to phase, curricular language, and curricular model. MAI and SRLPS scores of students from the medical school using a learner-centered curriculum were higher than the other schools' students. This study suggests that students who experience a learner-centered curriculum, such as PBL during their medical education demonstrate improved metacognitive awareness and self-regulated learning skills.

  14. A Description and Qualitative Assessment of a 4-Year Intervention to Improve Patient Counseling by Improving Medical Student Health

    PubMed Central

    Frank, Erica; Smith, Donna; Fitzmaurice, Dorothy

    2005-01-01

    Background To test whether promoting medical student health could efficiently improve patient counseling, we developed and implemented a 4-year-long curricular and extracurricular intervention to promote healthy behaviors among students in the Class of 2003 at Emory University School of Medicine, Atlanta, Georgia. Methods We asked students: (1) “What did you think about these [listed intervention components]”; (2) “did any of these interventions influence your personal health habits/attitudes toward your personal health”; and (3) “did any of these interventions influence your behavior or attitudes regarding current or future clinical practices, including history taking or counseling? If so, how? If not, why not?” Students evaluated the effectiveness of these formats and proposed changes in our intervention. The focus groups were transcribed and analyzed with QSR N5. Results Several major themes emerged from the focus groups: Listen to the students early, often, substantively, and noticeably;Incorporate many faculty and student leaders;Quietly integrate the curricular activities into the regular curriculum;Provide a strong, science-based, pragmatic prevention curriculum to complement the personal health promotion;Don't just use lectures to teach;Offer plentiful, nonrequired, fun extracurriculars;Don't nag;Have achievable interventions and recommendations;Provide collective data, but don't overexpose the students to it, and don't assume that collective data apply to every student, especially if it's unpleasant news;Provide personalized data where possible; andUncouple evaluations from the intervention, and keep evaluations brief. Conclusions Some students seemed pleased to have their medical school be attentive to their health, and believed that the project positively influenced their personal health practices and clinical practices (which was our goal). The students enjoyed many components of the intervention, especially the extracurricular activities

  15. Illustrated Medication Instructions as a Strategy to Improve Medication Management Among Latinos: A Qualitative Analysis

    PubMed Central

    Mohan, Arun; Riley, Brian; Boyington, Dane; Kripalani, Sunil

    2013-01-01

    Although illustrated medication instructions may improve medication management among vulnerable populations, little prior research has evaluated their use among Latinos. We conducted focus groups and interviews with Latino patients with diabetes at two safety net clinics in Tennessee to understand medication taking practices and perceptions of illustrated medication instructions. Patients reported confidence in being able to take medications, but demonstrated a lack of understanding of medication instructions. On further probing, they described several barriers to effective medication management rooted in poor communication. Patients expressed preference for illustrated medication instructions which could address several of the challenges raised by patients. PMID:22453163

  16. Improving the medical malpractice litigation process.

    PubMed

    Struve, Catherine T

    2004-01-01

    Critics charge that judges and juries are incompetent to address medical liability issues. Some advocate shifting authority away from ordinary judges and juries, either by appointing "expert" decisionmakers, such as "medical screening panels" or specialized "medical courts," or by instituting caps on damages. Problems with the tort liability system may weigh in favor of a shift to a no-fault administrative compensation system. If the current fault-based system is retained, however, policymakers should not adopt half-measures by creating "expert" panels or "expert" courts. Rather, they should better equip the existing decisionmakers to deal with liability and damages questions.

  17. Systematic Review of Educational Interventions to Improve Glaucoma Medication Adherence

    PubMed Central

    Newman-Casey, Paula Anne; Weizer, Jennifer S.; Heisler, Michele; Lee, Paul P.; Stein, Joshua D.

    2014-01-01

    Adherence to prescribed glaucoma medications is often poor, and proper adherence can be challenging for patients. We systematically reviewed the literature and identified eight studies using educational interventions to improve glaucoma medication adherence. Overall, five of the eight studies found that educational interventions lead to a significant improvement in medication adherence, and the remaining studies found a trend towards improvement. Using information from this systematic review and Health Behavior Theory, we constructed a conceptual framework to illustrate how counseling and education can improve glaucoma medication adherence. More rigorous studies grounded in Health Behavior Theory with adequately powered samples and longer follow-up are needed. PMID:23697623

  18. Curricular and Co-Curricular Leadership Learning for Engineering Students

    ERIC Educational Resources Information Center

    Reeve, Doug; Evans, Greg; Simpson, Annie; Sacks, Robin; Olivia-Fisher, Estelle; Rottmann, Cindy; Sheridan, Patricia

    2015-01-01

    In recent years engineering educators have been encouraged to blend technical and professional learning in their curricular and co-curricular programming (Engineers Canada, 2009; National Academy of Engineering [NAE], 2004). Our paper describes a multifaceted leadership learning program developed to achieve this goal by infusing reflective,…

  19. Curricular and Extra-Curricular Factors in Multilingual Education.

    ERIC Educational Resources Information Center

    Housen, Alex; Beardsmore, Hugo Baetens

    1987-01-01

    Analysis of multilingual acquisition processes among children at the European School of Brussels reveals how both curricular and extra-curricular factors combine to account for these students' high levels of proficiency in three or four languages. Schumann's (1979) Acculturation Model applied to one case study allows examination of how the…

  20. Improving Medical and Dental Readiness in the Reserve Components

    DTIC Science & Technology

    2012-01-01

    Improving Medical and Dental Readiness in the Reserve Components A s an integral part of the U.S. military, the reserve components (RCs) are...limit their ability to carry out their duties, whether in garrison or deployed. Medically ready reservists require less medical and dental support...IMR for this new operating environment. The study sought to quantify the current status of RC medical and dental readiness, identify obstacles to

  1. Reflections: Improving Medical Students' Presentation Skills.

    PubMed

    Tarkowski, Radoslaw

    2016-02-26

    Both good communication and presentation skills on the part of an academic teacher are crucial when trying to generate students' interest in the subject of a lecture. More generally, our task is to share knowledge in the most effective way possible. It is also worth teaching students presentation skills, as today's students are tomorrow's teachers. An engaging presentation is a powerful tool. There are some rules for presenting which I consider worthy of being discussed and taught at a medical university.

  2. Alcohol Medical Scholars Program--A Mentorship Program for Improving Medical Education regarding Substance Use Disorders

    ERIC Educational Resources Information Center

    Neufeld, Karin J.; Schuckit, Marc A.; Hernandez-Avila, Carlos A.

    2011-01-01

    The Alcohol Medical Scholars Program (AMSP) is designed to improve medical education related to substance use disorders (SUDs) through mentorship of junior, full-time academic faculty from medical schools across the United States. Scholarship focuses on literature review and synthesis, lecture development and delivery, increasing SUD education in…

  3. Alcohol Medical Scholars Program--A Mentorship Program for Improving Medical Education regarding Substance Use Disorders

    ERIC Educational Resources Information Center

    Neufeld, Karin J.; Schuckit, Marc A.; Hernandez-Avila, Carlos A.

    2011-01-01

    The Alcohol Medical Scholars Program (AMSP) is designed to improve medical education related to substance use disorders (SUDs) through mentorship of junior, full-time academic faculty from medical schools across the United States. Scholarship focuses on literature review and synthesis, lecture development and delivery, increasing SUD education in…

  4. Communication in a medical setting: can standards be improved?

    PubMed Central

    2013-01-01

    Do standards exist to improve communication in a medical setting? What are the minimal requirements to make our communication with patients and their family clear and simple? International literature, as well as psychology, philosophy, and even our brain structure offer ways to improve communication. We reflected about what is preventing effective communication in the medical setting and how/from where should we set about improving it. PMID:23295153

  5. Integrating patient safety into health professionals' curricula: a qualitative study of medical, nursing and pharmacy faculty perspectives.

    PubMed

    Tregunno, Deborah; Ginsburg, Liane; Clarke, Beth; Norton, Peter

    2014-03-01

    As efforts to integrate patient safety into health professional curricula increase, there is growing recognition that the rate of curricular change is very slow, and there is a shortage of research that addresses critical perspectives of faculty who are on the 'front-lines' of curricular innovation. This study reports on medical, nursing and pharmacy teaching faculty perspectives about factors that influence curricular integration and the preparation of safe practitioners. Qualitative methods were used to collect data from 20 faculty members (n=6 medical from three universities; n=6 pharmacy from two universities; n=8 nursing from four universities) engaged in medical, nursing and pharmacy education. Thematic analysis generated a comprehensive account of faculty perspectives. Faculty perspectives on key challenges to safe practice vary across the three disciplines, and these different perspectives lead to different priorities for curricular innovation. Additionally, accreditation and regulatory requirements are driving curricular change in medicine and pharmacy. Key challenges exist for health professional students in clinical teaching environments where the culture of patient safety may thwart the preparation of safe practitioners. Patient safety curricular innovation depends on the interests of individual faculty members and the leveraging of accreditation and regulatory requirements. Building on existing curricular frameworks, opportunities now need to be created for faculty members to act as champions of curricular change, and patient safety educational opportunities need to be harmonises across all health professional training programmes. Faculty champions and practice setting leaders can collaborate to improve the culture of patient safety in clinical teaching and learning settings.

  6. Interventions to improve antipsychotic medication adherence: review of recent literature.

    PubMed

    Dolder, Christian R; Lacro, Jonathan P; Leckband, Susan; Jeste, Dilip V

    2003-08-01

    Antipsychotic nonadherence is an important barrier to the successful treatment of schizophrenia and can lead to clinical and economic burdens. Interventions capable of significantly improving medication adherence in patients with schizophrenia would be beneficial in maximizing treatment outcomes with antipsychotics. This article reviews recent literature reporting interventions designed to improve antipsychotic adherence in patients with schizophrenia. We searched the Medline, Healthstar, and PsycInfo electronic databases for articles published since 1980 on interventions to improve medication adherence in schizophrenia. Twenty-one studies met our selection criteria. In this review, educational, behavioral, affective, or a combination of these approaches to improve adherence were examined. A total of 23 interventions were tested, as 2 studies investigated more than 1 intervention. While study design and adherence measures varied across the trials reviewed, medication adherence was noted to moderately improve with 15 of the 23 interventions tested. Interventions of a purely educational nature were the least successful at improving antipsychotic adherence. The greatest improvement in adherence was seen with interventions employing combinations of educational, behavioral, and affective strategies with which improvements in adherence were noted in 8 out of 12 studies, with additional secondary gains such as: reduced relapse, decreased hospitalization, decreased psychopathology, improved social function, gains in medication knowledge, and improved insight into the need for treatment. Longer interventions and an alliance with therapists also appeared important for successful outcomes. The continuing development and study of successful interventions to improve medication adherence are necessary to maximize the usefulness of pharmacologic treatment of schizophrenia.

  7. Improving Teaching in Medical Schools: A Practical Handbook.

    ERIC Educational Resources Information Center

    Holcomb, J. David; Garner, Arthur E.

    To help teachers in medical education improve their teaching skills, the book offers practical assistance and methods of improving the teaching-learning process. The first chapter, Behavioral Objectives and Improving Teaching, is devoted to the development and utilization of educational objectives and constitutes the first part of the book. Part 2…

  8. Elder and Caregiver Solutions to Improve Medication Adherence

    ERIC Educational Resources Information Center

    O'Quin, K. E.; Semalulu, T.; Orom, H.

    2015-01-01

    Medication mismanagement is a growing public health concern, especially among elders. Annually, it is a major contributor to emergency hospitalization and nursing home placement. Elders and their caregivers, as healthcare consumers and stakeholders in this issue, are uniquely qualified to inform strategies to improve medication adherence. We…

  9. Elder and Caregiver Solutions to Improve Medication Adherence

    ERIC Educational Resources Information Center

    O'Quin, K. E.; Semalulu, T.; Orom, H.

    2015-01-01

    Medication mismanagement is a growing public health concern, especially among elders. Annually, it is a major contributor to emergency hospitalization and nursing home placement. Elders and their caregivers, as healthcare consumers and stakeholders in this issue, are uniquely qualified to inform strategies to improve medication adherence. We…

  10. Improving Medication Management among At-risk Older Adults

    PubMed Central

    Martin, Delinda; Kripalani, Sunil; DuPapau, V.J.

    2013-01-01

    Low health literacy is common among Medicare recipients and affects their understanding of complex medication regimens. Interventions are needed to improve medication use among older adults, while addressing low health literacy. Community-dwelling older adults in this study were enrolled in an inner-city adult day center. They completed a baseline measure of health literacy, medication self-efficacy, and medication adherence. They were provided with a personalized, illustrated daily medication schedule (PictureRx™). Six weeks later, their medication self-efficacy and adherence were assessed. Among the 20 participants in this pilot project, 70% had high likelihood of limited health literacy and took an average of 13.2 prescription medications. Both self-efficacy and medication adherence increased significantly after provision of the PictureRx cards (p<0.001 and p<0.05, respectively). Al participants rated the PictureRx cards as very helpful in terms of helping them remember the medication’s purpose and dosing. Illustrated daily medication schedules improve medication self-efficacy and adherence among at-risk, community-dwelling older adults. PMID:22587641

  11. Interventional tools to improve medication adherence: review of literature

    PubMed Central

    Costa, Elísio; Giardini, Anna; Savin, Magda; Menditto, Enrica; Lehane, Elaine; Laosa, Olga; Pecorelli, Sergio; Monaco, Alessandro; Marengoni, Alessandra

    2015-01-01

    Medication adherence and persistence is recognized as a worldwide public health problem, particularly important in the management of chronic diseases. Nonadherence to medical plans affects every level of the population, but particularly older adults due to the high number of coexisting diseases they are affected by and the consequent polypharmacy. Chronic disease management requires a continuous psychological adaptation and behavioral reorganization. In literature, many interventions to improve medication adherence have been described for different clinical conditions, however, most interventions seem to fail in their aims. Moreover, most interventions associated with adherence improvements are not associated with improvements in other outcomes. Indeed, in the last decades, the degree of nonadherence remained unchanged. In this work, we review the most frequent interventions employed to increase the degree of medication adherence, the measured outcomes, and the improvements achieved, as well as the main limitations of the available studies on adherence, with a particular focus on older persons. PMID:26396502

  12. LGBTQ Experiences in Curricular Contexts

    ERIC Educational Resources Information Center

    Linley, Jodi L.; Nguyen, David J.

    2015-01-01

    This chapter examines curricula as important microsystems for LGBTQ college students. The authors explore sociocultural influences on curricula and discuss strategies for creating positive curricular experiences for LGBTQ students.

  13. LGBTQ Experiences in Curricular Contexts

    ERIC Educational Resources Information Center

    Linley, Jodi L.; Nguyen, David J.

    2015-01-01

    This chapter examines curricula as important microsystems for LGBTQ college students. The authors explore sociocultural influences on curricula and discuss strategies for creating positive curricular experiences for LGBTQ students.

  14. Imperatives in medical education and training in response to demands for a sustainable workforce.

    PubMed

    Dowton, S Bruce

    Factors to be considered in planning our medical workforce to meet future needs include: Need for outcomes-based curricular designs in medical schools and postgraduate training. Shortening the length of medical training. Improving career flexibility to permit professional re-invention. Developing awareness within the profession about how innovation happens.

  15. Nursing Home Medication Reconciliation: A Quality Improvement Initiative.

    PubMed

    Tong, Monica; Oh, Hye Young; Thomas, Jennifer; Patel, Sheila; Hardesty, Jennifer L; Brandt, Nicole J

    2017-04-01

    The current quality improvement initiative evaluated the medication reconciliation process within select nursing homes in Washington, DC. The identification of common types of medication discrepancies through monthly retrospective chart reviews of newly admitted patients in two different nursing homes were described. The use of high-risk medications, namely antidiabetic, anticoagulant, and opioid agents, was also recorded. A standardized spreadsheet tool based on multiple medication reconciliation implementation tool kits was created to record the information. The five most common medication discrepancies were incorrect indication (21%), no monitoring parameters (17%), medication name omitted (11%), incorrect dose (10%), and incorrect frequency (8%). Antidiabetic agents in both sites were the most used high-risk medication. This initiative highlights that medication discrepancies on admission are common in nursing homes and may be clinically impactful. More attention needs to be given to work flow processes to improve medication reconciliation considering the increased risk for adverse drug events and hospitalizations. [Journal of Gerontological Nursing and Mental Health Services, 43(4), 9-14.].

  16. Improving medication management competency of clinical trainees in geriatrics.

    PubMed

    Kostas, Tia; Zimmerman, Kristin; Salow, Marci; Simone, Mark; Whitmire, Natalie; Rudolph, James L; McMahon, Graham T

    2014-08-01

    The authors hypothesized that an interprofessional workshop would improve geriatrics trainees' medication management. The workshop was based on a needs assessment and comprised an interactive session with pharmacists on managing medications in elderly adults. Participants were trainees in their geriatrics rotation at a tertiary care medical center. Trainees completed a medication appropriateness survey for three patients, one of which was their own. After the workshop, trainees reviewed medications of the three patients. Trainees completed online surveys after their rotation and 3 months later. Of 95 trainees rotating through geriatrics, 76 (80%) attended the workshop and completed the worksheet. Trainees' scores on reviewing medication lists improved significantly, from 6.7±2.3 to 7.7±2.0 out of 11 for standardized patient 1 (P<.001) and from 5.7±1.8 to 6.4±1.5 out of 11 for standardized patient 2 (P=.009). Trainees' scores on their own patients' lists also improved significantly, from 5.6±1.5 to 6.6±1.5 out of 10 (P<.001). After the workshop, 95% (71/75) planned to change the medication regimen of the patient they presented, and 93% (68/73) planned to change other patients' medications based on information learned during the workshop. Three months later, 35% (12/34) had made changes to the regimen of the patient they discussed during the workshop, and 71% (15/21) had made changes to other patients' regimens. Seventy-eight percent (18/23) rated the workshop as the top nonclinical experience of their geriatrics rotation. In conclusion, this interprofessional medication management workshop improved trainees' ability to perform medication reviews accurately and led to change in self-reported prescribing behavior. © 2014, Copyright the Authors Journal compilation © 2014, The American Geriatrics Society.

  17. [Improvement of medical equipment setting for the hospital link of the medical service during wartime].

    PubMed

    Miroshnichenko, Yu V; Goryachev, A B; Popov, A A; Rodionov, E O

    2016-04-01

    One of the priorities of the military health care is to improve the system of rationing medical equipment for the hospital unit of the medical service of the Armed Forces in wartime. This is determined the fact that the effectiveness of measures to provide military field hospitals with medical supplies depends on the quality of medical care for the wounded and sick, as well as the level of their return to duty. The article presents the characteristics of modern standards medical supplies procurement of military field hospitals included in the new regulatory legal act of the Russian Federation Ministry of Defence--"Standards of supplies medical supplies medical and pharmaceutical organizations (units) of the Russian Federation on the wartime armed forces", approved and put into effect in 2015 by order of the Minister of Defence of the Russian Federation.

  18. "Anatomy and imaging": 10 years of experience with an interdisciplinary teaching project in preclinical medical education - from an elective to a curricular course.

    PubMed

    Schober, A; Pieper, C C; Schmidt, R; Wittkowski, W

    2014-05-01

    Presentation of an interdisciplinary, interactive, tutor-based preclinical teaching project called "Anatomy and Imaging". Experience report, analysis of evaluation results and selective literature review. From 2001 to 2012, 618 students took the basic course (4 periods per week throughout the semester) and 316 took the advanced course (2 periods per week). We reviewed 557 (return rate 90.1 %) and 292 (92.4 %) completed evaluation forms of the basic and the advanced course. Results showed overall high satisfaction with the courses (1.33 and 1.56, respectively, on a 5-point Likert scale). The recognizability of the relevance of the course content for medical training, the promotion of the interest in medicine and the quality of the student tutors were evaluated especially positively. The "Anatomy and Imaging" teaching project is a successful concept for integrating medical imaging into the preclinical stage of medical education. The course was offered as part of the curriculum in 2013 for the first time. "Anatomia in mortuis" and "Anatomia in vivo" are not regarded as rivaling entities in the delivery of knowledge, but as complementary methods. © Georg Thieme Verlag KG Stuttgart · New York.

  19. Improving Discharge Efficiency in Medically Complex Pediatric Patients.

    PubMed

    Statile, Angela M; Schondelmeyer, Amanda C; Thomson, Joanna E; Brower, Laura H; Davis, Blair; Redel, Jacob; Hausfeld, Julie; Tucker, Karen; White, Denise L; White, Christine M

    2016-08-01

    Children with medical complexity have unique needs when facilitating transitions from hospital to home. Defining readiness for discharge is challenging, and preparation requires coordination of family, education, equipment, and medications. Our multidisciplinary team aimed to increase the percentage of medically complex hospital medicine patients discharged within 2 hours of meeting medical discharge goals from 50% to 80%. We used quality improvement methods to identify key drivers and inform interventions. Medical discharge goals were defined on admission for each patient. Interventions included implementation of a complex care inpatient team with electronic admission order set, weekly care coordination rounds, needs assessment tool, and medication pathway. The primary measure, percentage of patients discharged within 2 hours of meeting medical discharge goals, was followed on a run chart. The secondary measures, pre- and post-intervention length of stay and 30-day readmission rate, were compared by using Wilcoxon rank-sum and χ(2) tests, respectively. The percentage of medically complex patients discharged within 2 hours of meeting medical discharge goals improved from 50% to 88% over 17 months and sustained for 6 months. In preintervention-postintervention comparison, median length of stay did not change (3.1 days [interquartile range, 1.8-7.0] vs 2.9 days [interquartile range, 1.7-6.1]; P = .67) and 30-day readmission rate was not impacted (30.7% vs 26.4%; P = .51). Efficient discharge for medically complex patients requires support of a multidisciplinary team to proactively address discharge needs, ensuring patients are ready for discharge when medical goals are met. Copyright © 2016 by the American Academy of Pediatrics.

  20. A curricular approach to improve the information literacy and academic writing skills of part-time post-registration nursing students in Hong Kong.

    PubMed

    Tarrant, Marie; Dodgson, Joan E; Law, Beatrice V K K

    2008-05-01

    In today's environment of rapidly changing health care and information technology, nurses require a broad range of skills. One of the key skills required of all health professionals in this environment is information literacy. For registered nurses returning to a university setting to study for their baccalaureate degree, becoming information literate is one of many challenges they face. Also key to students' ability to use and communicate information in an appropriate and effective manner is their writing skills. This article describes a curricular intervention designed to develop and strengthen post-registration nurses' information literacy and academic writing competencies. An introductory information management module was developed and provided to three successive cohorts of students (n=159). Students were predominantly female (85.4%) with a mean age of 34.2 years (SD=6.8). Prior to commencing the program, students reported low information literacy and writing skills, especially in accessing and searching electronic databases and using referencing formats. The post-test evaluation of skills showed substantial and statistically significant increases in all assessed competencies. This intervention demonstrated that with structured but flexible learning activities early in the curriculum, post-registration nursing students can quickly become information literate.

  1. Multifaceted Prospective Memory Intervention to Improve Medication Adherence

    PubMed Central

    Insel, Kathie C.; Einstein, Gilles O.; Morrow, Daniel G.; Koerner, Kari M.; Hepworth, Joseph T.

    2015-01-01

    Background/Objectives Older adults do not take medication as prescribed, diminishing the benefits of treatment and increasing costs to individuals and society. A multifaceted prospective memory intervention for improving adherence to antihypertensive medication was tested and assessed if executive function/working memory processes moderated intervention effects. Design A two group longitudinal randomized control trial was used. Setting and Participants and Measurements The sample consisted of community-based older adults (≥ 65 years of age) without signs of dementia or symptoms of severe depression who were self-managing prescribed medication. Following four weeks of initial adherence monitoring using a medication event monitoring system (MEMS®), individuals with 90% or less adherence were randomly assigned to groups. Intervention The prospective memory intervention was designed to provide strategies that switch older adults from relying on executive function/working memory processes (that show effects of cognitive aging) to mostly automatic associative processes (that are relatively spared with normal aging) for remembering to take one’s medications. Strategies included establishing a routine, establishing cues strongly associated with medication taking actions, performing the action immediately upon thinking about it, using a medication organizer, and imagining medication taking to enhance encoding and improve cuing. Results There was significant improvement in adherence for the intervention group (57% at baseline to 78% post intervention), but most of these gains were lost after 5 months. The control condition started at 68%, was stable during the intervention, but dropped to 62%. Executive function/working memory moderated the intervention effect, with the intervention producing greater benefit for those with lower executive function/working memory. Conclusion The intervention improved adherence, but the benefits were not sustained. Further research is

  2. Ambulatory Medication Reconciliation: Using a Collaborative Approach to Process Improvement at an Academic Medical Center.

    PubMed

    Keogh, Caroline; Kachalia, Allen; Fiumara, Karen; Goulart, Dorothy; Coblyn, Jonathan; Desai, Sonali P

    2016-04-01

    Incomplete medication reconciliation has been identified as a source of adverse drug events and a threat to patient safety. How best to measure and improve rates of medication reconciliation in ambulatory care remains unknown. An institutional collaborative improvement effort to develop and implement medication reconciliation processes was designed and facilitated across all 148 Brigham and Women's Hospital (Boston) ambulatory specialty practices: 63 underwent a more rigorous approach, a modified approach was undertaken in another 71 specialty practices, and a less intensive approach took place in the 14 primary care practices. The level of intervention varied on the basis of preexisting improvement infrastructure and practice prescription rates. Two electronically measured metrics were created to evaluate ambulatory visits to a provider in which there was a medication change: (1) Measure 1: the percentage of active medications prescribed by that provider that were reconciled; and (2) Measure 2: how often all the medications prescribed by that provider were reconciled. After the collaborative was completed, performance data were routinely shared with frontline staff and hospital leadership, and medication reconciliation rates became part of an institutional financial incentive program. For Measure 1, specialty practices improved from 71% to 90% (September 2012-August 2014; 24-month period). Primary care practice performance improved from 62% to 91% (December 2012-August 2014; 20-month period). For Measure 2, overall performance across all ambulatory practices increased from 81% to 90% during the first 12 months of the financial incentive program (October 2013- September 2014). A collaborative model of process improvement paired with financial incentives can successfully increase rates of ambulatory medication reconciliation.

  3. Multimodal medical image fusion using improved multi-channel PCNN.

    PubMed

    Zhao, Yaqian; Zhao, Qinping; Hao, Aimin

    2014-01-01

    Multimodal medical image fusion is a method of integrating information from multiple image formats. Its aim is to provide useful and accurate information for doctors. Multi-channel pulse coupled neural network (m-PCNN) is a recently proposed fusion model. Compared with previous methods, this network can effectively manage various types of medical images. However, it has two drawbacks: lack of control to feed function and low-level automation. The improved multi-channel PCNN proposed in this paper can adjust the impact of feed function by linking strength and adaptively compute the weighting coefficients for each pixel. Experimental results demonstrated the effectiveness of the improved m-PCNN fusion model.

  4. Asan medical information system for healthcare quality improvement.

    PubMed

    Ryu, Hyeon Jeong; Kim, Woo Sung; Lee, Jae Ho; Min, Sung Woo; Kim, Sun Ja; Lee, Yong Su; Lee, Young Ha; Nam, Sang Woo; Eo, Gi Seung; Seo, Sook Gyoung; Nam, Mi Hyun

    2010-09-01

    This purpose of this paper is to introduce the status of the Asan Medical Center (AMC) medical information system with respect to healthcare quality improvement. Asan Medical Information System (AMIS) is projected to become a completely electronic and digital information hospital. AMIS has played a role in improving the health care quality based on the following measures: safety, effectiveness, patient-centeredness, timeliness, efficiency, privacy, and security. AMIS CONSISTED OF SEVERAL DISTINCTIVE SYSTEMS: order communication system, electronic medical record, picture archiving communication system, clinical research information system, data warehouse, enterprise resource planning, IT service management system, and disaster recovery system. The most distinctive features of AMIS were the high alert-medication recognition & management system, the integrated and severity stratified alert system, the integrated patient monitoring system, the perioperative diabetic care monitoring and support system, and the clinical indicator management system. AMIS provides IT services for AMC, 7 affiliated hospitals and over 5,000 partners clinics, and was developed to improve healthcare services. The current challenge of AMIS is standard and interoperability. A global health IT strategy is needed to get through the current challenges and to provide new services as needed.

  5. Asan Medical Information System for Healthcare Quality Improvement

    PubMed Central

    Ryu, Hyeon Jeong; Kim, Woo Sung; Min, Sung Woo; Kim, Sun Ja; Lee, Yong Su; Lee, Young Ha; Nam, Sang Woo; Eo, Gi Seung; Seo, Sook Gyoung; Nam, Mi Hyun

    2010-01-01

    Objectives This purpose of this paper is to introduce the status of the Asan Medical Center (AMC) medical information system with respect to healthcare quality improvement. Methods Asan Medical Information System (AMIS) is projected to become a completely electronic and digital information hospital. AMIS has played a role in improving the health care quality based on the following measures: safety, effectiveness, patient-centeredness, timeliness, efficiency, privacy, and security. Results AMIS consisted of several distinctive systems: order communication system, electronic medical record, picture archiving communication system, clinical research information system, data warehouse, enterprise resource planning, IT service management system, and disaster recovery system. The most distinctive features of AMIS were the high alert-medication recognition & management system, the integrated and severity stratified alert system, the integrated patient monitoring system, the perioperative diabetic care monitoring and support system, and the clinical indicator management system. Conclusions AMIS provides IT services for AMC, 7 affiliated hospitals and over 5,000 partners clinics, and was developed to improve healthcare services. The current challenge of AMIS is standard and interoperability. A global health IT strategy is needed to get through the current challenges and to provide new services as needed. PMID:21818439

  6. Managerial process improvement: a lean approach to eliminating medication delivery.

    PubMed

    Hussain, Aftab; Stewart, LaShonda M; Rivers, Patrick A; Munchus, George

    2015-01-01

    Statistical evidence shows that medication errors are a major cause of injuries that concerns all health care oganizations. Despite all the efforts to improve the quality of care, the lack of understanding and inability of management to design a robust system that will strategically target those factors is a major cause of distress. The paper aims to discuss these issues. Achieving optimum organizational performance requires two key variables; work process factors and human performance factors. The approach is that healthcare administrators must take in account both variables in designing a strategy to reduce medication errors. However, strategies that will combat such phenomena require that managers and administrators understand the key factors that are causing medication delivery errors. The authors recommend that healthcare organizations implement the Toyota Production System (TPS) combined with human performance improvement (HPI) methodologies to eliminate medication delivery errors in hospitals. Despite all the efforts to improve the quality of care, there continues to be a lack of understanding and the ability of management to design a robust system that will strategically target those factors associated with medication errors. This paper proposes a solution to an ambiguous workflow process using the TPS combined with the HPI system.

  7. An improved FCM medical image segmentation algorithm based on MMTD.

    PubMed

    Zhou, Ningning; Yang, Tingting; Zhang, Shaobai

    2014-01-01

    Image segmentation plays an important role in medical image processing. Fuzzy c-means (FCM) is one of the popular clustering algorithms for medical image segmentation. But FCM is highly vulnerable to noise due to not considering the spatial information in image segmentation. This paper introduces medium mathematics system which is employed to process fuzzy information for image segmentation. It establishes the medium similarity measure based on the measure of medium truth degree (MMTD) and uses the correlation of the pixel and its neighbors to define the medium membership function. An improved FCM medical image segmentation algorithm based on MMTD which takes some spatial features into account is proposed in this paper. The experimental results show that the proposed algorithm is more antinoise than the standard FCM, with more certainty and less fuzziness. This will lead to its practicable and effective applications in medical image segmentation.

  8. Medication therapy management (MTM): an innovative approach to improve medication adherence in diabetics.

    PubMed

    Bindu Murali, Athira; Boban, Belsy; Karoor Shanmughan, Aswathy; Marimuthu, Karthikeyan; Ramakrishnan Sreelatha, Aravind; Xavier, Augustine

    2016-09-01

    Medication therapy management (MTM) is a pharmacist-led professional service, one of the main aims of which is to improve patient medication adherence. Ensuring adequate adherence to the prescribed therapeutic regimen is one of the major challenges in attaining the desired therapeutic goals in diabetics. The objective of this study was to implement MTM in diabetic patients and to identify its effectiveness in improving patient medication adherence. A prospective interventional study was carried out within a 1-year period in KIMS-Al-Shifa Hospital, which is a tertiary care referral hospital in Malabar region of Kerala, including inpatients with type 2 diabetes mellitus in the general medicine department of the hospital. The MTM programme was applied in selected patients, including personal medication record, medication-related action plan and detailed counselling. Adherence was measured using the Modified Morisky Medication Adherence Scale-4 both before and after the programme. A total of 104 patients were included in the study. The adherence of patients to anti-diabetic therapy was very low, which showed significant improvement after applying intervention (p-value<0.05 in a paired t-test). Initially, only 37.5% had high adherence which was increased to 59.5% after intervention. Age and educational status were identified to have a significant impact on patient medication adherence (p-value<0.05 in a χ2-test). Medication adherence is a key component of self-management for patients with diabetes. A pharmacist-led MTM programme if appropriately designed and implemented will have a potential positive impact on medication adherence in diabetic patients.

  9. Medical messages in the media – barriers and solutions to improving medical journalism

    PubMed Central

    Larsson, Anna; Oxman, Andrew D; Carling, Cheryl; Herrin, Jeph

    2003-01-01

    Abstract Context  Medical issues are widely reported in the mass media. These reports influence the general public, policy makers and health‐care professionals. This information should be valid, but is often criticized for being speculative, inaccurate and misleading. An understanding of the obstacles medical reporters meet in their work can guide strategies for improving the informative value of medical journalism. Objective  To investigate constraints on improving the informative value of medical reports in the mass media and elucidate possible strategies for addressing these. Design  We reviewed the literature and organized focus groups, a survey of medical journalists in 37 countries, and semi‐structured telephone interviews. Results  We identified nine barriers to improving the informative value of medical journalism: lack of time, space and knowledge; competition for space and audience; difficulties with terminology; problems finding and using sources; problems with editors and commercialism. Lack of time, space and knowledge were the most common obstacles. The importance of different obstacles varied with the type of media and experience. Many health reporters feel that it is difficult to find independent experts willing to assist journalists, and also think that editors need more education in critical appraisal of medical news. Almost all of the respondents agreed that the informative value of their reporting is important. Nearly everyone wanted access to short, reliable and up‐to‐date background information on various topics available on the Internet. A majority (79%) was interested in participating in a trial to evaluate strategies to overcome identified constraints. Conclusion  Medical journalists agree that the validity of medical reporting in the mass media is important. A majority acknowledge many constraints. Mutual efforts of health‐care professionals and journalists employing a variety of strategies will be needed to address

  10. Leadership, Medication Administration, and Knowledge Retention: A Quality Improvement Project

    ERIC Educational Resources Information Center

    Treister, Pamela

    2017-01-01

    A leadership and quality improvement project was undertaken in order to assist undergraduate baccalaureate nursing students in knowledge retention for medication administration during their senior semester in nursing school. Specific changes in curriculum were implemented to assist these undergraduate baccalaureate nursing students at a suburban…

  11. Enhancing Commitment Improves Adherence to a Medical Regimen.

    ERIC Educational Resources Information Center

    Putnam, Dana E.; And Others

    1994-01-01

    Evaluated commitment-based intervention for improvement of adherence to 10-day antibiotic regimen. Subjects were 60 college students. Experimental subjects made verbal and written commitments for adherence and completed tasks designed to increase their investment in medication regimen. Controls performed similarly structured tasks unrelated to…

  12. Enhancing Commitment Improves Adherence to a Medical Regimen.

    ERIC Educational Resources Information Center

    Putnam, Dana E.; And Others

    1994-01-01

    Evaluated commitment-based intervention for improvement of adherence to 10-day antibiotic regimen. Subjects were 60 college students. Experimental subjects made verbal and written commitments for adherence and completed tasks designed to increase their investment in medication regimen. Controls performed similarly structured tasks unrelated to…

  13. Effectiveness of a quality improvement curriculum for medical students.

    PubMed

    Tartaglia, Kimberly M; Walker, Curt

    2015-01-01

    As health systems find ways to improve quality of care, medical training programs are finding opportunities to prepare learners on principles of quality improvement (QI). The impact of QI curricula for medical students as measured by student learning is not well delineated. The aim of this study is to evaluate the effectiveness of a QI curriculum for senior medical students as measured by student knowledge and skills. This study was an observational study that involved a self-assessment and post-test Quality Improvement Knowledge Application Tool (QIKAT) for intervention and control students. A QI curriculum consisting of online modules, live discussions, independent readings and reflective writing, and participation in a mentored QI project was offered to fourth-year medical students completing an honor's elective (intervention group). Senior medical students who received the standard QI curriculum only were recruited as controls. A total of 22 intervention students and 12 control students completed the self-assessment and QIKAT. At baseline, there was no difference between groups in self-reported prior exposure to QI principles. Students in the intervention group reported more comfort with their skills in QI overall and in 9 of the 12 domains (p<0.05). Additionally, intervention students performed better in each of the three case scenarios (p<0.01). A brief QI curriculum for senior medical students results in improved comfort and knowledge with QI principles. The strengths of our curriculum include effective use of classroom time and faculty mentorship with reliance on pre-existing online modules and written resources. Additionally, the curriculum is easily expandable to larger groups of students and transferable to other institutions.

  14. Effectiveness of a quality improvement curriculum for medical students.

    PubMed

    Tartaglia, Kimberly M; Walker, Curt

    2015-01-01

    Introduction As health systems find ways to improve quality of care, medical training programs are finding opportunities to prepare learners on principles of quality improvement (QI). The impact of QI curricula for medical students as measured by student learning is not well delineated. The aim of this study is to evaluate the effectiveness of a QI curriculum for senior medical students as measured by student knowledge and skills. Methods This study was an observational study that involved a self-assessment and post-test Quality Improvement Knowledge Application Tool (QIKAT) for intervention and control students. A QI curriculum consisting of online modules, live discussions, independent readings and reflective writing, and participation in a mentored QI project was offered to fourth-year medical students completing an honor's elective (intervention group). Senior medical students who received the standard QI curriculum only were recruited as controls. Results A total of 22 intervention students and 12 control students completed the self-assessment and QIKAT. At baseline, there was no difference between groups in self-reported prior exposure to QI principles. Students in the intervention group reported more comfort with their skills in QI overall and in 9 of the 12 domains (p<0.05). Additionally, intervention students performed better in each of the three case scenarios (p<0.01). Discussion A brief QI curriculum for senior medical students results in improved comfort and knowledge with QI principles. The strengths of our curriculum include effective use of classroom time and faculty mentorship with reliance on pre-existing online modules and written resources. Additionally, the curriculum is easily expandable to larger groups of students and transferable to other institutions.

  15. Levodopa medication improves incidental sequence learning in Parkinson's disease.

    PubMed

    Beigi, M; Wilkinson, L; Gobet, F; Parton, A; Jahanshahi, M

    2016-12-01

    Empirical evidence suggests that levodopa medication used to treat the motor symptoms of Parkinson's disease (PD) may either improve, impair or not affect specific cognitive processes. This evidence led to the 'dopamine overdose' hypothesis that levodopa medication impairs performance on cognitive tasks if they recruit fronto-striatal circuits which are not yet dopamine-depleted in early PD and as a result the medication leads to an excess of dopamine. This hypothesis has been supported for various learning tasks including conditional associative learning, reversal learning, classification learning and intentional deterministic sequence learning, on all of which PD patients demonstrated significantly worse performance when tested on relative to off dopamine medication. Incidental sequence learning is impaired in PD, but how such learning is affected by dopaminergic therapy remains undetermined. The aim of the current study was to investigate the effect of dopaminergic medication on incidental sequence learning in PD. We used a probabilistic serial reaction time task (SRTT), a sequence learning paradigm considered to make the sequence less apparent and more likely to be learned incidentally rather than intentionally. We compared learning by the same group of PD patients (n=15) on two separate occasions following oral administration of levodopa medication (on state) and after overnight withdrawal of medication (off state). Our results demonstrate for the first time that levodopa medication enhances incidental learning of a probabilistic sequence on the serial reaction time task in PD. However, neither group significantly differed from performance of a control group without a neurological disease, which indicates the importance of within group comparisons for identifying deficits. Levodopa medication enhanced incidental learning by patients with PD on a probabilistic sequence learning paradigm even though the patients were not aware of the existence of the sequence or

  16. Mapping to Curricular and Institutional Goals

    ERIC Educational Resources Information Center

    Oaks, D'Arcy J.

    2015-01-01

    This chapter will discuss how institutional research professionals might integrate co-curricular learning outcomes into larger measures of institutional effectiveness. By mapping co-curricular learning outcomes to align with curricular and institutional goals, linkages can be made that demonstrate mission-congruent activities and outcomes across…

  17. Using A3 thinking to improve the STAT medication process.

    PubMed

    Manojlovich, Milisa; Chase, Valerie J; Mack, Megan; Conroy, Meghan K; Belanger, Karen; Zawol, Debbie; Corr, Karen M; Fowler, Karen E; Viglianti, Elizabeth

    2014-08-01

    Although the term STAT conveys a sense of urgency, it is sometimes used to circumvent a system that may be too slow to accomplish tasks in a timely manner. We describe a quality-improvement project undertaken by a US Department of Veterans Affairs (VA) hospital to improve the STAT medication process. We adapted A3 Thinking, a problem-solving process common in Lean organizations, to our problem. In the discovery phase, a color-coded flow map of the existing process was constructed, and a real-time STAT order was followed in a modified "Go to the Gemba" exercise. In the envisioning phase, the team brainstormed to come up with as many improvement ideas as possible, which were then prioritized based on the anticipated effort and impact. The team then identified initial experiments to be carried out in the experimentation phase; each experiment followed a standard Plan-Do-Study-Act cycle. On average, the number of STAT medications ordered per month decreased by 9.5%. The average time from STAT order entry to administration decreased by 21%, and time from medication delivery to administration decreased by 26%. Improvements were also made in technician awareness of STAT medications and nurse notification of STAT medication delivery. Adapting A3 Thinking for process improvement was a low-cost/low-tech option for a VA facility. The A3 Thinking process led to a better understanding of the meaning of STAT across disciplines, and promoted a collaborative culture in which other hospital-wide problems may be addressed in the future. Published 2014. This article is a U.S. Government work and is in the public domain in the USA.

  18. How Patients Can Improve the Accuracy of their Medical Records

    PubMed Central

    Dullabh, Prashila M.; Sondheimer, Norman K.; Katsh, Ethan; Evans, Michael A.

    2014-01-01

    Objectives: Assess (1) if patients can improve their medical records’ accuracy if effectively engaged using a networked Personal Health Record; (2) workflow efficiency and reliability for receiving and processing patient feedback; and (3) patient feedback’s impact on medical record accuracy. Background: Improving medical record’ accuracy and associated challenges have been documented extensively. Providing patients with useful access to their records through information technology gives them new opportunities to improve their records’ accuracy and completeness. A new approach supporting online contributions to their medication lists by patients of Geisinger Health Systems, an online patient-engagement advocate, revealed this can be done successfully. In late 2011, Geisinger launched an online process for patients to provide electronic feedback on their medication lists’ accuracy before a doctor visit. Patient feedback was routed to a Geisinger pharmacist, who reviewed it and followed up with the patient before changing the medication list shared by the patient and the clinicians. Methods: The evaluation employed mixed methods and consisted of patient focus groups (users, nonusers, and partial users of the feedback form), semi structured interviews with providers and pharmacists, user observations with patients, and quantitative analysis of patient feedback data and pharmacists’ medication reconciliation logs. Findings/Discussion: (1) Patients were eager to provide feedback on their medications and saw numerous advantages. Thirty percent of patient feedback forms (457 of 1,500) were completed and submitted to Geisinger. Patients requested changes to the shared medication lists in 89 percent of cases (369 of 414 forms). These included frequency—or dosage changes to existing prescriptions and requests for new medications (prescriptions and over-the counter). (2) Patients provided useful and accurate online feedback. In a subsample of 107 forms

  19. Perception of medical students about pharmacology and scope of improvement.

    PubMed

    Prasad, A; Datta, P P; Pattanayak, C; Panda, P

    2014-01-01

    Pharmacology is a subject taught in the medical curriculum in India over a period of one and half years along with pathology, microbiology and forensic medicine. The present study was planned to know the opinion of medical students regarding pharmacology and to assess the proposed teaching schedule and methods of teaching pharmacology. The study was conducted in a private medical college in eastern India among the medical undergraduate students in 5th semester. Total 74 students participated in the study. A pre-designed, pre-tested, semi-structured questionnaire was given to the students and data was collected after one hour. Collected data was compiled, tabulated and analyzed in SPSS (version 16.0). The subject was perceived as interesting and useful by majority of students and most of them were in opinion to integrate pharmacology with the clinical subjects. Lecture in whole class was the most preferred teaching method according to the students and teaching with chalk and board they preferred most. Rational use of medicine, clinical trial, pediatric and geriatric pharmacology are the important topics the students felt to be included in the curriculum. Regular assessment of teaching methods by the students and taking suggestions from the students about improving the teaching method and redesigning the curriculum can help a lot in improving the learning capacity of the medical students and that will give benefit for the society as a whole.

  20. A Synchronized Prescription Refill Program Improved Medication Adherence.

    PubMed

    Doshi, Jalpa A; Lim, Raymond; Li, Pengxiang; Young, Peinie P; Lawnicki, Victor F; State, Joseph J; Troxel, Andrea B; Volpp, Kevin G

    2016-08-01

    Synchronizing medication refills-renewing all medications at the same time from the same pharmacy-is an increasingly popular strategy to improve adherence to medication regimens, but there has been little research regarding its effectiveness. In light of increasing policy interest, we evaluated the impact of a pilot refill synchronization program implemented by a large national insurer. A random sample of Medicare Advantage patients receiving mail-order refills for common maintenance medications (antihypertensive, lipid-lowering, or antidiabetic agents) were invited to join the program and followed for twelve months. On average, the absolute increase in the proportion of patients deemed adherent during follow-up was 3-10 percentage points for the intervention group, compared to 1-5 percentage points for the control group. Patients with poorer baseline adherence showed larger increases in the absolute proportion deemed adherent in intervention (23-26 percentage points) compared to a control group (13-15 percentage points). Synchronizing refills might be a promising intervention to improve adherence to maintenance medications, especially among Medicare patients with low baseline adherence.

  1. Applying Lean Six Sigma to improve medication management.

    PubMed

    Nayar, Preethy; Ojha, Diptee; Fetrick, Ann; Nguyen, Anh T

    2016-01-01

    A significant proportion of veterans use dual care or health care services within and outside the Veterans Health Administration (VHA). In this study conducted at a VHA medical center in the USA, the authors used Lean Six Sigma principles to develop recommendations to eliminate wasteful processes and implement a more efficient and effective process to manage medications for dual care veteran patients. The purpose of this study is to: assess compliance with the VHA's dual care policy; collect data and describe the current process for co-management of dual care veterans' medications; and draft recommendations to improve the current process for dual care medications co-management. Input was obtained from the VHA patient care team members to draw a process map to describe the current process for filling a non-VHA prescription at a VHA facility. Data were collected through surveys and direct observation to measure the current process and to develop recommendations to redesign and improve the process. A key bottleneck in the process that was identified was the receipt of the non-VHA medical record which resulted in delays in filling prescriptions. The recommendations of this project focus on the four domains of: documentation of dual care; veteran education; process redesign; and outreach to community providers. This case study describes the application of Lean Six Sigma principles in one urban Veterans Affairs Medical Center (VAMC) in the Mid-Western USA to solve a specific organizational quality problem. Therefore, the findings may not be generalizable to other organizations. The Lean Six Sigma general principles applied in this project to develop recommendations to improve medication management for dual care veterans are applicable to any process improvement or redesign project and has valuable lessons for other VAMCs seeking to improve care for their dual care veteran patients. The findings of this project will be of value to VA providers and policy makers and health

  2. Safe medication swallowing in Dysphagia: a collaborative improvement project.

    PubMed

    Jackson, Lawrence D; Little, Jane; Kung, Edward; Williams, Evelyn M; Siemiatkowska, Krystyna; Plowman, Suzanne

    2008-01-01

    Episodes of choking during medication administration to patients with dysphagia prompted a chart audit and caregiver interview to identify system problems that allowed inappropriate drug administration to occur. Sixty elderly patients residing on two patient care areas in a 500-bed complex continuing care facility were studied. The audit explored the actual nursing medication administration methods and compared this to the information obtained from various communication tools including instructions that appeared on the medication administration record (MAR), the current diet order, the recommendations of the speech-language pathologist (SLP) and comments on the nursing care plan. The audit yielded a number of discrepancies between nursing actions and the instructions obtain from these sources. We proposed that changes to the process of communicating medication swallowing recommendations among team members would lead to greater patient safety. Major practice changes included the use of standardized language by the SLP when making recommendations, the writing of SLP recommendations in the doctor's orders, the inclusion of SLP recommendations on the MAR and the creation of a "dysphagia alert" on the pharmacy computer system. An educational intervention was conducted to implement process changes. Its effectiveness was evaluated using a pre- and post-test and a participant satisfaction survey. A post-implementation audit showed compliance with the practice change. In summary, process changes were implemented to improve compliance with SLP medication-related swallowing recommendations and to prevent the inadvertent prescribing, dispensing or crushing of sustained-release medications in patients with dysphagia.

  3. Teachers' Perceptions of Curricular Change

    ERIC Educational Resources Information Center

    Rulison, Sheila R.

    2012-01-01

    The purpose of this study was to examine teachers' perceptions of curricular change and how teachers in one high school in the southwestern United States viewed the potential effects of the implementation of Common Core State Standards. Surveys, focus group sessions, one-on-one interviews, and various observational techniques were used to…

  4. Curricular Models for Culturally Disadvantaged

    ERIC Educational Resources Information Center

    King, Clement T.

    1976-01-01

    Two psychological theories which seem to have had a great impact on compensatory education programs are Skinnerian reinforcement theory and the cognitive developmental theory derived in part from Jean Piaget. The Englemann-Becker program is a typical example of the Programmed Curricular kind of program; the Florida Project, an Open Framework; and…

  5. Curricular Transposition in Citizenship Education

    ERIC Educational Resources Information Center

    McCowan, Tristan

    2008-01-01

    The considerable debate in recent years on the aims of citizenship education has not been accompanied by an equally substantial discussion on the educational processes involved. This article puts forward a theoretical framework, referred to as "curricular transposition", for understanding the complex task of realizing normative ideals of…

  6. Situating Research on Curricular Change

    ERIC Educational Resources Information Center

    Confrey, Jere; King, Karen D.; Strutchens, Marilyn E.; Sutton, John T.; Battista, Michael T.; Boerst, Timothy A.; Smith, Margaret Schwan; Reed, Judith

    2008-01-01

    Research on curricular choices has attracted widespread attention and merits increased investment by the research community. Multiple studies, publications, conferences, and a multicampus center (The Show-Me Project, n.d.) speak to the need to discuss what is taught in the classrooms and to whom, how, and when. Since the 1990s, with the creation…

  7. Improving medical record retrieval for validation studies in Medicare data.

    PubMed

    Wright, Nicole C; Delzell, Elizabeth S; Smith, Wilson K; Xue, Fei; Auroa, Tarun; Curtis, Jeffrey R

    2017-04-01

    The purpose of the study is to describe medical record retrieval for a study validating claims-based algorithms used to identify seven adverse events of special interest (AESI) in a Medicare population. We analyzed 2010-2011 Medicare claims of women with postmenopausal osteoporosis and men ≥65 years of age in the Medicare 5% national sample. The final cohorts included beneficiaries covered continuously for 12+ months by Medicare parts A, B, and D and not enrolled in Medicare Advantage before starting follow-up. We identified beneficiaries using each AESI algorithm and randomly selected 400 women and 100 men with each AESI for medical record retrieval. The Centers for Medicare and Medicaid Services provided beneficiary contact information, and we requested medical records directly from providers, without patient contact. We selected 3331 beneficiaries (women: 2272; men: 559) for whom we requested 3625 medical records. Overall, we received 1738 [47.9% (95%CI 46.3%, 49.6%)] of the requested medical records. We observed small differences in the characteristics of the total population with AESIs compared with those randomly selected for retrieval; however, no differences were seen between those selected and those retrieved. We retrieved 54.7% of records requested from hospitals compared with 26.3% of records requested from physician offices (p < 0.001). Retrieval did not differ by sex or vital status of the beneficiaries. Our national medical record validation study of claims-based algorithms produced a modest retrieval rate. The medical record procedures outlined in this paper could have led to the improved retrieval from our previous medical record retrieval study. Copyright © 2016 John Wiley & Sons, Ltd. Copyright © 2016 John Wiley & Sons, Ltd.

  8. Improving the usability of intravenous medication labels to support safe medication delivery

    PubMed Central

    Bauer, David T.; Guerlain, Stephanie

    2011-01-01

    Medication label design is frequently a contributing factor to medication errors. Design regulations and recommendations have been predominantly aimed at manufacturers’ product labels. Pharmacy-generated labels have received less scrutiny despite being an integral artifact throughout the medication use process. This article is an account of our efforts to improve the design of a hospital’s intravenous (IV) medication labels. Our analysis revealed a set of interrelated processes and stakeholders that restrict the range of feasible label designs. The technological and system constraints likely vary among hospitals and represent significant barriers to developing and implementing specific design standards. We propose both an ideal IV label design and one that adheres to the current constraints of the hospital under study. PMID:21731156

  9. Improving the usability of intravenous medication labels to support safe medication delivery.

    PubMed

    Bauer, David T; Guerlain, Stephanie

    2011-07-01

    Medication label design is frequently a contributing factor to medication errors. Design regulations and recommendations have been predominantly aimed at manufacturers' product labels. Pharmacy-generated labels have received less scrutiny despite being an integral artifact throughout the medication use process. This article is an account of our efforts to improve the design of a hospital's intravenous (IV) medication labels. Our analysis revealed a set of interrelated processes and stakeholders that restrict the range of feasible label designs. The technological and system constraints likely vary among hospitals and represent significant barriers to developing and implementing specific design standards. We propose both an ideal IV label design and one that adheres to the current constraints of the hospital under study.

  10. Method of evaluating and improving ambulatory medical care.

    PubMed Central

    Payne, B C; Lyons, T F; Neuhaus, E; Kolton, M; Dwarshius, L

    1984-01-01

    The usefulness of an action-research model is demonstrated in the evaluation and improvement of ambulatory medical care in a variety of settings: solo office practice, prepaid capitation multiple-specialty group practice, and medical school hospital-based outpatient clinic practice. Improvements in the process of medical care are found to relate directly to the intensity and duration of planned interventions by the study group and are demonstrated to follow organizational changes in the participating sites--primarily managerial and support services initiated by policy decisions in each study site. Improvement in performance approaching one standard deviation results from the most intense intervention, about one-half standard deviation at the next level of intervention, and virtually no change from a simple feedback of performance measures. On the basis of these findings and other operational and research efforts to improve physician performance, it is unlikely that simple feedback of performance measures will elicit a change in behavior. However, noncoercive methods involving health care providers in problem identification, problem solving, and solution implementation are demonstrated to be effective. PMID:6735736

  11. Improving medical education in Kenya: an international collaboration*†

    PubMed Central

    Mayo, Alexa

    2014-01-01

    This paper describes a partnership between the University of Nairobi College of Health Sciences (CHS) Library and the University of Maryland Health Sciences and Human Services Library (HS/HSL). The libraries are collaborating to develop best practices for the CHS Library as it meets the challenge of changing medical education information needs in a digital environment. The collaboration is part of a Medical Education Partnership Initiative. The library project has several components: an assessment of the CHS Library, learning visits in the United States and Kenya, development of recommendations to enhance the CHS Library, and ongoing evaluation of the program's progress. Development of new services and expertise at the CHS Library is critical to the project's success. A productive collaboration between the HS/HSL and CHS Library is ongoing. A successful program to improve the quality of medical education will have a beneficial impact on health outcomes in Kenya. PMID:24860265

  12. Improving medical education in Kenya: an international collaboration.

    PubMed

    Mayo, Alexa

    2014-04-01

    This paper describes a partnership between the University of Nairobi College of Health Sciences (CHS) Library and the University of Maryland Health Sciences and Human Services Library (HS/HSL). The libraries are collaborating to develop best practices for the CHS Library as it meets the challenge of changing medical education information needs in a digital environment. The collaboration is part of a Medical Education Partnership Initiative. The library project has several components: an assessment of the CHS Library, learning visits in the United States and Kenya, development of recommendations to enhance the CHS Library, and ongoing evaluation of the program's progress. Development of new services and expertise at the CHS Library is critical to the project's success. A productive collaboration between the HS/HSL and CHS Library is ongoing. A successful program to improve the quality of medical education will have a beneficial impact on health outcomes in Kenya.

  13. Improving Patient's Primary Medication Adherence: The Value of Pharmaceutical Counseling.

    PubMed

    Leguelinel-Blache, Géraldine; Dubois, Florent; Bouvet, Sophie; Roux-Marson, Clarisse; Arnaud, Fabrice; Castelli, Christel; Ray, Valérie; Kinowski, Jean-Marie; Sotto, Albert

    2015-10-01

    Quality of transitions of care is one of the first concerns in patient safety. Redesigning the discharge process to incorporate clinical pharmacy activities could reduce the incidence of postdischarge adverse events by improving medication adherence. The present study investigated the value of pharmacist counseling sessions on primary medication adherence after hospital discharge.This study was conducted in a 1844-bed hospital in France. It was divided in an observational period and an interventional period of 3 months each. In both periods, ward-based clinical pharmacists performed medication reconciliation and inpatient follow-up. In interventional period, initial counseling and discharge counseling sessions were added to pharmaceutical care. The primary medication adherence was assessed by calling community pharmacists 7 days after patient discharge.We compared the measure of adherence between the patients from the observational period (n = 201) and the interventional period (n = 193). The rate of patients who were adherent increased from 51.0% to 66.7% between both periods (P < 0.01). When discharge counseling was performed (n = 78), this rate rose to 79.7% (P < 0.001). The multivariate regression performed on data from both periods showed that age of at least 78 years old, and 3 or less new medications on discharge order were predictive factors of adherence. New medications ordered at discharge represented 42.0% (n = 1018/2426) of all medications on discharge order. The rate of unfilled new medications decreased from 50.2% in the observational period to 32.5% in the interventional period (P < 10). However, patients included in the observational period were not significantly more often readmitted or visited the emergency department than the patients who experienced discharge counseling during the interventional period (45.3% vs. 46.2%; P = 0.89).This study highlights that discharge counseling sessions are essential to improve

  14. 2007 survey of medical toxicology practice improvement activities.

    PubMed

    White, Suzanne R; Baker, Beth; Baum, Carl R; Harvey, Anne; Korte, Robert; Avery, A Nelson; Nelson, Lewis; Osterhoudt, Kevin; Snook, Curtis; Williams, Saralyn

    2010-09-01

    To date, there appear to be no studies that assess Medical Toxicologists' (MTs) practice improvement (PI) activities in their Medical Toxicology practice settings. The MT Assessment of Practice Performance (APP) Taskforce queried all MT diplomates about (1) activities currently available in their practice settings that potentially would meet the requirements of APP, (2) potential APP activities that best fit with current MT practice, and (3) the relationship between MT practice patterns and APP requirements. One hundred twenty-seven surveys were completed. Participation in MT practice improvement activities is not universal, with approximately a third of the survey participants reporting that they are not involved in any practice improvement activity. Few respondents reported that they collected performance improvement-related data. Most who did so participated in CME, case, or chart reviews. Peer reviews, self-improvement plans based on chart reviews, and population research were considered the most valid measures of MT practice improvement. Communication skills were considered important topics for patient surveys. Suggested outcomes for peer assessment included accuracy of information provided, understanding medical staff concerns, timeliness of feedback, and helpfulness. Most respondents rated all of the APP options as being somewhat very intrusive. Access to those with sufficient knowledge of the diplomate's practice improvement program to verify APP could pose a challenge to a successful completion of APP requirements. Optimal settings for the APP program administration are hospitals and poison centers. While barriers to MT APP activities exist, studying current MT diplomates' opinions and practices could inform the future development and administration of such programs.

  15. [Quality assurance and quality improvement in medical practice. Part 3: Clinical audit in medical practice].

    PubMed

    Godény, Sándor

    2012-02-05

    The first two articles in the series were about the definition of quality in healthcare, the quality approach, the importance of quality assurance, the advantages of quality management systems and the basic concepts and necessity of evidence based medicine. In the third article the importance and basic steps of clinical audit are summarised. Clinical audit is an integral part of quality assurance and quality improvement in healthcare, that is the responsibility of any practitioner involved in medical practice. Clinical audit principally measures the clinical practice against clinical guidelines, protocols and other professional standards, and sometimes induces changes to ensure that all patients receive care according to principles of the best practice. The clinical audit can be defined also as a quality improvement process that seeks to identify areas for service improvement, develop and carry out plans and actions to improve medical activity and then by re-audit to ensure that these changes have an effect. Therefore, its aims are both to stimulate quality improvement interventions and to assess their impact in order to develop clinical effectiveness. At the end of the article key points of quality assurance and improvement in medical practice are summarised.

  16. Improving medical stores management through automation and effective communication

    PubMed Central

    Kumar, Ashok; Cariappa, M.P.; Marwaha, Vishal; Sharma, Mukti; Arora, Manu

    2016-01-01

    Background Medical stores management in hospitals is a tedious and time consuming chore with limited resources tasked for the purpose and poor penetration of Information Technology. The process of automation is slow paced due to various inherent factors and is being challenged by the increasing inventory loads and escalating budgets for procurement of drugs. Methods We carried out an indepth case study at the Medical Stores of a tertiary care health care facility. An iterative six step Quality Improvement (QI) process was implemented based on the Plan–Do–Study–Act (PDSA) cycle. The QI process was modified as per requirement to fit the medical stores management model. The results were evaluated after six months. Results After the implementation of QI process, 55 drugs of the medical store inventory which had expired since 2009 onwards were replaced with fresh stock by the suppliers as a result of effective communication through upgraded database management. Various pending audit objections were dropped due to the streamlined documentation and processes. Inventory management improved drastically due to automation, with disposal orders being initiated four months prior to the expiry of drugs and correct demands being generated two months prior to depletion of stocks. The monthly expense summary of drugs was now being done within ten days of the closing month. Conclusion Improving communication systems within the hospital with vendor database management and reaching out to clinicians is important. Automation of inventory management requires to be simple and user-friendly, utilizing existing hardware. Physical stores monitoring is indispensable, especially due to the scattered nature of stores. Staff training and standardized documentation protocols are the other keystones for optimal medical store management. PMID:26900225

  17. Curricular Implications of Current Scientific and Sociopolitical Trends.

    ERIC Educational Resources Information Center

    Shipp, Melvin D.

    1994-01-01

    The author argues that any new curricular model for optometric education must be responsive to evolving scientific and societal trends and consistent with the long-term goals of the profession. Some of these trends are outlined, including advancing technology and related improvement in health care and health care reform. (MSE)

  18. Does Medical Malpractice Law Improve Health Care Quality?

    PubMed

    Frakes, Michael; Jena, Anupam B

    2016-11-01

    We assess the potential for medical liability forces to deter medical errors and improve health care treatment quality, identifying liability's influence by drawing on variations in the manner by which states formulate the negligence standard facing physicians. Using hospital discharge records from the National Hospital Discharge Survey and clinically-validated quality metrics inspired by the Agency for Health Care Research and Quality, we find evidence suggesting that treatment quality may improve upon reforms that expect physicians to adhere to higher quality clinical standards. We do not find evidence, however, suggesting that treatment quality may deteriorate following reforms to liability standards that arguably condone the delivery of lower quality care. Similarly, we do not find evidence of deterioration in health care quality following remedy-focused liability reforms such as caps on non-economic damages awards.

  19. "Stealth" alerts to improve warfarin monitoring when initiating interacting medications.

    PubMed

    Koplan, Kate E; Brush, Alan D; Packer, Marvin S; Zhang, Fang; Senese, Margaret D; Simon, Steven R

    2012-12-01

    As electronic health records (EHRs) become widely adopted, alerts and reminders can improve medication safety, but excessive alerts may irritate or overwhelm clinicians, thereby reducing their effectiveness. We developed a novel "stealth" alert in an EHR to improve anticoagulation monitoring for patients prescribed a medication that could interact with warfarin. Instead of alerting the prescribing provider, the system notified a multidisciplinary anticoagulation management service, so that the prescribing clinicians never saw the alerts. We aimed to determine whether these "stealth" alerts increased the frequency of anticoagulation monitoring following the co-prescription of warfarin and a potentially interacting medication. We conducted a pre-post intervention study, analyzed using an interrupted time-series, within a large, multispecialty group practice that uses a common EHR. The study included a 12-month period preceding the intervention, a 2-month period during intervention implementation, and a 6-month post-intervention period. The primary outcome measure was the proportion of patients completing anticoagulation monitoring within 5 days of a new co-prescribing event. Prior to implementation of the stealth alert, 34 % of patients completed anticoagulation monitoring within 5 days after the prescription of a medication with a potential warfarin interaction. After implementation of the alert, 39 % completed testing within 5 days (odds ratio 1.24, 95 % confidence interval 1.12-1.37). Stealth alerts increased the proportion of patients who underwent anticoagulation monitoring following the prescription of a medication that could potentially interact with warfarin. This team-based approach to clinical-decision support directs alerts away from prescribing clinicians and toward individuals who can directly implement them.

  20. Lessons from industry: one school's transformation toward "lean" curricular governance.

    PubMed

    Stratton, Terry D; Rudy, David W; Sauer, Marlene J; Perman, Jay A; Jennings, C Darrell

    2007-04-01

    As medical education grapples with organizational calls for centralized curricular oversight, programs may be compelled to respond by establishing highly vertical, stacked governance structures. Although these models offer discrete advantages over the horizontal, compartmentalized structures they are designed to replace, they pose new challenges to ensuring curricular quality and the educational innovations that drive the curricula. The authors describe a hybrid quality-assurance (QA) governance structure introduced in 2003 at the University of Kentucky College of Medicine (UKCOM) that ensures centralized curricular oversight of the educational product while allowing individualized creative control over the educational process. Based on a Lean production model, this approach draws on industry experiences that strategically separate institutional accountability (management) for a quality curriculum from the decision-making processes required to ensure it (production). In so doing, the authors acknowledge general similarities and key differences between overseeing the manufacture of a complex product versus the education of a physician-emphasizing the structured, sequential, and measurable nature of each process. Further, the authors briefly trace the emergence of quality approaches in manufacturing and discuss the philosophical changes that accompany transition to an institutional governance system that relies on vigorous, robust performance measures to offer continuous feedback on curricular quality.

  1. Has the UK Clinical Aptitude Test improved medical student selection?

    PubMed

    Wright, Sarah R; Bradley, Philip M

    2010-11-01

    In 2006, the United Kingdom Clinical Aptitude Test (UKCAT) was introduced as a new medical school admissions tool. The aim of this cohort study was to determine whether the UKCAT has made any improvements to the way medical students are selected. Regression analysis was performed in order to study the ability of previous school type and gender to predict UKCAT, personal statement or interview scores in two cohorts of accepted students. The ability of admissions scores and demographic data to predict performance on knowledge and skills examinations was also studied. Previous school type was not a significant predictor of either interview or UKCAT scores amongst students who had been accepted onto the programme (n = 307). However, it was a significant predictor of personal statement score, with students from independent and grammar schools performing better than students from state-maintained schools. Previous school type, personal statements and interviews were not significant predictors of knowledge examination performance. UKCAT scores were significant predictors of knowledge examination performance for all but one examination administered in the first 2 years of medical school. Admissions data explained very little about performance on skills (objective structured clinical examinations [OSCEs]) assessments. The use of personal statements as a basis for selection results in a bias towards students from independent and grammar schools. However, no evidence was found to suggest that students accepted from these schools perform any better than students from maintained schools on Year 1 and 2 medical school examinations. Previous school type did not predict interview or UKCAT scores of accepted students. UKCAT scores are predictive of Year 1 and 2 examination performance at this medical school, whereas interview scores are not. The results of this study challenge claims made by other authors that aptitude tests do not have a place in medical school selection in the UK

  2. Improving outpatient primary medication adherence with physician guided, automated dispensing

    PubMed Central

    Moroshek, Jacob G

    2017-01-01

    Background Physician dispensing, different from pharmacist dispensing, is a way for practitioners to supply their patients with medications, at the point of care. The InstyMeds dispenser and logistics system can automate much of the dispensing, insurance adjudication, inventory management, and regulatory reporting that is required of physician dispensing. Objective To understand the percentage of patients that exhibit primary adherence to medication in the outpatient setting when choosing InstyMeds. Method The InstyMeds dispensing database was de-identified and analyzed for primary adherence. This is the ratio of patients who dispensed their medication to those who received an eligible prescription. Results The average InstyMeds emergency department installation has a primary adherence rate of 91.7%. The maximum rate for an installed device was 98.5%. Conclusion Although national rates of primary adherence have been found to be in the range of 70%, automated physician dispensing vastly improves the rate of adherence. Improved adherence should lead to better patient outcomes, fewer return visits, and lower healthcare costs. PMID:28115860

  3. Prioritizing health disparities in medical education to improve care.

    PubMed

    Awosogba, Temitope; Betancourt, Joseph R; Conyers, F Garrett; Estapé, Estela S; Francois, Fritz; Gard, Sabrina J; Kaufman, Arthur; Lunn, Mitchell R; Nivet, Marc A; Oppenheim, Joel D; Pomeroy, Claire; Yeung, Howa

    2013-05-01

    Despite yearly advances in life-saving and preventive medicine, as well as strategic approaches by governmental and social agencies and groups, significant disparities remain in health, health quality, and access to health care within the United States. The determinants of these disparities include baseline health status, race and ethnicity, culture, gender identity and expression, socioeconomic status, region or geography, sexual orientation, and age. In order to renew the commitment of the medical community to address health disparities, particularly at the medical school level, we must remind ourselves of the roles of doctors and medical schools as the gatekeepers and the value setters for medicine. Within those roles are responsibilities toward the social mission of working to eliminate health disparities. This effort will require partnerships with communities as well as with academic centers to actively develop and to implement diversity and inclusion strategies. Besides improving the diversity of trainees in the pipeline, access to health care can be improved, and awareness can be raised regarding population-based health inequalities. © 2013 New York Academy of Sciences.

  4. Prioritizing health disparities in medical education to improve care

    PubMed Central

    Awosogba, Temitope; Betancourt, Joseph R.; Conyers, F. Garrett; Estapé, Estela S.; Francois, Fritz; Gard, Sabrina J.; Kaufman, Arthur; Lunn, Mitchell R.; Nivet, Marc A.; Oppenheim, Joel D.; Pomeroy, Claire; Yeung, Howa

    2015-01-01

    Despite yearly advances in life-saving and preventive medicine, as well as strategic approaches by governmental and social agencies and groups, significant disparities remain in health, health quality, and access to health care within the United States. The determinants of these disparities include baseline health status, race and ethnicity, culture, gender identity and expression, socioeconomic status, region or geography, sexual orientation, and age. In order to renew the commitment of the medical community to address health disparities, particularly at the medical school level, we must remind ourselves of the roles of doctors and medical schools as the gatekeepers and the value setters for medicine. Within those roles are responsibilities toward the social mission of working to eliminate health disparities. This effort will require partnerships with communities as well as with academic centers to actively develop and to implement diversity and inclusion strategies. Besides improving the diversity of trainees in the pipeline, access to health care can be improved, and awareness can be raised regarding population-based health inequalities. PMID:23659676

  5. Educational improvement in Medical English Practice: Questionnaire survey to sophomore medical students of Hokkaido University.

    PubMed

    Murakami, Manabu; Olga, Amengual; Iguchi, Kaori; Otaki, Junji

    2015-11-01

    In the past, we made several efforts making curriculum changes to Medical English Practice, however, these changes did not improve motivation effectively. We have completely modified the curriculum in 2012, and performed a questionnaire survey to 112 sophomore medical students. In the final exam, students answered a questionnaire assessing all classes of the course by scoring 3 points (no change required), 2 points (minor change required), and 1 point (major change required or discontinue). In addition, students could write free comments about potential contents they would like to add to the curriculum. Each class was assessed as more than or equal to 2.5 points on average (range: 2.50-2.96). Potential contents students want to add are: 1. Speaking (45 students [55%]), 2. Listening (30 students [37%]), 3. Reading (6 students [7%]), 4. Writing (1 student [1%]). The most frequent suggestion was to include group discussions in speaking (27 students [33%]), followed by listening on topics of healthcare systems (11 students [13%]). Many students suggested to include conversation classes in small groups, or classes in which international students introduce the structure of healthcare systems of their home countries to the curriculum. Increasing the participation of international faculty, staff and students in the Medical English Practice might contribute to the improvement of medical students' motivation.

  6. A comprehensive medical student career development program improves medical student satisfaction with career planning.

    PubMed

    Zink, Brian J; Hammoud, Maya M; Middleton, Eric; Moroney, Donney; Schigelone, Amy

    2007-01-01

    In 1999, the University of Michigan Medical School (UMMS) initiated a new career development program (CDP). The CDP incorporates the 4-phase career development model described by the Association of American Medical Colleges (AAMC) Careers in Medicine (CiM). The CDP offers self-assessment exercises with guidance from trained counselors for 1st- and 2nd-year medical students. Career exploration experiences include Career Seminar Series luncheons, shadow experiences with faculty, and a shadow program with second-year (M2) and fourth-year (M4) medical students. During the decision-making phase, students work with trained faculty career advisors (FCA). Mandatory sessions are held on career selection, preparing the residency application, interviewing, and program evaluation. During the implementation phase, students meet with deans or counselors to discuss residency application and matching. An "at-risk plan" assists students who may have difficulty matching. The CiM Web site is extensively used during the 4 stages. Data from the AAMC and UMMS Graduation Questionnaires (GQ) show significant improvements for UMMS students in overall satisfaction with career planning services and with faculty mentoring, career assessment activities, career information, and personnel availability. By 2003, UMMS students had significantly higher satisfaction in all measured areas of career planning services when compared with all other U.S. medical students.

  7. Heparin coatings for improving blood compatibility of medical devices.

    PubMed

    Biran, Roy; Pond, Daniel

    2016-12-29

    Blood contact with biomaterials triggers activation of multiple reactive mechanisms that can impair the performance of implantable medical devices and potentially cause serious adverse clinical events. This includes thrombosis and thromboembolic complications due to activation of platelets and the coagulation cascade, activation of the complement system, and inflammation. Numerous surface coatings have been developed to improve blood compatibility of biomaterials. For more than thirty years, the anticoagulant drug heparin has been employed as a covalently immobilized surface coating on a variety of medical devices. This review describes the fundamental principles of non-eluting heparin coatings, mechanisms of action, and clinical applications with focus on those technologies which have been commercialized. Because of its extensive publication history, there is emphasis on the CARMEDA(®) BioActive Surface (CBAS(®) Heparin Surface), a widely used commercialized technology for the covalent bonding of heparin.

  8. Teacher training program for medical students: improvements needed.

    PubMed

    van Diggele, Christie; Burgess, Annette; Mellis, Craig

    2015-01-01

    Skills in peer teaching, assessment, and feedback are increasingly documented internationally as required graduate attributes in medicine. Yet these skills are rarely taught in medical schools. We sought to design and deliver a short but effective teacher training (TT) program for medical students that could be easily integrated into the professional development curriculum. This study sought to evaluate such a pilot program, based on student perception. The study took place at a major metropolitan teaching hospital, where 38 medical students were invited to attend a voluntary, newly designed four-module TT program. In total, 23/38 (61%) of invited students attended. Mixed methods were used for evaluation. Questionnaires were completed by 21/23 (91%) of students, and 6/23 (26%) of students participated in a focus group. Students reported that as a result of the program they felt more confident to facilitate small group teaching activities and to provide feedback to peers using the suggested frameworks. Students would like the program to contain more in-depth educational theory and to allow a more time for small group learning activities. They would also like to see opportunities for participation across all clinical schools. The TT program was successful in increasing student awareness of educational theory and practice, thereby improving their confidence in teaching and assessing their peers and making them feel better prepared for their careers as medical practitioners. Key improvements to the program are needed in terms of more in-depth theory and more time spent on small group learning. This might be achieved by complementing the course with e-learning.

  9. Improving physician and medical student education in substance use disorders.

    PubMed

    Wyatt, Stephen A; Dekker, Michael A

    2007-09-01

    Medical and psychosocial problems related to substance use disorders (SUDs) remain a major source of national morbidity and mortality. This situation exists despite greater understanding of genetic, neurobiologic, and social underpinnings of the development of these illnesses that has resulted in many advances in addiction medicine. The value of assessment and brief intervention of this disease is well documented. Patients need to be identified and engaged in order for them to be treated. A variety of evidence-based pharmacologic and psychotherapeutic treatments are now available. Strong evidence exists that treatment of patients for SUDs produces results similar to or better than those obtained from treatment for other chronic illnesses. It is also clear that physicians can play a pivotal role in helping to reduce the burden of disease related to SUDs However, to do this, physicians need to be better educated. Through such education comes greater confidence in identification and providing treatment. Also, the discomfort and stigma often associated with this disease are reduced. The federal government-through the Office of National Drug Control Policy, the Surgeon General, the Center for Substance Abuse Treatment, the National Institute on Drug Abuse, the National Institute on Alcohol Abuse and Alcoholism, and the National Highway Traffic Safety Administration of the Department of Transportation (DOT)-is expending concerted efforts to improve physician education in addiction medicine. These efforts culminated in the Second Leadership Conference on Medical Education in Substance Abuse in December 2006. The osteopathic medical profession was represented at this conference. This article reviews not only the recommendations from this meeting, but also the nature of the problem, how members of the osteopathic medical profession are currently addressing it, and a strategy for improvement endorsed by the American Osteopathic Academy of Addiction Medicine.

  10. Improving medication titration in heart failure by embedding a structured medication titration plan.

    PubMed

    Hickey, Annabel; Suna, Jessica; Marquart, Louise; Denaro, Charles; Javorsky, George; Munns, Andrew; Mudge, Alison; Atherton, John J

    2016-12-01

    To improve up-titration of medications to target dose in heart failure patients by improving communication from hospital to primary care. This quality improvement project was undertaken within three heart failure disease management (HFDM) services in Queensland, Australia. A structured medication plan was collaboratively designed and implemented in an iterative manner, using methods including awareness raising and education, audit and feedback, integration into existing work practice, and incentive payments. Evaluation was undertaken using sequential audits, and included process measures (use of the titration plan, assignment of responsibility) and outcome measures (proportion of patients achieving target dose) in HFDM service patients with reduced left ventricular ejection fraction. Comparison of the three patient cohorts (pre-intervention cohort A n=96, intervention cohort B n=95, intervention cohort C n=89) showed increase use of the titration plan, a shift to greater primary care responsibility for titration, and an increase in the proportion of patients achieving target doses of angiotensin converting enzyme inhibitors/angiotensin receptor blockers (ACEI/ARB) (A 37% vs B 48% vs C 55%, p=0.051) and beta-blockers (A 38% vs B 33% vs C 51%, p=0.045). Combining all three cohorts, patients not on target doses when discharged from hospital were more likely to achieve target doses of ACEI/ARB (p<0.0001) and beta blockers (p<0.0001) within six months if they received a medication titration plan. A medication titration plan was successfully implemented in three HFDM services and improved transitional communication and achievement of target doses of evidence-based therapies within six months of hospital discharge. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  11. Undergraduate medical academic performance is improved by scientific training.

    PubMed

    Zhang, Lili; Zhang, Wei; Wu, Chong; Liu, Zhongming; Cai, Yunfei; Cao, Xingguo; He, Yushan; Liu, Guoxiang; Miao, Hongming

    2017-09-01

    The effect of scientific training on course learning in undergraduates is still controversial. In this study, we investigated the academic performance of undergraduate students with and without scientific training. The results show that scientific training improves students' test scores in general medical courses, such as biochemistry and molecular biology, cell biology, physiology, and even English. We classified scientific training into four levels. We found that literature reading could significantly improve students' test scores in general courses. Students who received scientific training carried out experiments more effectively and published articles performed better than their untrained counterparts in biochemistry and molecular biology examinations. The questionnaire survey demonstrated that the trained students were more confident of their course learning, and displayed more interest, motivation and capability in course learning. In summary, undergraduate academic performance is improved by scientific training. Our findings shed light on the novel strategies in the management of undergraduate education in the medical school. © 2017 by The International Union of Biochemistry and Molecular Biology, 45(5):379-384, 2017. © 2017 The International Union of Biochemistry and Molecular Biology.

  12. Improving Mathematics Learning by Integrating Curricular Activities with Innovative and Developmentally Appropriate Digital Apps: Findings from the Next Generation Preschool Math Evaluation

    ERIC Educational Resources Information Center

    Presser, Ashley Lewis; Vahey, Philip; Dominguez, Ximena

    2015-01-01

    This paper describes findings from a blocked randomized design (BRD) field study conducted to examine the "Next Generation Preschool Math" (NGPM) program's implementation in preschool classrooms and promise in improving young children's mathematic learning. NGPM integrates traditional preschool activities with developmentally appropriate…

  13. A Quality Improvement Project to Improve Family Recognition of Medical Team Member Roles.

    PubMed

    Hayes, Rebecca M; Wickline, Afton; Hensley, Christina; Cowen, Kelsey; Jessie, Ashley; Akers, Melanie; Dolan, Jenna; Pritt, Audra; Goodrich, Shea; O'Neill, Kelly; Flesher, Susan L

    2015-09-01

    Previous studies have shown that inpatients and families in academic settings have a limited ability to recall either their medical team members or the roles of those members. This is an important issue for patient and family satisfaction as well as patient safety. The objective of this study was to increase families' recognition of medical team members' roles. We established a multidisciplinary quality improvement leadership team, measured family recognition of medical team members and their roles, and conducted 2 PDSA (Plan-Do-Study-Act) cycles. The first intervention was standardization of the content and delivery of our verbal team introductions to ensure inclusion of essential elements and family engagement. The second intervention was addition of an informational white board in each patient room. The prospective study included 105 families in the preintervention phase, 103 post-PDSA cycle 1, and 92 post-PDSA cycle 2. After conduction of 2 PDSA cycles, the recognition of the attending role increased from 49% to 87% (P = .000), the resident role from 39% to 73% (P = .000), and the medical student from 75% to 89% (P = .038). The multidisciplinary quality improvement model was effective in improving family recognition of the roles of attending physicians, resident physicians, and medical students. Consistent attention to engaging the families and explaining our roles as well as providing informational white boards are effective interventions to facilitate this process. Copyright © 2015 by the American Academy of Pediatrics.

  14. Improving the Teaching Skills of Residents in a Surgical Training Program: Results of the Pilot Year of a Curricular Initiative in an Ophthalmology Residency Program.

    PubMed

    Chee, Yewlin E; Newman, Lori R; Loewenstein, John I; Kloek, Carolyn E

    2015-01-01

    To design and implement a teaching skills curriculum that addressed the needs of an ophthalmology residency training program, to assess the effect of the curriculum, and to present important lessons learned. A teaching skills curriculum was designed for the Harvard Medical School (HMS) Residency Training Program in Ophthalmology. Results of a needs assessment survey were used to guide curriculum objectives. Overall, 3 teaching workshops were conducted between October 2012 and March 2013 that addressed areas of need, including procedural teaching. A postcurriculum survey was used to assess the effect of the curriculum. Massachusetts Eye and Ear Infirmary, a tertiary care institution in Boston, MA. Overall, 24 residents in the HMS Residency Training Program in Ophthalmology were included. The needs assessment survey demonstrated that although most residents anticipated that teaching would be important in their future career, only one-third had prior formal training in teaching. All residents reported they found the teaching workshops to be either very or extremely useful. All residents reported they would like further training in teaching, with most residents requesting additional training in best procedural teaching practices for future sessions. The pilot year of the resident-as-teacher curriculum for the HMS Residency Training Program in Ophthalmology demonstrated a need for this curriculum and was perceived as beneficial by the residents, who reported increased comfort in their teaching skills after attending the workshops. Copyright © 2015 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

  15. Improving the medical records department processes by lean management

    PubMed Central

    Ajami, Sima; Ketabi, Saeedeh; Sadeghian, Akram; Saghaeinnejad-Isfahani, Sakine

    2015-01-01

    Background: Lean management is a process improvement technique to identify waste actions and processes to eliminate them. The benefits of Lean for healthcare organizations are that first, the quality of the outcomes in terms of mistakes and errors improves. The second is that the amount of time taken through the whole process significantly improves. Aims: The purpose of this paper is to improve the Medical Records Department (MRD) processes at Ayatolah-Kashani Hospital in Isfahan, Iran by utilizing Lean management. Materials and Methods: This research was applied and an interventional study. The data have been collected by brainstorming, observation, interview, and workflow review. The study population included MRD staff and other expert staff within the hospital who were stakeholders and users of the MRD. Statistical Analysis Used: The MRD were initially taught the concepts of Lean management and then formed into the MRD Lean team. The team then identified and reviewed the current processes subsequently; they identified wastes and values, and proposed solutions. Results: The findings showed that the MRD units (Archive, Coding, Statistics, and Admission) had 17 current processes, 28 wastes, and 11 values were identified. In addition, they offered 27 comments for eliminating the wastes. Conclusion: The MRD is the critical department for the hospital information system and, therefore, the continuous improvement of its services and processes, through scientific methods such as Lean management, are essential. Originality/Value: The study represents one of the few attempts trying to eliminate wastes in the MRD. PMID:26097862

  16. Improving the medical records department processes by lean management.

    PubMed

    Ajami, Sima; Ketabi, Saeedeh; Sadeghian, Akram; Saghaeinnejad-Isfahani, Sakine

    2015-01-01

    Lean management is a process improvement technique to identify waste actions and processes to eliminate them. The benefits of Lean for healthcare organizations are that first, the quality of the outcomes in terms of mistakes and errors improves. The second is that the amount of time taken through the whole process significantly improves. The purpose of this paper is to improve the Medical Records Department (MRD) processes at Ayatolah-Kashani Hospital in Isfahan, Iran by utilizing Lean management. This research was applied and an interventional study. The data have been collected by brainstorming, observation, interview, and workflow review. The study population included MRD staff and other expert staff within the hospital who were stakeholders and users of the MRD. The MRD were initially taught the concepts of Lean management and then formed into the MRD Lean team. The team then identified and reviewed the current processes subsequently; they identified wastes and values, and proposed solutions. The findings showed that the MRD units (Archive, Coding, Statistics, and Admission) had 17 current processes, 28 wastes, and 11 values were identified. In addition, they offered 27 comments for eliminating the wastes. The MRD is the critical department for the hospital information system and, therefore, the continuous improvement of its services and processes, through scientific methods such as Lean management, are essential. The study represents one of the few attempts trying to eliminate wastes in the MRD.

  17. Big data in medical informatics: improving education through visual analytics.

    PubMed

    Vaitsis, Christos; Nilsson, Gunnar; Zary, Nabil

    2014-01-01

    A continuous effort to improve healthcare education today is currently driven from the need to create competent health professionals able to meet healthcare demands. Limited research reporting how educational data manipulation can help in healthcare education improvement. The emerging research field of visual analytics has the advantage to combine big data analysis and manipulation techniques, information and knowledge representation, and human cognitive strength to perceive and recognise visual patterns. The aim of this study was therefore to explore novel ways of representing curriculum and educational data using visual analytics. Three approaches of visualization and representation of educational data were presented. Five competencies at undergraduate medical program level addressed in courses were identified to inaccurately correspond to higher education board competencies. Different visual representations seem to have a potential in impacting on the ability to perceive entities and connections in the curriculum data.

  18. Improving Patient Outcomes With Oral Heart Failure Medications.

    PubMed

    Sherrod, Melissa M; Cheek, Dennis J; Seale, Ashlie

    2016-05-01

    Hospitals are under immense pressure to reduce heart failure readmissions that occur within 30 days of discharge, and to improve the quality of care for these patients. Penalties mandated by the Affordable Care Act decrease hospital reimbursement and ultimately the overall cost of caring for these patients increases if they are not well managed. Approximately 25% of patients hospitalized for heart failure are at high risk for readmission and these rates have not changed over the past decade. As a result of an aging population, the incidence of heart failure is expected to increase to one in five Americans over the age of 65. Pharmacologic management can reduce the risk of death and help prevent unnecessary hospitalizations. Healthcare providers who have knowledge of heart failure medications and drug interactions and share this information with their patients contribute to improved long-term survival and physical functioning as well as fewer hospitalizations and a delay of progressive worsening of heart failure.

  19. The Dialogue Between Medical Doctors and Bioethicists: Rethinking Experience to Improve Medical Education.

    PubMed

    Valera, Luca; Russo, María Teresa; Curcio, Giuseppe

    2016-01-01

    More and more seems to be necessary to find new ways of communication between medical doctors and bioethicists in order to build a shared vocabulary and to prevent conflicts: many bioethical problems seem to be caused by the lack of dialogue between them, which both seem to speak two different languages. Improving this dialogue means searching new languages and innovative forms of communication: the narration could be a really effective tool to enhance the physicians' and bioethicist's moral conscience, since it facilitates reasoning on someone's particular experience, and, ultimately, on our experience. Starting from the results of a questionnaire administered to a group of students of the Faculty of Medicine and Surgery of the University Campus Bio-Medico we present a theoretical discussion about the need for more dialogue and for a shared vocabulary in medical experiences. In this regard, we suggest as a possible solution to the conflicts among medical doctors and bioethicists, an educational strategy, i.e., humanities courses for medical students, which may help them to deeply describe their practical present (and future) experience.

  20. Integrated software system for improving medical equipment management.

    PubMed

    Bliznakov, Z; Pappous, G; Bliznakova, K; Pallikarakis, N

    2003-01-01

    The evolution of biomedical technology has led to an extraordinary use of medical devices in health care delivery. During the last decade, clinical engineering departments (CEDs) turned toward computerization and application of specific software systems for medical equipment management in order to improve their services and monitor outcomes. Recently, much emphasis has been given to patient safety. Through its Medical Device Directives, the European Union has required all member nations to use a vigilance system to prevent the reoccurrence of adverse events that could lead to injuries or death of patients or personnel as a result of equipment malfunction or improper use. The World Health Organization also has made this issue a high priority and has prepared a number of actions and recommendations. In the present workplace, a new integrated, Windows-oriented system is proposed, addressing all tasks of CEDs but also offering a global approach to their management needs, including vigilance. The system architecture is based on a star model, consisting of a central core module and peripheral units. Its development has been based on the integration of 3 software modules, each one addressing specific predefined tasks. The main features of this system include equipment acquisition and replacement management, inventory archiving and monitoring, follow up on scheduled maintenance, corrective maintenance, user training, data analysis, and reports. It also incorporates vigilance monitoring and information exchange for adverse events, together with a specific application for quality-control procedures. The system offers clinical engineers the ability to monitor and evaluate the quality and cost-effectiveness of the service provided by means of quality and cost indicators. Particular emphasis has been placed on the use of harmonized standards with regard to medical device nomenclature and classification. The system's practical applications have been demonstrated through a pilot

  1. [A workshop to improve written communication skills of medical students].

    PubMed

    Bitran, Marcela; Zúñiga, Denisse; Flotts, Paulina; Padilla, Oslando; Moreno, Rodrigo

    2009-05-01

    Despite being among the best academically prepared of the country, many medical students have difficulties to communicate in writing. In 2005, the School of Medicine at the Pontificia Universidad Católica de Chile introduced a writing workshop in the undergraduate curriculum, to enhance the students' writing skills. To describe the workshop and its impact on the writing skills of 3 cohorts of students. This 30-h workshop used a participative methodology with emphasis on deliberate practice and feedback. Students worked in small groups with a faculty member specially trained in writing. The qualities of the essays written before and after the workshop were compared. Essays were rated by a professional team that used an analytic rubric to measure formal aspects of text writing as well as more complex thinking processes. There was a significant improvement in the quality of the texts written after the workshop; the main changes occurred in argumentation, and in paragraph and text structure. This improvement was inversely proportional to the initial level of performance, and independent of gender. A writing workshop based on deliberate practice and personalized feedback is effective to enhance the writing proficiency of medical students. Due to its design, this workshop could be useful for students of other careers and universities.

  2. Hamline/3M Project: Liaison for Curricular Change

    NASA Astrophysics Data System (ADS)

    Rundquist, Andy

    2002-03-01

    This project was designed to catalyze curricular changes to better prepare students for the workplace. Industrial managers provided a list of 16 characteristics valued in the workplace: most were NOT related to science course content. The project formed 5 teams each including 3M professionals and students. Each team developed curricular changes in one of the 16 areas. Team goals were to improve skills in communication, data analysis, business/economics, team problem solving, and culture competency. Curricular changes realized include communication skill activities embodied in science courses and faculty communication teaching skill seminars, self learning tools in data analysis, statistics and model building, a new course developed with assistance from 3M personnel focussing on topics directly related to technological industries, high performance team problem solving training/coaching for faculty and workshops for students and faculty relative to importance of cultural competencies in the workplace, and a new course focusing on culture, team problem solving and conflict resolution in the technical workplace. Process for developing and content of curricular changes will be reported.

  3. Hamline/3M Corp. Project: Liason for Curricular Change*

    NASA Astrophysics Data System (ADS)

    Artz, Jerry L.

    2002-04-01

    This project was designed to catalyze curricular changes to better prepare students for the workplace. Industrial managers provided a list of 16 characteristics valued in the workplace; most were NOT related to science course content. The project formed 5 teams each including 3M professionals and students. Each team developed curricular changes in one of the 16 areas. Team goals were to improve skills in communication, data analysis, business/economics, team problem solving, and cultural competency. Curricular changes realized include communication skill activities embodied in science courses and faculty communication teaching skill seminars; self learning tools in data analysis, statistics and model building; a new course developed with assistance from 3M personnel focusing on topics directly related to technological industries; high performance team problem solving training/coaching for faculty; workshops for students and faculty relative to importance of cultural competencies in the workplace; and a new course focusing on culture, team problem solving and conflict resolution in the technical workplace. Process for developing and content of curricular changes will be reported. *Thanks to: NSF GOALI CHE-99010782

  4. Perspective: deconstructing integration: a framework for the rational application of integration as a guiding curricular strategy.

    PubMed

    Goldman, Ellen; Schroth, W Scott

    2012-06-01

    In response to historical criticism, evolving accreditation standards, and recent reports on curricula, medical educators and medical schools have been eagerly pursuing integration as a goal of curricular reform. The general education literature broadly considers integration to be the deliberate unification of separate areas of knowledge, and it provides support for the concept that integration better meets the needs of adult learners in professional education. The use of integration as a curricular goal is not without its critics, however, nor is it free of difficulties in implementation. In this perspective, the authors propose that most of these difficulties arise from a failure to recognize that integration is a strategy for curricular development rather than a goal in itself, and they argue that adopting a systematic approach to integration offers many potential benefits. They articulate the conceptual and practical issues that they believe are critical to consider in order to achieve successful curricular integration, and they suggest that integration should be approached as a subset of broader curriculum development decisions. They propose a three-level framework for applying integration as a guiding curricular strategy, in which decisions about integration must follow curricular decisions made at the program level, the course level, and then the individual session level.

  5. Improved neurobehavioral functioning in emphysema patients following medical therapy.

    PubMed

    Kozora, Elizabeth; Emery, Charles F; Zhang, Lening; Make, Barry

    2010-01-01

    To evaluate the neuropsychological and psychological functioning of emphysema patients following 10 weeks of multidisciplinary medical therapy (MT). Patients with moderate to severe emphysema (n = 56) enrolled in the National Emphysema Treatment Trial at 2 sites (National Jewish Health and Ohio State University) completed cognitive, psychological, and quality-of-life (QOL) tests at baseline and 6 to 10 weeks following participation in pulmonary rehabilitation. Healthy control subjects (matched on age, sex, race, and education, n = 54) completed the same tests at baseline and 6 to 10 weeks later. Controlling for practice effects and educational level, emphysema patients in the MT group demonstrated significant improvement compared with controls on a global index of cognition, and in measures of visuomotor sequential skills and visual memory. The MT group showed significant reductions in several measures of depression and anxiety, and the control group showed a significant reduction in total depression, but acute anxiety scores were worse 6 to 10 weeks later. The MT group showed significant improvement on 6 of 9 QOL variables and no change was detected in the control group. Improvement on the cognitive index score in the mt group was related to decline in depression and increased workload. emphysema patients who received MT demonstrated improvement in specific neuropsychological functions, depression, anxiety, and QOL scores compared with control subjects during the same interval (with no treatment). Mechanisms for these neurobehavioral changes include greater exercise endurance and decreased depression.

  6. Spaced education in medical residents: An electronic intervention to improve competency and retention of medical knowledge

    PubMed Central

    Matos, Jason; Petri, Camille R.; Mukamal, Kenneth J.; Vanka, Anita

    2017-01-01

    Background Spaced education is a novel method that improves medical education through online repetition of core principles often paired with multiple-choice questions. This model is a proven teaching tool for medical students, but its effect on resident learning is less established. We hypothesized that repetition of key clinical concepts in a “Clinical Pearls” format would improve knowledge retention in medical residents. Methods This study investigated spaced education with particular emphasis on using a novel, email-based reinforcement program, and a randomized, self-matched design, in which residents were quizzed on medical knowledge that was either reinforced or not with electronically-administered spaced education. Both reinforced and non-reinforced knowledge was later tested with four quizzes. Results Overall, respondents incorrectly answered 395 of 1008 questions (0.39; 95% CI, 0.36–0.42). Incorrect response rates varied by quiz (range 0.34–0.49; p = 0.02), but not significantly by post-graduate year (PGY1 0.44, PGY2 0.33, PGY3 0.38; p = 0.08). Although there was no evidence of benefit among residents (RR = 1.01; 95% CI, 0.83–1.22; p = 0.95), we observed a significantly lower risk of incorrect responses to reinforced material among interns (RR = 0.83, 95% CI, 0.70–0.99, p = 0.04). Conclusions Overall, repetition of Clinical Pearls did not statistically improve test scores amongst junior and senior residents. However, among interns, repetition of the Clinical Pearls was associated with significantly higher test scores, perhaps reflecting their greater attendance at didactic sessions and engagement with Clinical Pearls. Although the study was limited by a low response rate, we employed test and control questions within the same quiz, limiting the potential for selection bias. Further work is needed to determine the optimal spacing and content load of Clinical Pearls to maximize retention amongst medical residents. This particular protocol of

  7. Spaced education in medical residents: An electronic intervention to improve competency and retention of medical knowledge.

    PubMed

    Matos, Jason; Petri, Camille R; Mukamal, Kenneth J; Vanka, Anita

    2017-01-01

    Spaced education is a novel method that improves medical education through online repetition of core principles often paired with multiple-choice questions. This model is a proven teaching tool for medical students, but its effect on resident learning is less established. We hypothesized that repetition of key clinical concepts in a "Clinical Pearls" format would improve knowledge retention in medical residents. This study investigated spaced education with particular emphasis on using a novel, email-based reinforcement program, and a randomized, self-matched design, in which residents were quizzed on medical knowledge that was either reinforced or not with electronically-administered spaced education. Both reinforced and non-reinforced knowledge was later tested with four quizzes. Overall, respondents incorrectly answered 395 of 1008 questions (0.39; 95% CI, 0.36-0.42). Incorrect response rates varied by quiz (range 0.34-0.49; p = 0.02), but not significantly by post-graduate year (PGY1 0.44, PGY2 0.33, PGY3 0.38; p = 0.08). Although there was no evidence of benefit among residents (RR = 1.01; 95% CI, 0.83-1.22; p = 0.95), we observed a significantly lower risk of incorrect responses to reinforced material among interns (RR = 0.83, 95% CI, 0.70-0.99, p = 0.04). Overall, repetition of Clinical Pearls did not statistically improve test scores amongst junior and senior residents. However, among interns, repetition of the Clinical Pearls was associated with significantly higher test scores, perhaps reflecting their greater attendance at didactic sessions and engagement with Clinical Pearls. Although the study was limited by a low response rate, we employed test and control questions within the same quiz, limiting the potential for selection bias. Further work is needed to determine the optimal spacing and content load of Clinical Pearls to maximize retention amongst medical residents. This particular protocol of spaced education, however, was unique and readily

  8. Effect of mental health nurses' beliefs and knowledge of medication on their use of strategies to improve medication adherence.

    PubMed

    Drori, Tal; Guetta, Hava; Ben Natan, Merav; Polakevich, Yaakov

    2014-08-01

    Despite the proven efficiency of medication for mental illness, research indicates low patient adherence to medication. Nonetheless, only few studies have directly examined the relationship between nurse beliefs and knowledge, and their use of strategies to improve patient adherence to psychiatric medication. Therefore, the aim of the present study was to clarify nurses' views, beliefs about, and knowledge of psychiatric medication affect their inclination to implement various strategies to improve patient adherence. One hundred nurses working at an Israeli psychiatric hospital participated in the study. Self-completed questionnaires were distributed. The research findings showed that nurses' levels of knowledge of psychiatric medication were moderate, but their beliefs of taking psychiatric medication were positive. The findings also showed that the higher the nurses' age and seniority, as well as their positive beliefs about taking medication, the higher their probability of implementing strategies to improve patient adherence to medication. Additionally, there was a positive correlation between positive beliefs about the nursing staff on taking medication and the staff's utilization of strategies to improve patient adherence to medication. The current study shows that nurses' traits and beliefs affect their use of strategies promoting mental health patient adherence to medication and the enhancement of these strategies. © 2014 Australian College of Mental Health Nurses Inc.

  9. Improving emergency department flow through Rapid Medical Evaluation unit

    PubMed Central

    Chartier, Lucas; Josephson, Timothy; Bates, Kathy; Kuipers, Meredith

    2015-01-01

    The Toronto Western Hospital is an academic hospital in Toronto, Canada, with an annual Emergency Department (ED) volume of 64,000 patients. Despite increases in patient volumes of almost six percent per annum over the last decade, there have been no commensurate increases in resources, infrastructure, and staffing. This has led to substantial increase in patient wait times, most specifically for those patients with lower acuity presentations. Despite requiring only minimal care, these patients contribute disproportionately to ED congestion, which can adversely impact resource utilization and quality of care for all patients. We undertook a retrospective evaluation of a quality improvement initiative aimed at improving wait times experienced by patients with lower acuity presentations. A rapid improvement event was organized by frontline workers to rapidly overhaul processes of care, leading to the creation of the Rapid Medical Evaluation (RME) unit – a new pathway of care for patients with lower acuity presentations. The RME unit was designed by re-purposing existing resources and re-assigning one physician and one nurse towards the specific care of these patients. We evaluated the performance of the RME unit through measurement of physician initial assessment (PIA) times and total length of stay (LOS) times for multiple groups of patients assigned to various ED care pathways, during three periods lasting three months each. Weekly measurements of mean and 90th percentile of PIA and LOS times showed special cause variation in all targeted patient groups. Of note, the patients seen in the RME unit saw their median PIA and LOS times decrease from 98min to 70min and from 165min to 130min, respectively, from baseline. Despite ever-growing numbers of patient visits, wait times for all patients with lower acuity presentations remained low, and wait times of patients with higher acuity presentations assigned to other ED care pathways were not adversely affected. By

  10. Improving emergency department flow through Rapid Medical Evaluation unit.

    PubMed

    Chartier, Lucas; Josephson, Timothy; Bates, Kathy; Kuipers, Meredith

    2015-01-01

    The Toronto Western Hospital is an academic hospital in Toronto, Canada, with an annual Emergency Department (ED) volume of 64,000 patients. Despite increases in patient volumes of almost six percent per annum over the last decade, there have been no commensurate increases in resources, infrastructure, and staffing. This has led to substantial increase in patient wait times, most specifically for those patients with lower acuity presentations. Despite requiring only minimal care, these patients contribute disproportionately to ED congestion, which can adversely impact resource utilization and quality of care for all patients. We undertook a retrospective evaluation of a quality improvement initiative aimed at improving wait times experienced by patients with lower acuity presentations. A rapid improvement event was organized by frontline workers to rapidly overhaul processes of care, leading to the creation of the Rapid Medical Evaluation (RME) unit - a new pathway of care for patients with lower acuity presentations. The RME unit was designed by re-purposing existing resources and re-assigning one physician and one nurse towards the specific care of these patients. We evaluated the performance of the RME unit through measurement of physician initial assessment (PIA) times and total length of stay (LOS) times for multiple groups of patients assigned to various ED care pathways, during three periods lasting three months each. Weekly measurements of mean and 90th percentile of PIA and LOS times showed special cause variation in all targeted patient groups. Of note, the patients seen in the RME unit saw their median PIA and LOS times decrease from 98min to 70min and from 165min to 130min, respectively, from baseline. Despite ever-growing numbers of patient visits, wait times for all patients with lower acuity presentations remained low, and wait times of patients with higher acuity presentations assigned to other ED care pathways were not adversely affected. By

  11. Effecting curricular change through comprehensive course assessment: using structure and process to change outcomes.

    PubMed

    Goldman, Ellen F; Swayze, Susan S; Swinehart, Sarah E; Schroth, W Scott

    2012-03-01

    Effective curriculum oversight requires periodic assessment and continuous improvement of individual course offerings as well as their overall integration. The literature indicates that most course review processes do not use the breadth of information available or sufficiently encourage faculty feedback and reflection, limiting the value derived. Suggestions for which data to include in the course evaluations are available in the literature; however, there is little guidance on effective course review structures and processes. In this article, the authors discuss a course review process revised as part of a comprehensive reform of the George Washington University School of Medicine and Health Sciences undergraduate medical school curriculum management structure. The process improvements incorporated evaluation practices grounded in the medical and higher education literatures and included changes to the data reviewed as well as the review timing, participants, and structure. The revised process uses a broad array of information, requires significant faculty participation, and uses questioning, writing, and dialogue to encourage faculty reflection and learning. Course directors indicate that the process helps them focus, and the information and the perspectives of others lead to reflection and new ideas. Through the process, course directors have changed course content and teaching methods, improved assessments of learning, and expanded course integration across the curriculum. The procedural and content elements of the process can be easily transferred to other medical schools and are applicable to other curricular reform projects across the continuum of medical education.

  12. Cross-Curricular Approaches Using Environmental Education.

    ERIC Educational Resources Information Center

    Tyldesley, Peter

    1990-01-01

    Describes a workshop that presented both implementation strategies and a working model for education programs seeking to infuse environmental education (EE) in the classroom. Reviews possible obstacles to cross-curricular EE in the school setting and includes a list of factors useful in selecting cross-curricular program themes. (MCO)

  13. Research on Teaching from a Curricular Perspective.

    ERIC Educational Resources Information Center

    Romberg, Thomas A.; And Others

    The intent of this theoretical paper is to recast our ideas about teaching mathematics as a result of an extensive research review on teaching behaviors. The product of this review is an explanatory curricular model which takes into account the content being taught. The purpose of studying teaching from a curricular perspective and the constructs…

  14. Implementation of quality improvement methodology and the medical profession.

    PubMed

    Kennedy, M P

    1998-06-01

    Modern quality management (QM) has evolved in industry over the last few decades to be a major factor in organizational structure and focus. The health industry has to a degree recognized or perceived merits in this model and has applied the principles of QM to many of its activities. It has also incorporated the concept of a commitment to quality improvement (QI) into its most recognized peer-review structure, hospital accreditation (ACHS). Apparent resistance exists in the medical fraternity to a transition from audit-focused quality assurance to contemporary systematic QI. An understanding of this issue may be gained from analysis of the medical profession's perception of QI, factors in the historical structures within health, and a review of the factors which hinder the transition to QI. By considering within a framework of organisational behaviour theory (OBT), some key concepts it is possible to work towards some solutions and proposals. These concepts include attitude, motivation, conflict, organizational change and development. It is likely that the appropriate focus should be broader than the 'recalcitrant group of conservative practitioners who resist change'. Indeed where a deficiency exists, QI methodology would have us look beyond an individual or single group towards the processes that create the opportunity for deficiency to occur. Within the current context, such processes are inherently structural and are historically established within the health industry. A solution to this problem requires organizational commitment and a period of analysis as well as the transformation of attitudes and practices. Organizational commitment will take the form of adequate resourcing and a developmental approach to organizational change. Internal professional change (perhaps guided by organizational development) must address the interface between the 'medical profession' and the broader group of professional health-care providers.

  15. Improving continuing medical education by enhancing interactivity: lessons from Iran.

    PubMed

    Faghihi, Seyed Aliakbar; Khankeh, Hamid Reza; Hosseini, Seyed Jalil; Soltani Arabshahi, Seyed Kamran; Faghih, Zahra; Parikh, Sagar V; Shirazi, Mandana

    2016-04-01

    Continuing Medical Education (CME) has been considered as a lifelong commitment for doctors to provide the optimal care for patients. Despite a long history of creating CME programs, outcomes are far from ideal. The present qualitative study aims to clarify the barriers affecting effectiveness of the CME programs in Iran based on the experiences of general practitioners. Sixteen general practitioners were recruited to participate in in-depth interviews and field observations concerning experiences with CME. The study was performed using a qualitative content analysis method. The codes, categories and themes were explored through an inductive process in which the researchers moved from specific to general. The participants' experiences identified a number of barriers, particularly insufficient interaction with the instructors; additional problems included the teachers' use of an undifferentiated approach; unreal and abstract CME; and ignorance of the diverse reasons to participate in CME. Based on the study results, there are multiple barriers to effective implementation of CME in Iran. The key barriers include insufficient interaction between the trainees and providers, which must be considered by other stakeholders and program designers. Such interactions would facilitate improved program design, invite more specific tailoring of the education to the participants, allow for more effective educational methods and set the stage for outcome evaluation from the learners actually applying their new knowledge in practice. Replication of these findings with another sample would improve confidence in these recommendations, but these findings are broadly consistent with findings in the educational literature on improving the efficacy of CME.

  16. Improvement in medical consultation responses with a structured request form.

    PubMed

    Geist, Shin-Mey Rose Y; Geist, James R

    2008-05-01

    Physicians often do not provide adequate information regarding patients' medical conditions when presented with consultation requests (CR) generated by dental students and their instructors about the students' patients. We hypothesized that a structured CR form, which requests specific information by providing a checklist and/or closed-ended questions for physicians to answer, would lead to better communication and improved responses. We also hypothesized that providing in-service education to clinical faculty on the conditions that require and don't require CRs would reduce the number of unwarranted CRs sent to physicians. We assessed the responses obtained with the new form and compared them to findings over a similar period using our older, unstructured CR forms. We also evaluated the numbers of CRs written unnecessarily during both time periods. Improvements in the appropriateness of information provided by physicians were noted with the new CR forms for diabetes mellitus, hypertension, heart murmur, and anticoagulant therapy. The number of CRs written for conditions that did not need a consultation was approximately the same after provision of instruction as before. We conclude that structured CR forms improve the flow of information between dentists and physicians and should enhance student knowledge and skills in soliciting relevant information. Greater efforts must be taken to inform clinical faculty about the indications for CRs.

  17. Continuing Medical Education via Telemedicine and Sustainable Improvements to Health

    PubMed Central

    2016-01-01

    Background. This research aims to investigate the quantitative relationship between telemedicine and online continuing medical education (CME) and to find the optimal CME lectures to be delivered via telemedicine to improve the population's health status. Objective. This study examines the following: (1) What factors foster learning processes in CME via telemedicine? (2) What is the possible role of online CME in health improvement? And (3) How optimal learning processes can be integrated with various health services? Methods. By applying telemedicine experiences in Taiwan over the period 1995–2004, this study uses panel data and the method of ordinary least squares to embed an adequate set of phenomena affecting the provision of online CME lectures versus health status. Results. Analytical results find that a nonlinear online CME-health nexus exists. Increases in the provision of online CME lectures are associated with health improvements. However, after the optimum has been reached, greater provision of online CME lectures may be associated with decreasing population health. Conclusion. Health attainment could be partially viewed as being determined by the achievement of the appropriately providing online CME lectures. This study has evaluated the population's health outcomes and responded to the currently inadequate provision of online CME lectures via telemedicine. PMID:27660637

  18. Continuing Medical Education via Telemedicine and Sustainable Improvements to Health.

    PubMed

    Wang, Fuhmei

    2016-01-01

    Background. This research aims to investigate the quantitative relationship between telemedicine and online continuing medical education (CME) and to find the optimal CME lectures to be delivered via telemedicine to improve the population's health status. Objective. This study examines the following: (1) What factors foster learning processes in CME via telemedicine? (2) What is the possible role of online CME in health improvement? And (3) How optimal learning processes can be integrated with various health services? Methods. By applying telemedicine experiences in Taiwan over the period 1995-2004, this study uses panel data and the method of ordinary least squares to embed an adequate set of phenomena affecting the provision of online CME lectures versus health status. Results. Analytical results find that a nonlinear online CME-health nexus exists. Increases in the provision of online CME lectures are associated with health improvements. However, after the optimum has been reached, greater provision of online CME lectures may be associated with decreasing population health. Conclusion. Health attainment could be partially viewed as being determined by the achievement of the appropriately providing online CME lectures. This study has evaluated the population's health outcomes and responded to the currently inadequate provision of online CME lectures via telemedicine.

  19. Does the Flipped Classroom Improve Learning in Graduate Medical Education?

    PubMed

    Riddell, Jeff; Jhun, Paul; Fung, Cha-Chi; Comes, James; Sawtelle, Stacy; Tabatabai, Ramin; Joseph, Daniel; Shoenberger, Jan; Chen, Esther; Fee, Christopher; Swadron, Stuart P

    2017-08-01

    The flipped classroom model for didactic education has recently gained popularity in medical education; however, there is a paucity of performance data showing its effectiveness for knowledge gain in graduate medical education. We assessed whether a flipped classroom module improves knowledge gain compared with a standard lecture. We conducted a randomized crossover study in 3 emergency medicine residency programs. Participants were randomized to receive a 50-minute lecture from an expert educator on one subject and a flipped classroom module on the other. The flipped classroom included a 20-minute at-home video and 30 minutes of in-class case discussion. The 2 subjects addressed were headache and acute low back pain. A pretest, immediate posttest, and 90-day retention test were given for each subject. Of 82 eligible residents, 73 completed both modules. For the low back pain module, mean test scores were not significantly different between the lecture and flipped classroom formats. For the headache module, there were significant differences in performance for a given test date between the flipped classroom and the lecture format. However, differences between groups were less than 1 of 10 examination items, making it difficult to assign educational importance to the differences. In this crossover study comparing a single flipped classroom module with a standard lecture, we found mixed statistical results for performance measured by multiple-choice questions. As the differences were small, the flipped classroom and lecture were essentially equivalent.

  20. A watershed approach for improving medical image segmentation.

    PubMed

    Zanaty, E A; Afifi, Ashraf

    2013-01-01

    In this paper, a novel watershed approach based on seed region growing and image entropy is presented which could improve the medical image segmentation. The proposed algorithm enables the prior information of seed region growing and image entropy in its calculation. The algorithm starts by partitioning the image into several levels of intensity using watershed multi-degree immersion process. The levels of intensity are the input to a computationally efficient seed region segmentation process which produces the initial partitioning of the image regions. These regions are fed to entropy procedure to carry out a suitable merging which produces the final segmentation. The latter process uses a region-based similarity representation of the image regions to decide whether regions can be merged. The region is isolated from the level and the residual pixels are uploaded to the next level and so on, we recall this process as multi-level process and the watershed is called multi-level watershed. The proposed algorithm is applied to challenging applications: grey matter-white matter segmentation in magnetic resonance images (MRIs). The established methods and the proposed approach are experimented by these applications to a variety of simulating immersion, multi-degree, multi-level seed region growing and multi-level seed region growing with entropy. It is shown that the proposed method achieves more accurate results for medical image oversegmentation.

  1. Medical Observation Units and Emergency Department Collaboration: Improving Patient Throughput.

    PubMed

    Gabele, Danielle; Bugais, Charlene; Laguna, Joanne

    2016-01-01

    The aim of this study was to identify whether observation status patients placed in a dedicated unit would decompress the emergency department (ED) more than observation patients who were admitted to other available beds. An urban quaternary hospital has a high volume of patients with average daily census of 95% capacity. A medical observation unit (MOU) was created to improve patient throughput. In phase 1, the MOU charge nurse reviewed the ED patients to be admitted and selected appropriate patients based on unit inclusion criteria. In phase 2, the MOU charge nurse did rounds with the ED charge nurse once per shift. MOU observation patients demonstrated a 53-minute (16%) reduction in average overall ED length of stay compared with observation patients admitted to other units. Inclusion criteria, a rounding checklist, and engagement of MOU and ED nurses helped the MOU and ED with patient throughput.

  2. Improving Workplace-Based Learning for Undergraduate Medical Students.

    PubMed

    Sajjad, Madiha; Mahboob, Usman

    2015-01-01

    Workplace-based learning is considered as one of the most effective way of translating medical theory into clinical practice. Although employed traditionally at postgraduate level, this strategy can be used in undergraduate students coming for clerkships in clinical departments. There are many challenges to workplace learning such as, unfavorable physical environment, lack of interest by clinical staff and teachers, and lack of student motivation. Clinical teachers can help bridge this gap and improve workplace learning through individual and collaborative team effort. Knowledge of various educational theories and principles and their application at workplace can enhance student learning and motivation, for which faculty development is much needed. Different teaching and learning activities can be used and tailored according to the clinical setting. Active reflection by students and constructive feedback from the clinicians forms the backbone of effective workplace learning.

  3. Drug delivery systems improve pharmaceutical profile and facilitate medication adherence.

    PubMed

    Wertheimer, Albert I; Santella, Thomas M; Finestone, Albert J; Levy, Richard A

    2005-01-01

    Innovations in dosage forms and dose delivery systems across a wide range of medications offer substantial clinical advantages, including reduced dosing frequency and improved patient adherence; minimized fluctuation of drug concentrations and maintenance of blood levels within a desired range; localized drug delivery; and the potential for reduced adverse effects and increased safety. The advent of new large-molecule drugs for previously untreatable or only partially treatable diseases is stimulating the development of suitable delivery systems for these agents. Although advanced formulations may be more expensive than conventional dosage forms, they often have a more favorable pharmacologic profile and can be cost-effective. Inclusion of these dosage forms on drug formulary lists may help patients remain on therapy and reduce the economic and social burden of care.

  4. [Discharge from hospital: how to improve continuity of medical care?].

    PubMed

    Garnier, A; Uhlmann, M; Griesser, A-C; Lamy, O

    2015-11-04

    Early readmission is the major success indicator of the transition between hospital and home. Patients admitted with heart failure reach a 20% rate. Potentially avoidable readmissions, defined as unpredictable and related to a known condition during index hospitalization, represent the improvement margin. For these latter, implementation of specific interventions can be effective. Complex interventions on transition, including several modalities and seeking to encourage patient autonomy seem more effective than others. We describe two models: a pragmatic one developed in a regional hospital, and a more complex one developed in a university hospital during the LEAR-HF study. In both cases, it is imperative to work on "medical liability": should it extend beyond discharge up to the threshold of the private practice?

  5. Integrating patient safety into health professionals’ curricula: a qualitative study of medical, nursing and pharmacy faculty perspectives

    PubMed Central

    Tregunno, Deborah; Ginsburg, Liane; Clarke, Beth; Norton, Peter

    2014-01-01

    Background As efforts to integrate patient safety into health professional curricula increase, there is growing recognition that the rate of curricular change is very slow, and there is a shortage of research that addresses critical perspectives of faculty who are on the ‘front-lines’ of curricular innovation. This study reports on medical, nursing and pharmacy teaching faculty perspectives about factors that influence curricular integration and the preparation of safe practitioners. Methods Qualitative methods were used to collect data from 20 faculty members (n=6 medical from three universities; n=6 pharmacy from two universities; n=8 nursing from four universities) engaged in medical, nursing and pharmacy education. Thematic analysis generated a comprehensive account of faculty perspectives. Results Faculty perspectives on key challenges to safe practice vary across the three disciplines, and these different perspectives lead to different priorities for curricular innovation. Additionally, accreditation and regulatory requirements are driving curricular change in medicine and pharmacy. Key challenges exist for health professional students in clinical teaching environments where the culture of patient safety may thwart the preparation of safe practitioners. Conclusions Patient safety curricular innovation depends on the interests of individual faculty members and the leveraging of accreditation and regulatory requirements. Building on existing curricular frameworks, opportunities now need to be created for faculty members to act as champions of curricular change, and patient safety educational opportunities need to be harmonises across all health professional training programmes. Faculty champions and practice setting leaders can collaborate to improve the culture of patient safety in clinical teaching and learning settings. PMID:24299734

  6. Establishing Maximal Medical Improvement After Arthroscopic Rotator Cuff Repair.

    PubMed

    Zuke, William A; Leroux, Timothy S; Gregory, Bonnie P; Black, Austin; Forsythe, Brian; Romeo, Anthony A; Verma, Nikhil N

    2017-06-01

    As health care transitions from a pay-for-service to a pay-for-performance infrastructure, the value of orthopaedic care must be defined accurately. Significant efforts have been made in defining quality and cost in arthroplasty; however, there remains a lag in ambulatory orthopaedic care. Two-year follow-up has been a general requirement for reporting outcomes after rotator cuff repair. However, this time requirement has not been established scientifically and is of increasing importance in the era of value-based health care. Given that arthroscopic rotator cuff repair is a common ambulatory orthopaedic procedure, the purpose of this study was to establish a time frame for maximal medical improvement (the state when improvement has stabilized) after arthroscopic rotator cuff repair. Systematic review. A systematic review of the literature was conducted, identifying studies reporting sequential patient-reported outcomes up to a minimum of 2 years after arthroscopic rotator cuff repair. The primary clinical outcome was patient-reported outcomes at 3-month, 6-month, 1-year, and 2-year follow-up. Secondary clinical outcomes included range of motion, strength, retears, and complications. Clinically significant improvement was determined between various time intervals by use of the minimal clinically important difference. The review included 19 studies including 1370 patients who underwent rotator cuff repair. Clinically significant improvement in patient-reported outcomes was seen up to 1 year after rotator cuff repair, but no clinical significance was noted from 1 year to 2 years. The majority of improvement in strength and range of motion was seen up to 6 months, but no clinically meaningful improvement was seen thereafter. All reported complications and the majority of retears occurred within 6 months after rotator cuff repair. After rotator cuff repair, a clinically significant improvement in patient-reported outcomes, range of motion, and strength was seen up to 1

  7. Medical student-led patient education prior to hospital discharge improves 1-month adherence rates.

    PubMed

    Leung, Chun H S; Chong, Carol; Lim, Wen K

    2017-03-01

    Approximately 40% of patients are non-adherent to their medications. A prospective study of 80 patients evaluated the effectiveness of medical student-led pre-discharge medication education sessions. A significantly greater proportion of patients in the intervention group were adherent to their regular medications at 1 month compared with the control group (76.3% compared to 60.3%, P = 0.037). Medical student-led patient education significantly improved medication adherence rates.

  8. Quality improvement in medical education: current state and future directions.

    PubMed

    Wong, Brian M; Levinson, Wendy; Shojania, Kaveh G

    2012-01-01

    During the last decade, there has been a drive to improve the quality of patient care and prevent the occurrence of avoidable errors. This review describes current efforts to teach or engage trainees in patient safety and quality improvement (QI), summarises progress to date, as well as successes and challenges, and lists our recommendations for the next steps that will shape the future of patient safety and QI in medical education. Trainees encounter patient safety and QI through three main groups of activity. First are formal curricula that teach concepts or methods intended to facilitate trainees' participation in QI activities. These curricula increase learner knowledge and may improve clinical processes, but demonstrate limited capacity to modify learner behaviours. Second are educational activities that impart specific skills related to safety or quality which are considered to represent core doctor competencies (e.g. effective patient handover). These are frequently taught effectively, but without emphasis on the general safety or quality principles that inform the relevant skills. Third are real-life QI initiatives that involve trainees as active or passive participants. These innovative approaches expose trainees to safety and quality by integrating QI activities into trainees' day-to-day work. However, this integration can be challenging and can sometimes result in tension with broader educational goals. To prepare the next generation of doctors to make meaningful contributions to the quality mission, we propose the following call to action. Firstly, a major effort to build faculty capacity, especially among teachers of QI, should be instigated. Secondly, accreditation standards and assessment methods, both during training and at end-of-training certification examinations, should explicitly target these competencies. Finally, and perhaps most importantly, we must refocus our attention at all levels of training and instil fundamental, collaborative, open

  9. Formal art observation training improves medical students' visual diagnostic skills.

    PubMed

    Naghshineh, Sheila; Hafler, Janet P; Miller, Alexa R; Blanco, Maria A; Lipsitz, Stuart R; Dubroff, Rachel P; Khoshbin, Shahram; Katz, Joel T

    2008-07-01

    Despite evidence of inadequate physical examination skills among medical students, teaching these skills has declined. One method of enhancing inspection skills is teaching "visual literacy," the ability to reason physiology and pathophysiology from careful and unbiased observation. To improve students' visual acumen through structured observation of artworks, understanding of fine arts concepts and applying these skills to patient care. Prospective, partially randomized pre- vs. post-course evaluation using mixed-methods data analysis. Twenty-four pre-clinical student participants were compared to 34 classmates at a similar stage of training. Training the Eye: Improving the Art of Physical Diagnosis consists of eight paired sessions of art observation exercises with didactics that integrate fine arts concepts with physical diagnosis topics and an elective life drawing session. The frequency of accurate observations on a 1-h visual skills examination was used to evaluate pre- vs. post-course descriptions of patient photographs and art imagery. Content analysis was used to identify thematic categories. All assessments were blinded to study group and pre- vs. post-course evaluation. Following the course, class participants increased their total mean number of observations compared to controls (5.41 +/- 0.63 vs. 0.36 +/- 0.53, p < 0.0001) and had increased sophistication in their descriptions of artistic and clinical imagery. A 'dose-response' was found for those who attended eight or more sessions, compared to participants who attended seven or fewer sessions (6.31 + 0.81 and 2.76 + 1.2, respectively, p = 0.03). This interdisciplinary course improved participants' capacity to make accurate observations of art and physical findings.

  10. Improving continuing medical education by enhancing interactivity: lessons from Iran

    PubMed Central

    FAGHIHI, SEYED ALIAKBAR; KHANKEH, HAMID REZA; HOSSEINI, SEYED JALIL; SOLTANI ARABSHAHI, SEYED KAMRAN; FAGHIH, ZAHRA; PARIKH, SAGAR V.; SHIRAZI, MANDANA

    2016-01-01

    Introduction Continuing Medical Education (CME) has been considered as a lifelong commitment for doctors to provide the optimal care for patients. Despite a long history of creating CME programs, outcomes are far from ideal. The present qualitative study aims to clarify the barriers affecting effectiveness of the CME programs in Iran based on the experiences of general practitioners. Methods Sixteen general practitioners were recruited to participate in in-depth interviews and field observations concerning experiences with CME. The study was performed using a qualitative content analysis method. The codes, categories and themes were explored through an inductive process in which the researchers moved from specific to general. Results The participants’ experiences identified a number of barriers, particularly insufficient interaction with the instructors; additional problems included the teachers’ use of an undifferentiated approach; unreal and abstract CME; and ignorance of the diverse reasons to participate in CME. Conclusion Based on the study results, there are multiple barriers to effective implementation of CME in Iran. The key barriers include insufficient interaction between the trainees and providers, which must be considered by other stakeholders and program designers. Such interactions would facilitate improved program design, invite more specific tailoring of the education to the participants, allow for more effective educational methods and set the stage for outcome evaluation from the learners actually applying their new knowledge in practice. Replication of these findings with another sample would improve confidence in these recommendations, but these findings are broadly consistent with findings in the educational literature on improving the efficacy of CME. PMID:27104199

  11. 20 CFR 220.179 - Exceptions to medical improvement.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... of the review process, the annuitant will be asked about any medical or vocational therapy that he or... evidence shows that the annuitant is the beneficiary of advances in medical or vocational therapy or technology (related to his or her ability to work). Advances in medical or vocational therapy or technology...

  12. 20 CFR 220.179 - Exceptions to medical improvement.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... of the review process, the annuitant will be asked about any medical or vocational therapy that he or... evidence shows that the annuitant is the beneficiary of advances in medical or vocational therapy or technology (related to his or her ability to work). Advances in medical or vocational therapy or...

  13. A performance improvement plan to increase nurse adherence to use of medication safety software.

    PubMed

    Gavriloff, Carrie

    2012-08-01

    Nurses can protect patients receiving intravenous (IV) medication by using medication safety software to program "smart" pumps to administer IV medications. After a patient safety event identified inconsistent use of medication safety software by nurses, a performance improvement team implemented the Deming Cycle performance improvement methodology. The combined use of improved direct care nurse communication, programming strategies, staff education, medication safety champions, adherence monitoring, and technology acquisition resulted in a statistically significant (p < .001) increase in nurse adherence to using medication safety software from 28% to above 85%, exceeding national benchmark adherence rates (Cohen, Cooke, Husch & Woodley, 2007; Carefusion, 2011).

  14. Identifying opportunities to improve medication management in transitions of care.

    PubMed

    Downes, Jessica M; O'Neal, Katherine S; Miller, Michael J; Johnson, Jeremy L; Gildon, Brooke L; Weisz, Michael A

    2015-09-01

    The types and causes of medication discrepancies during the transition from inpatient to ambulatory care were investigated. A descriptive study was conducted at an academic outpatient group practice affiliated with a private nonacademic hospital to (1) describe discrepancies between inpatient discharge summaries and patient-reported medication lists, (2) identify patient and system factors related to breakdowns in medication documentation, and (3) determine reasons for medication discrepancies. During a four-month period, 17 patients at high risk for medication misadventures while transitioning from hospital care to outpatient follow-up were contacted by telephone soon after discharge and asked to provide information on all medications they were taking. Patient-reported medication lists were compared with the corresponding discharge summaries, and medication discrepancies were categorized by patient- and system-level factors using a validated instrument. Of the total of 96 discrepancies identified, more than two thirds (n = 67, 68%) involved the omission of a prescribed medication from either the patient-reported list or the discharge summary. Cardiovascular medications, including antihypertensives, antilipemics, diuretics, and antiarrhythmics, accounted for almost one quarter of all medication discrepancies. About 15% (n = 14) and 16% (n = 15) of identified discrepancies related to medication dose and frequency, respectively. Among 17 patients transitioning from inpatient to outpatient care, nearly 100 discrepancies between patient-reported medication lists and discharge summaries were identified. Most discrepancies were attributed to nonintentional nonadherence and resumption of home medications without instructions to do so. All 17 patients had at least 1 medication discrepancy categorized as involving a system-level factor. Copyright © 2015 by the American Society of Health-System Pharmacists, Inc. All rights reserved.

  15. The mediatory role of medication adherence in improving patients' medication experience through patient-physician communication among older hypertensive patients.

    PubMed

    Lee, Woojung; Noh, Youran; Kang, Hyeonjin; Hong, Song Hee

    2017-01-01

    Understanding how patient-physician communication affects patients' medication experience would help hypertensive patients maintain their regular long-term medication therapy. This study aimed to examine whether patient-physician communication (information and interpersonal treatment) affects patients' medication experience directly or indirectly through changing medication adherence for each of the two communication domains. A self-administered cross-sectional survey was conducted for older patients who had visited a community senior center as a member. Two communication domains were assessed using two subscales of the Primary Care Assessment Survey. Medication adherence and experience were measured using the Morisky Medication Adherence Scale and a five-point Likert scale, respectively. Mediatory effects were assessed via Baron and Kenny's procedure and a Sobel test. Patient-physician communication had a positive prediction on patients' medication experience (β=0.25, P=0.03), and this was fully mediated by medication adherence (z=3.62, P<0.001). Of the two components of patient-physician communication, only informative communication showed a mediatory effect (z=2.21, P=0.03). Patient-physician communication, specifically informative communication, had the potential to improve patients' medication experience via changes in medication adherence. This finding can inform health care stakeholders of the mediatory role of medication adherence in ensuring favorable medication experience for older hypertensive patients by fostering informative patient-physician communication.

  16. 20 CFR 220.178 - Determining medical improvement and its relationship to the annuitant's ability to do work.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 20 Employees' Benefits 1 2010-04-01 2010-04-01 false Determining medical improvement and its... Disability Due to Substantial Gainful Activity or Medical Improvement § 220.178 Determining medical... (c) of § 220.177 discuss what is meant by medical improvement, medical improvement not related to the...

  17. Using Mind Maps to Improve Medical Student Performance in a Pharmacology Course at Kunming Medical University.

    PubMed

    Ying, Guo; Jianping, Xie; Haiyun, Luo; Xia, Li; Jianyu, Yang; Qun, Xuan; Jianyun, Yu

    2017-07-01

    To determine whether students using mind maps would improve their performance in a final examination at the end of lecture-based pharmacology course. Aquasi-experimental study. Kunming Medical University, from September 2014 to January 2015. One hundred and twenty-two (122) third year undergraduate medical students, starting a 48-hour lecturebased pharmacology course, volunteered to use mind maps as one of their study strategies (intervention group), while the remaining 100 students in the class continued to use their usual study strategies (control group) over the duration of the course. The performance of both groups in the final course examination was compared. Students in the intervention group also completed a questionnaire on the usefulness of mind maps during the course and in preparation for the final examination. The students' performance of intervention group was superior to performance of the control group in all parts of a multi-modal final examination. For the multiple choice questions and comprehensive scores, average marks of 45.97 ±7.22 and 68.07 ±12.77, respectively were acquired by the control group, and 51.77 ±4.95 (p<0.01) and 80.05 ±7.54 (p<0.01), respectively by the intervention group. The median IQR scores for "filling in the blanks" questions, short answers questions and case analyses, were 6.00 (6.00), 8.00 (3.50), 8.75 (5.88), respectively for the control group, and were all significantly higher at 8.00 (4.00) (p=0.024), 10.00 (2.00) (p<0.001), and 11.00 (3.25) (p=0.002), respectively for the interventiongroup. Questionnaire responses showed that 95.45% thought that mind maps helped them to prepare more efficiently for the final exam; 90.91% believed that mind maps helped them to better understand all of pharmacology. Ninety-one percent also thought that mind maps would help them to better understand other disciplines, and 86.36% students would like the lecturers to utilize mind mapping as an alternative to conventional teaching

  18. [Proposal for a media guideline to improve medical and health journalism].

    PubMed

    Kojima, Masami

    2012-01-01

    A lot of healthcare professionals experienced annoyance with biased mass media news regarding medical and health issues. In this paper, I propose "news profiling method" and "media guideline" to improve the medical and health journalism.

  19. Voluntary Medical Incident Reporting Tool to Improve Physician Reporting of Medical Errors in an Emergency Department.

    PubMed

    Okafor, Nnaemeka G; Doshi, Pratik B; Miller, Sara K; McCarthy, James J; Hoot, Nathan R; Darger, Bryan F; Benitez, Roberto C; Chathampally, Yashwant G

    2015-12-01

    Medical errors are frequently under-reported, yet their appropriate analysis, coupled with remediation, is essential for continuous quality improvement. The emergency department (ED) is recognized as a complex and chaotic environment prone to errors. In this paper, we describe the design and implementation of a web-based ED-specific incident reporting system using an iterative process. A web-based, password-protected tool was developed by members of a quality assurance committee for ED providers to report incidents that they believe could impact patient safety. The utilization of this system in one residency program with two academic sites resulted in an increase from 81 reported incidents in 2009, the first year of use, to 561 reported incidents in 2012. This is an increase in rate of reported events from 0.07% of all ED visits to 0.44% of all ED visits. In 2012, faculty reported 60% of all incidents, while residents and midlevel providers reported 24% and 16% respectively. The most commonly reported incidents were delays in care and management concerns. Error reporting frequency can be dramatically improved by using a web-based, user-friendly, voluntary, and non-punitive reporting system.

  20. Voluntary Medical Incident Reporting Tool to Improve Physician Reporting of Medical Errors in an Emergency Department

    PubMed Central

    Okafor, Nnaemeka G.; Doshi, Pratik B.; Miller, Sara K.; McCarthy, James J.; Hoot, Nathan R.; Darger, Bryan F.; Benitez, Roberto C.; Chathampally, Yashwant G.

    2015-01-01

    Introduction Medical errors are frequently under-reported, yet their appropriate analysis, coupled with remediation, is essential for continuous quality improvement. The emergency department (ED) is recognized as a complex and chaotic environment prone to errors. In this paper, we describe the design and implementation of a web-based ED-specific incident reporting system using an iterative process. Methods A web-based, password-protected tool was developed by members of a quality assurance committee for ED providers to report incidents that they believe could impact patient safety. Results The utilization of this system in one residency program with two academic sites resulted in an increase from 81 reported incidents in 2009, the first year of use, to 561 reported incidents in 2012. This is an increase in rate of reported events from 0.07% of all ED visits to 0.44% of all ED visits. In 2012, faculty reported 60% of all incidents, while residents and midlevel providers reported 24% and 16% respectively. The most commonly reported incidents were delays in care and management concerns. Conclusion Error reporting frequency can be dramatically improved by using a web-based, user-friendly, voluntary, and non-punitive reporting system. PMID:26759657

  1. Formal Art Observation Training Improves Medical Students’ Visual Diagnostic Skills

    PubMed Central

    Naghshineh, Sheila; Hafler, Janet P.; Miller, Alexa R.; Blanco, Maria A.; Lipsitz, Stuart R.; Dubroff, Rachel P.; Khoshbin, Shahram

    2008-01-01

    Background Despite evidence of inadequate physical examination skills among medical students, teaching these skills has declined. One method of enhancing inspection skills is teaching “visual literacy,” the ability to reason physiology and pathophysiology from careful and unbiased observation. Objective To improve students’ visual acumen through structured observation of artworks, understanding of fine arts concepts and applying these skills to patient care. Design Prospective, partially randomized pre- vs. post-course evaluation using mixed-methods data analysis. Participants Twenty-four pre-clinical student participants were compared to 34 classmates at a similar stage of training. Intervention Training the Eye: Improving the Art of Physical Diagnosis consists of eight paired sessions of art observation exercises with didactics that integrate fine arts concepts with physical diagnosis topics and an elective life drawing session. Measurements The frequency of accurate observations on a 1-h visual skills examination was used to evaluate pre- vs. post-course descriptions of patient photographs and art imagery. Content analysis was used to identify thematic categories. All assessments were blinded to study group and pre- vs. post-course evaluation. Results Following the course, class participants increased their total mean number of observations compared to controls (5.41 ± 0.63 vs. 0.36 ± 0.53, p < 0.0001) and had increased sophistication in their descriptions of artistic and clinical imagery. A ‘dose-response’ was found for those who attended eight or more sessions, compared to participants who attended seven or fewer sessions (6.31 + 0.81 and 2.76 + 1.2, respectively, p = 0.03). Conclusions This interdisciplinary course improved participants’ capacity to make accurate observations of art and physical findings. Electronic supplementary material The online version of this article (doi:10.1007/s11606-008-0667-0) contains

  2. A curricular model for the training of physician scientists: the evolution of the Duke University School of Medicine curriculum.

    PubMed

    O'Connor Grochowski, Colleen; Halperin, Edward Charles; Buckley, Edward George

    2007-04-01

    Duke University School of Medicine offers an unusual doctor of medicine educational program. The core basic sciences are taught in year one, core clinical clerkships are completed in the second year, the entire third year is devoted to scholarly investigation, and elective rotations are fulfilled in the fourth year. The creation of this unique structure presented many challenges and is the product of a desire of key faculty 40 years ago to change radically the way medical education was taught. Over the years, improvements have been made, but the underlying principles of these visionary leaders have been retained: inquire not just acquire, flexibility of choice, and in-depth exploration. In the spirit of innovation that was established 40 years ago, leaders and faculty at Duke developed a new curricular model in 2004, called Foundation for Excellence, which is anchored in integrated, interdisciplinary innovation. The authors describe the process of curricular reform and provide a detailed overview of this unique approach to medical education. In keeping with Duke's mission to graduate clinician-researchers and clinician-educators, reducing the basic science curriculum to one year created a year saved, which students are now required to devote to scholarly pursuits. The authors argue that adopting a similar one-year basic science curriculum would make instructional time available for other schools to achieve their own institutional goals.

  3. Co-Curricular Outcomes Assessment and Accreditation

    ERIC Educational Resources Information Center

    Busby, Katie

    2015-01-01

    This chapter describes how assessment of co-curricular student learning outcomes can be used as part of the institutional accreditation process and the opportunities institutional researchers and student affairs educators have to collaborate in those efforts.

  4. Using Multidimensional Scaling for Curricular Goal Analysis.

    ERIC Educational Resources Information Center

    Leitzman, David F.; And Others

    1980-01-01

    Reports research that utilized multidimensional scaling and related analytic procedures to validate the curricular goals of a graduate therapeutic recreation program. Data analysis includes the use of the two-dimensional KYST and PREFMAP spaces. (Author/JD)

  5. [The Russian Armed Forces Military Medical Service: condition and ways of improvement].

    PubMed

    Fisun, A Ia

    2014-01-01

    In 2013 the main efforts of the Medical Service were aimed at the following tasks: optimization of management system of military medical service, improvement of medical evacuation system, medical service security for military contingents, assigned according to territory principle to military-medical facilities of the Ministry of Defence of the Russian Federation, implementation of innovations at all stages of medical evacuation in peace- and wartime, security of combat and mobilization readiness of regulatory bodies of the Medical Service, medical military units and military medical facilities, medical service of troops battle training, improvement of material and technical resources, security of regular pharmacy and equipment supply, activation of research work in the Medical Service interests. Lines of military medicine development in 2014 are: transfer of treatment facilities that are not used by the Ministry of Defence into the Federal Biomedical Agency till the end of 2014, prevention of pneumonia and meningitis in military personnel, improvement of early diagnosis system, medical service for military contingents according to territory principle, improvement of diagnostic and treatment work in military-medical units and subunits and military-medical facilities by means of development of material and technical resources, monitor the implementation of innovative diagnostic and treatment technologies, completion of construction projects of central military hospitals and etc.

  6. Using evidence to improve satisfaction with medication side-effects education on a neuro-medical surgical unit.

    PubMed

    Ahrens, Susan L; Wirges, Ashley M

    2013-10-01

    Patient satisfaction is viewed as a significant indicator of quality of care. More specifically, improving patient satisfaction related to communication about medications and potential side effects can improve healthcare outcomes. Patient satisfaction scores related to medication side effects on a neuro-medical surgical unit were monitored following a quality improvement program. These patients frequently experience cognitive impairment and functional difficulties that can affect the way they understand and handle medications. The purpose of this quality improvement practice change was to (a) develop an educational approach for post acute neurosurgical patients and (b) evaluate whether the use of the approach is successful in improving patient satisfaction scores related to medication education on side effects. The quality improvement program interventions included (a) patient informational handouts inserted into admission folders, (b) nurse education about the importance of providing education on side effects to patient and discussion of their involvement with the program, (c) unit flyers with nurse education, and (d) various communications with bedside nurses through personal work mail and emails. The primary focus was for nurses to employ the "teach back" method to review and reinforce the medication side-effect teaching with patients. Evaluation of the data showed an increase in patient satisfaction after the implementation of the "Always Ask" program.

  7. Medication Safety During Pregnancy: Improving Evidence-Based Practice.

    PubMed

    Sinclair, Susan M; Miller, Richard K; Chambers, Christina; Cooper, Elizabeth M

    2016-01-01

    Nearly 90% of women in the United States have taken medications during pregnancy. Medication exposures during pregnancy can result in adverse pregnancy and neonatal outcomes including birth defects, fetal loss, intrauterine growth restriction, prematurity, and longer-term neurodevelopmental outcomes. Advising pregnant women about the safety of medication use during pregnancy is complicated by a lack of data necessary to engage the woman in an informed discussion. Routinely, health care providers turn to the package insert, yet this information can be incomplete and can be based entirely on animal studies. Often, adequate safety data are not available. In a busy clinical setting, health care providers need to be able to quickly locate the most up-to-date information in order to counsel pregnant women concerned about medication exposure. Deciding where to locate the best available information is difficult, particularly when the needed information does not exist. Pregnancy registries are initiated to obtain more data about the safety of specific medication exposures during pregnancy; however, these studies are slow to produce meaningful information, and when they do, the information may not be readily available in a published form. Health care providers have valuable data in their everyday practice that can expand the knowledge base about medication safety during pregnancy. This review aims to discuss the limitations of the package insert regarding medication safety during pregnancy, highlight additional resources available to health care providers to inform practice, and communicate the importance of pregnancy registries for expanding knowledge about medication safety during pregnancy.

  8. Chemical and Biological Terrorism: Improvements to Emergency Medical Response.

    ERIC Educational Resources Information Center

    DeGraffenreid, Jeff Gordon

    The challenge facing many emergency medical services (EMS) is the implementation of a comprehensive educational strategy to address emergency responses to terrorism. One such service, Johnson County (Kansas) Medical Action, needed a strategy that would keep paramedics safe and offer the community an effective approach to mitigation. A…

  9. Medication management at home: enhancing nurse's skills and improving patient satisfaction--a longitudinal study.

    PubMed

    Mager, Diana R; Morrissey Ross, Mary

    2013-01-01

    The purpose of this longitudinal study was to improve nurse medication management skills during home care (HC) visits, and thus improve care quality and the related patient ratings of nurse performance. Nurses completed presurveys asking how often they asked to see, taught about, and explained side effects of patient medications. Two focus groups were held with HC nurses to determine barriers to provision of such medication interventions, followed by presentation of a series of 5 medication-related educational sessions. HC nurse's surveys 6 months later reveal an increased frequency of medication skill performance, and patient ratings in these same areas improved statistically significantly, nearing or surpassing national benchmarks.

  10. SOAP to SNOCAMP: improving the medical record format.

    PubMed

    Larimore, W L; Jordan, E V

    1995-10-01

    Not since the development of the SOAP note in the problem-oriented medical record has there been a significant need to alter the format of medical record documentation. With the intrusion of third-party audits, malpractice attorney subpoenas, medical guidelines, and reimbursement code criteria into the practice of medicine, there is a need to expand the traditional SOAP note. This article proposes a new acronym, "SNOCAMP," for medical record documentation. SNOCAMP retains the SOAP format, which includes subjective, objective, assessment, and plan of treatment, with the addition of nature of the presenting complaint, counseling, and medical decision-making. It is hoped that this new, more explicit format will prove successful in meeting the divergent needs of practicing physicians, the patients they serve, and the inquiring minds that look over their shoulders.

  11. Cryptanalysis and improvement of an improved two factor authentication protocol for telecare medical information systems.

    PubMed

    Chaudhry, Shehzad Ashraf; Naqvi, Husnain; Shon, Taeshik; Sher, Muhammad; Farash, Mohammad Sabzinejad

    2015-06-01

    Telecare medical information systems (TMIS) provides rapid and convenient health care services remotely. Efficient authentication is a prerequisite to guarantee the security and privacy of patients in TMIS. Authentication is used to verify the legality of the patients and TMIS server during remote access. Very recently Islam et al. (J. Med. Syst. 38(10):135, 2014) proposed a two factor authentication protocol for TMIS using elliptic curve cryptography (ECC) to improve Xu et al.'s (J. Med. Syst. 38(1):9994, 2014) protocol. They claimed their improved protocol to be efficient and provides all security requirements. However our analysis reveals that Islam et al.'s protocol suffers from user impersonation and server impersonation attacks. Furthermore we proposed an enhanced protocol. The proposed protocol while delivering all the virtues of Islam et al.'s protocol resists all known attacks.

  12. Clinical nutrition in medical gastroenterology: room for improvement.

    PubMed

    Johansson, Ulla; Rasmussen, Henrik Höjgaard; Mowe, Morten; Staun, Michael

    2009-04-01

    Undernutrition is a problem in hospitals, with lack of nutritional routines. Recently, guidelines concerning the nutritional care process were developed from ESPEN. This study was conducted to assess the present status of nutritional routines among doctors and nurses in internal medicine (IM) and medical gastroenterology (MG), in comparison with the ESPEN guidelines. A questionnaire-based investigation among doctors and nurses working in departments of internal medicine and gastroenterology in Scandinavia, based on further analysis of previous data. Overall, 4512 (1753 doctors, 2759 nurses) answered the questionnaire, of which 1155 were from internal medicine and 193 from gastroenterology. A similar, non-significant, discrepancy in attitudes and nutritional routines was noted in gastroenterologists and internists. Concerning basic nutritional education, 46% in MG and 48% in IM considered it insufficient (not significant). When comparing all doctors with all nurses, 60% and 39% respectively considered their basic nutritional education insufficient (p<0.001). Concerning prescription of parenteral nutrition, 65% of the internists and 92% of the gastroenterologists had sufficient knowledge (p<0.001), while technical skill did not differ (not significant). Lack of interest was more pronounced in the internists than in the gastroenterologists, 42% vs. 32% (p<0.05), and more pronounced in doctors when comparing all doctors with all nurses (47 vs. 36%, p<0.001). A discrepancy between clinical practice and attitudes towards nutrition is evident in both gastroenterology and internal medicine. Although gastroenterologists are more interested, there is room for improvement in both groups. This is true for doctors as well as nurses, even though nurses seem to be more interested and better trained than doctors.

  13. Improving the Methods for the Economic Evaluation of Medical Devices.

    PubMed

    Tarricone, Rosanna; Callea, Giuditta; Ogorevc, Marko; Prevolnik Rupel, Valentina

    2017-02-01

    Medical devices (MDs) have distinctive features, such as incremental innovation, dynamic pricing, the learning curve and organisational impact, that need to be considered when they are evaluated. This paper investigates how MDs have been assessed in practice, in order to identify methodological gaps that need to be addressed to improve the decision-making process for their adoption. We used the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) checklist supplemented by some additional categories to assess the quality of reporting and consideration of the distinctive features of MDs. Two case studies were considered: transcatheter aortic valve implantation (TAVI) representing an emerging technology and implantable cardioverter defibrillators (ICDs) representing a mature technology. Economic evaluation studies published as journal articles or within Health Technology Assessment reports were identified through a systematic literature review. A total of 19 studies on TAVI and 41 studies on ICDs were analysed. Learning curve was considered in only 16% of studies on TAVI. Incremental innovation was more frequently mentioned in the studies of ICDs, but its impact was considered in only 34% of the cases. Dynamic pricing was the most recognised feature but was empirically tested in less than half of studies of TAVI and only 32% of studies on ICDs. Finally, organisational impact was considered in only one study of ICDs and in almost all studies on TAVI, but none of them estimated its impact. By their very nature, most of the distinctive features of MDs cannot be fully assessed at market entry. However, their potential impact could be modelled, based on the experience with previous MDs, in order to make a preliminary recommendation. Then, well-designed post-market studies could help in reducing uncertainties and make policymakers more confident to achieve conclusive recommendations. © 2017 The Authors. Health Economics published by John Wiley & Sons, Ltd.

  14. Improving risk assessment of color additives in medical device polymers.

    PubMed

    Chandrasekar, Vaishnavi; Janes, Dustin W; Forrey, Christopher; Saylor, David M; Bajaj, Akhil; Duncan, Timothy V; Zheng, Jiwen; Riaz Ahmed, Kausar B; Casey, Brendan J

    2017-01-31

    Many polymeric medical device materials contain color additives which could lead to adverse health effects. The potential health risk of color additives may be assessed by comparing the amount of color additive released over time to levels deemed to be safe based on available toxicity data. We propose a conservative model for exposure that requires only the diffusion coefficient of the additive in the polymer matrix, D, to be specified. The model is applied here using a model polymer (poly(ether-block-amide), PEBAX 2533) and color additive (quinizarin blue) system. Sorption experiments performed in an aqueous dispersion of quinizarin blue (QB) into neat PEBAX yielded a diffusivity D = 4.8 × 10(-10) cm(2 ) s(-1) , and solubility S = 0.32 wt %. On the basis of these measurements, we validated the model by comparing predictions to the leaching profile of QB from a PEBAX matrix into physiologically representative media. Toxicity data are not available to estimate a safe level of exposure to QB, as a result, we used a Threshold of Toxicological Concern (TTC) value for QB of 90 µg/adult/day. Because only 30% of the QB is released in the first day of leaching for our film thickness and calculated D, we demonstrate that a device may contain significantly more color additive than the TTC value without giving rise to a toxicological concern. The findings suggest that an initial screening-level risk assessment of color additives and other potentially toxic compounds found in device polymers can be improved. © 2017 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 2017. © 2017 Wiley Periodicals, Inc.

  15. Quality Improvement Project to Improve Timeliness Between Bronchodilator Treatments from Emergency Department to Medical Wards.

    PubMed

    Cockerham, Jennifer R; Lowe, Gary R; Willis, Randy; Stecks, Ryan M; Berlinski, Ariel

    2016-12-01

    Quality improvement methodology was applied to study sporadic reports that patients with asthma were not given bronchodilator treatments or assessed within an appropriate time frame when they were admitted from the emergency department to the medical ward. The goal was to increase the number of patients who had an interval between emergency department assessment/bronchodilator treatment and medical ward assessment/treatment of <120 min. A flow chart diagram, a fishbone diagram, data collection, intervention implementation, and data monitoring and analysis were used in this study. Data were collected on a pre-test of change cohort of 227 subjects with asthma from January 2013 to March 2014. A test of change adding a Q2H respiratory therapist assessment and as needed bronchodilator treatment order while the subject was in the emergency department was implemented during May of 2014. These data were compared with a post-test of change cohort of 278 subjects with asthma from May 2014 to July 2015. Data collection for both cohorts included the time from the last assessment/bronchodilator treatment in the emergency department to emergency department discharge, the time from emergency department discharge to assessment/treatment in the medical ward, and the sum of these 2 time periods. Mean times (minutes) were noted, and comparisons were made using 2-tailed independent t tests with significance set at P < .05. Mean monthly times were also compared in process control charts. There was a 124% increase noted in the percentage of subjects who received bronchodilator treatment within 120 min, a 53% increase within 180 min, and a 19% increase within 240 min. The interval time between treatments decreased 21%. Through quality improvement methodology, the group was able to significantly decrease the time between the last assessment/bronchodilator treatment in the emergency department and the first assessment/treatment in the medical ward for subjects with asthma. Moreover

  16. Educating the educators: a key to curricular integration.

    PubMed

    Haramati, Aviad

    2015-02-01

    According to Hopkins and colleagues, integration of basic science and clinical practice in the medical curriculum has been "incremental" at best, rather than transformative, in part because of a lack of focus on the individuals central to the integration--basic science educators. These authors maintain that those who lead change in education should not only address the systemic structure but also understand the meaning of integration for individual basic scientists at different levels of change. Their view has merit, and this Commentary author suggests three concrete steps that institutions should undertake to engage basic scientists who are interested in becoming "educationally literate" and assuming leadership roles in curriculum integration: (1) Offer opportunities to help interested basic science teaching faculty gain the necessary expertise to become skilled educators; (2) establish institutional programs and structures that foster a community of medical educators across departments and schools; and (3) align institutional priorities and incentives to promote, rather than hinder, integration in medical education. In essence, curricular integration cannot succeed if the participants do not understand the "language of education." Furthermore, faculty who opt for an education-focused career path should be brought together from across departments, centers, and schools to create a community of educators within the academic health center. Finally, institutional leaders should place high value and proper incentives in terms of recognition and opportunities for faculty advancement to ensure that those opting to gain additional training as skilled educators will drive innovation and help move curricular reform from incremental change to transformation.

  17. Competency-based curricular design to encourage significant learning.

    PubMed

    Hurtubise, Larry; Roman, Brenda

    2014-07-01

    Most significant learning (SL) experiences produce long-lasting learning experiences that meaningfully change the learner's thinking, feeling, and/or behavior. Most significant teaching experiences involve strong connections with the learner and recognition that the learner felt changed by the teaching effort. L. Dee Fink in Creating Significant Learning Experiences: An Integrated Approach to Designing College Course defines six kinds of learning goals: Foundational Knowledge, Application, Integration, Human Dimension, Caring, and Learning to Learn. SL occurs when learning experiences promote interaction between the different kinds of goals, for example, acquiring knowledge alone is not enough, but when paired with a learning experience, such as an effective patient experience as in Caring, then significant (and lasting) learning occurs. To promote SL, backward design principles that start with clearly defined learning goals and the context of the situation of the learner are particularly effective. Emphasis on defining assessment methods prior to developing teaching/learning activities is the key: this ensures that assessment (where the learner should be at the end of the educational activity/process) drives instruction and that assessment and learning/instruction are tightly linked so that assessment measures a defined outcome (competency) of the learner. Employing backward design and the AAMC's MedBiquitous standard vocabulary for medical education can help to ensure that curricular design and redesign efforts effectively enhance educational program quality and efficacy, leading to improved patient care. Such methods can promote successful careers in health care for learners through development of self-directed learning skills and active learning, in ways that help learners become fully committed to lifelong learning and continuous professional development.

  18. Curricular Adaptations in Inpatient Child Psychiatry for the 21st Century: The Flexner Model Revisited

    ERIC Educational Resources Information Center

    Bell, Cathy K.; Guerrero, Anthony; Matsu, Courtenay; Takeshita, Junji; Haning, William; Schultz, Karen

    2010-01-01

    Objective: The authors describe curricular modifications created in response to the changing culture of medical education, health care systems, academic medicine, and generational differences. The authors propose a model child psychiatry inpatient curriculum that is sustainable within a community teaching hospital in the 21st century. Methods: The…

  19. Curricular Adaptations in Inpatient Child Psychiatry for the 21st Century: The Flexner Model Revisited

    ERIC Educational Resources Information Center

    Bell, Cathy K.; Guerrero, Anthony; Matsu, Courtenay; Takeshita, Junji; Haning, William; Schultz, Karen

    2010-01-01

    Objective: The authors describe curricular modifications created in response to the changing culture of medical education, health care systems, academic medicine, and generational differences. The authors propose a model child psychiatry inpatient curriculum that is sustainable within a community teaching hospital in the 21st century. Methods: The…

  20. From "F = ma" to Flying Squirrels: Curricular Change in an Introductory Physics Course

    ERIC Educational Resources Information Center

    O'Shea, Brian; Terry, Laura; Benenson, Walter

    2013-01-01

    We present outcomes from curricular changes made to an introductory calculus-based physics course whose audience is primarily life sciences majors, the majority of whom plan to pursue postbaccalaureate studies in medical and scientific fields. During the 2011-2012 academic year, we implemented a Physics of the Life Sciences curriculum centered on…

  1. From "F = ma" to Flying Squirrels: Curricular Change in an Introductory Physics Course

    ERIC Educational Resources Information Center

    O'Shea, Brian; Terry, Laura; Benenson, Walter

    2013-01-01

    We present outcomes from curricular changes made to an introductory calculus-based physics course whose audience is primarily life sciences majors, the majority of whom plan to pursue postbaccalaureate studies in medical and scientific fields. During the 2011-2012 academic year, we implemented a Physics of the Life Sciences curriculum centered on…

  2. SmartMed: A Medication Management System to Improve Adherence.

    PubMed

    Diemert, Simon; Richardson, Kirk; Hunter, Paul; Weber, Jens; Price, Morgan

    2015-01-01

    Adherence is the degree to which patients comply with their caregivers prescribed treatments. Lack of adherence due to various causes negatively affects health objectives. Prior work in the field of medication management has indicated the usefulness of IT as a possible aid for those who have difficulty adhering to prescribed medication regimes. In this paper we present a medication management system (SmartMed) that has been designed to monitor and increase adherence. The SmartMed system consists of a portable pill bottle device, a local base station, and a cloud data service. It reminds users when it is time to take their medications, and acquires adherence data which is accessible for applications that query the data service. The project was undertaken as an undergraduate engineering design project. This paper describes the design and prototype implementation of this system and provides direction for future work.

  3. Improving pneumococcal vaccination rates of medical inpatients in urban Nepal using quality improvement measures

    PubMed Central

    Bock, Allison; Chintamaneni, Kathan; Rein, Lisa; Frazer, Tifany; Kayastha, Gyan; MacKinney, Theodore

    2016-01-01

    Streptococcus pneumoniae infection is associated with high morbidity and mortality in low income countries. In Nepal, there is a high lung disease burden and incidence of pneumonia due to multiple factors including indoor air pollution, dust exposure, recurrent infections, and cigarette smoking. Despite the ready availability of effective pneumococcal vaccines (PNV), vaccine coverage rates remain suboptimal globally. Quality Improvement (QI) principles could be applied to improve compliance, but it is a virtually new technology in Nepal. This QI study for Patan Hospital sought to introduce the concept of QI there, to measure the baseline pneumococcal vaccination rate of qualifying adult patients discharged from the medical wards and to assess reasons for non-vaccination. QI interventions were instituted to improve this rate, measuring the effectiveness of QI methods to produce the desired outcomes using the Model for Improvement, Plan-Do-Study-Change (PDSA) methodology. In the three week baseline assessment, 2 out of 81 (2%) eligible patients recalled ever receiving a prior pneumococcal vaccine; 68 (84%) unvaccinated patients responded that they were not asked or were unaware of the PNV. After the QI interventions, the pneumococcal vaccination rate significantly increased to 42% (23/56, p<0.001). Post-intervention, the leading reason for non-vaccination was cost (20%, 11/56). Only 5 (9%) unvaccinated patients were not asked or were unaware of the PNV, a significant change in that process outcome from baseline (p<0.001). Quality improvement measures were effective in increasing pneumococcal vaccination rates, despite the limited familiarity with QI methods at this major teaching hospital. QI techniques may be useful in this and other efforts to improve quality in resource-limited settings, without great cost. PMID:27933153

  4. Learner-centred medical education: Improved learning or increased stress?

    PubMed

    McLean, Michelle; Gibbs, Trevor J

    2009-12-01

    Globally, as medical education undergoes significant reform towards more "learner-centred" approaches, specific implications arise for medical educators and learners. Although this learner-centredness is grounded in educational theory, a point of discussion would be whether the application and practice of these new curricula alleviate or exacerbate student difficulties and levels of stress. This commentary will argue that while this reform in medical education is laudable, with positive implications for learning, medical educators may not have understood or perhaps not embraced "learner-centredness" in its entirety. During their training, medical students are expected to be "patient-centred". They are asked to apply a biopsychosocial model, which takes cognisance of all aspects of a patient's well-being. While many medical schools profess that their curricula reflect these principles, in reality, many may not always practice what they preach. Medical training all too often remains grounded in the biomedical model, with the cognitive domain overshadowing the psychosocial development and needs of learners. Entrusted by parents and society with the education and training of future healthcare professionals, medical education needs to move to a "learner-centred philosophy", in which the "whole" student is acknowledged. As undergraduate and post-graduate students increasingly apply their skills in an international arena, this learner-centredness should equally encapsulate the gender, cultural and religious diversity of both patients and students. Appropriate support structures, role models and faculty development are required to develop skills, attitudes and professional behaviour that will allow our graduates to become caring and sensitive healthcare providers.

  5. Improving medication administration in nursing home residents with swallowing difficulties: sustainability of the effect of a multifaceted medication safety programme.

    PubMed

    Stuijt, Clementine C M; Klopotowska, Joanna E; Kluft-van Driel, Chantal; Le, Nhut; Binnekade, Jan; van der Kleij, Bea; van der Schors, Tjalling; van den Bemt, Patricia; Lie-A-Huen, Loraine

    2013-04-01

    Crushing solid oral dosage forms is an important risk factor for medication administration errors (MAEs) in patients with swallowing difficulties. Nursing home (NH) residents, especially those on psychogeriatric wards, have a high prevalence of such difficulties. Six different psychogeriatric wards in two Dutch NH facilities, participating over a total period of 1 year divided into preintervention, implementation, and the first and second evaluation period. Number of MAEs per number of observed medication administrations calculated for all and three subtypes of MAEs: crushing-uncrushable-medication, inappropriate-technique, and food-drug interactions. The intervention included (i) education for nursing staff about crushing medication safely, (ii) a medication administration protocol for patients with swallowing difficulties, (iii) a 'do-not-crush-medication' pocket card for the nursing staff, (iv) screening of medication charts by pharmacy technicians on potential crushing problems, and (v) advices on medication charts on safe medication administration to residents with swallowing problems. The number of crushing uncrushable medication errors, an MAE subtype with the highest potential risk for patient harm, was reduced significantly from 19 (9.6%) to 7 (3.0%; first evaluation period), adjusted odds ratio 0.20 (OR = 95%CI, 0.07-0.55). During the second evaluation period, the proportion crushing uncrushable medications errors was the only outcome that remained significantly lower in comparison with the preintervention period (p = 0.045). Introduction of a multifaceted medication safety programme in NH facilities by a pharmacy team is a tool towards safer medication administration practice in residents with swallowing difficulties. Commitment on organisational level is, however, vital to achieve sustainable improvements. Copyright © 2012 John Wiley & Sons, Ltd.

  6. Graphic Strategies for Analyzing and Interpreting Curricular Mapping Data

    PubMed Central

    Leonard, Sean T.

    2010-01-01

    Objective To describe curricular mapping strategies used in analyzing and interpreting curricular mapping data and present findings on how these strategies were used to facilitate curricular development. Design Nova Southeastern University's doctor of pharmacy curriculum was mapped to the college's educational outcomes. The mapping process included development of educational outcomes followed by analysis of course material and semi-structured interviews with course faculty members. Data collected per course outcome included learning opportunities and assessment measures used. Assessment Nearly 1,000 variables and 10,000 discrete rows of curricular data were collected. Graphic representations of curricular data were created using bar charts and stacked area graphs relating the learning opportunities to the educational outcomes. Graphs were used in the curricular evaluation and development processes to facilitate the identification of curricular holes, sequencing misalignments, learning opportunities, and assessment measures. Conclusion Mapping strategies that use graphic representations of curricular data serve as effective diagnostic and curricular development tools. PMID:20798804

  7. Graphic strategies for analyzing and interpreting curricular mapping data.

    PubMed

    Armayor, Graciela M; Leonard, Sean T

    2010-06-15

    To describe curricular mapping strategies used in analyzing and interpreting curricular mapping data and present findings on how these strategies were used to facilitate curricular development. Nova Southeastern University's doctor of pharmacy curriculum was mapped to the college's educational outcomes. The mapping process included development of educational outcomes followed by analysis of course material and semi-structured interviews with course faculty members. Data collected per course outcome included learning opportunities and assessment measures used. Nearly 1,000 variables and 10,000 discrete rows of curricular data were collected. Graphic representations of curricular data were created using bar charts and stacked area graphs relating the learning opportunities to the educational outcomes. Graphs were used in the curricular evaluation and development processes to facilitate the identification of curricular holes, sequencing misalignments, learning opportunities, and assessment measures. Mapping strategies that use graphic representations of curricular data serve as effective diagnostic and curricular development tools.

  8. A Medical Resident-Pharmacist Collaboration Improves the Rate of Medication Reconciliation Verification at Discharge.

    PubMed

    Caroff, Daniel A; Bittermann, Therese; Leonard, Charles E; Gibson, Gene A; Myers, Jennifer S

    2015-10-01

    At the Hospital of the University of Pennsylvania (Philadelphia), it is standard practice to perform medication reconciliation at patient discharge. Although pharmacists historically were available to assist resident physicians in the discharge medication reconciliation process, the process was never standardized. An internal review showed a 60%-70% rate of pharmacist review of discharge medication lists, potentially enabling medication errors to go unnoticed during transitions of care. In response, a medical resident- and pharmacist-led collaboration was designed, and a pre-post-intervention study was conducted to assess its effectiveness. A new work flow was established in which house staff notified pharmacists when a preliminary discharge medication list was ready for reconciliation and provided access for pharmacists to correct medication errors in the electronic discharge document with physician approval. Length of stay, average time of day of patient discharge, and readmission data were compared in the pre- and post-intervention periods. There were 981 discharges in the preintervention period and 1,207 in the postintervention period. The rate of pharmacist reconciliation increased from 64.0% to 82.4% after the intervention (p<.0001). The average number of errors identified and corrected by pharmacists decreased from 0.979 to 0.862 per discharge (p<.0001). There was no significant change in readmission rates or time of discharge after the intervention. Redesigning the discharge medication reconciliation process in a teaching hospital to include a review of medical resident discharge medication lists by pharmacists provided more opportunities for discharge medication error identification and correction.

  9. Improving accuracy of medication identification in an older population using a medication bottle color symbol label system.

    PubMed

    Cardarelli, Roberto; Mann, Christopher; Fulda, Kimberly G; Balyakina, Elizabeth; Espinoza, Anna; Lurie, Sue

    2011-12-29

    The purpose of this pilot study was to evaluate and refine an adjuvant system of color-specific symbols that are added to medication bottles and to assess whether this system would increase the ability of patients 65 years of age or older in matching their medication to the indication for which it was prescribed. This study was conducted in two phases, consisting of three focus groups of patients from a family medicine clinic (n = 25) and a pre-post medication identification test in a second group of patient participants (n = 100). Results of focus group discussions were used to refine the medication label symbols according to themes and messages identified through qualitative triangulation mechanisms and data analysis techniques. A pre-post medication identification test was conducted in the second phase of the study to assess differences between standard labeling alone and the addition of the refined color-specific symbols. The pre-post test examined the impact of the added labels on participants' ability to accurately match their medication to the indication for which it was prescribed when placed in front of participants and then at a distance of two feet. Participants appreciated the addition of a visual aid on existing medication labels because it would not be necessary to learn a completely new system of labeling, and generally found the colors and symbols used in the proposed labeling system easy to understand and relevant. Concerns were raised about space constraints on medication bottles, having too much information on the bottle, and having to remember what the colors meant. Symbols and colors were modified if they were found unclear or inappropriate by focus group participants. Pre-post medication identification test results in a second set of participants demonstrated that the addition of the symbol label significantly improved the ability of participants to match their medication to the appropriate medical indication at a distance of two feet (p < 0

  10. Improving medical records filing in a municipal hospital in Ghana.

    PubMed

    Teviu, E A A; Aikins, M; Abdulai, T I; Sackey, S; Boni, P; Afari, E; Wurapa, F

    2012-09-01

    Medical records are kept in the interest of both the patient and clinician. Proper filing of patient's medical records ensures easy retrieval and contributes to decreased patient waiting time at the hospital and continuity of care. This paper reports on an intervention study to address the issue of misfiling and multiple patient folders in a health facility. Intervention study. Municipal Hospital, Goaso, Asunafo North District, Brong Ahafo Region, Ghana. Methods employed for data collection were records review, direct observation and tracking of folders. Interventions instituted were staff durbars, advocacy and communication, consultations, in-service trainings, procurement and monitoring. Factors contributing to issuance of multiple folders and misfiling were determined. Proportion of multiple folders was estimated. Results revealed direct and indirect factors contributing to issuance of multiple patient folders and misfiling. Interventions and monitoring reduce acquisition of numerous medical folders per patient and misfiling. After the intervention, there was significant reduction in the use of multiple folders (i.e., overall 97% reduction) and a high usage of single patient medical folders (i.e., 99%). In conclusion, a defined medical records filing system with adequate training, logistics and regular monitoring and supervision minimises issuance of multiple folders and misfiling.

  11. [The reform of military medical education and the tasks of the Military Medical Academy in improving personnel training].

    PubMed

    Shevchenko, Iu L

    1994-08-01

    The Military Medical Academy is a military educational institution which carries out the primary profile training of physicians for the Armed Services and all types of post-graduation training and advanced training of the scientific-pedagogical and medical specialists. Internship as a first stage of the post-graduation training is intended to improve practical medical training of the graduates of the Russian Military Medical Academy and other medico-military educational institutions by means of their primary specialization in one of the clinical or profile branches of medicine. The reforming of the post-graduation training rest system in the Military Medical Academy aims at its further development and putting specialists' training system into accordance with the Armed Forces reorganizations. This will make it possible to ensure high professional qualification of military doctors at the level of national and international standards.

  12. Medical record review conduction model for improving interrater reliability of abstracting medical-related information.

    PubMed

    Engel, Lisa; Henderson, Courtney; Fergenbaum, Jennifer; Colantonio, Angela

    2009-09-01

    Medical record review (MRR) is often used in clinical research and evaluation, yet there is limited literature regarding best practices in conducting a MRR, and there are few studies reporting interrater reliability (IRR) from MRR data. The aim of this research was twofold: (a) to develop a MRR abstraction tool and standardize the MRR process and (b) to examine the IRR from MRR data. This study introduces the MRR-Conduction Model, which was used to implement a MRR, and examines the IRR between two abstractors who collected preinjury medical and psychiatric, incident-related medical and postinjury head symptom information from the medical records of 47 neurologically injured workers. Results showed that the percentage agreement was > or =85% and the unweighted kappa statistic was > or =.60 for most variables, indicating substantial IRR. An effective and reliable MRR to abstract medical-related information requires planning and time. The MRR-Conduction Model is proposed to guide the process of creating a MRR.

  13. Reflections on efforts to improve medical publishing in Africa.

    PubMed

    Gondwe, Mzamose

    2010-12-01

    Over the last five years several scholarly publishing associations have been launched in Africa - the Forum for African Medical Editors (FAME), the Society of African Journals (SAJE), the Consortium of African Scholarly Publishers (CASP), the Africa Journals Partnership Project and the African Association of Science Editors (AASE). What, if any, has been the impact of these initiatives? This paper reviews the most notable of these associations, FAME, which was established in 2003 with the support of the World Association of Medical Editors, the Council of Science Editors and the Special Program for Research and Training in Tropical Diseases (TDR). FAME is evaluated in relation to two other international scholarly publishing associations - the Scientific Electronic Library Online (SciELO) in South America and the Eastern Mediterranean Association of Medical Editors (EMAME). The article also discusses the future of FAME with regards to new developments in open access publishing through African Journals Online.

  14. Improving Learning Efficiency of Factual Knowledge in Medical Education.

    PubMed

    Yeh, D Dante; Park, Yoon Soo

    2015-01-01

    The purpose of this review is to synthesize recent literature relating to factual knowledge acquisition and retention and to explore its applications to medical education. Distributing, or spacing, practice is superior to massed practice (i.e. cramming). Testing, compared to re-study, produces better learning and knowledge retention, especially if tested as retrieval format (short answer) rather than recognition format (multiple choice). Feedback is important to solidify the testing effect. Learning basic factual knowledge is often overlooked and under-appreciated in medical education. Implications for applying these concepts to smartphones are discussed; smartphones are owned by the majority of medical trainees and can be used to deploy evidence-based educational methods to greatly enhance learning of factual knowledge. Copyright © 2015 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

  15. Do Clinical Breast Examination Skills Improve During Medical School?

    ERIC Educational Resources Information Center

    Lee, Karen C.; Dunlop, Dorothy; Dolan, Nancy C.

    1998-01-01

    A study assessed the effect of training stage, gender, and specialty interest on 493 Northwestern University (Illinois) medical students' breast cancer knowledge, attitudes, and clinical breast examination skills. Results suggest knowledge and attitudes are not related to clinical breast examination proficiency, which is a practiced tactile skill.…

  16. An improved anonymous authentication scheme for telecare medical information systems.

    PubMed

    Wen, Fengtong; Guo, Dianli

    2014-05-01

    Telecare medical information system (TMIS) constructs an efficient and convenient connection between patients and the medical server. The patients can enjoy medical services through public networks, and hence the protection of patients' privacy is very significant. Very recently, Wu et al. identified Jiang et al.'s authentication scheme had some security drawbacks and proposed an enhanced authentication scheme for TMIS. However, we analyze Wu et al.'s scheme and show that their scheme suffers from server spoofing attack, off-line password guessing attack, impersonation attack. Moreover, Wu et al.'s scheme fails to preserve the claimed patient anonymity and its password change phase is unfriendly and inefficient. Thereby, we present a novel anonymous authentication scheme for telecare medical information systems to eliminate the aforementioned faults. Besides, We demonstrate the completeness of the proposed scheme through the BAN logic. Furthermore, the security of our proposed scheme is proven through Bellare and Rogaways model. Compared with the related existing schemes, our scheme is more secure.

  17. 20 CFR 220.179 - Exceptions to medical improvement.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... diabetes mellitus which the prior adjudicator believed was medically disabling. The prior record shows that the annuitant has “brittle” diabetes for which he was taking insulin. The annuitant's urine was 3+ for sugar, and he alleged occasional hypoglycemic attacks caused by exertion. His doctor felt the diabetes...

  18. Using the World Wide Web To Improve Medication Calculation Skills.

    ERIC Educational Resources Information Center

    Stillman, Gloria A.; Alison, Justine; Croker, Felicity

    1999-01-01

    Describes the development of a computer-assisted learning package at James Cook University (Australia) that uses the World Wide Web to provide accessible practice in medication calculations for undergraduate nursing students and inservice education for nurses in isolated areas. Highlights include design features, constraints, cost effectiveness,…

  19. Mediators and Moderators of Improvements in Medication Adherence: Secondary Analysis of a Community Health Worker-Led Diabetes Medication Self-Management Support Program.

    PubMed

    Hofer, Rebecca; Choi, Hwajung; Mase, Rebecca; Fagerlin, Angela; Spencer, Michael; Heisler, Michele

    2016-07-14

    Objective In a randomized controlled trial we compared two models of community health worker-led diabetes medication decision support for low-income Latino and African American adults with diabetes. Most outcomes were improved when community health workers used either an interactive e-Health tool or print materials. This article investigates mediators and moderators of improved medication adherence in these two models. Method Because both programs significantly improved satisfaction with medication information, medication knowledge, and decisional conflict, we examined whether improvements in each of these outcomes in turn were associated with improvements in self-reported medication adherence, and if so, whether these improvements were mediated by improvements in diabetes self-efficacy or diabetes distress. Potential moderators of improvement included gender, race/ethnicity, age, education, insulin use, health literacy, and baseline self-efficacy, diabetes distress, and A1c. Results A total of 176 participants (94%) completed all assessments. After adjusting for potential confounders, only increased satisfaction with medication information was correlated with improved medication adherence (p = .024). Improved self-efficacy, but not diabetes distress, was associated with improvements in both satisfaction with medication information and medication adherence. However, the Sobel-Goodman Mediation test did not support improvements in self-efficacy as a mechanism by which improved satisfaction led to better adherence. None of the examined variables achieved statistical significance as moderators. Conclusions Improvements in satisfaction with medication information but not in medication knowledge or decision conflict were associated with improvements in medication adherence. Interventions that target low-income ethnic and racial minorities may need to focus on increasing participants' satisfaction with information provided on diabetes medications and not just improving

  20. The Ontological Architectures in the Application of a Knowledge Management System for Curricular Assessment

    ERIC Educational Resources Information Center

    Olson, Brandon D.

    2012-01-01

    Institutions of higher education are facing increasing pressure to improve the effectiveness and quality of academic programs (Association of Governing Boards, Top public policy issues 2011-2012, 2011). These institutions apply curricular assessment processes as a means to evaluate and improve academic effectiveness and quality. Knowledge…

  1. The Ontological Architectures in the Application of a Knowledge Management System for Curricular Assessment

    ERIC Educational Resources Information Center

    Olson, Brandon D.

    2012-01-01

    Institutions of higher education are facing increasing pressure to improve the effectiveness and quality of academic programs (Association of Governing Boards, Top public policy issues 2011-2012, 2011). These institutions apply curricular assessment processes as a means to evaluate and improve academic effectiveness and quality. Knowledge…

  2. Revising the formal, retrieving the hidden: Undergraduate curricular reform in medicine and the scientific, institutional, & social transformation of the clinical training environment

    NASA Astrophysics Data System (ADS)

    Jagosh, Justin J.

    2009-12-01

    In 2004, members of the McGill University Faculty of Medicine began implementing a new curriculum for undergraduate medical education entitled, Physicianship: The Physician as Professional and Healer. The initiative underscores the idea that physician training entails cultivating not only scientific knowledge and technical skill, but a mindset guided by intrinsic principles of doctoring. Although the McGill case exemplifies a wide-spread paradigm shift in medical teaching, there is a dearth of analysis concerning the degree of congruency between the objectives of formal undergraduate curricular revision and the so-called 'hidden curriculum' of the hospital training environment. With Physicianship as a point of departure, this dissertation maps evolutionary patterns in clinical medicine and, using qualitative methods, analyzes the perspectives of twenty physician-educators on curricular reform and the transforming clinical training environment. Physicians interviewed were generally supportive of the new curricular initiative. Concerns were raised, however, that many recent changes within the teaching hospital environment interfere with students' cultivation of professional and healer attributes. These changes were organized into three main themes: scientific, institutional, and social. Physicians expressed concern that what is often considered beneficial for patients is often detrimental for medical training. For example, increased use of diagnostic technologies has improved patient care but reduces opportunities for trainees' clinical skill development. Concern was raised that the concept of selfless service has been undermined through recent shift-work regulations and a culture gap between older and younger generation physicians. Alternatively, some perceived new policies of the clinical environment to be more conducive to physicians' self-care and quality of life. Younger trainees were often described as more competent in managing medical information, more open

  3. Improving combat casualty care and field medicine: focus on the military medic.

    PubMed

    De Lorenzo, R A

    1997-04-01

    As military medicine in general copes with a rapidly changing world environment, so too must the backbone of the medical force, the enlisted medic. To meet these challenges, the training and utilization of military medics must match new and different missions. This paper will explore innovative approaches to training and preparing for combat casualty care and field medicine. The focus will fall on the education, evaluation, operations, patient-care skills, equipment, and telemedicine potential of the military medic. Future directions for study and development will be suggested. Exploration of the following may improve the capability of the military medic: (1) improved training to include advanced-level skills and interventions for combat casualty care and broader exposure to the casualties expected in operations other than war; (2) annual educational and periodic proficiency evaluation requirements; (3) strengthened medical control at all echelons; and (4) carefully selected additional equipment and technologies to enhance medical capabilities.

  4. The Implementation of a Course Design Using Online Curricular Tools for Assurance of Learning at a Small Private AACSB School of Business

    ERIC Educational Resources Information Center

    Fratto, Victoria A.

    2010-01-01

    This study was designed to determine if the use of online curricular tools as a pedagogical supplement to an introductory accounting course would improve student accounting knowledge as compared to traditional teaching methodology. The curricular model employed course-embedded online assessments and tools that were designed to assist an accounting…

  5. Virtual reality training improves students' knowledge structures of medical concepts.

    PubMed

    Stevens, Susan M; Goldsmith, Timothy E; Summers, Kenneth L; Sherstyuk, Andrei; Kihmm, Kathleen; Holten, James R; Davis, Christopher; Speitel, Daniel; Maris, Christina; Stewart, Randall; Wilks, David; Saland, Linda; Wax, Diane; Panaiotis; Saiki, Stanley; Alverson, Dale; Caudell, Thomas P

    2005-01-01

    Virtual environments can provide training that is difficult to achieve under normal circumstances. Medical students can work on high-risk cases in a realistic, time-critical environment, where students practice skills in a cognitively demanding and emotionally compelling situation. Research from cognitive science has shown that as students acquire domain expertise, their semantic organization of core domain concepts become more similar to those of an expert's. In the current study, we hypothesized that students' knowledge structures would become more expert-like as a result of their diagnosing and treating a patient experiencing a hematoma within a virtual environment. Forty-eight medical students diagnosed and treated a hematoma case within a fully immersed virtual environment. Student's semantic organization of 25 case-related concepts was assessed prior to and after training. Students' knowledge structures became more integrated and similar to an expert knowledge structure of the concepts as a result of the learning experience. The methods used here for eliciting, representing, and evaluating knowledge structures offer a sensitive and objective means for evaluating student learning in virtual environments and medical simulations.

  6. Facilitated Nurse Medication-Related Event Reporting to Improve Medication Management Quality and Safety in Intensive Care Units.

    PubMed

    Xu, Jie; Reale, Carrie; Slagle, Jason M; Anders, Shilo; Shotwell, Matthew S; Dresselhaus, Timothy; Weinger, Matthew B

    Medication safety presents an ongoing challenge for nurses working in complex, fast-paced, intensive care unit (ICU) environments. Studying ICU nurse's medication management-especially medication-related events (MREs)-provides an approach to analyze and improve medication safety and quality. The goal of this study was to explore the utility of facilitated MRE reporting in identifying system deficiencies and the relationship between MREs and nurses' work in the ICUs. We conducted 124 structured 4-hour observations of nurses in three different ICUs. Each observation included measurement of nurse's moment-to-moment activity and self-reports of workload and negative mood. The observer then obtained MRE reports from the nurse using a structured tool. The MREs were analyzed by three experts. MREs were reported in 35% of observations. The 60 total MREs included four medication errors and seven adverse drug events. Of the 49 remaining MREs, 65% were associated with negative patient impact. Task/process deficiencies were the most common contributory factor for MREs. MRE occurrence was correlated with increased total task volume. MREs also correlated with increased workload, especially during night shifts. Most of these MREs would not be captured by traditional event reporting systems. Facilitated MRE reporting provides a robust information source about potential breakdowns in medication management safety and opportunities for system improvement.

  7. Using lean to improve medication administration safety: in search of the "perfect dose".

    PubMed

    Ching, Joan M; Long, Christina; Williams, Barbara L; Blackmore, C Craig

    2013-05-01

    At Virginia Mason Medical Center (Seattle), the Collaborative Alliance for Nursing Outcomes (CALNOC) Medication Administration Accuracy Quality Study was used in combination with Lean quality improvement efforts to address medication administration safety. Lean interventions were targeted at improving the medication room layout, applying visual controls, and implementing nursing standard work. The interventions were designed to prevent medication administration errors through improving six safe practices: (1) comparing medication with medication administration record, (2) labeling medication, (3) checking two forms of patient identification, (4) explaining medication to patient, (5) charting medication immediately, and (6) protecting the process from distractions/interruptions. Trained nurse auditors observed 9,244 doses for 2,139 patients. Following the intervention, the number of safe-practice violations decreased from 83 violations/100 doses at baseline (January 2010-March 2010) to 42 violations/100 doses at final follow-up (July 2011-September 2011), resulting in an absolute risk reduction of 42 violations/100 doses (95% confidence interval [CI]: 35-48), p < .001). The number of medication administration errors decreased from 10.3 errors/100 doses at baseline to 2.8 errors/100 doses at final follow-up (absolute risk reduction: 7 violations/100 doses [95% CI: 5-10, p < .001]). The "perfect dose" score, reflecting compliance with all six safe practices and absence of any of the eight medication administration errors, improved from 37 in compliance/100 doses at baseline to 68 in compliance/100 doses at the final follow-up. Lean process improvements coupled with direct observation can contribute to substantial decreases in errors in nursing medication administration.

  8. Curricular framework: core competencies in multicultural geriatric care.

    PubMed

    Xakellis, George; Brangman, Sharon A; Hinton, W Ladson; Jones, Vida Y; Masterman, Donna; Pan, Cynthia X; Rivero, Jorge; Wallhagen, Margaret; Yeo, Gwen

    2004-01-01

    Strategies to reduce the documented disparities in health and health care for the rapidly growing numbers of older patients from diverse ethnic populations include increased cultural competence of providers. To assist geriatric faculty in medical and other health professional schools develop cultural competence training for their ethnogeriatric programs, the University of California Academic Geriatric Resource Program partnered with the Ethnogeriatric Committee of the American Geriatrics Society to develop a curricular framework. The framework includes core competencies based on the format of the Core Competencies for the Care of Older Patients developed by the Education Committee of the American Geriatrics Society. Competencies in attitudes, knowledge, and skills for medical providers caring for elders from diverse populations are specified. Also included are recommended teaching strategies and resources for faculty to pursue the development of full curricula.

  9. Teaching Performance Improvement: An Opportunity for Continuing Medical Education

    ERIC Educational Resources Information Center

    Staker, Larry V.

    2003-01-01

    Practicing physicians generally are not engaged in either the methods of performance improvement for health care or the measurement and reporting of clinical outcomes. The principal reasons are lack of compensation for such work, the perception that the work of performance improvement adds no value and is a waste of time, the lack of knowledge and…

  10. Teaching Performance Improvement: An Opportunity for Continuing Medical Education

    ERIC Educational Resources Information Center

    Staker, Larry V.

    2003-01-01

    Practicing physicians generally are not engaged in either the methods of performance improvement for health care or the measurement and reporting of clinical outcomes. The principal reasons are lack of compensation for such work, the perception that the work of performance improvement adds no value and is a waste of time, the lack of knowledge and…

  11. Scientism in Medical Education and the Improvement of Medical Care: Opioids, Competencies, and Social Accountability.

    PubMed

    Reid, Lynette

    2017-10-06

    Scientism in medical education distracts educators from focusing on the content of learning; it focuses attention instead on individual achievement and validity in its measurement. I analyze the specific form that scientism takes in medicine and in medical education. The competencies movement attempts to challenge old "scientistic" views of the role of physicians, but in the end it has invited medical educators to focus on validity in the measurement of individual performance for attitudes and skills that medicine resists conceptualizing as objective. Academic medicine should focus its efforts instead on quality and relevance of care. The social accountability movement proposes to shift the focus of academic medicine to the goal of high quality and relevant care in the context of community service and partnership with the institutions that together with medicine create and cope with health and with health deficits. I make the case for this agenda through a discussion of the linked histories of the opioid prescribing crisis and the professionalism movement.

  12. Can improved prescription medication labeling influence adherence to chronic medications? An evaluation of the Target pharmacy label.

    PubMed

    Shrank, William H; Gleason, Patrick P; Canning, Claire; Walters, Carol; Heaton, Alan H; Jan, Saira; Patrick, Amanda; Brookhart, M Alan; Schneeweiss, Sebastian; Solomon, Daniel H; Avorn, Jerry; Choudhry, Niteesh K

    2009-05-01

    Prescription medication labels contain valuable health information, and better labels may enhance patient adherence to chronic medications. A new prescription medication labeling system was implemented by Target pharmacies in May 2005 and aimed to improve readability and understanding. We evaluated whether the new Target label influenced patient medication adherence. Using claims from two large health plans, we identified patients with one of nine chronic diseases who filled prescriptions at Target pharmacies and a matched sample who filled prescriptions at other community pharmacies. We stratified our cohort into new and prevalent medication users and evaluated the impact of the Target label on medication adherence. We used linear regression and segmented linear regression to evaluate the new-user and prevalent-user analyses, respectively. Our sample included 23,745 Target users and 162,368 matched non-Target pharmacy users. We found no significant change in adherence between new users of medications at Target or other community pharmacies (p = 0.644) after implementing the new label. In prevalent users, we found a 0.0069 percent reduction in level of adherence (95% CI -0.0138-0.0; p < 0.001) and a 0.0007 percent increase in the slope in Target users (the monthly rate of change of adherence) after implementation of the new label (95% CI 0.0001-0.0013; p = 0.001). We found no changes in adherence of chronic medication in new users, and small and likely clinically unimportant changes in prevalent users after implementation of the new label. While adherence may not be improved with better labeling, evaluation of the effect of labeling on safety and adverse effects is needed.

  13. Internet supply ordering. Helping medical group practices improve business operations.

    PubMed

    Mayer, D

    2000-01-01

    Technology has opened the door to a new world of management tools in the physician practice environment. Productivity aids on the Web promise to alter forever the way we do everything--from interacting with vendors to caring for patients. Online medical, surgical and pharmaceutical supply acquisition sites, for example, already offer more efficient alternatives to phone and fax ordering, back-order challenges and supply cost monitoring. Not all sites are the same, however, and physicians and practice administrators must compare and contrast their needs with site offerings.

  14. The Effect of Cross-Curricular Instruction on Reading Comprehension

    ERIC Educational Resources Information Center

    Aslan, Yasin

    2016-01-01

    Cross-curricular objectives serve as a kind of "safety net" for core objectives. Firstly, cross-curricular objectives refer to competencies that do not pertain to the content of one or more subjects, but that can be taught, practised and applied in it, such as learning to learn and social skills. Secondly, certain cross-curricular final…

  15. Staff Conceptions of Curricular and Extracurricular Activities in Higher Education

    ERIC Educational Resources Information Center

    Clegg, Sue; Stevenson, Jacqueline; Willott, John

    2010-01-01

    This paper explores conceptions of curricular and extracurricular in UK higher education. Reporting on a case study of staff understandings of the extracurricular we argue that our data highlight the lack of debate about curricular matters. We found that there was considerable blurring of boundaries in conceptions of the curricular and…

  16. Teacher Fidelity to One Physical Education Curricular Model

    ERIC Educational Resources Information Center

    Kloeppel, Tiffany; Kulinna, Pamela Hodges; Stylianou, Michalis; van der Mars, Hans

    2013-01-01

    This study addressed teachers' fidelity to one Physical Education curricular model. The theoretical framework guiding this study included professional development and fidelity to curricular models. In this study, teachers' fidelity to the Dynamic Physical Education (DPE) curricular model was measured for high and nonsupport district groups.…

  17. Teacher Fidelity to One Physical Education Curricular Model

    ERIC Educational Resources Information Center

    Kloeppel, Tiffany; Kulinna, Pamela Hodges; Stylianou, Michalis; van der Mars, Hans

    2013-01-01

    This study addressed teachers' fidelity to one Physical Education curricular model. The theoretical framework guiding this study included professional development and fidelity to curricular models. In this study, teachers' fidelity to the Dynamic Physical Education (DPE) curricular model was measured for high and nonsupport district groups.…

  18. Improved elastic medical image registration using mutual information

    NASA Astrophysics Data System (ADS)

    Ens, Konstantin; Schumacher, Hanno; Franz, Astrid; Fischer, Bernd

    2007-03-01

    One of the future-oriented areas of medical image processing is to develop fast and exact algorithms for image registration. By joining multi-modal images we are able to compensate the disadvantages of one imaging modality with the advantages of another modality. For instance, a Computed Tomography (CT) image containing the anatomy can be combined with metabolic information of a Positron Emission Tomography (PET) image. It is quite conceivable that a patient will not have the same position in both imaging systems. Furthermore some regions for instance in the abdomen can vary in shape and position due to different filling of the rectum. So a multi-modal image registration is needed to calculate a deformation field for one image in order to maximize the similarity between the two images, described by a so-called distance measure. In this work, we present a method to adapt a multi-modal distance measure, here mutual information (MI), with weighting masks. These masks are used to enhance relevant image structures and suppress image regions which otherwise would disturb the registration process. The performance of our method is tested on phantom data and real medical images.

  19. Improved cosine similarity measures of simplified neutrosophic sets for medical diagnoses.

    PubMed

    Ye, Jun

    2015-03-01

    In pattern recognition and medical diagnosis, similarity measure is an important mathematical tool. To overcome some disadvantages of existing cosine similarity measures of simplified neutrosophic sets (SNSs) in vector space, this paper proposed improved cosine similarity measures of SNSs based on cosine function, including single valued neutrosophic cosine similarity measures and interval neutrosophic cosine similarity measures. Then, weighted cosine similarity measures of SNSs were introduced by taking into account the importance of each element. Further, a medical diagnosis method using the improved cosine similarity measures was proposed to solve medical diagnosis problems with simplified neutrosophic information. The improved cosine similarity measures between SNSs were introduced based on cosine function. Then, we compared the improved cosine similarity measures of SNSs with existing cosine similarity measures of SNSs by numerical examples to demonstrate their effectiveness and rationality for overcoming some shortcomings of existing cosine similarity measures of SNSs in some cases. In the medical diagnosis method, we can find a proper diagnosis by the cosine similarity measures between the symptoms and considered diseases which are represented by SNSs. Then, the medical diagnosis method based on the improved cosine similarity measures was applied to two medical diagnosis problems to show the applications and effectiveness of the proposed method. Two numerical examples all demonstrated that the improved cosine similarity measures of SNSs based on the cosine function can overcome the shortcomings of the existing cosine similarity measures between two vectors in some cases. By two medical diagnoses problems, the medical diagnoses using various similarity measures of SNSs indicated the identical diagnosis results and demonstrated the effectiveness and rationality of the diagnosis method proposed in this paper. The improved cosine measures of SNSs based on cosine

  20. Electronic medical records as tools for quality improvement in ambulatory practice: theory and a case study.

    PubMed

    Ornstein, S M; Jenkins, R G; MacFarlane, L; Glaser, A; Snyder, K; Gundrum, T

    1998-11-01

    Information management is critical in today's health care environment. Traditional paper-based medical records are inadequate information management tools. Electronic medical records (EMRs) overcome many problems with paper records and are ideally suited to help physicians increase productivity and improve the quality of care they provide. The Department of Family Medicine at the Medical University of South Carolina uses the Practice Partner Patient Record EMR system. Department members have developed a quality improvement model based on this EMR system. The model has been used to improve care for acute bronchitis, diabetes mellitus, tobacco abuse, asthma, and postmenopausal osteoporosis.

  1. How to improve the performance of a good medical practice team: twelve techniques.

    PubMed

    Hills, Laura

    2013-01-01

    It is incredibly easy to ignore the medical practice team that is doing a good job. However, when we allow good performers to continue as they are, they probably won't improve. Their performance may even worsen. This is unfortunate because with a little bit of effort and support, good performers can often learn to excel. This article offers 12 techniques medical practice managers can use to bring their team members from good performance to excellent. It describes how to use goal-setting, work assignments, modeling, confidence building, team retreats, rewards, incentives, and reinforcement to ratchet up a good medical practice team's performance. This article also identifies the signs of medical employee mediocrity. It describes why setting higher expectations of your medical practice employees will ultimately improve their performance. Finally, this article suggests 10 practical and affordable strategies that medical practice managers can use to reinforce excellent performance in their good employees.

  2. [Perspectives of improvement of the medical service of the Armed Forces of Russian Federation].

    PubMed

    Shappo, V V

    2008-08-01

    The article presents the data concerned the creation of perspective image of the medical service of the Armed Forces of Russian Federation for the term up to 2016 year. Particularly, it's planed to optimize structure and staff of the medical service on the base of territorial principle of medical provision, exchange some military posts for civil ones, improve the financial system and system of material stimulation of work, engrain a double level of administration. It is in store to modernize the system of military-medical education, review the organization and establishment of military hospitals, break up medical stores, and on theirs account create centers of providing by medcial techniques and properties, to form mobile-technical centers, improve the administration of sanatorium-resort maintenance. The military unit of military medicine was defined as the foreground direction of reforming of medical service.

  3. Checklist clerking document improves health promotion among medical admissions

    PubMed Central

    Cousins, Sarah

    2013-01-01

    Health promotion, as defined by the Ottawa Charter (1) is the ‘process of enabling people to increase control over, and to improve their health’. Four life style risk factors: smoking, alcohol, obesity and physical activity are recognised as leading to health inequalities. These factors have implications at an individual, community and national level and the burden of disease has large cost implications for the NHS and country as a whole. Therefore the assessment of these risk factors, and the provision of good health promotion assist to address these problems. A pilot and initial audit demonstrated that assessment for the key life style risk factors and the provision of health promotion was poor. This quality improvement audit developed an easy to use, checklist based, amended clerking document. This improved both assessment and provision of health promotion and will be carried forward to influence the designing of a new clerking document. PMID:26734175

  4. Postinsertion central line site care: quality improvement in a medical cardiac ICU.

    PubMed

    Hickox, Benjamin C

    2015-01-01

    Using the Six Sigma quality improvement framework of Define, Measure, Analyze, Improve, and Control, nurses in the medical cardiac intensive care unit at a large academic medical center in the Midwest identified a gap in the quality of central line site care, evaluated the current state of site care, implemented an intervention to create an improvement in nursing performance of site care, quantified this improvement, and created a model for sustained quality control. Reasons for nonocclusive dressings were revealed and addressed. An unexpected benefit was found in a unifying sense of pride in improving patient care.

  5. High-fidelity medical simulation training improves medical students' knowledge and confidence levels in septic shock resuscitation.

    PubMed

    Vattanavanit, Veerapong; Kawla-Ied, Jarernporn; Bhurayanontachai, Rungsun

    2017-01-01

    Septic shock resuscitation bundles have poor compliance worldwide partly due to a lack of knowledge and clinical skills. High-fidelity simulation-based training is a new teaching technology in our faculty which may improve the performance of medical students in the resuscitation process. However, since the efficacy of this training method in our institute is limited, we organized an extra class for this evaluation. The aim was to evaluate the effect on medical students' knowledge and confidence levels after the high-fidelity medical simulation training in septic shock management. A retrospective study was performed in sixth year medical students during an internal medicine rotation between November 2015 and March 2016. The simulation class was a 2-hour session of a septic shock management scenario and post-training debriefing. Knowledge assessment was determined by a five-question pre-test and post-test examination. At the end of the class, the students completed their confidence evaluation questionnaire. Of the 79 medical students, the mean percentage score ± standard deviation (SD) of the post-test examination was statistically significantly higher than the pre-test (66.83%±19.7% vs 47.59%±19.7%, p<0.001). In addition, the student mean percentage confidence level ± SD in management of septic shock was significantly better after the simulation class (68.10%±12.2% vs 51.64%±13.1%, p<0.001). They also strongly suggested applying this simulation class to the current curriculum. High-fidelity medical simulation improved the students' knowledge and confidence in septic shock resuscitation. This simulation class should be included in the curriculum of the sixth year medical students in our institute.

  6. High-fidelity medical simulation training improves medical students’ knowledge and confidence levels in septic shock resuscitation

    PubMed Central

    Vattanavanit, Veerapong; Kawla-ied, Jarernporn; Bhurayanontachai, Rungsun

    2017-01-01

    Background Septic shock resuscitation bundles have poor compliance worldwide partly due to a lack of knowledge and clinical skills. High-fidelity simulation-based training is a new teaching technology in our faculty which may improve the performance of medical students in the resuscitation process. However, since the efficacy of this training method in our institute is limited, we organized an extra class for this evaluation. Purpose The aim was to evaluate the effect on medical students’ knowledge and confidence levels after the high-fidelity medical simulation training in septic shock management. Methods A retrospective study was performed in sixth year medical students during an internal medicine rotation between November 2015 and March 2016. The simulation class was a 2-hour session of a septic shock management scenario and post-training debriefing. Knowledge assessment was determined by a five-question pre-test and post-test examination. At the end of the class, the students completed their confidence evaluation questionnaire. Results Of the 79 medical students, the mean percentage score ± standard deviation (SD) of the post-test examination was statistically significantly higher than the pre-test (66.83%±19.7% vs 47.59%±19.7%, p<0.001). In addition, the student mean percentage confidence level ± SD in management of septic shock was significantly better after the simulation class (68.10%±12.2% vs 51.64%±13.1%, p<0.001). They also strongly suggested applying this simulation class to the current curriculum. Conclusion High-fidelity medical simulation improved the students’ knowledge and confidence in septic shock resuscitation. This simulation class should be included in the curriculum of the sixth year medical students in our institute. PMID:28053558

  7. Systematic Review of Educational Interventions to Improve Glaucoma Medication Adherence: an update in 2015

    PubMed Central

    Newman-Casey, Paula Anne; Dayno, Megan; Robin, Alan L.

    2016-01-01

    Purpose To evaluate the current state of the research on educational interventions whose aim is to improve glaucoma medication adherence. Methods A systematic review of Pubmed, Embase and CINAHL was conducted to identify research studies evaluating educational interventions to improve glaucoma medication adherence. Studies were included if the intervention was described, the outcomes assessed glaucoma medication adherence, and the focus of the research was on adults with glaucoma. The search was conducted on June 2, 2015. Results Seventeen studies were identified that met the inclusion criteria. These included nine randomized controlled trials and eight observational studies. Eight of the studies demonstrated an impact on glaucoma medication adherence, though their outcome measures were too heterogeneous to estimate a pooled effect size.. Conclusion The interventions that successfully improved glaucoma medication adherence used an adequate dose of face-to-face counseling to overcome barriers to health behavior change alongside education about glaucoma. PMID:27134639

  8. Increasing Medicare part D enrollment in medication therapy management could improve health and lower costs.

    PubMed

    Stuart, Bruce; Loh, F Ellen; Roberto, Pamela; Miller, Laura M

    2013-07-01

    Targeting efforts to improve medication adherence, especially among people with high health needs, can improve health and lower health care spending. To this end, Medicare requires that insurance plans that provide prescription drug (Part D) coverage offer specialized medication therapy management services to optimize medication use for enrollees with high drug costs, multiple chronic diseases, and multiple covered drugs. We analyzed a large random sample of Part D enrollees with diabetes, heart failure, and chronic obstructive pulmonary disease, to see whether poor adherence to recommended drugs was associated with higher Medicare costs. We found that beneficiaries with poor adherence had higher costs, ranging from $49 to $840 per month for patients with diabetes, for example. However, such beneficiaries were not uniformly more likely than others to be eligible for medication therapy management services. Aligning medication therapy management eligibility with a metric such as potentially preventable future costs holds promise for both improving the quality of care and reducing spending.

  9. Curricular Content for Pupils' Mental Health

    ERIC Educational Resources Information Center

    Ebadi, Seyed Hossein; Keshtiaray, Narges; Aghaei, Asghar; Yousefy, Alireza

    2016-01-01

    Present-day curricular designs have to take the pupils' psychological needs in account, thus becoming melodies of mental health and happiness for the next generation. Emphasizing the findings from previous investigations using the research synthesis methodology, the present study has been conducted aiming at achieving some integrative knowledge…

  10. Bridge Program: An Alternative Curricular Model

    ERIC Educational Resources Information Center

    George, Deborah A.

    2012-01-01

    With the motivation for career advancement, many adult learners have chosen to return to graduate education or professional programs. The bridge program is one relatively new alternative curricular model available for adult learners who wish to build on their education within their chosen profession. Evidence on the effectiveness of such programs…

  11. Life Science, Grade 7. Curricular Guide.

    ERIC Educational Resources Information Center

    York County School District 3, Rock Hill, SC.

    This curricular guide focuses on life science and is designed for use with seventh grade students. Life science was chosen as the course of study based on the rationale that, as pupils enter junior high school, they are in early adolescence and find it difficult to understand themselves so that the study of living things with a thorough…

  12. Curricular Guidelines for Dental Auxiliary Radiology.

    ERIC Educational Resources Information Center

    Journal of Dental Education, 1981

    1981-01-01

    AADS curricular guidelines suggest objectives for these areas of dental auxiliary radiology: physical principles of X-radiation in dentistry, related radiobiological concepts, principles of radiologic health, radiographic technique, x-ray films and intensifying screens, factors contributing to film quality, darkroom, and normal variations in…

  13. Co-Curricular Assessment Scale Development

    ERIC Educational Resources Information Center

    Feldmann, Matthew; Aper, Jeffery P.; Meredith, Sam T.

    2011-01-01

    This article discusses the development of a scale informed by the construct of emotional intelligence designed to measure student development outcomes identified as co-curricular goals. Supervisors, staff, and coaches provided firsthand accounts of student development outcomes at a small, private, liberal arts work college, generating data on…

  14. Curricular Guidelines for Dental Auxiliary Radiology.

    ERIC Educational Resources Information Center

    Journal of Dental Education, 1981

    1981-01-01

    AADS curricular guidelines suggest objectives for these areas of dental auxiliary radiology: physical principles of X-radiation in dentistry, related radiobiological concepts, principles of radiologic health, radiographic technique, x-ray films and intensifying screens, factors contributing to film quality, darkroom, and normal variations in…

  15. A Total Curricular Approach to Environmental Education

    ERIC Educational Resources Information Center

    Jinks, Jerry L.

    1975-01-01

    Presented is an environmental education model based on an interdisciplinary curricular structure. The model consists of three two-dimensional matrices organizing objectives, strategies, and content. Each matrix lists environmental concepts along one axis and the disciplines along the other. One interpretation of the model is presented as a…

  16. Bridge Program: An Alternative Curricular Model

    ERIC Educational Resources Information Center

    George, Deborah A.

    2012-01-01

    With the motivation for career advancement, many adult learners have chosen to return to graduate education or professional programs. The bridge program is one relatively new alternative curricular model available for adult learners who wish to build on their education within their chosen profession. Evidence on the effectiveness of such programs…

  17. Advancing medical-surgical nursing practice: improving management of the changing patient condition.

    PubMed

    Monroe, Heidi; Plylar, Peggy; Krugman, Mary

    2014-01-01

    Higher patient acuities and more novice nurses on medical-surgical units have Educators focused on achieving positive outcomes with changes in patient condition. An educational program was developed to enhance nurses' knowledge, skill, and confidence in assessing hemodynamics, recognizing early signs of instability, and administering vasoactive medications. The program was successful with significant knowledge improvement as well as an increased use of the Medical Emergency Team while maintaining a low number of code calls.

  18. [Medical practice and clinical research: keys to generate knowledge and improve care].

    PubMed

    Martínez Castuera-Gómez, Carla; Talavera, Juan O

    2013-01-01

    The increased quality in medical care may be immediately accomplished if clinical research is integrated into daily clinical practice. In the generation of medical knowledge are four steps: an unanswered question awakened from clinical practice, the critical analysis of specialized literature, the development of a research protocol, and, finally, the publication of outcomes. Decision making and continuous training are becoming part of an effective strategy of medical attention improvement.

  19. Rationale and design of the Multicenter Medication Reconciliation Quality Improvement Study (MARQUIS)

    PubMed Central

    2013-01-01

    Background Unresolved medication discrepancies during hospitalization can contribute to adverse drug events, resulting in patient harm. Discrepancies can be reduced by performing medication reconciliation; however, effective implementation of medication reconciliation has proven to be challenging. The goals of the Multi-Center Medication Reconciliation Quality Improvement Study (MARQUIS) are to operationalize best practices for inpatient medication reconciliation, test their effect on potentially harmful unintentional medication discrepancies, and understand barriers and facilitators of successful implementation. Methods Six U.S. hospitals are participating in this quality improvement mentored implementation study. Each hospital has collected baseline data on the primary outcome: the number of potentially harmful unintentional medication discrepancies per patient, as determined by a trained on-site pharmacist taking a “gold standard” medication history. With the guidance of their mentors, each site has also begun to implement one or more of 11 best practices to improve medication reconciliation. To understand the effect of the implemented interventions on hospital staff and culture, we are performing mixed methods program evaluation including surveys, interviews, and focus groups of front line staff and hospital leaders. Discussion At baseline the number of unintentional medication discrepancies in admission and discharge orders per patient varies by site from 2.35 to 4.67 (mean=3.35). Most discrepancies are due to history errors (mean 2.12 per patient) as opposed to reconciliation errors (mean 1.23 per patient). Potentially harmful medication discrepancies averages 0.45 per patient and varies by site from 0.13 to 0.82 per patient. We discuss several barriers to implementation encountered thus far. In the end, we anticipate that MARQUIS tools and lessons learned have the potential to decrease medication discrepancies and improve patient outcomes. Trial

  20. From Matterhorn to Mt Everest: empowering rescuers and improving medical care in Nepal.

    PubMed

    Maeder, Monika M Brodmann; Basnyat, Buddha; Harris, N Stuart

    2014-06-01

    This article describes a private initiative in which professional Swiss rescuers, based at the foot of the Matterhorn, trained Nepalese colleagues in advanced high altitude helicopter rescue and medical care techniques. What started as a limited program focused on mountain safety has rapidly developed into a comprehensive project to improve rescue and medical care in the Mt Everest area for both foreign travelers and the local Nepalese people. Copyright © 2014 Wilderness Medical Society. Published by Elsevier Inc. All rights reserved.

  1. Improving healthcare recruitment: the jupiter medical center experience.

    PubMed

    Uomo, Paul Dell; Schwieters, Jill

    2009-04-01

    Hospitals that want to improve their recruitment efforts should: Make recruitment a priority within the organization. Take steps to reduce high vacancy rates and turnover among first-year employees. Develop a recruitment marketing plan for key positions. Establish human resources metrics to track costs and effectiveness of recruiting efforts. Enhance the recruitment process for hiring managers and job candidates.

  2. An improved accrual: reducing medical malpractice year-end adjustments.

    PubMed

    Frese, Richard C

    2012-08-01

    Healthcare organizations can improve their year-end malpractice insurance accruals by taking the following steps: Maintain productive communication. Match accrual and accounting policies. Adjust amount of credit to own historical loss experience. Request more frequent analysis. Obtain a second opinion.

  3. An effective intervention to improve the cleanliness of medical lead clothes in an orthopedic specialized hospital.

    PubMed

    Chen, Lu; Xu, YingJun; Zhang, Fengxia; Yang, Qingfeng; Yuan, Juxiang

    2016-11-01

    Dirty medical lead clothes, contaminated with blood or other infected material, may carry ongoing bioburden, which increase the risk of hospital-acquired infection. In this study, we investigated medical lead clothes contamination levels and assessed the effectiveness of the intervention that was constructed to improve the cleanliness of lead clothes.

  4. Improving the Quality of Nursing Home Care and Medical-Record Accuracy with Direct Observational Technologies

    ERIC Educational Resources Information Center

    Schnelle, John F.; Osterweil, Dan; Simmons, Sandra F.

    2005-01-01

    Nursing home medical-record documentation of daily-care occurrence may be inaccurate, and information is not documented about important quality-of-life domains. The inadequacy of medical record data creates a barrier to improving care quality, because it supports an illusion of care consistent with regulations, which reduces the motivation and…

  5. [Actions for improvement of medical safety by all parties involved in healthcare].

    PubMed

    Miyamoto, Atsushi

    2003-01-01

    How to prevent medical adverse events and augment the public's confidence in healthcare has become an urgent and one of the highest-priority medical policy issues in Japan. All parties involved in healthcare, such as medical institutions, companies that sell medical supplies and devices, educational institutions, and medical societies, are asked to work together cooperatively in their respective roles to ensure medical safety. Medical institutions, as the facilities that actually provide healthcare, are responsible for improving the safety and reliability of medical treatment. They must do this through appropriate supervision of their organizations and maintenance of their systems under the sound leadership of their management, and they must tackle safety measures by improving their organizations. Medical societies are expected not only to make scientific contributions but also to collect and evaluate information on the risks in their specialties and disseminate the information widely to their members. The national government must clarify the short- and long-term goals for promoting medical safety. At the same time, it must maintain the appropriate environment and coordinate the involvement of concerned parties in the achievement of those goals.

  6. Podiatric Medical Education: A Review.

    ERIC Educational Resources Information Center

    Pollock, George P.

    1980-01-01

    The basic curricular structure and courses deemed necessary to podiatric medical education are outlined and their rationale explained. Specialties appropriate to podiatric practice, such as electrophysiology and cardiovascular physiology, are noted, and the sequence of coursework suggested. (MSE)

  7. Podiatric Medical Education: A Review.

    ERIC Educational Resources Information Center

    Pollock, George P.

    1980-01-01

    The basic curricular structure and courses deemed necessary to podiatric medical education are outlined and their rationale explained. Specialties appropriate to podiatric practice, such as electrophysiology and cardiovascular physiology, are noted, and the sequence of coursework suggested. (MSE)

  8. Recent Improvement of Medical Optical Fibre Pressure and Temperature Sensors

    PubMed Central

    Poeggel, Sven; Duraibabu, Dineshbabu; Kalli, Kyriacos; Leen, Gabriel; Dooly, Gerard; Lewis, Elfed; Kelly, Jimmy; Munroe, Maria

    2015-01-01

    This investigation describes a detailed analysis of the fabrication and testing of optical fibre pressure and temperature sensors (OFPTS). The optical sensor of this research is based on an extrinsic Fabry–Perot interferometer (EFPI) with integrated fibre Bragg grating (FBG) for simultaneous pressure and temperature measurements. The sensor is fabricated exclusively in glass and with a small diameter of 0.2 mm, making it suitable for volume-restricted bio-medical applications. Diaphragm shrinking techniques based on polishing, hydrofluoric (HF) acid and femtosecond (FS) laser micro-machining are described and analysed. The presented sensors were examined carefully and demonstrated a pressure sensitivity in the range of sp = 2–10 nmkPa and a resolution of better than ΔP = 10 Pa (0.1 cm H2O). A static pressure test in 38 cmH2O shows no drift of the sensor in a six-day period. Additionally, a dynamic pressure analysis demonstrated that the OFPTS never exceeded a drift of more than 130 Pa (1.3 cm H2O) in a 12-h measurement, carried out in a cardiovascular simulator. The temperature sensitivity is given by k=10.7 pmK, which results in a temperature resolution of better than ΔT = 0.1 K. Since the temperature sensing element is placed close to the pressure sensing element, the pressure sensor is insensitive to temperature changes. PMID:26184331

  9. Recent Improvement of Medical Optical Fibre Pressure and Temperature Sensors.

    PubMed

    Poeggel, Sven; Duraibabu, Dineshbabu; Kalli, Kyriacos; Leen, Gabriel; Dooly, Gerard; Lewis, Elfed; Kelly, Jimmy; Munroe, Maria

    2015-07-13

    This investigation describes a detailed analysis of the fabrication and testing of optical fibre pressure and temperature sensors (OFPTS). The optical sensor of this research is based on an extrinsic Fabry-Perot interferometer (EFPI) with integrated fibre Bragg grating (FBG) for simultaneous pressure and temperature measurements. The sensor is fabricated exclusively in glass and with a small diameter of 0.2 mm, making it suitable for volume-restricted bio-medical applications. Diaphragm shrinking techniques based on polishing, hydrofluoric (HF) acid and femtosecond (FS) laser micro-machining are described and analysed. The presented sensors were examined carefully and demonstrated a pressure sensitivity in the range of sp = 2-10 nm/kPa and a resolution of better than ΔP = 10 Pa protect (0.1 cm H2O). A static pressure test in 38 cm H2O shows no drift of the sensor in a six-day period. Additionally, a dynamic pressure analysis demonstrated that the OFPTS never exceeded a drift of more than 130 Pa (1.3 cm H2O) in a 12-h measurement, carried out in a cardiovascular simulator. The temperature sensitivity is given by k = 10.7 pm/K, which results in a temperature resolution of better than ΔT = 0.1 K. Since the temperature sensing element is placed close to the pressure sensing element, the pressure sensor is insensitive to temperature changes.

  10. A multi-institutional medical educational collaborative: advocacy training in California pediatric residency programs.

    PubMed

    Chamberlain, Lisa J; Wu, Susan; Lewis, Gena; Graff, Nancy; Javier, Joyce R; Park, Joseph S R; Johnson, Christine L; Woods, Steven D; Patel, Mona; Wong, Daphne; Blaschke, Gregory S; Lerner, Marc; Kuo, Anda K

    2013-03-01

    Educational collaboratives offer a promising approach to disseminate educational resources and provide faculty development to advance residents' training, especially in areas of novel curricular content; however, their impact has not been clearly described. Advocacy training is a recently mandated requirement of the Accreditation Council for Graduate Medical Education that many programs struggle to meet.The authors describe the formation (in 2007) and impact (from 2008 to 2010) of 13 California pediatric residency programs working in an educational collaboration ("the Collaborative") to improve advocacy training. The Collaborative defined an overarching mission, assessed the needs of the programs, and mapped their strengths. The infrastructure required to build the collaboration among programs included a social networking site, frequent conference calls, and face-to-face semiannual meetings. An evaluation of the Collaborative's activities showed that programs demonstrated increased uptake of curricular components and an increase in advocacy activities. The themes extracted from semistructured interviews of lead faculty at each program revealed that the Collaborative (1) reduced faculty isolation, increased motivation, and strengthened faculty academic development, (2) enhanced identification of curricular areas of weakness and provided curricular development from new resources, (3) helped to address barriers of limited resident time and program resources, and (4) sustained the Collaborative's impact even after formal funding of the program had ceased through curricular enhancement, the need for further resources, and a shared desire to expand the collaborative network.

  11. A quality improvement study using fishbone analysis and an electronic medical records intervention to improve care for children with asthma.

    PubMed

    Gold, Jonathan; Reyes-Gastelum, David; Turner, Jane; Davies, H Dele

    2014-01-01

    Despite expert guidelines, gaps persist in quality of care for children with asthma. This study sought to identify barriers and potential interventions to improve compliance to national asthma prevention guidelines at a single academic pediatric primary care clinic. Using the plan-do-check-act (PDCA) quality improvement framework and fishbone analysis, several barriers to consistent asthma processes and possible interventions were identified by a group of key stakeholders. Two interventions were implemented using the electronic medical record (EMR). Physician documentation of asthma quality measures were analyzed before intervention and during 2 subsequent time points over 16 months. Documentation of asthma action plans (core group P < .001, noncore group P = .004) and medication counseling (core group P < .001, noncore group P < .001) improved substantially by the third time point. A systematic approach to quality improvement using PDCA and fishbone analysis in conjunction with embedded EMR tools can improve asthma care in a pediatric primary care setting.

  12. Improving the Effectiveness of Medication Review: Guidance from the Health Literacy Universal Precautions Toolkit.

    PubMed

    Weiss, Barry D; Brega, Angela G; LeBlanc, William G; Mabachi, Natabhona M; Barnard, Juliana; Albright, Karen; Cifuentes, Maribel; Brach, Cindy; West, David R

    2016-01-01

    Although routine medication reviews in primary care practice are recommended to identify drug therapy problems, it is often difficult to get patients to bring all their medications to office visits. The objective of this study was to determine whether the medication review tool in the Agency for Healthcare Research and Quality Health Literacy Universal Precautions Toolkit can help to improve medication reviews in primary care practices. The toolkit's "Brown Bag Medication Review" was implemented in a rural private practice in Missouri and an urban teaching practice in California. Practices recorded outcomes of medication reviews with 45 patients before toolkit implementation and then changed their medication review processes based on guidance in the toolkit. Six months later we conducted interviews with practice staff to identify changes made as a result of implementing the tool, and practices recorded outcomes of medication reviews with 41 additional patients. Data analyses compared differences in whether all medications were brought to visits, the number of medications reviewed, drug therapy problems identified, and changes in medication regimens before and after implementation. Interviews revealed that practices made the changes recommended in the toolkit to encourage patients to bring medications to office visits. Evaluation before and after implementation revealed a 3-fold increase in the percentage of patients who brought all their prescription medications and a 6-fold increase in the number of prescription medications brought to office visits. The percentage of reviews in which drug therapy problems were identified doubled, as did the percentage of medication regimens revised. Use of the Health Literacy Universal Precautions Toolkit can help to identify drug therapy problems. © Copyright 2016 by the American Board of Family Medicine.

  13. Improving the Effectiveness of Medication Review: Guidance from the Health Literacy Universal Precautions Toolkit

    PubMed Central

    Weiss, Barry D.; Brega, Angela G.; LeBlanc, William G.; Mabachi, Natabhona M.; Barnard, Juliana; Albright, Karen; Cifuentes, Maribel; Brach, Cindy; West, David R.

    2016-01-01

    Background Although routine medication reviews in primary care practice are recommended to identify drug therapy problems, it is often difficult to get patients to bring all their medications to office visits. The objective of this study was to determine whether the medication review tool in the Agency for Healthcare Research and Quality Health Literacy Universal Precautions Toolkit can help to improve medication reviews in primary care practices. Methods The toolkit's “Brown Bag Medication Review” was implemented in a rural private practice in Missouri and an urban teaching practice in California. Practices recorded outcomes of medication reviews with 45 patients before toolkit implementation and then changed their medication review processes based on guidance in the toolkit. Six months later we conducted interviews with practice staff to identify changes made as a result of implementing the tool, and practices recorded outcomes of medication reviews with 41 additional patients. Data analyses compared differences in whether all medications were brought to visits, the number of medications reviewed, drug therapy problems identified, and changes in medication regimens before and after implementation. Results Interviews revealed that practices made the changes recommended in the toolkit to encourage patients to bring medications to office visits. Evaluation before and after implementation revealed a 3-fold increase in the percentage of patients who brought all their prescription medications and a 6-fold increase in the number of prescription medications brought to office visits. The percentage of reviews in which drug therapy problems were identified doubled, as did the percentage of medication regimens revised. Conclusions Use of the Health Literacy Universal Precautions Toolkit can help to identify drug therapy problems. PMID:26769873

  14. Mechanical ventilation weaning protocol improves medical adherence and results.

    PubMed

    Borges, Luís Guilherme Alegretti; Savi, Augusto; Teixeira, Cassiano; de Oliveira, Roselaine Pinheiro; De Camillis, Marcio Luiz Ferreira; Wickert, Ricardo; Brodt, Sérgio Fernando Monteiro; Tonietto, Túlio Frederico; Cremonese, Ricardo; da Silva, Leonardo Silveira; Gehm, Fernanda; Oliveira, Eubrando Silvestre; Barth, Jose Herve Diel; Macari, Juçara Gasparetto; de Barros, Cíntia Dias; Vieira, Sílvia Regina Rios

    2017-10-01

    Implementation of a weaning protocol is related to better patient prognosis. However, new approaches may take several years to become the standard of care in daily practice. We conducted a prospective cohort study to investigate the effectiveness of a multifaceted strategy to implement a protocol to wean patients from mechanical ventilation (MV) and to evaluate the weaning success rate as well as practitioner adherence to the protocol. We investigated all consecutive MV-dependent subjects admitted to a medical-surgical intensive care unit (ICU) for >24h over 7years. The multifaceted strategy consisted of continuing education of attending physicians and ICU staff and regular feedback regarding patient outcomes. The study was conducted in three phases: protocol development, protocol and multifaceted strategy implementation, and protocol monitoring. Data regarding weaning outcomes and physician adherence to the weaning protocol were collected during all phases. We enrolled 2469 subjects over 7years, with 1,943 subjects (78.7%) experiencing weaning success. Physician adherence to the protocol increased during the years of protocol and multifaceted strategy implementation (from 38% to 86%, p<0.01) and decreased in the protocol monitoring phase (from 73.9% to 50.0%, p<0.01). However, during the study years, the weaning success of all subjects increased (from 73.1% to 85.4%, p<0.001). When the weaning protocol was evaluated step-by-step, we found high adherence for noninvasive ventilation use (95%) and weaning predictor measurement (91%) and lower adherence for control of fluid balance (57%) and daily interruption of sedation (24%). Weaning success was higher in patients who had undergone the weaning protocol compared to those who had undergone weaning based in clinical practice (85.6% vs. 67.7%, p<0.001). A multifaceted strategy consisting of continuing education and regular feedback can increase physician adherence to a weaning protocol for mechanical ventilation

  15. Does applying technology throughout the medication use process improve patient safety with antineoplastics?

    PubMed

    Bubalo, Joseph; Warden, Bruce A; Wiegel, Joshua J; Nishida, Tess; Handel, Evelyn; Svoboda, Leanne M; Nguyen, Lam; Edillo, P Neil

    2014-12-01

    Medical errors, in particular medication errors, continue to be a troublesome factor in the delivery of safe and effective patient care. Antineoplastic agents represent a group of medications highly susceptible to medication errors due to their complex regimens and narrow therapeutic indices. As the majority of these medication errors are frequently associated with breakdowns in poorly defined systems, developing technologies and evolving workflows seem to be a logical approach to provide added safeguards against medication errors. This article will review both the pros and cons of today's technologies and their ability to simplify the medication use process, reduce medication errors, improve documentation, improve healthcare costs and increase provider efficiency as relates to the use of antineoplastic therapy throughout the medication use process. Several technologies, mainly computerized provider order entry (CPOE), barcode medication administration (BCMA), smart pumps, electronic medication administration record (eMAR), and telepharmacy, have been well described and proven to reduce medication errors, improve adherence to quality metrics, and/or improve healthcare costs in a broad scope of patients. The utilization of these technologies during antineoplastic therapy is weak at best and lacking for most. Specific to the antineoplastic medication use system, the only technology with data to adequately support a claim of reduced medication errors is CPOE. In addition to the benefits these technologies can provide, it is also important to recognize their potential to induce new types of errors and inefficiencies which can negatively impact patient care. The utilization of technology reduces but does not eliminate the potential for error. The evidence base to support technology in preventing medication errors is limited in general but even more deficient in the realm of antineoplastic therapy. Though CPOE has the best evidence to support its use in the

  16. "Teachosaurus" and "Learnoceratops": Dinosaurs as a Motivating Cross-Curricular Theme

    ERIC Educational Resources Information Center

    Duggan, Denis

    2011-01-01

    The author takes a look into the benefits that dinosaurs may bring to the classroom. He discusses how he used dinosaurs as a cross-curricular theme to improve children's understanding and knowledge of science concepts. To investigate what a child might learn from dinosaurs, he started by comparing the many non-fiction dinosaur books using the…

  17. "Teachosaurus" and "Learnoceratops": Dinosaurs as a Motivating Cross-Curricular Theme

    ERIC Educational Resources Information Center

    Duggan, Denis

    2011-01-01

    The author takes a look into the benefits that dinosaurs may bring to the classroom. He discusses how he used dinosaurs as a cross-curricular theme to improve children's understanding and knowledge of science concepts. To investigate what a child might learn from dinosaurs, he started by comparing the many non-fiction dinosaur books using the…

  18. Curricular Impact of College Level Skills Assessments. AIR 1988 Annual Forum Paper.

    ERIC Educational Resources Information Center

    Coleman, Daniel R.; Bolte, John R.

    The quest for excellence in American higher education has been accompanied by the implementation of basic skills requirements and the corresponding assessment programs. Assessment results could provide feedback for curricular improvement, although they are frequently used as indicators of institutional quality. A study is presented that compared…

  19. World Cultures: A Theme Guide to K-12 Curricular Resources, Activities, and Processes.

    ERIC Educational Resources Information Center

    Stanford Univ., CA. Stanford Program on International and Cross Cultural Education.

    This guide is for educators who wish to improve existing curricular frameworks for teaching about world cultures. The guide is anchored by six goal statements for student learning: (1) to begin to understand that cultures are complex and are made up of many components (values, behavior, habitat, aesthetics, etc.); (2) to recognize the part…

  20. [The role and place of pathology services in ensuring and improving the quality of medical care: Organizational and legal aspects].

    PubMed

    Timofeev, I V

    2015-01-01

    The paper considers the legal and organizational issues of the activity of pathology services in improving medical care. It shows the main (diagnostic and medico-organizational) areas of pathology work to improve the quality of medical care.

  1. Use-related risk analysis for medical devices based on improved FMEA.

    PubMed

    Liu, Long; Shuai, Ma; Wang, Zhu; Li, Ping

    2012-01-01

    In order to effectively analyze and control use-related risk of medical devices, quantitative methodologies must be applied. Failure Mode and Effects Analysis (FMEA) is a proactive technique for error detection and risk reduction. In this article, an improved FMEA based on Fuzzy Mathematics and Grey Relational Theory is developed to better carry out user-related risk analysis for medical devices. As an example, the analysis process using this improved FMEA method for a certain medical device (C-arm X-ray machine) is described.

  2. Medication Harmony: A Framework to Save Time, Improve Accuracy and Increase Patient Activation.

    PubMed

    Pandolfe, Frank; Crotty, Bradley H; Safran, Charles

    2016-01-01

    Incompletely reconciled medication lists contribute to prescribing errors and adverse drug events. Providers expend time and effort at every point of patient contact attempting to curate a best possible medication list, and yet often the list is incomplete or inaccurate. We propose a framework that builds upon the existing infrastructure of a health information exchange (HIE), centralizes data and encourages patient activation. The solution is a constantly accessible, singular, patient-adjudicated medication list that incorporates useful information and features into the list itself. We aim to decrease medication errors across transitions of care, increase awareness of potential drug-drug interactions, improve patient knowledge and self-efficacy regarding medications, decrease polypharmacy, improve prescribing safety and ultimately decrease cost to the health-care system.

  3. Medication Harmony: A Framework to Save Time, Improve Accuracy and Increase Patient Activation

    PubMed Central

    Pandolfe, Frank; Crotty, Bradley H; Safran, Charles

    2016-01-01

    Incompletely reconciled medication lists contribute to prescribing errors and adverse drug events. Providers expend time and effort at every point of patient contact attempting to curate a best possible medication list, and yet often the list is incomplete or inaccurate. We propose a framework that builds upon the existing infrastructure of a health information exchange (HIE), centralizes data and encourages patient activation. The solution is a constantly accessible, singular, patient-adjudicated medication list that incorporates useful information and features into the list itself. We aim to decrease medication errors across transitions of care, increase awareness of potential drug-drug interactions, improve patient knowledge and self-efficacy regarding medications, decrease polypharmacy, improve prescribing safety and ultimately decrease cost to the health-care system. PMID:28269955

  4. An improved Chebyshev distance metric for clustering medical images

    NASA Astrophysics Data System (ADS)

    Mousa, Aseel; Yusof, Yuhanis

    2015-12-01

    A metric or distance function is a function which defines a distance between elements of a set. In clustering, measuring the similarity between objects has become an important issue. In practice, there are various similarity measures used and this includes the Euclidean, Manhattan and Minkowski. In this paper, an improved Chebyshev similarity measure is introduced to replace existing metrics (such as Euclidean and standard Chebyshev) in clustering analysis. The proposed measure is later realized in analyzing blood cancer images. Results demonstrate that the proposed measure produces the smallest objective function value and converge at the lowest number of iteration. Hence, it can be concluded that the proposed distance metric contribute in producing better clusters.

  5. Applying Toyota production system techniques for medication delivery: improving hospital safety and efficiency.

    PubMed

    Newell, Terry L; Steinmetz-Malato, Laura L; Van Dyke, Deborah L

    2011-01-01

    The inpatient medication delivery system used at a large regional acute care hospital in the Midwest had become antiquated and inefficient. The existing 24-hr medication cart-fill exchange process with delivery to the patients' bedside did not always provide ordered medications to the nursing units when they were needed. In 2007 the principles of the Toyota Production System (TPS) were applied to the system. Project objectives were to improve medication safety and reduce the time needed for nurses to retrieve patient medications. A multidisciplinary team was formed that included representatives from nursing, pharmacy, informatics, quality, and various operational support departments. Team members were educated and trained in the tools and techniques of TPS, and then designed and implemented a new pull system benchmarking the TPS Ideal State model. The newly installed process, providing just-in-time medication availability, has measurably improved delivery processes as well as patient safety and satisfaction. Other positive outcomes have included improved nursing satisfaction, reduced nursing wait time for delivered medications, and improved efficiency in the pharmacy. After a successful pilot on two nursing units, the system is being extended to the rest of the hospital.

  6. Improving detection and treatment of osteoporosis: redesigning care using the electronic medical record and shared medical appointments.

    PubMed

    Ayoub, W T; Newman, E D; Blosky, M A; Stewart, W F; Wood, G C

    2009-01-01

    To determine whether a process redesign could improve detection and treatment of osteoporosis, at-risk women over the age of 65 were identified using an electronic medical record and proactively contacted by letter and phone call. This resulted in a significant increase in testing for osteoporosis by DXA scan. The high-risk patients were then offered a shared medical appointment, which resulted in improved treatment outcomes compared to usual care. Our objective was to determine if redesigning care through proactive contact with women 65 at-risk of osteoporosis increased BMD testing and to determine if a shared medical appointment (SMA) improved treatment for high-risk women. Two primary care sites received the redesign intervention and two other sites served as the usual care controls. At the intervention sites, all women 65 who had not had a DXA scan performed in the prior 2 years were contacted by mail and phone calls. High-risk patients were invited to attend a SMA or follow-up visit with their primary physician. A significantly higher proportion of women at the intervention sites had a DXA (39.6% vs. 13.2%, p < 0.0001). Patients who attended the SMA were more likely to have calcium and vitamin D recommended, a vitamin D level checked, and receive a prescription medicine than those patients who had follow-up with their primary care physician. The redesigned process was highly effective in improving BMD testing for women 65. The SMA was shown to be a more effective method to make calcium and vitamin D recommendations, to evaluate secondary causes of low bone density, and to prescribe prescription medications, compared to usual care with the PCP.

  7. Transient improvement of urticaria induces poor adherence as assessed by Morisky Medication Adherence Scale-8.

    PubMed

    Kaneko, Sakae; Masuda, Koji; Hiragun, Takaaki; Inomata, Naoko; Furue, Masutaka; Onozuka, Daisuke; Takeuchi, Satoshi; Murota, Hiroyuki; Sugaya, Makoto; Saeki, Hidehisa; Shintani, Yoichi; Tsunemi, Yuichiro; Abe, Shinya; Kobayashi, Miwa; Kitami, Yuki; Tanioka, Miki; Imafuku, Shinichi; Abe, Masatoshi; Hagihara, Akihito; Morisky, Donald E; Katoh, Norito

    2015-11-01

    Poor adherence to medication is a major public health challenge. Here, we aimed to determine the adherence to oral and topical medications and to analyze underlying associated factors using the translated Japanese version of Morisky Medication Adherence Scale-8 regarding urticaria treatment. Web-based questionnaires were performed for 3096 registered dermatological patients, along with a subanalysis of 751 registered urticaria patients in this study. The adherence to oral medication was significantly associated with the frequency of hospital visits. Variables that affected the adherence to topical medication included age and experience of drug effectiveness. The rate of responses that "It felt like the symptoms had improved" varied significantly among the dermatological diseases treated with oral medications. Dermatologists should be aware that adherence to the treatment of urticaria is quite low. Regular visits and active education for patients with urticaria are mandatory in order to achieve a good therapeutic outcome by increasing the adherence.

  8. Improving Medication Administration Safety in a Community Hospital Setting Using Lean Methodology.

    PubMed

    Critchley, Sandy

    2015-01-01

    Virtually all health care organizations have goals of improving patient safety, but despite clear goals and considerable investments, gains have been limited. This article explores a community hospital's resounding success using Lean methodology to improve medication administration safety with process changes designed by engaged employees and leaders with the knowledge and skill to effect improvements. This article inspires an interdisciplinary approach to quality improvement using reproducible strategies.

  9. Has the inclusion of a longitudinally integrated communication skills program improved consultation skills in medical students? A pilot study.

    PubMed

    Shah, Sameena; Andrades, Marie; Basir, Fasia; Jaleel, Anila; Azam, Iqbal; Islam, Muhammad; Ahmed, Rashida

    2016-01-01

    Evidence highlights a lack of communication skills in doctors leading to dysfunctional consultations. To address this deficit, a private medical college instituted curricular reforms with inclusion of a longitudinal communication skills program. A pilot study was undertaken to evaluate the effectiveness of this program by comparing the consultation skills of medical students of this college with a medical college without a communication skills program. A 4-station Objective Structured Clinical Examination (OSCE) was conducted in the third and final year. Mann-Whitney U-test was used to compare the difference in the distribution between OSCE stations total and construct scores. At the end of the third year, 21 (31.34%), students of the study site (medical college 1 [college with integrated longitudinal communication skills program]) and 31 (46.26%) students from the comparison site (medical college 2 [comparable college without communication skills program]) consented. Medical college 1 achieved a significantly higher overall mean total station score of 68.0% (standard deviation [SD] =13.5) versus 57.2% (SD = 15.4) (P < 0.001). Significantly higher mean scores were achieved on three stations. At the end of the final year, 19 students (29.3%) from medical college 1 and 22 (34%) students from medical college 2 consented. The difference in overall mean total station score reduced from 9.2% to 7.1% (70.2) (SD = 13.7) versus 63.1 (SD = 15.2) (P = 0.004). The mean scores of both colleges decreased in "Patient presenting with Hepatitis C Report" station (P values 0.004 and 0.775) and in "Patient Request for Faith Healing Therapy in Diabetes Mellitus" station (P values 0.0046 and 0.036), respectively. Longitudinal communication skills in an undergraduate curriculum positively impacted consultation skills. Community-based training and faculty development are required to develop effective patient-centered consultation skills.

  10. The potential for intelligent decision support systems to improve the quality and consistency of medication reviews.

    PubMed

    Bindoff, I; Stafford, A; Peterson, G; Kang, B H; Tenni, P

    2012-08-01

    Drug-related problems (DRPs) are of serious concern worldwide, particularly for the elderly who often take many medications simultaneously. Medication reviews have been demonstrated to improve medication usage, leading to reductions in DRPs and potential savings in healthcare costs. However, medication reviews are not always of a consistently high standard, and there is often room for improvement in the quality of their findings. Our aim was to produce computerized intelligent decision support software that can improve the consistency and quality of medication review reports, by helping to ensure that DRPs relevant to a patient are overlooked less frequently. A system that largely achieved this goal was previously published, but refinements have been made. This paper examines the results of both the earlier and newer systems. Two prototype multiple-classification ripple-down rules medication review systems were built, the second being a refinement of the first. Each of the systems was trained incrementally using a human medication review expert. The resultant knowledge bases were analysed and compared, showing factors such as accuracy, time taken to train, and potential errors avoided. The two systems performed well, achieving accuracies of approximately 80% and 90%, after being trained on only a small number of cases (126 and 244 cases, respectively). Through analysis of the available data, it was estimated that without the system intervening, the expert training the first prototype would have missed approximately 36% of potentially relevant DRPs, and the second 43%. However, the system appeared to prevent the majority of these potential expert errors by correctly identifying the DRPs for them, leaving only an estimated 8% error rate for the first expert and 4% for the second. These intelligent decision support systems have shown a clear potential to substantially improve the quality and consistency of medication reviews, which should in turn translate into

  11. Linking Community Hospital Initiatives With Osteopathic Medical Students' Quality Improvement Training: A Pilot Program.

    PubMed

    Brannan, Grace D; Russ, Ronald; Winemiller, Terry R; Mast, Eric

    2016-01-01

    Quality improvement (QI) continues to be a health care challenge, and the literature indicates that osteopathic medical students need more training. To qualify for portions of managed care reimbursement, hospitals are required to meet measures intended to improve quality of care and patient satisfaction, which may be challenging for small community hospitals with limited resources. Because osteopathic medical training is grounded on community hospital experiences, an opportunity exists to align the outcomes needs of hospitals and QI training needs of students. In this pilot program, 3 sponsoring hospitals recruited and mentored 1 osteopathic medical student each through a QI project. A mentor at each hospital identified a project that was important to the hospital's patient care QI goals. This pilot program provided osteopathic medical students with hands-on QI training, created opportunities for interprofessional collaboration, and contributed to hospital initiatives to improve patient outcomes.

  12. Health technology assessment to improve the medical equipment life cycle management.

    PubMed

    Margotti, Ana E; Ferreira, Filipa B; Santos, Francisco A; Garcia, Renato

    2013-01-01

    Health technology assessment (HTA) is a tool to support decision making that is intended to assist healthcare managers in their strategic decisions. The use of HTA as a tool for clinical engineering is especially relevant in the domain of the medical equipment once it could improve the performance of the medical equipment. It would be done by their systematically evaluation in several aspects, in their life cycle. In Brazil, the Institute of Biomedical Engineering (IEB-UFSC) through the clinical engineering area has been working on the development of methodologies and improvements on HTA for medical equipment. Therefore, this paper presents the effort to create specific methodologies that will improve the dissemination of HTA, focusing on incorporation and utilization phase of the medical equipment life cycle. This will give a better support to the decision makers in the management of the health care system.

  13. Beyond a curricular design of convenience: replacing the noon conference with an academic half day in three internal medicine residency programs.

    PubMed

    Batalden, Maren K; Warm, Eric J; Logio, Lia S

    2013-05-01

    Several residency programs have created an academic half day (AHD) for the delivery of core curriculum, and some program Web sites provide narrative descriptions of individual AHD curricula; nonetheless, little published literature on the AHD format exists. This article details three distinctive internal medicine residency programs (Cambridge Health Alliance, University of Cincinnati, and New York Presbyterian/Weill Cornell Medical College) whose leaders replaced the traditional noon conference curriculum with an AHD. Although each program's AHD developed independently of the other two, retrospective comparative review reveals instructive similarities and differences that may be useful to other residency directors. In this article, the authors describe the distinct approaches to the AHD at the three institutions through a framework of six core principles: (1) protect time and space to facilitate learning, (2) nurture active learning in residents, (3) choose and sequence curricular content deliberately, (4) develop faculty, (5) encourage resident preparation and accountability for learning, and (6) employ a continuous improvement approach to curriculum development and evaluation. The authors chronicle curricular adaptations at each institution over the first three years of experience. Preliminary outcome data, presented in the article, suggests that the transition from the traditional noon conference to an AHD may increase conference attendance, improve resident and faculty satisfaction with the curriculum, and improve resident performance on the In Training Examination.

  14. Behavior Change Counseling Curricula for Medical Trainees: A Systematic Review

    PubMed Central

    Hauer, Karen E.; Carney, Patricia A.; Chang, Anna; Satterfield, Jason

    2012-01-01

    Purpose Unhealthy behaviors contribute to half of U.S. deaths. However, physicians lack sufficient skill in counseling patients to change behaviors. Characterizing effective published curricular interventions for behavior-change counseling for medical trainees would inform educators toward improved training. Method The authors conducted a systematic literature search of studies published 1965–2011 evaluating curricula on behavior change counseling for medical trainees. Included studies described: (1) behavior change counseling, (2) teaching interventions for medical trainees, and (3) assessment of interventions. The authors extracted eligible articles, rated outcomes for learners and patients using Kirkpatrick’s hierarchy, and determined study quality. Results Of 2,788 identified citations, 109 met inclusion criteria. Most studies were performed in the United States (98), 93 at a single institution, and 81 in primary care settings. Curricular topics for counseling included smoking (67 studies), nutrition (30), alcohol/drug use (26), and exercise (22). Although most studies did not include theoretical frameworks, 39 used the Transtheoretical Model of Change. Sixty-two studies involved eight or fewer hours of curricular time, and 51 spanned four or fewer weeks. The studies with highest-level outcomes and quality employed multiple curricular techniques and included practice of counseling techniques in either simulated or actual clinical settings. Conclusions Existing literature suggests that trainees learn behavior change counseling through active, realistic practice and implementation of reminder and feedback systems within actual clinical practice settings. Multi-institutional medical education research on methods of teaching behavior-change counseling that influence patients’ health outcomes are needed to ensure trainees’ clinical competence and improve patient care. PMID:22622220

  15. DESIGN OF MEDICAL RADIOMETER FRONT-END FOR IMPROVED PERFORMANCE.

    PubMed

    Klemetsen, O; Birkelund, Y; Jacobsen, S K; Maccarini, P F; Stauffer, P R

    2011-01-01

    (amplifiers and power meter). For the configuration with a low noise amplifier up front, damage would occur to the active components of the radiometer if used in presence of the microwave heating antenna. Nevertheless, this design showed significantly improved sensitivity of measured temperatures and merits further investigation to determine methods of protecting the radiometer for amplifier first front ends.

  16. Using OSCE-based evaluation: curricular impact over time.

    PubMed

    Zartman, Rosemarie R; McWhorter, Alton G; Seale, N Sue; Boone, William John

    2002-12-01

    The Objective Structured Clinical Examination (OSCE) is becoming more widely used for performance assessment in dentistry. The department of pediatric dentistry at Baylor College of Dentistry (BCD) began incorporating the OSCE into its curriculum in 1995. This article describes the evolution of the department's use of the OSCE and its impact on teaching and the curriculum. The discussion focuses on logistics and station design, curricular content and order, student anxiety, writing and scoring exams, and curriculum assessment. BCD has found that using an OSCE-based testing format is time-consuming and labor-intensive, but provides unprecedented feedback about students' understanding and pinpoints areas of confusion. The demands of an OSCE-based testing format reveal that students can master, to the level of competency, only a finite amount of information in a given time period. The timed, interactive aspects of the OSCE create high levels of student anxiety that must be addressed. Writing and scoring OSCE items are different from traditional test items. The OSCE is a valuable mechanism to assess the students' progress toward competency. This review of the process of incorporating OSCEs into a curriculum is the foundation for future assessment of the OSCE and its use for curricular improvement.

  17. Empowering frontline nurses: a structured intervention enables nurses to improve medication administration accuracy.

    PubMed

    Kliger, Julie; Blegen, Mary A; Gootee, Dave; O'Neil, Edward

    2009-12-01

    Seven hospitals from the San Francisco Bay Area participated in an 18-month-long Integrated Nurse Leadership Program, which was designed to improve the reliability of medication administration by developing and deploying nurse leadership and process improvement skills on one medical/surgical inpatient unit. Each hospital formed a nurse-led project team that worked on six safety processes to improve the accuracy of medication administration: Compare medication to the medication administration record, keep medication labeled from preparation to administration, check two forms of patient identification, explain drug to patient (if applicable), chart immediately after administration, and protect process from distractions and interruptions. For the six hospitals included in the analysis, the accuracy of medication administration (as measured by the percent of correct doses administered) improved from 85% in the baseline period to 92% six months after the intervention and 96% 18 months after the intervention. The sum of the six safety processes completed also improved significantly, from 4.8 on a 0-6 scale at baseline to 5.6 at 6 months to 5.75 at 18 months. This study suggests that frontline nurses and other hospital-based staff, if given the training, resources, and authority, are well positioned to improve patient care and safety processes on hospital patient units. Frontline clinicians have the unique opportunity to see what is and is not working in the direct provision of patient care. To address the sustainability of the program's changes after the official project ended, each team was required to develop a sustainability plan entailing monitoring of progress, actions to ensure the improvements are built into the organizational infrastructure, and staff's interaction with leaders to ensure that the work could continue.

  18. Improving Medication Safety Based on Reports in Computerized Patient Safety Systems.

    PubMed

    Pitkänen, Anneli; Teuho, Susanna; Uusitalo, Marjo; Kaunonen, Marja

    2016-03-01

    In recent years, patient safety has been a serious concern internationally. Medication in particular is a significant area in improving patient safety because medication errors are a crucial clinical problem. This study aimed to explore suggestions to improve medication safety reported via computerized patient safety systems in hospitals. The research data were retrospectively collected from the computerized patient safety incident reporting systems in one university hospital and two regional hospitals in Finland. Open-ended records concerning prescribing medicines (n = 136), dispensing medicines (n = 362), administering medicines to patients (n = 538), and documenting medication (n = 434) were included in the analysis. The data were analyzed by using inductive content analysis. Based on the study findings, there is a need to develop and standardize procedures related to all four parts of medication management process. Moreover, working environment, multiprofessional collaboration, and knowledge and skills of the professionals should be developed. Promoting medication safety in hospitals is an urgent challenge. The study results indicated that computerized patient safety incident reporting systems can provide important qualitative information to improve medication process to be safer.

  19. A pilot study of the impact of an educational intervention aimed at improving medical record documentation.

    PubMed

    Farzandipour, M; Meidani, Z; Rangraz Jeddi, F; Gilasi, H; Shokrizadeh Arani, L; Fakharian, E; Saddik, B

    2013-01-01

    Studies have shown the importance of medical staff education in improving chart documentation and accuracy of medical coding. This study aimed to examine the effect of an educational intervention on recording medical diagnoses among a sample of medical residents based at Kashan University of Medical Sciences. This pilot study was conducted in 2010 and involved 19 residents in different specialties (internal medicine, obstetrics and gynecology, and surgery). Guidelines for recording diagnostic information related to surgery, obstetrics and internal medicine were taught at a five-hour lecture. Five medical records from each resident from before and after the educational intervention were assessed using a checklist based on relevant diagnostic information related to each discipline. Data were analysed using a paired t-test and Wilcoxson signed rank test. There was no improvement in the quality and accuracy of the recording of obstetric diagnoses (type, place, outcome and complications of delivery) after the training. There was also no effect on the documentation of underlying causes and clinical manifestations of disease by internal medicine and surgery residents (p=0.285 and p=0.584, respectively). The single education session did not improve recording of diagnoses among residents. The gathering and recording of complete, accurate and high quality medical records requires interaction between the hospital management, health information management professionals and healthcare providers. It is therefore essential to develop a more sophisticated portfolio of strategies that involves these key stakeholders.

  20. A quantitative systematic review of the efficacy of mobile phone interventions to improve medication adherence.

    PubMed

    Park, Linda G; Howie-Esquivel, Jill; Dracup, Kathleen

    2014-09-01

    To evaluate the characteristics and efficacy of mobile phone interventions to improve medication adherence. Secondary aims are to explore participants' acceptability and satisfaction with mobile phone interventions and to evaluate the selected studies in terms of study rigour, impact, cost and resource feasibility, generalizability and implications for nursing practice and research. Medication non-adherence is a major global challenge. Mobile phones are the most commonly used form of technology worldwide and have the potential to promote medication adherence. Guidelines from the Centre for Reviews and Dissemination were followed for this systematic review. A comprehensive search of databases (PubMed, Web of Science, CINAHL, PsycInfo, Google Chrome and Cochrane) and bibliographies from related articles was performed from January 2002-January 2013 to identify the included studies. A quantitative systematic review without meta-analysis was conducted and the selected studies were critically evaluated to extract and summarize pertinent characteristics and outcomes. The literature search produced 29 quantitative research studies related to mobile phones and medication adherence. The studies were conducted for prevention purposes as well as management of acute and chronic illnesses. All of the studies used text messaging. Eighteen studies found significant improvement in medication adherence. While the majority of investigators found improvement in medication adherence, long-term studies characterized by rigorous research methodologies, appropriate statistical and economic analyses and the test of theory-based interventions are needed to determine the efficacy of mobile phones to influence medication adherence. © 2014 John Wiley & Sons Ltd.

  1. Instructional analysis of lecture video recordings and its application for quality improvement of medical lectures.

    PubMed

    Baek, Sunyong; Im, Sun Ju; Lee, Sun Hee; Kam, Beesung; Yune, So Joung; Lee, Sang Soo; Lee, Jung A; Lee, Yuna; Lee, Sang Yeoup

    2011-12-01

    The lecture is a technique for delivering knowledge and information cost-effectively to large medical classes in medical education. The aim of this study was to analyze teaching quality, based on triangle analysis of video recordings of medical lectures, to strengthen teaching competency in medical school. The subjects of this study were 13 medical professors who taught 1st- and 2nd-year medical students and agreed to a triangle analysis of video recordings of their lectures. We first performed triangle analysis, which consisted of a professional analysis of video recordings, self-assessment by teaching professors, and feedback from students, and the data were crosschecked by five school consultants for reliability and consistency. Most of the distress that teachers experienced during the lecture occurred in uniform teaching environments, such as larger lecture classes. Larger lectures that primarily used PowerPoint as a medium to deliver information effected poor interaction with students. Other distressing factors in the lecture were personal characteristics and lack of strategic faculty development. Triangle analysis of video recordings of medical lectures gives teachers an opportunity and motive to improve teaching quality. Faculty development and various improvement strategies, based on this analysis, are expected to help teachers succeed as effective, efficient, and attractive lecturers while improving the quality of larger lecture classes.

  2. Improving written and verbal communication skills for international medical graduates: a linguistic and medical approach.

    PubMed

    Cross, Duncan; Smalldridge, Ann

    2011-01-01

    Adapting to UK communication styles can be difficult for International Medical Graduates (IMGs). Reache Northwest provides education, training and support for internationally trained refugee and asylum seeking health professionals who are looking to return to work in the UK. A Safe and Effective Communication Skills course was designed by a team of language teachers and clinicians to provide IMGs with an understanding of the written, verbal and summarisation skills required in the UK work environment. A series of language exercises adapted to clinical situations was developed. These increased in complexity to the practical application of language skills in clinical settings using simulated patients. The combination of language and clinical tutors meant that feedback could be given from a language teacher's perspective, the clinical perspective and the cultural context. The combination of language and clinical tutors meant that analysis of communication difficulties could be made from different perspectives and detailed, specific feedback could be given to each student in these areas. Using a combined linguistic and clinical approach can provide solutions to clinical communication problems that may otherwise be missed. This strategy could be extended to cover communication areas in other contexts.

  3. Nurse interventions to improve medication adherence among discharged older adults: a systematic review.

    PubMed

    Verloo, Henk; Chiolero, Arnaud; Kiszio, Blanche; Kampel, Thomas; Santschi, Valérie

    2017-09-01

    discharged older adult inpatients are often prescribed numerous medications. However, they only take about half of their medications and many stop treatments entirely. Nurse interventions could improve medication adherence among this population. to conduct a systematic review of trials that assessed the effects of nursing interventions to improve medication adherence among discharged, home-dwelling and older adults. we conducted a systematic review according to the methods in the Cochrane Collaboration Handbook and reported results according to the PRISMA statement. We searched for controlled clinical trials (CCTs) and randomised CCTs (RCTs), published up to 8 November 2016 (using electronic databases, grey literature and hand searching), that evaluated the effects of nurse interventions conducted alone or in collaboration with other health professionals to improve medication adherence among discharged older adults. Medication adherence was defined as the extent to which a patient takes medication as prescribed. out of 1,546 records identified, 82 full-text papers were evaluated and 14 studies were included-11 RCTs and 2 CCTs. Overall, 2,028 patients were included (995 in intervention groups; 1,033 in usual-care groups). Interventions were nurse-led in seven studies and nurse-collaborative in seven more. In nine studies, adherence was higher in the intervention group than in the usual-care group, with the difference reaching statistical significance in eight studies. There was no substantial difference in increased medication adherence whether interventions were nurse-led or nurse-collaborative. Four of the 14 studies were of relatively high quality. nurse-led and nurse-collaborative interventions moderately improved adherence among discharged older adults. There is a need for large, well-designed studies using highly reliable tools for measuring medication adherence.

  4. Using a Medical Information System to Improve the Quality of Patient Care

    PubMed Central

    Sneider, Richard M.

    1978-01-01

    A Medical Information System (MIS) impacts virtually every department in a hospital. Technicon's MATRIX MIS is designed to improve patient care while reducing the cost of delivering that care. This paper discusses several of the features designed to improve the quality of patient care at user hospitals.

  5. Improved particle swarm optimization algorithm for android medical care IOT using modified parameters.

    PubMed

    Sung, Wen-Tsai; Chiang, Yen-Chun

    2012-12-01

    This study examines wireless sensor network with real-time remote identification using the Android study of things (HCIOT) platform in community healthcare. An improved particle swarm optimization (PSO) method is proposed to efficiently enhance physiological multi-sensors data fusion measurement precision in the Internet of Things (IOT) system. Improved PSO (IPSO) includes: inertia weight factor design, shrinkage factor adjustment to allow improved PSO algorithm data fusion performance. The Android platform is employed to build multi-physiological signal processing and timely medical care of things analysis. Wireless sensor network signal transmission and Internet links allow community or family members to have timely medical care network services.

  6. Cultural diversity process improves organizational community in urban teaching medical center.

    PubMed

    Carter, R; Spence, M M

    1996-01-01

    An urban teaching facility with nearly 3,000 employees had communication problems associated with race, gender and other cultural differences. It also competed for health care dollars and faced possible reduction in federal funding. The medical center instituted mandatory training in cultural diversity and customer service-and integrated the training process with the hospital's overall quality improvement plan and marketing strategy. The integrated approach affected the bottom line-Hurley's patient base has increased, and the medical center operates in the black. Training in cultural diversity and customer service is an effective tool to improve employee communication and improve financial outlook.

  7. Design of electronic medical record user interfaces: a matrix-based method for improving usability.

    PubMed

    Kuqi, Kushtrim; Eveleigh, Tim; Holzer, Thomas; Sarkani, Shahryar; Levin, James E; Crowley, Rebecca S

    2013-01-01

    This study examines a new approach of using the Design Structure Matrix (DSM) modeling technique to improve the design of Electronic Medical Record (EMR) user interfaces. The usability of an EMR medication dosage calculator used for placing orders in an academic hospital setting was investigated. The proposed method captures and analyzes the interactions between user interface elements of the EMR system and groups elements based on information exchange, spatial adjacency, and similarity to improve screen density and time-on-task. Medication dose adjustment task time was recorded for the existing and new designs using a cognitive simulation model that predicts user performance. We estimate that the design improvement could reduce time-on-task by saving an average of 21 hours of hospital physicians' time over the course of a month. The study suggests that the application of DSM can improve the usability of an EMR user interface.

  8. Process improvements and shared medical appointments for cardiovascular disease prevention in women.

    PubMed

    Pastore, Lisa M; Rossi, Ann M; Tucker, Amy L

    2014-10-01

    Cardiovascular disease (CVD) is clinically unique in women and is often underdiagnosed and undertreated. Chronic diseases account for 75% of healthcare expenditures in the United States, of which 70% are preventable through lifestyle changes and active medical management. Lifestyle modification is difficult in the context of the traditional medical visit. The Club Red Clinic uses a novel approach to enhance the care of women at risk for or with CVD. Through shared medical appointments (SMAs) and a multidisciplinary team approach, Club Red provides lifestyle training in addition to evidence-based practice to reduce CVD risk factors in women. In Club Red, nurse practitioners function independently and effectively in delivering lifestyle intervention for the management and prevention of CVD. The clinic functions within an academic medical school at the University of Virginia. Patient access, patient satisfaction, provider efficiency, and frequency of cardiovascular visits. Process improvements include reduced appointment wait times, improved provider efficiency (more patients seen with the SMAs), high patient satisfaction (96%), and improved adherence to recommended medical monitoring (3.8 visits/year). Club Red improved patient access, patient satisfaction, medical and behavioral management, and health promotion education for women with or at risk for CVD. ©2013 American Association of Nurse Practitioners.

  9. Curricular Renovation through Population Education.

    ERIC Educational Resources Information Center

    de la Cruz, Leonardo

    The document is intended to assist educators in Nepal in implementing curriculum reform or improvement by using population education as a means. Procedural designs that can be followed are described. First, the goals of population education must be defined. Second, a decision has to be made as to which body of knowledge or population concepts are…

  10. Audit and feedback by medical students to improve the preventive care practices of general practice supervisors.

    PubMed

    Gilkes, Lucy A; Liira, Helena; Emery, Jon

    Medical students benefit from their contact with clinicians and patients in the clinical setting. However, little is known about whether patients and clinicians also benefit from medical students. We developed an audit and feedback intervention activity to be delivered by medical students to their general practice supervisors. We tested whether the repeated cycle of audit had an effect on the preventive care practices of general practitioners (GPs). The students performed an audit on topics of preventive medicine and gave feedback to their supervisors. Each supervisor in the study had more than one student performing the audit over the academic year. After repetitive cycles of audit and feedback, the recording of social history items by GPs improved. For example, recording alcohol history increased from 24% to 36%. This study shows that medical students can be effective auditors, and their repeated audits may improve their general practice supervisors' recording of some aspects of social history.

  11. Assessing the Quality of Medical Information Technology Economic Evaluations: Room for Improvement

    PubMed Central

    Eisenstein, Eric L.; Ortiz, Maqui; Anstrom, Kevin J.; Crosslin, David R.; Lobach, David F.

    2006-01-01

    Medical information systems are being recognized for their ability to improve patient outcomes. While standards for the economic evaluation of medical technologies were instituted in the mid-1990s, little is known about their application in medical information technology studies. In a review of medical information technology evaluation studies published between 1982 and 2002, we found that the volume and variety of economic evaluations had increased; however, investigators routinely omitted key cost or effectiveness elements in their designs, resulting in publications with incomplete, and potentially biased, economic findings. Of the studies that made economic claims, 23% did not report any economic data, 40% failed to include any effectiveness measures, and more than 50% used a case study or pre- post- test design. Thus, during a time when health economic study methods in general have experienced significant development, there is little evidence of similar progress in medical information technology economic evaluations. PMID:17238338

  12. Medical education and family planning: developing future leaders and improving global health.

    PubMed

    Landy, Uta; Blodgett, Madeline; Darney, Philip

    2013-05-01

    Well-trained medical professionals are key to improving global reproductive health and reducing rates of unsafe abortion, but medical training often fails to prepare practitioners to provide essential family planning services. The field of medical education is currently undergoing reformation to better meet the needs of a global population, and comprehensive, integrated family planning training will be an important part of those reforms. Family planning training is not only vital to address global reproductive healthcare demand, but integrates effectively with cornerstones of current medical education reform: competency-based education, leadership development, collaboration with practitioners of all levels, and global health context. Examples of successful integration of family planning education are outlined, and recommendations for integrating family planning into medical education detailed at the 2012 FIGO World Congress are discussed. Copyright © 2013. Published by Elsevier Ireland Ltd.

  13. Improving the coordination of patients' medication management: a regional Finnish development project.

    PubMed

    Kivekäs, Eija; Luukkonen, Irmeli; Mykkänen, Juha; Saranto, Kaija

    2014-01-01

    In this paper, we present an overview of activities and results from a regional development project in Finland. The aim in this project was to analyze how healthcare providers produce and receive information on a patient's medication, and to identify opportunities to improve the quality, effectiveness, availability and collaboration of social and healthcare services in relation to medication information. The project focused on the most important points in patients' medication management such as home care and care transitions. In a regional development project, data was gathered by interviews and a multi professional workshop. The study revealed that medication information reached only some professionals and lay caregivers despite electronic patient record (EPR) systems and tools. Differences in work processes related to medication reconciliation and information management were discussed in the group meeting and were regarded as a considerable risk for patient safety.

  14. Improving Safe Use of Medications During Pregnancy: The Roles of Patients, Physicians, and Pharmacists.

    PubMed

    Lynch, Molly M; Amoozegar, Jacqueline B; McClure, Emily M; Squiers, Linda B; Broussard, Cheryl S; Lind, Jennifer N; Polen, Kara N; Frey, Meghan T; Gilboa, Suzanne M; Biermann, Janis

    2017-10-01

    Our study sought to explore the actual and potential roles of patients, physicians, and pharmacists, as well as their shared challenges and opportunities, in improving the safety of medication use during pregnancy. We conducted virtual focus groups with 48 women and in-depth interviews with nine physicians and five pharmacists. Qualitative analysis revealed that all three groups of participants reported "playing it safe," the need for an engaged patient making informed decisions, challenges surrounding communication about pregnancy status, and a lack of patient-centric resources. Patients, physicians, and pharmacists are highly motivated to protect developing babies from potential harms of medication use during pregnancy while maintaining the patient's health. Strategic messaging could maximize the effectiveness of these interactions by helping physicians discuss the benefits and risks of medication use during pregnancy, pharmacists screen for pregnancy and counsel on medication safety, and patients using medications to share pregnancy intentions with their providers pre-pregnancy.

  15. Opportunities for improving post-hospital home medication management among older adults.

    PubMed

    Foust, Janice B; Naylor, Mary D; Boling, Peter A; Cappuzzo, Kimberly A

    2005-01-01

    Effective post-hospital home medication management among older adults is a convoluted, error-prone process. Older adults, whose complex medication regimens are often changed at hospital discharge, are susceptible to medication-related problems (e.g. Adverse Drug Events or ADEs) as they resume responsibility for managing their medications at home. Human error theory frames the discussion of multi-faceted, interacting factors including care system functions, like discharge medication teaching that contribute to post-hospital ADEs. The taxonomy and causes of post-hospital ADEs and related risk factors are reviewed, as we describe in high-risk older adults a population that may benefit from targeted interventions. Potential solutions and future research possibilities highlight the importance of interdisciplinary teams, involvement of clinical pharmacists, use of transitional care models, and improved use of informational technologies.

  16. Software architecture for improving accessibility to medical text-based information.

    PubMed

    Topac, Vasile; Stoicu-Tivadar, Vasile

    2009-01-01

    The paper presents a software architecture aiming to improve accessibility to information in specialized texts, with focus on medical texts. This software also addresses other problems related to text accessibility such as vision problems and language problems. It allows text input in any media format (text, image, sound) and outputs the text as digital text or sound, permitting the user to scan the medical papers and listen to the translated and adapted text.

  17. Medical emergency teams: a strategy for improving patient care and nursing work environments.

    PubMed

    Galhotra, Sanjay; Scholle, Carol C; Dew, Mary Amanda; Mininni, Nicolette C; Clermont, Gilles; DeVita, Michael A

    2006-07-01

    This paper reports a study of nurses' perceptions about medical emergency teams and their impact on patient care and the nursing work environment. In many acute care hospitals, nurses can summon emergency help by calling a medical emergency team, which is a team of expert critical care professionals adept at handling patient crisis scenarios. Critical care nurses form the core of such teams. In addition, of all the healthcare professionals, nurses are the ones who most often need and call for medical emergency team assistance. A simple anonymous questionnaire distributed amongst 300 staff nurses at two sites of an acute care teaching hospital in the United States of America in mid-January of 2005. A total of 248 nurses responded to the survey (response rate = 82.7%). Ninety-three per cent of the nurses reported that medical emergency teams improved patient care and 84% felt that they improved the nursing work environment. Veteran nurses (with at least 10 years of experience) and new nurses (<1 year's experience) were more likely to perceive an improvement in patient care than other nurses (P = 0.025). Nurses who had called a medical emergency team on more than one occasion were more likely to value their ability to call a team (P = 0.002). Nearly sixty-five per cent of respondents said they would consider institutional medical emergency team response as a factor when seeking a new job in the future. Only 7% suggested a change in the team response process, and 4% suggested a change in activation criteria. Most nurses surveyed had a favourable opinion of the medical emergency team. Our findings suggest that other institutions should consider implementing a medical emergency team programme as a strategy to improve patient care and nurse working environment.

  18. Survey of Pharmacy Schools’ Approaches and Attitudes toward Curricular Integration

    PubMed Central

    Fan, Jingyang; Nieto, Marcelo J.

    2016-01-01

    Objective. To identify ways in which curricular integration is addressed in US pharmacy schools, the structure of therapeutics and foundational science courses, and perceptions of the effects current curricular integration methods have on student learning. Methods. An electronic survey was sent to academic leaders representing 131 pharmacy schools in the United States. Frequency data was tabulated and demographic analysis was performed. Results. Respondent data represents 94 schools of pharmacy. Arranging similar content from various disciplines in a course, a skills laboratory and pharmacy practice experiences were the most common methods for achieving curricular integration. More than one half of the schools indicated that foundational sciences were integrated with therapeutics. The most common reported challenge to curricular integration was logistics. Conclusion. Pharmacy education in the United States has evolved in addressing curricular integration in the curricula, which is consistent with changes in accreditation standards. Most pharmacy schools reported a variety of methods for achieving the intent of curricular integration. PMID:27667833

  19. Survey of Pharmacy Schools' Approaches and Attitudes toward Curricular Integration.

    PubMed

    Poirier, Therese I; Fan, Jingyang; Nieto, Marcelo J

    2016-08-25

    Objective. To identify ways in which curricular integration is addressed in US pharmacy schools, the structure of therapeutics and foundational science courses, and perceptions of the effects current curricular integration methods have on student learning. Methods. An electronic survey was sent to academic leaders representing 131 pharmacy schools in the United States. Frequency data was tabulated and demographic analysis was performed. Results. Respondent data represents 94 schools of pharmacy. Arranging similar content from various disciplines in a course, a skills laboratory and pharmacy practice experiences were the most common methods for achieving curricular integration. More than one half of the schools indicated that foundational sciences were integrated with therapeutics. The most common reported challenge to curricular integration was logistics. Conclusion. Pharmacy education in the United States has evolved in addressing curricular integration in the curricula, which is consistent with changes in accreditation standards. Most pharmacy schools reported a variety of methods for achieving the intent of curricular integration.

  20. Fighting cancer together: Development and implementation of shared medical appointments to standardize and improve chemotherapy education.

    PubMed

    Prescott, Lauren S; Dickens, Andrea S; Guerra, Sandra L; Tanha, Jila M; Phillips, Desiree G; Patel, Katherine T; Umberson, Katie M; Lozano, Miguel A; Lowe, Kathryn B; Brown, Alaina J; Taylor, Jolyn S; Soliman, Pamela T; Garcia, Elizabeth A; Levenback, Charles F; Bodurka, Diane C

    2016-01-01

    Shared medical appointments offer a novel approach to improve efficiency and quality of care consistent with the goals of the Institute of Medicine. Our objective was to develop and implement a shared medical appointment for gynecologic cancer patients initiating chemotherapy. We first assessed the level of interest in shared medical appointments among our patients and providers through qualitative interviews. Both patients and providers identified pre-chemotherapy as an optimal area to pilot shared medical appointments. We subsequently created a multidisciplinary team comprised of physicians, advanced practice providers, nurses, pharmacists, administrators, health education specialists and members of the Quality Improvement Department to establish a Shared Medical Appointment and Readiness Teaching (SMART) program for all gynecologic oncology patients initiating chemotherapy with platinum- and/or taxane-based regimens. We developed a standardized chemotherapy education presentation and provided patients with a tool kit that consisted of chemotherapy drug education, a guide to managing side effects, advance directives, and center contact information. From May 9, 2014 to June 26, 2015, 144 patients participated in 51 SMART visits. The majority of patients had ovarian cancer and were treated with carboplatin/paclitaxel. Surveyed patients reported being highly satisfied with the group visit and would recommend shared medical appointments to other patients. This model of care provides patient education within a framework of social support that empowers patients. Shared medical appointments for oncology patients initiating chemotherapy are both feasible and well accepted. Copyright © 2015 Elsevier Inc. All rights reserved.

  1. Fighting Cancer Together: Development and Implementation of Shared Medical Appointments to Standardize and Improve Chemotherapy Education

    PubMed Central

    Prescott, Lauren S.; Dickens, Andrea S.; Guerra, Sandra L.; Tanha, Jila M.; Phillips, Desiree G.; Patel, Katherine T.; Umberson, Katie M.; Lozano, Miguel A.; Lowe, Kathryn B.; Brown, Alaina J.; Taylor, Jolyn S.; Soliman, Pamela T.; Garcia, Elizabeth A.; Levenback, Charles F.; Bodurka, Diane C.

    2015-01-01

    Objective Shared medical appointments offer a novel approach to improve efficiency and quality of care consistent with the goals of the Institute of Medicine. Our objective was to develop and implement a shared medical appointment for gynecologic cancer patients initiating chemotherapy. Methods We first assessed the level of interest in shared medical appointments among our patients and providers through qualitative interviews. Both patients and providers identified pre-chemotherapy as an optimal area to pilot shared medical appointments. We subsequently created a multidisciplinary team comprised of physicians, advanced practice providers, nurses, pharmacists, administrators, health education specialists and members of the Quality Improvement Department to establish a Shared Medical Appointment and Readiness Teaching (SMART) program for all gynecologic oncology patients initiating chemotherapy with platinum- and/or taxane-based regimens. We developed a standardized chemotherapy education presentation and provided patients with a tool kit that consisted of chemotherapy drug education, a guide to managing side effects, advance directives, and center contact information. Results From May 9, 2014 to June 26, 2015, 144 patients participated in 51 SMART visits. The majority of patients had ovarian cancer and were treated with carboplatin/paclitaxel. Surveyed patients reported being highly satisfied with the group visit and would recommend shared medical appointments to other patients. Conclusions This model of care provides patient education within a framework of social support that empowers patients. Shared medical appointments for oncology patients initiating chemotherapy are both feasible and well accepted. PMID:26549108

  2. Using Simulation to Improve First-Year Pharmacy Students' Ability to Identify Medication Errors Involving the Top 100 Prescription Medications.

    PubMed

    Atayee, Rabia S; Awdishu, Linda; Namba, Jennifer

    2016-06-25

    Objective. To evaluate first-year pharmacy students' ability to identify medication errors involving the top 100 prescription medications. Design. In the first quarter of a 3-quarter pharmacy self-care course, a didactic lecture on the most common prescribing and dispensing prescription errors was presented to first-year pharmacy students (P1) in preparation for a prescription review simulation done individually and as a group. In the following quarter, they were given a formal prescription review workshop before a second simulation involving individual and group review of a different set of prescriptions. Students were evaluated based on the number of correctly checked prescriptions and a self-assessment of their confidence in reviewing prescriptions. Assessment. All 63 P1 students completed the prescription review simulations. The individual scores did not significantly change, but group scores improved from 79 (16.2%) in the fall quarter to 98.6 (4.7%) in the winter quarter. Students perceived improvement of their prescription checking skills, specifically in their ability to fill a prescription on their own, identify prescribing and dispensing errors, and perform pharmaceutical calculations. Conclusion. A prescription review module consisting of a didactic lecture, workshop and simulation-based methods to teach prescription analysis was successful at improving first year pharmacy students' knowledge, confidence, and application of these skills.

  3. Using Simulation to Improve First-Year Pharmacy Students’ Ability to Identify Medication Errors Involving the Top 100 Prescription Medications

    PubMed Central

    Awdishu, Linda; Namba, Jennifer

    2016-01-01

    Objective. To evaluate first-year pharmacy students’ ability to identify medication errors involving the top 100 prescription medications. Design. In the first quarter of a 3-quarter pharmacy self-care course, a didactic lecture on the most common prescribing and dispensing prescription errors was presented to first-year pharmacy students (P1) in preparation for a prescription review simulation done individually and as a group. In the following quarter, they were given a formal prescription review workshop before a second simulation involving individual and group review of a different set of prescriptions. Students were evaluated based on the number of correctly checked prescriptions and a self-assessment of their confidence in reviewing prescriptions. Assessment. All 63 P1 students completed the prescription review simulations. The individual scores did not significantly change, but group scores improved from 79 (16.2%) in the fall quarter to 98.6 (4.7%) in the winter quarter. Students perceived improvement of their prescription checking skills, specifically in their ability to fill a prescription on their own, identify prescribing and dispensing errors, and perform pharmaceutical calculations. Conclusion. A prescription review module consisting of a didactic lecture, workshop and simulation-based methods to teach prescription analysis was successful at improving first year pharmacy students’ knowledge, confidence, and application of these skills. PMID:27402989

  4. [Improvement of medical service organization for wounded in traffic accidents in Moscow].

    PubMed

    Fedotov, S A

    2012-11-01

    The article is devoted to the problem of reducing the severity of consequences of the road traffic. This problem refers to the actual intersectoral problems including medical service. The author showed that the main way to improve the medical service administration for the wounded in road accidents is to reduce time of the on-the-scene care and arrival of the wounded at the hospitals. A few ways of improvement of work of First Aid Teams are suggested. The author came to conclusion that every of the incorporated organizational forms improves the effectiveness of emergency medical service for the wounded in road accidents to some extent, but only joint introduction of these forms and creation of united organization-management system are the real ways of getting optimum results.

  5. [Main ways of improvements of the systems of medical rehabilitation of military servicemen after cardiovascular surgery].

    PubMed

    Iudin, V E; Klimko, V V; Shkarupa, O F; Guzenko, I E

    2014-08-01

    For better improvement of medical rehabilitation referred to effective restoration of functional status of servicemen after cardiovascular surgery it is necessary to introduce standards of medical rehabilitation at all stages of rehabilitation, syndrome-pathologic principle of grouping patients, multidisciplinary organisation of medical activity: cardiologist-physician, specialist of functional diagnostics, specialist of physical therapy, psychotherapist, physical therapeutic, surgeon and specialist of professional rehabilitation. Basic ways of improvement of the system of rehabilitation were organisational technologies of interaction during early and late stages of rehabilitation and persistent control of quality and effectiveness of rehabilitation. Optimization of organisation of late stage of hospitalisation allowed to reduce the average time of rehabilitation to 33,3% and at the same time to improve effectiveness of rehabilitation.

  6. [Curricular adjustments in the clinical fields].

    PubMed

    Uribe Elías, Roberto

    2011-01-01

    The 2010 undergraduate medical degree curriculum at the National Autonomous University of Mexico (UNAM) faculty of medicine is based on the reality of the operating structure of the medical care units qualified for teaching. The clinical teaching/learning is based on the cooperative work of the professor and student; this means, it is based on the institutional physician responsible for medical care in a professor/assistant action together with the student being brought up. Therefore, the permanent education and training of all medical teams in the institutions offering teaching is essential. Teaching must be one distinctive characteristic of excellence for the units of the Health Ministry as it is teaching the central factor that raises the quality of medical care. The clinical evaluation must be permanent, improving the value of the daily action in front of a patient at the formative level and as a means to allow the assessment for its development, as it is the clinical aspect that is the essence of medicine.

  7. A cross-sectional study of medical students' knowledge of patient safety and quality improvement.

    PubMed

    Blasiak, Rachel C; Stokes, Claire L; Meyerhoff, Karen L; Hines, Rachel E; Wilson, Lindsay A; Viera, Anthony J

    2014-01-01

    The Association of American Medical Colleges and the World Health Organization have endorsed formal patient safety and quality improvement (QI) education for medical students. We surveyed medical students to assess their current level of patient safety and QI knowledge and to identify factors associated with increased knowledge. A literature review, focus groups with medical students, and local expert interviews were used to develop an electronic survey, which was distributed to all medical students at a single medical school in the spring of 2012. Fifty-seven percent of the medical school student body (N = 790) participated in the survey. A greater proportion of students reported previous exposure to patient safety education than to QI education (79% vs 47%). Students scored an average of 56% and 58% on the patient safety and QI knowledge tests, respectively. Having or pursuing an advanced degree (P = .02) and previous exposure to patient safety education (P = .02) were associated with higher knowledge scores. After adjusting for confounding variables, only previous exposure to QI education (P = .02) was associated with higher QI knowledge scores. There is a risk of measurement bias due to the use of an unvalidated instrument. Students who have greater knowledge of patient safety or QI might recall exposure at a greater frequency, inflating the association between exposure and knowledge. Also, this is a cross-sectional study, so we cannot draw conclusions about causality. Medical students' knowledge of patient safety and QI is low. Previous formal or informal education about these topics is associated with increased knowledge.

  8. Predicting Urban Medical Services Demand in China: An Improved Grey Markov Chain Model by Taylor Approximation

    PubMed Central

    Duan, Jinli; Jiao, Feng; Zhang, Qishan

    2017-01-01

    The sharp increase of the aging population has raised the pressure on the current limited medical resources in China. To better allocate resources, a more accurate prediction on medical service demand is very urgently needed. This study aims to improve the prediction on medical services demand in China. To achieve this aim, the study combines Taylor Approximation into the Grey Markov Chain model, and develops a new model named Taylor-Markov Chain GM (1,1) (T-MCGM (1,1)). The new model has been tested by adopting the historical data, which includes the medical service on treatment of diabetes, heart disease, and cerebrovascular disease from 1997 to 2015 in China. The model provides a predication on medical service demand of these three types of disease up to 2022. The results reveal an enormous growth of urban medical service demand in the future. The findings provide practical implications for the Health Administrative Department to allocate medical resources, and help hospitals to manage investments on medical facilities. PMID:28783088

  9. Predicting Urban Medical Services Demand in China: An Improved Grey Markov Chain Model by Taylor Approximation.

    PubMed

    Duan, Jinli; Jiao, Feng; Zhang, Qishan; Lin, Zhibin

    2017-08-06

    The sharp increase of the aging population has raised the pressure on the current limited medical resources in China. To better allocate resources, a more accurate prediction on medical service demand is very urgently needed. This study aims to improve the prediction on medical services demand in China. To achieve this aim, the study combines Taylor Approximation into the Grey Markov Chain model, and develops a new model named Taylor-Markov Chain GM (1,1) (T-MCGM (1,1)). The new model has been tested by adopting the historical data, which includes the medical service on treatment of diabetes, heart disease, and cerebrovascular disease from 1997 to 2015 in China. The model provides a predication on medical service demand of these three types of disease up to 2022. The results reveal an enormous growth of urban medical service demand in the future. The findings provide practical implications for the Health Administrative Department to allocate medical resources, and help hospitals to manage investments on medical facilities.

  10. Effectiveness of interventions to improve antidepressant medication adherence: a systematic review.

    PubMed

    Chong, W W; Aslani, P; Chen, T F

    2011-09-01

    Non-adherence to antidepressant medications is a significant barrier to the successful treatment of depression in clinical practice. This review aims to systematically assess the effectiveness of interventions for improving antidepressant medication adherence among patients with unipolar depression, and to evaluate the effect of these interventions on depression clinical outcomes. MEDLINE, PsycINFO and EMBASE databases were searched for English-language randomised controlled trials published between January 1990 and December 2010 on interventions to improve antidepressant adherence. The impact of interventions on antidepressant medication adherence (compliance and persistence) and depression clinical outcomes was evaluated. Data concerning the quality of the included studies were also extracted. Twenty-six studies met the inclusion criteria. Interventions were classified as educational, behavioural and multifaceted interventions. A total of 28 interventions were tested, as two studies investigated two interventions each. Sixteen (57%) of the 28 interventions showed significant effects on antidepressant adherence outcomes, whereas 12 (43%) interventions demonstrated significant effects on both antidepressant adherence and depression outcomes. The interventions which showed significant improvement in outcomes were primarily multifaceted and complex, with proactive care management and involvement of mental health specialists. The most commonly used elements of multifaceted interventions included patient educational strategies, telephone follow-up to monitor patients' progress, as well as providing medication support and feedback to primary care providers. Overall, educational interventions alone were ineffective in improving antidepressant medication adherence. In conclusion, improving adherence to antidepressants requires a complex behavioural change and there is some evidence to support behavioural and multifaceted interventions as the most effective in improving

  11. [Medication administration practices in elderly residential facilities in Ile de France Region in 2014: findings and room for improvement].

    PubMed

    de Saunière, Anne; Bonneau, Laetitia; Donio, Valérie; Godinot, Valérie; Flouzat, Jean-Philippe; Bensasson, Géraldine; Code, Christelle; Galay, Guillaume; Pige, Dominique

    2016-11-25

    The institutions expressed great interest in medication administration systems and tools designed to monitor all stages of medication administration. A dozen simple and pragmatic improvement actions were identified and listed in the Ile-de-France Regional Health Agency action plan to improve medication administration management of in EHPAD..

  12. Improving the Quality of Home Health Care for Children With Medical Complexity.

    PubMed

    Nageswaran, Savithri; Golden, Shannon L

    2017-08-01

    The objectives of this study are to describe the quality of home health care services for children with medical complexity, identify barriers to delivering optimal home health care, and discuss potential solutions to improve home health care delivery. In this qualitative study, we conducted 20 semistructured in-depth interviews with primary caregivers of children with medical complexity, and 4 focus groups with 18 home health nurses. During an iterative analysis process, we identified themes related to quality of home health care. There is substantial variability between home health nurses in the delivery of home health care to children. Lack of skills in nurses is common and has serious negative health consequences for children with medical complexity, including hospitalizations, emergency room visits, and need for medical procedures. Inadequate home health care also contributes to caregiver burden. A major barrier to delivering optimal home health care is the lack of training of home health nurses in pediatric care and technology use. Potential solutions for improving care include home health agencies training nurses in the care of children with medical complexity, support for nurses in clinical problem solving, and reimbursement for training nurses in pediatric home care. Caregiver-level interventions includes preparation of caregivers about: providing medical care for their children at home and addressing problems with home health care services. There are problems in the quality of home health care delivered to children with medical complexity. Training nurses in the care of children with medical complexity and preparing caregivers about home care could improve home health care quality. Copyright © 2017 Academic Pediatric Association. Published by Elsevier Inc. All rights reserved.

  13. Improving the National Board of Medical Examiners internal Medicine Subject Exam for use in clerkship evaluation.

    PubMed

    Elnicki, D Michael; Lescisin, Dianne A; Case, Susan

    2002-06-01

    To provide a consensus opinion on modifying the National Board of Medical Examiners (NBME) Medicine Subject Exam (Shelf) to: 1) reflect the internal medicine clerkship curriculum, developed by the Society of General Internal Medicine (SGIM) and the Clerkship Directors in Internal Medicine (CDIM); 2) emphasize knowledge important for a clerkship student; and 3) obtain feedback about students' performances on the Shelf. Two-round Delphi technique. The CDIM Research and Evaluation Committee and CDIM members on NBME Step 2 Committees. Using 1-5 Likert scales (5 = highest ratings), the group rated test question content for relevance to the SGIM-CDIM Curriculum Guide and importance for clerkship students' knowledge. The Shelf content is organized into 4 physician tasks and into 11 sections that are generally organ system based. Each iteration of the Shelf has 100 questions. Participants indicated a desired distribution of questions by physician task and section, topics critical for inclusion on each exam, and new topics to include. They specified the types of feedback clerkship directors desired on students' performances. Following the first round, participants viewed pooled results prior to submitting their second-round responses. Of 15 individuals contacted, 12 (80%) participated in each round. The desired distribution by physician task was: diagnosis (43), treatment (23), mechanism of disease (20), and health maintenance (15). The sections with the most questions requested were the cardiovascular (17), respiratory (15), and gastroenterology (12) sections. The fewest were requested in aging/ethics (4) and neurology, dermatology, and immunology (5 each). Examples of low-rated content were Wilson's Disease, chancroid and tracheal rupture (all <2.0). Health maintenance in type 2 diabetes, hypertension, and cardiovascular disease all received 5.0 ratings. Participants desired feedback by: section (4.6) and physician task (3.9), on performances of the entire class (4

  14. Medication Errors in Pediatric Anesthesia: A Report From the Wake Up Safe Quality Improvement Initiative.

    PubMed

    Lobaugh, Lauren M Y; Martin, Lizabeth D; Schleelein, Laura E; Tyler, Donald C; Litman, Ronald S

    2017-09-01

    Wake Up Safe is a quality improvement initiative of the Society for Pediatric Anesthesia that contains a deidentified registry of serious adverse events occurring in pediatric anesthesia. The aim of this study was to describe and characterize reported medication errors to find common patterns amenable to preventative strategies. In September 2016, we analyzed approximately 6 years' worth of medication error events reported to Wake Up Safe. Medication errors were classified by: (1) medication category; (2) error type by phase of administration: prescribing, preparation, or administration; (3) bolus or infusion error; (4) provider type and level of training; (5) harm as defined by the National Coordinating Council for Medication Error Reporting and Prevention; and (6) perceived preventability. From 2010 to the time of our data analysis in September 2016, 32 institutions had joined and submitted data on 2087 adverse events during 2,316,635 anesthetics. These reports contained details of 276 medication errors, which comprised the third highest category of events behind cardiac and respiratory related events. Medication errors most commonly involved opioids and sedative/hypnotics. When categorized by phase of handling, 30 events occurred during preparation, 67 during prescribing, and 179 during administration. The most common error type was accidental administration of the wrong dose (N = 84), followed by syringe swap (accidental administration of the wrong syringe, N = 49). Fifty-seven (21%) reported medication errors involved medications prepared as infusions as opposed to 1 time bolus administrations. Medication errors were committed by all types of anesthesia providers, most commonly by attendings. Over 80% of reported medication errors reached the patient and more than half of these events caused patient harm. Fifteen events (5%) required a life sustaining intervention. Nearly all cases (97%) were judged to be either likely or certainly preventable. Our findings

  15. Effectiveness of Electronic Reminders to Improve Medication Adherence in Tuberculosis Patients: A Cluster-Randomised Trial

    PubMed Central

    Liu, Xiaoqiu; Lewis, James J.; Zhang, Hui; Lu, Wei; Zhang, Shun; Zheng, Guilan; Bai, Liqiong; Li, Jun; Li, Xue; Chen, Hongguang; Liu, Mingming; Chen, Rong; Chi, Junying; Lu, Jian; Huan, Shitong; Cheng, Shiming; Wang, Lixia; Jiang, Shiwen; Chin, Daniel P.; Fielding, Katherine L.

    2015-01-01

    Background Mobile text messaging and medication monitors (medication monitor boxes) have the potential to improve adherence to tuberculosis (TB) treatment and reduce the need for directly observed treatment (DOT), but to our knowledge they have not been properly evaluated in TB patients. We assessed the effectiveness of text messaging and medication monitors to improve medication adherence in TB patients. Methods and Findings In a pragmatic cluster-randomised trial, 36 districts/counties (each with at least 300 active pulmonary TB patients registered in 2009) within the provinces of Heilongjiang, Jiangsu, Hunan, and Chongqing, China, were randomised using stratification and restriction to one of four case-management approaches in which patients received reminders via text messages, a medication monitor, combined, or neither (control). Patients in the intervention arms received reminders to take their drugs and reminders for monthly follow-up visits, and the managing doctor was recommended to switch patients with adherence problems to more intensive management or DOT. In all arms, patients took medications out of a medication monitor box, which recorded when the box was opened, but the box gave reminders only in the medication monitor and combined arms. Patients were followed up for 6 mo. The primary endpoint was the percentage of patient-months on TB treatment where at least 20% of doses were missed as measured by pill count and failure to open the medication monitor box. Secondary endpoints included additional adherence and standard treatment outcome measures. Interventions were not masked to study staff and patients. From 1 June 2011 to 7 March 2012, 4,292 new pulmonary TB patients were enrolled across the 36 clusters. A total of 119 patients (by arm: 33 control, 33 text messaging, 23 medication monitor, 30 combined) withdrew from the study in the first month because they were reassessed as not having TB by their managing doctor (61 patients) or were switched to

  16. Improving educational environment in medical colleges through transactional analysis practice of teachers

    PubMed Central

    Rajan, Marina

    2012-01-01

    Context: A FAIMER (Foundation for Advancement in International Medical Education and Research) fellow organized a comprehensive faculty development program to improve faculty awareness resulting in changed teaching practices and better teacher student relationships using Transactional Analysis (TA). Practicing TA tools help development of ‘awareness’ about intrapersonal and interpersonal processes. Objectives: To improve self-awareness among medical educators.To bring about self-directed change in practices among medical educators.To assess usefulness of TA tools for the same. Methods: An experienced trainer conducted a basic course (12 hours) in TA for faculty members. The PAC model of personality structure, functional fluency model of personal functioning, stroke theory on motivation, passivity and script theories of adult functional styles were taught experientially with examples from the Medical Education Scenario. Self-reported improvement in awareness and changes in practices were assessed immediately after, at three months, and one year after training. Findings: The mean improvement in self-'awareness' is 13.3% (95% C.I 9.3-17.2) among nineteen participants. This persists one year after training. Changes in practices within a year include, collecting feedback, new teaching styles and better relationship with students. Discussion and Conclusions: These findings demonstrate sustainable and measurable improvement in self-awareness by practice of TA tools. Improvement in self-'awareness' of faculty resulted in self-directed changes in teaching practices. Medical faculty has judged the TA tools effective for improving self-awareness leading to self-directed changes. PMID:24358808

  17. Applying athletic principles to medical rounds to improve teaching and patient care.

    PubMed

    Southwick, Frederick; Lewis, Michelle; Treloar, Dina; Cherabuddi, Kartikeya; Radhakrishnan, Nila; Leverence, Robert; Han, Xiaoxia; Cottler, Linda

    2014-07-01

    Teaching hospital multidisciplinary work rounds are often inefficient, delaying the completion of patient care tasks and detracting from teaching. Participants often act as working groups rather than interdependent teams. Athletic principles were used to train multidisciplinary rounding teams to adopt the systems used by manufacturing to improve the efficiency and quality of patient care, as well as teamwork and didactic teaching. Experimental groups of general medical rounding teams-faculty member, house staff, medical students, bedside nurses, pharmacists, and a case manager-were introduced to individual job descriptions (playbooks), key customer-supplier relation ships, and efficient communication protocols, accompanied by weekly feed back (game films). A two-phase pilot 11-month prospective trial (February to July 2009 and September 2011 to January 2012) compared the experimental and control rounding teams on the basis of length of stay, 30-day readmission rates, and physician, student, and patient satisfaction. These interventions resulted in a 30% reduction in 30-day readmissions and, in the 2011-2012 phase, an 18% shorter length of stay. Anonymous surveys documented greater satisfaction of faculty, residents, and medical students, and student ratings of teaching were markedly improved. Patient satisfaction did not change. The new rounding system has the potential to reduce waste and improve the quality of patient care while improving caregiver satisfaction and medical student teaching. Adaptive leadership skills will be required to overcome resistance to change. The use of athletic analogies can improve teamwork and facilitate the adoption of a systems approach to the delivery of patient care.

  18. To improve postgraduate training: medical residents' input in residency quality improvement.

    PubMed

    Eymann, Alfredo; Durante, Eduardo; Carrió, Silvia; Figari, Marcelo

    2012-01-01

    The "Open Space Technology" (OST) is an innovative group process introduced by Harrison Owen in 1997. There is some evidence for its effectiveness in education quality improvement. However, its application in higher education has not been reported. Our objective was to apply a modified OST as a quality improvement tool in a postgraduate training quality improvement program at a university hospital in Argentina. OST is a method in which a program's participants propose and discuss topics of their interest with an aim that had been defined for them by coordinators. After proposing and writing down themes important to improving the quality of their postgraduate training, residents were divided into small groups to discuss the suggested topics for 90 minutes. They then reconvened in the large group and presented the conclusions of their small group discussions. Thirty-six percent of residents (75/208) participated in one of the two OST sessions. Topics suggested by participants were similar in both sessions: (1) work hours, (2) work conditions, (3) residency curriculum, (4) residents' duties, (5) salaries, (6) professional burnout, (7) patient care load, and (8) interdisciplinary activities. In only four hours, residents were able to share their concerns and proposals for improving the quality of their residencies with their faculty. Most of the topics they suggested were subsequently included in the program's quality improvement agenda.

  19. A Positive Deviance Approach to Understanding Key Features to Improving Diabetes Care in the Medical Home

    PubMed Central

    Gabbay, Robert A.; Friedberg, Mark W.; Miller-Day, Michelle; Cronholm, Peter F.; Adelman, Alan; Schneider, Eric C.

    2013-01-01

    PURPOSE The medical home has gained national attention as a model to reorganize primary care to improve health outcomes. Pennsylvania has undertaken one of the largest state-based, multipayer medical home pilot projects. We used a positive deviance approach to identify and compare factors driving the care models of practices showing the greatest and least improvement in diabetes care in a sample of 25 primary care practices in southeast Pennsylvania. METHODS We ranked practices into improvement quintiles on the basis of the average absolute percentage point improvement from baseline to 18 months in 3 registry-based measures of performance related to diabetes care: glycated hemoglobin concentration, blood pressure, and low-density lipoprotein cholesterol level. We then conducted surveys and key informant interviews with leaders and staff in the 5 most and least improved practices, and compared their responses. RESULTS The most improved/higher-performing practices tended to have greater structural capabilities (eg, electronic health records) than the least improved/lower-performing practices at baseline. Interviews revealed striking differences between the groups in terms of leadership styles and shared vision; sense, use, and development of teams; processes for monitoring progress and obtaining feedback; and presence of technologic and financial distractions. CONCLUSIONS Positive deviance analysis suggests that primary care practices’ baseline structural capabilities and abilities to buffer the stresses of change may be key facilitators of performance improvement in medical home transformations. Attention to the practices’ structural capabilities and factors shaping successful change, especially early in the process, will be necessary to improve the likelihood of successful medical home transformation and better care. PMID:23690393

  20. Enhancing practice improvement by facilitating practitioner interactivity: new roles for providers of continuing medical education.

    PubMed

    Parboosingh, I John; Reed, Virginia A; Caldwell Palmer, James; Bernstein, Henry H

    2011-01-01

    Research into networking and interactivity among practitioners is providing new information that has the potential to enhance the effectiveness of practice improvement initiatives. This commentary reviews the evidence that practitioner interactivity can facilitate emergent learning and behavior change that lead to practice improvements. Insights from learning theories provide a framework for understanding emergent learning as the product of interactions between individuals in trusted relationships, such as occurs in communities of practice. This framework helps explain why some groups respond more favorably to improvement initiatives than others. Failure to take advantage of practitioner interactivity may explain in part the disappointingly low mean rates of practice improvement reported in studies of the effectiveness of practice improvement projects. Examples of improvement models in primary care settings that explicitly use relationship building and facilitation techniques to enhance practitioner interactivity are provided. Ingredients of a curriculum to teach relationship building in communities of practice and facilitation skills to enhance learning in small group education sessions are explored. Sufficient evidence exists to support the roles of relationships and interactivity in practice improvement initiatives such that we recommend the development of training programs to teach these skills to CME providers. Copyright © 2011 The Alliance for Continuing Medical Education, the Society for Academic Continuing Medical Education, and the Council on CME, Association for Hospital Medical Education.

  1. A Quantitative Assessment of a 4-year Intervention That Improved Patient Counseling Through Improving Medical Student Health

    PubMed Central

    Frank, Erica; Elon, Lisa; Hertzberg, Vicki

    2007-01-01

    Objective Despite efforts to produce healthier physicians and patients, there are no published experiments where health promotion interventions throughout medical school have been compared with a control group regarding the school environment, students' personal health practices, and students' patient counseling practices. Design Using the Class of 2002 as controls, we performed a 4-year pilot study of a personal health promotion intervention on the Class of 2003 at Emory University School of Medicine (EUSM). We focused on improving the actual and perceived healthfulness of the educational milieu, and on improving their personal and clinical practices about diet, tobacco, exercise, and alcohol use. Data were collected at freshman and ward orientations and during a senior rotation (ncontrols = 110, 109, 100 and ntreatment = 114, 104, 106; all response rates greater than 90%). Results Students receiving the intervention perceived EUSM as a healthier environment than did control students. By senior year, control males reported twice the tobacco use reported by males in the intervention (43% vs 22%, P = .02), although they had previously reported very similar levels (31% vs 29%, P = .8). Diet, exercise, and tobacco counseling practices were positively related to the intervention; alcohol was inversely related to the intervention. Conclusions In this pilot, compared with controls, the intervention positively affected medical students' perceptions of their school health promotion environment, reduced tobacco use among male students and, to some extent, improved their patient counseling practices. Such a medical school-based health promotion intervention shows promise and should be studied in a broader setting. PMID:17955112

  2. Text Messaging to Improve Hypertension Medication Adherence in African Americans: BPMED Intervention Development and Study Protocol

    PubMed Central

    Artinian, Nancy T; Schwiebert, Loren; Yarandi, Hossein; Levy, Phillip D

    2015-01-01

    Background Hypertension (HTN) is a major public health concern in the United States, with almost 78 million Americans age 20 years and over suffering from the condition. Moreover, HTN is a key risk factor for health disease and stroke. African Americans disproportionately shoulder the burdens of HTN, with greater prevalence, disease severity, earlier onset, and more HTN-related complications than age-matched whites. Medication adherence for the treatment of HTN is poor, with estimates indicating that only about half of hypertensive patients are adherent to prescribed medication regimens. Although no single intervention for improving medication adherence has emerged as superior to others, text message medication reminders have the potential to help improve medication adherence in African Americans with uncontrolled HTN as mobile phone adoption is very high in this population. Objective The purpose of this two-phased study was to develop (Phase I) and test in a randomized controlled trial (RCT) (Phase II) a text message system, BPMED, to improve the quality of medication management through increasing medication adherence in African Americans with uncontrolled HTN. Methods In Phase I, we recruited 16 target end-users from a primary care clinic, to assist in the development of BPMED through participating in one of three focus groups. Focus groups sought to gain patient perspectives on HTN, medication adherence, mobile phone use, and the use of text messaging to support medication adherence. Potential intervention designs were presented to participants, and feedback on the designs was solicited. In Phase II, we conducted two pilot RCTs to determine the feasibility, acceptability, and preliminary efficacy of BPMED in primary care and emergency department settings. Both pilot studies recruited approximately 60 participants, who were randomized equally between usual care and the BPMED intervention. Results Although data collection is now complete, data analysis from the

  3. Improving medical student attitudes toward older patients through a "council of elders" and reflective writing experience.

    PubMed

    Westmoreland, Glenda R; Counsell, Steven R; Sennour, Youcef; Schubert, Cathy C; Frank, Kathryn I; Wu, Jingwei; Frankel, Richard M; Litzelman, Debra K; Bogdewic, Stephen P; Inui, Thomas S

    2009-02-01

    In an effort to reduce "agism" which is prevalent among medical trainees, a new geriatrics educational experience for medical students aimed at improving attitudes toward older patients was developed. Each 90-minute Older Adult Session included four components: initial reflective writing exercise; introduction to the session; 75-minute dialogue with the "Council of Elders," a group of active, "well" older adults; and final reflective writing exercise. The new session was provided to 237 first- and second-year medical students during the 2006/07 academic year at Indiana University School of Medicine. Session evaluation included comparing scores on the 14-item Geriatrics Attitude Scale administered before and after the session, identifying attitude changes in the reflective writing exercises, and a student satisfaction survey. Student responses on the Geriatrics Attitude Scale after the session were significantly improved in seven of 14 items, demonstrating better attitudes toward being with and listening to older people and caring for older patients. Analysis of the reflective writings revealed changing of negative to positive or reinforced positive attitudes in 27% of medical students, with attitudes not discernable in the remaining 73% (except one student, in whom positive attitudes changed to negative). Learner satisfaction with the Older Adult Session was high, with 98% agreeing that the session had a positive effect on insight into the care of older adults. A Council of Elders coupled with a reflective writing exercise is a promising new approach to improving attitudes of medical students toward their geriatric patients.

  4. [Impact of a software application to improve medication reconciliation at hospital discharge].

    PubMed

    Corral Baena, S; Garabito Sánchez, M J; Ruíz Rómero, M V; Vergara Díaz, M A; Martín Chacón, E R; Fernández Moyano, A

    2014-01-01

    To assess the impact of a software application to improve the quality of information concerning current patient medications and changes on the discharge report after hospitalization. To analyze the incidence of errors and to classify them. Quasi-experimental pre / post study with non-equivalent control group study. Medical patients at hospital discharge. implementation of a software application. Percentage of reconciled patient medication on discharge, and percentage of patients with more than one unjustified discrepancy. A total of 349 patients were assessed; 199 (pre-intervention phase) and 150 (post-intervention phase). Before the implementation of the application in 157 patients (78.8%) medication reconciliation had been completed; finding reconciliation errors in 99 (63.0%). The most frequent type of error, 339 (78.5%), was a missing dose or administration frequency information. After implementation, all the patient prescriptions were reconciled when the software was used. The percentage of patients with unjustified discrepancies decreased from 63.0% to 11.8% with the use of the application (p<.001). The main type of discrepancy found on using the application was confusing prescription, due to the fact that the professionals were not used to using the new tool. The use of a software application has been shown to improve the quality of the information on patient treatment on the hospital discharge report, but it is still necessary to continue development as a strategy for improving medication reconciliation. Copyright © 2014 SECA. Published by Elsevier Espana. All rights reserved.

  5. Performance improvement indicators of the Medical Records Department and Information Technology (IT) in hospitals

    PubMed Central

    Ajami, Sima; Ketabi, Saedeh; Torabiyan, Fatemeh

    2015-01-01

    Medical Record Department (MRD) has a vital role in making short and long term plans to improve health system services. The aim of this study was to describe performance improvement indicators of hospital MRD and information technology (IT). Collection of Data: A search was conducted in various databases, through related keywords in articles, books, and abstracts of conferences from 2001 to 2009. About 58 articles and books were available which were evaluated and finally 15 of them were selected based on their relevance to the study. MRD must be capable of supporting tasks such as patient care and continuity, institute management processes, medical education programs, medical research, communication between different wards of a hospital and administrative and medical staff. The use of IT in MRD can facilitate access to department, expedite communication within and outside department, reduce space with electronic medical records, reduce costs, accelerate activities such as coding by use of coding guide software and facilitate retrieval of records that will ultimately improve the performance of MRD. PMID:26150874

  6. [Conceptual approaches to improve the system of preventive medical examinations of the adult population].

    PubMed

    Зюков, Олег Л; Гандзюк, Володимир А; Кондратюк, Наталія Ю

    Health indicators Ukraine's adult population over the last decade still too high for both countries of the European Community. Features direction of preventive health system of Ukraine, currently used extremely limited. Existing approaches to planning and carrying out preventive medical examinations in our country are outdated and are formal, so improving the existing system of preventive medical examinations of the adult population is necessary and timely. To prove scientifically conceptual approaches to improving the planning and implementation of preventive medical examinations of adults through functional and structural changes. Literature review, system analysis and conceptual modeling method. The analysis of the experience of our country for the prevention of the most common diseases and the state of the resource base for its conduct theoretically grounded and presented, functional-structural model of preventive medical examinations of the adult population, based on are: phasing of checkups, the introduction of sex and age of maps, determination at increased risk of diseases and the establishment / improvement of the automated monitoring systems of risk factors for noncommunicable diseases. Carrying out preventive medical examinations of the adult population using gender and age card allows you to choose the most appropriate preventive measures and to pay particular attention to preventive measures aimed at preventing the leading causes of disease and disability in a particular age group.

  7. From Yoda to Sackett: The Future of Psychiatry Medical Student Education

    ERIC Educational Resources Information Center

    Thornhill, Joshua T., IV; Tong, Lowell

    2006-01-01

    Objective: The authors discuss approaches to curricular goals, methods, and assessments in the education of medical students in psychiatry. Methods: Using current educational principles and opinions on curricular reform in medical student education, an outline for a core curriculum and an individualized approach to medical student education were…

  8. From Yoda to Sackett: The Future of Psychiatry Medical Student Education

    ERIC Educational Resources Information Center

    Thornhill, Joshua T., IV; Tong, Lowell

    2006-01-01

    Objective: The authors discuss approaches to curricular goals, methods, and assessments in the education of medical students in psychiatry. Methods: Using current educational principles and opinions on curricular reform in medical student education, an outline for a core curriculum and an individualized approach to medical student education were…

  9. The use of focused electronic medical record forms to improve health-care outcomes.

    PubMed

    Caldwell, Bryan D; Katz, Robert D; Pascarella, Eugene M

    2011-01-01

    We tested the use of specifically designed electronic medical record forms, thereby demonstrating the ability to electronically capture, report, and compare clinical data. To that end, podiatric physicians can determine what constitutes the most effective program or treatment for specific conditions by documenting their treatment outcomes. A prospective case series was initiated to determine the value of using focused electronic medical record forms to track walking programs in the practices of podiatric physicians. Three patients were observed for 48 weeks using focused electronic medical record forms to input data (body mass index, cholesterol level, hemoglobin A(1c) level, blood pressure, and other vital information). Patients were given pedometers so that they could log their mileage and their podiatric physicians could enter it into the medical record. Information was collected using an electronic medical record system with the ability to link multiple templates together and assign logic to create flexible entry completion requirements. The clinical data generated are captured in a common database, where the data offer future opportunity to compare statistics among a multitude of practices in various demographic regions. Focused electronic medical record forms were effectively used to track improvements and overall health benefits in a walking program supervised by podiatric physicians. Valuable information can be ascertained with focused electronic medical record forms to help determine treatment effectiveness. This information can later be compared with practices across many different demographics to ascertain the best evidence-based practice.

  10. Use of simulated pages to prepare medical students for internship and improve patient safety.

    PubMed

    Schwind, Cathy J; Boehler, Margaret L; Markwell, Stephen J; Williams, Reed G; Brenner, Michael J

    2011-01-01

    During the transition from medical school to internship, trainees experience high levels of stress related to pages on the inpatient wards. The steep learning curve during this period may also affect patient safety. The authors piloted the use of simulated pages to improve medical student preparedness, decrease stress related to pages, and familiarize medical students with common patient problems. A multidisciplinary team at Southern Illinois University School of Medicine developed simulated pages that were tested among senior medical students. Sixteen medical students were presented with 11 common patient scenarios. Data on assessment, management, and global performance were collected. Mean confidence levels were evaluated pre- and postintervention. Students were also surveyed on how the simulated pages program influenced their perceived comfort in managing patient care needs and the usefulness of the exercise in preparing them to handle inpatient pages. Mean scores on the assessment and management portions of the scenarios varied widely depending on the scenario (range -15.6 ± 41.6 to 95.7 ± 9.5). Pass rates based on global performance ranged from 12% to 93%. Interrater agreement was high (mean kappa = 0.88). Students' confidence ratings on a six-point scale increased from 1.87 preintervention to 3.53 postintervention (P < .0001). Simulated pages engage medical students and may foster medical student preparedness for internship. Students valued the opportunity to simulate "on call" responsibilities, and exposure to simulated pages significantly increased their confidence levels. Further studies are needed to determine effects on patient safety outcomes.

  11. Human factors tools for improving simulation activities in continuing medical education.

    PubMed

    Seagull, F Jacob

    2012-01-01

    Human factors (HF) is a discipline often drawn upon when there is a need to train people to perform complex, high-stakes tasks and effectively assess their performance. Complex tasks often present unique challenges for training and assessment. HF has developed specialized techniques that have been effective in overcoming several of these challenges in work settings such as aviation, process control, and the military. Many HF techniques could be applied to simulation in continuing medical education to enhance effectiveness of simulation and training, yet these techniques are not widely known by medical educators. Three HF techniques are described that could benefit health care simulation in areas of training techniques, assessment, and task design: (1) bandwidth feedback techniques for designing better feedback and task guidance, (2) dual-task assessment techniques that can differentiate levels of expertise in tasks where performance is essentially perfect, and (3) task abstraction techniques for developing task-relevant fidelity for simulations. Examples of each technique are given from work settings in which these principles have been applied successfully. Application of these principles to medical simulation and medical education is discussed. Adapting these techniques to health care could improve training in medical education. Copyright © 2012 The Alliance for Continuing Education in the Health Professions, the Society for Academic Continuing Medical Education, and the Council on CME, Association for Hospital Medical Education.

  12. Improving medical graduates’ training in palliative care: advancing education and practice

    PubMed Central

    Head, Barbara A; Schapmire, Tara J; Earnshaw, Lori; Chenault, John; Pfeifer, Mark; Sawning, Susan; Shaw, Monica A

    2016-01-01

    The needs of an aging population and advancements in the treatment of both chronic and life-threatening diseases have resulted in increased demand for quality palliative care. The doctors of the future will need to be well prepared to provide expert symptom management and address the holistic needs (physical, psychosocial, and spiritual) of patients dealing with serious illness and the end of life. Such preparation begins with general medical education. It has been recommended that teaching and clinical experiences in palliative care be integrated throughout the medical school curriculum, yet such education has not become the norm in medical schools across the world. This article explores the current status of undergraduate medical education in palliative care as published in the English literature and makes recommendations for educational improvements which will prepare doctors to address the needs of seriously ill and dying patients. PMID:26955298

  13. Improving medical graduates' training in palliative care: advancing education and practice.

    PubMed

    Head, Barbara A; Schapmire, Tara J; Earnshaw, Lori; Chenault, John; Pfeifer, Mark; Sawning, Susan; Shaw, Monica A

    2016-01-01

    The needs of an aging population and advancements in the treatment of both chronic and life-threatening diseases have resulted in increased demand for quality palliative care. The doctors of the future will need to be well prepared to provide expert symptom management and address the holistic needs (physical, psychosocial, and spiritual) of patients dealing with serious illness and the end of life. Such preparation begins with general medical education. It has been recommended that teaching and clinical experiences in palliative care be integrated throughout the medical school curriculum, yet such education has not become the norm in medical schools across the world. This article explores the current status of undergraduate medical education in palliative care as published in the English literature and makes recommendations for educational improvements which will prepare doctors to address the needs of seriously ill and dying patients.

  14. Improvement of the Russian system of medical care at the site of space crew landing

    NASA Astrophysics Data System (ADS)

    Rukavishnikov, Ilya; Bogomolov, Valery; Polyakov, Alexey

    The crew members are delivered to ISS and return back to the Earth on the space craft "Soyuz TMA" at present time. The technical means providing the safe landing of space crews are reliable enough. In spite of that the complex of negative factors (long lasting alternating and shock overloads, effects of landing apparatus rotation on vestibular system) affects the crew during landing and can reach the extreme values under the certain conditions. According to this fact there is a possibility of appearance of bodily damages of different weight besides the traditional functional disturbances. The group of search and rescue on the landing site includes the medical specialists appropriately equipped to stop the symptoms of medical contingency (strong vestibule-vegetative reactions, traumas of different weight, etc.) Medical evacuation complex which provides the acceptable conditions for the cosmonauts including the conditions for medical care is delivered to the landing site as well. The long term experience of search and rescue assurance at the landing site have shown that the specialists successfully cope with this task. In some cases it was required to give the medical help which allowed to improve the general condition and physical capacity of crewmembers and provide their evacuation to the places of postflight rehabilitation. At the same time the solution of some of the problems from our point of view could increase the efficacy of medical care for the landing crew. The organization of the training on emergency under the field conditions for medical specialists on the regular basis (not less that once a year) is extremely important. The equipment of medical specialists requires the regular improvement and modernization due to the fast changing medical technologies and standards. Wearable medical sets must provide the first aid performing in accordance to the modern medical requirements. It is also necessary to include in the list of equipment the textbook of

  15. Improvement in Language Function Correlates with Gait Improvement in Drug-naïve Parkinson's Disease Patients Taking Dopaminergic Medication.

    PubMed

    Murakami, Hidetomo; Momma, Yutaro; Nohara, Tetsuhito; Mori, Yukiko; Futamura, Akinori; Sugita, Toshihisa; Ishigaki, Seiichiro; Katoh, Hirotaka; Kezuka, Machiko; Ono, Kenjiro; Miller, Michael W; Kawamura, Mitsuru

    2016-01-01

    Dopaminergic drugs, the gold standard for motor symptoms, are known to affect cognitive function in Parkinson's disease (PD) patients. We compared the effects of dopaminergic treatment on motor and cognitive function in drug-naïve patients. Dopaminergic medication (levodopa, dopamine agonist, selegiline) was given to 27 drug-naïve PD patients and increased to a dose optimal for improved motor symptoms. Patients were tested prior to, and 4-7 months after, drug initiation. Motor function was assessed using the Unified Parkinson's Disease Rating Scale (UPDRS). Cognitive function was assessed using both the Japanese version of the Montreal Cognitive Assessment (MoCA-J) and the Neurobehavioral Cognitive Status Examination (COGNISTAT-J). Improvements from baseline for both motor and cognitive assessment were compared. Mean score of all motor assessments (UPDRS total score of Parts II and III, and sub-scores of tremor, rigidity, bradykinesia, gait, and postural instability) and certain cognitive assessments (MoCA-J total score and subscore of delayed recall) significantly improved with dopaminergic medication. Gait score improvement showed significant positive correlation with improvement in MoCA-J language domain and in language-comprehension subtests of COGNISTAT-J using Spearman's correlation coefficients. Furthermore, multiple regression analysis showed gait score improvement significantly correlated with improvements in the subtests of language-comprehension in COGNISTAT-J. There is correlated improvement in both gait and language function in de novo PD patients in response to dopaminergic drugs. Gait and language dysfunction in these patients may share a common pathophysiology linked to dopamine deficits.

  16. Improving medical students' written communication skills: design and evaluation of an educational curriculum.

    PubMed

    Melvin, L; Connolly, K; Pitre, L; Dore, K L; Wasi, P

    2015-06-01

    Written and verbal communication skills are important skills for all physicians. While verbal skills are taught and assessed in medical school, medical students report limited instruction in written communication skills. This study examined the impact of a curriculum delivered during a 6-week clinical rotation in Internal Medicine on the objective assessment of medical students' written communication skills. The curriculum consisted of two educational programmes: a medical student communication tutorial and a resident feedback workshop. The study was conducted from March 2012 to January 2013 at McMaster University in Hamilton, Ontario, Canada. The study featured three arms: (1) control, (2) medical student communication tutorial alone and (3) student tutorial and resident feedback workshop. Data were collected on 126 students during 6-week Internal Medicine clerkship rotations. Students' written consultation notes were collected prior to the educational programmes and at 6 weeks. Blinded faculty assessors used an independently validated Assessment Checklist to evaluate consultation notes. Consultation note scores improved from week 1 to week 6 across all study arms. However, the change was statistically significant only in arm 3, featuring both the medical student tutorial and the resident feedback workshop, with mean scores improving from 4.75 (SD=1.496) to 5.56 (SD=0.984) out of 7. The mean difference between week 1 and week 6 was significantly different (0.806, p=0.002, 95% CI 0.306 to 1.058). The combination of a resident feedback workshop with medical student written communication tutorial improves objective evaluations of consultation note scores over student tutorial alone. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  17. A Randomized Controlled Study of Art Observation Training to Improve Medical Student Ophthalmology Skills.

    PubMed

    Gurwin, Jaclyn; Revere, Karen E; Niepold, Suzannah; Bassett, Barbara; Mitchell, Rebecca; Davidson, Stephanie; DeLisser, Horace; Binenbaum, Gil

    2017-08-03

    Observation and description are critical to the practice of medicine, and to ophthalmology in particular. However, medical education does not provide explicit training in these areas, and medical students are often criticized for deficiencies in these skills. We sought to evaluate the effects of formal observation training in the visual arts on the general and ophthalmologic observational skills of medical students. Randomized, single-masked, controlled trial. Thirty-six first-year medical students, randomized 1:1 into art-training and control groups. Students in the art-training group were taught by professional art educators at the Philadelphia Museum of Art, during 6 custom-designed, 1.5-hour art observation sessions over a 3-month period. All subjects completed pre- and posttesting, in which they described works of art, retinal pathology images, and external photographs of eye diseases. Grading of written descriptions for observational and descriptive abilities by reviewers using an a priori rubric and masked to group assignment and pretesting/posttesting status. Observational skills, as measured by description testing, improved significantly in the training group (mean change +19.1 points) compared with the control group (mean change -13.5 points), P = 0.001. There were significant improvements in the training vs. control group for each of the test subscores. In a poststudy questionnaire, students reported applying the skills they learned in the museum in clinically meaningful ways at medical school. Art observation training for first-year medical students can improve clinical ophthalmology observational skills. Principles from the field of visual arts, which is reputed to excel in teaching observation and descriptive abilities, can be successfully applied to medical training. Further studies can examine the impact of such training on clinical care. Copyright © 2017 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.

  18. The development of substance-abuse curricular content by five North Carolina schools.

    PubMed

    Fang, W L; Applegate, S N; Stein, R M; Lohr, J A

    1998-10-01

    In 1992, the four medical schools in North Carolina and that state's dental school initiated a four-year project to more thoroughly integrate content about substance abuse into their curricula. The project was based on the premise that medical schools are failing to provide their students with adequate training about substance abuse issues, yet substance abuse is a large and growing source of health problems nationwide. While the authors indicate in broad ways the kinds of curricular content that the project sought, in this article they concentrate on the processes by which key faculty, administrators, and staff members from all the schools worked together in the curriculum development process, with each school tailoring the project's findings to the needs of its own students. Phase I of the project focused on the selection and orientation of the key faculty and members of the working committee at each institution, and garnering institutional support. Phase II focused on the development by key faculty of the project's philosophy, goals, and objectives; conducting needs assessment and curriculum analysis at each school; and identifying the content needed. During Phase III, project participants refined the needed content and integrated it, in individual ways, into each school's curriculum. Some (but not enough) evaluation of these curricular implementations was done. The authors highlight the lessons learned, both positive and negative, in hopes that these will be useful to other educators who wish to design, implement, and institutionalize substance-abuse curricular content.

  19. A proposed framework to improve the safety of medical devices in a Canadian hospital context

    PubMed Central

    Polisena, Julie; Jutai, Jeffrey; Chreyh, Rana

    2014-01-01

    Purpose Medical devices are used to monitor, replace, or modify anatomy or physiological processes. They are important health care innovations that enable effective treatment using less invasive techniques, and they improve health care delivery and patient outcomes. Devices can also introduce risk of harm to patients. Our objective was to propose a surveillance system framework to improve the safety associated with the use of medical devices in a hospital. Materials and methods The proposed medical device surveillance system incorporates multiple components to accurately document and assess the appropriate actions to reduce the risk of incidents, adverse events, and patient harm. The assumptions on which the framework is based are highlighted. The surveillance system was designed from the perspective of a tertiary teaching hospital that includes dedicated hospital staff whose mandate is to provide safe patient care to inpatients and outpatients and biomedical engineering services. Results The main components of the surveillance system would include an adverse medical device events database, a medical device/equipment library, education and training, and an open communication and feedback strategy. Close linkages among these components and with external medical device/equipment networks to the hospital must be established and maintained. A feedback mechanism on medical device-related incidents, as well as implementation and evaluation strategies for the surveillance system are described to ensure a seamless transition and a high satisfactory level among the hospital staff. The direct cost items of the proposed surveillance system for consideration, and its potential benefits are outlined. Conclusion The effectiveness of the proposed medical device surveillance system framework can be measured after it has been implemented in a Canadian hospital facility. PMID:24876796

  20. [A Program to Improve the Implementation Rate for the Barcode Medication Administration System].

    PubMed

    Yen, Ying-Ting; Chang, Shih-Fen; Tsai, Kuei-Lan; Chen, Chen-Ju; Liu, Li-Ching; Fang, Yu-Chiung

    2015-12-01

    Fully implementing the barcode medication administration system has been shown to help improve medication safety. We have promoted the barcode medication administration system in our hospital since May of 2014. However, the rate of implementation reached only 32% initially. We identified the major obstacles to fully implementing the barcode system as: (1) the barcodes on patients' wristbands were smudged or broken; (2) the barcodes on transparent drug bags and infusion bags were difficult to scan; (3) nurses were not familiar with the scanner and lacked the skills necessary to conduct barcode scans; (4) poor wireless Internet access inhibited effective barcode scanning; and (5) the beep sound generated during barcode scanning disturbed patients' sleep. The present project was conducted to improve the implementation by nursing staff of the barcode medication administration system. The purpose was to increase the rate of implementation from 32% to 80%. The key members of the project were nurses, computer technicians, and pharmacists. The following procedures were conducted: (1) check the integrity of the wrist band and renew this band periodically; (2) print the barcode against a white background on transparent drug transfusion bags; (3) demonstration the skills of barcode scanning to nurses and inspect the function of scanners periodically; (4) increase the number of access points for the wireless network; (5) demonstrate the procedure for adjusting the sound volume on the scanner; and (6) provide rewards / incentives for using the barcode medication administration system. The rate of implementation of the barcode medication administration system increased from 32% to 85.2%. This project significantly increased the use of the barcode medication administration system by our nursing staff. The procedures used in this project may be referenced by administrators at other hospitals with low rates of barcode medication administration system usage.

  1. A review of behavioral tailoring strategies for improving medication adherence in serious mental illness.

    PubMed

    Kreyenbuhl, Julie; Record, Elizabeth J; Palmer-Bacon, Jessica

    2016-06-01

    Nonadherence to psychopharmacological treatments poses a significant challenge to treatment success in individuals with serious mental illness, with upwards of 60% of people not taking their psychiatric medications as prescribed. Nonadherence is associated with adverse outcomes, including exacerbation of psychiatric symptoms, impaired functioning, increased hospitalizations and emergency room use, and increased health care costs. Whereas interventions using psychoeducation or cognitive approaches, such as motivational interviewing, have largely proven ineffective in improving adherence, approaches employing behavioral tailoring that incorporate medication taking into the daily routine and/or use environmental supports have shown promise. Recently, adherence-enhancing behavioral tailoring interventions that utilize novel technologies, such as electronic monitors and mobile phones, have been developed. Although interventions utilizing these platforms have the potential for widespread dissemination to a broad range of individuals, most require further empirical testing. This paper reviews selected behavioral tailoring strategies that aim to improve medication adherence and other functional outcomes among individuals with serious mental illness.

  2. A review of behavioral tailoring strategies for improving medication adherence in serious mental illness

    PubMed Central

    Kreyenbuhl, Julie; Record, Elizabeth J.; Palmer-Bacon, Jessica

    2016-01-01

    Nonadherence to psychopharmacological treatments poses a significant challenge to treatment success in individuals with serious mental illness, with upwards of 60% of people not taking their psychiatric medications as prescribed. Nonadherence is associated with adverse outcomes, including exacerbation of psychiatric symptoms, impaired functioning, increased hospitalizations and emergency room use, and increased health care costs. Whereas interventions using psychoeducation or cognitive approaches, such as motivational interviewing, have largely proven ineffective in improving adherence, approaches employing behavioral tailoring that incorporate medication taking into the daily routine and/or use environmental supports have shown promise. Recently, adherence-enhancing behavioral tailoring interventions that utilize novel technologies, such as electronic monitors and mobile phones, have been developed. Although interventions utilizing these platforms have the potential for widespread dissemination to a broad range of individuals, most require further empirical testing. This paper reviews selected behavioral tailoring strategies that aim to improve medication adherence and other functional outcomes among individuals with serious mental illness. PMID:27489459

  3. Curricular Adaptations in Introductory Physics Labs

    NASA Astrophysics Data System (ADS)

    Dreyfus, Benjamin W.; Ewell, Mary; Moore, Kimberly

    2017-01-01

    When curricular materials are disseminated to new sites, there can be a tension between fidelity to the original intent of the developers and adaptation to local needs. In this case study we look at a lab activity that was initially developed for an introductory physics for the life sciences (IPLS) course at the University of Maryland, then implemented at George Mason University with significant adaptations. The goals of the two implementations were overlapping, but also differed in ways that are reflected in the two versions of the lab. We compare student lab report data from the two sites to examine the impacts of the adaptation on how students engaged with the lab.

  4. Structured Medication Review to Improve Pharmacotherapy in People with Intellectual Disability and Behavioural Problems

    ERIC Educational Resources Information Center

    Scheifes, Arlette; Egberts, Toine C. G.; Stolker, Joost Jan; Nijman, Henk. L. I.; Heerdink, Eibert R.

    2016-01-01

    Background: Polypharmacy and chronic drug use are common in people with intellectual disability and behavioural problems, although evidence of effectiveness and safety in this population is lacking. This study examined the effects of a structured medication review and aimed to improve pharmacotherapy in inpatients with intellectual disability.…

  5. Integrating Education into Primary Care Quality and Cost Improvement at an Academic Medical Center

    ERIC Educational Resources Information Center

    Harrison, R. Van; Standiford, Connie J.; Green, Lee A.; Bernstein, Steven J.

    2006-01-01

    Introduction: In 1996 the University of Michigan Health System created the Guidelines Utilization, Implementation, Development, and Evaluation Studies (GUIDES) unit to improve the quality and cost-effectiveness of primary care for common medical problems. GUIDES's primary functions are to oversee the development of evidence-based, practical…

  6. Structured Medication Review to Improve Pharmacotherapy in People with Intellectual Disability and Behavioural Problems

    ERIC Educational Resources Information Center

    Scheifes, Arlette; Egberts, Toine C. G.; Stolker, Joost Jan; Nijman, Henk. L. I.; Heerdink, Eibert R.

    2016-01-01

    Background: Polypharmacy and chronic drug use are common in people with intellectual disability and behavioural problems, although evidence of effectiveness and safety in this population is lacking. This study examined the effects of a structured medication review and aimed to improve pharmacotherapy in inpatients with intellectual disability.…

  7. Integrating Education into Primary Care Quality and Cost Improvement at an Academic Medical Center

    ERIC Educational Resources Information Center

    Harrison, R. Van; Standiford, Connie J.; Green, Lee A.; Bernstein, Steven J.

    2006-01-01

    Introduction: In 1996 the University of Michigan Health System created the Guidelines Utilization, Implementation, Development, and Evaluation Studies (GUIDES) unit to improve the quality and cost-effectiveness of primary care for common medical problems. GUIDES's primary functions are to oversee the development of evidence-based, practical…

  8. 76 FR 12969 - Campaign To Improve Poor Medication Adherence (U18)

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-03-09

    ... goal of the Center for Drug Evaluation and Research is to raise consumers' awareness of the ] importance of good medication adherence, a vital first step toward improved adherence behavior and better... National Consumers League (NCL) to develop and lead a groundbreaking national campaign to raise...

  9. The Patient Safety and Clinical Pharmacy Collaborative: improving medication use systems for the underserved.

    PubMed

    Wallack, Madeline Carpinelli; Loafman, Mark; Sorensen, Todd D

    2012-08-01

    The Patient Safety and Clinical Pharmacy Services Collaborative (PSPC) is demonstrating improvements in the quality of care delivered by safety-net organizations through integration of clinical pharmacy services. This article describes how the PSPC is leading meaningful change in the arena of medication use in management of chronic disease.

  10. [An intervention program to improve the quality of the medical records in an Internal Medicine Department].

    PubMed

    Wikman, A; Safont, P; Merino, J; Martínez Baltanás, A; Matarranz Del Amo, M; López Calleja, E

    2009-09-01

    The medical records are key documents for the patient's diagnosis, treatment and follow-up. Thus, the clinical histories must be made with high technical quality. Although some studies relate the quality of the clinical history with better control of a disease, as far as we know, there are few that evaluate the quality of the medical record itself. This study aims to analyze the quality of the clinical histories of our Internal Medicine Department and then evaluate the improvement achieved. A descriptive and intervention study with a before and after design was conducted. It included 186 medical records elaborated by the physicians of our Internal Medicine Department. A 16-item Likert-like scale was designed for the evaluation. The items were analyzed item by item and a score combining them was elaborated. A baseline analysis and a second analysis 3 months after making several interventions were made. Weak points were detected in the baseline analysis (described) and after the interventions. There was an improvement in almost all the items, this being very significant in the recording of allergies and habits. The global score also improved significantly. CONCLUSION. The study has allowed us to learn our weak points in the elaboration of the medical records. We have improved their quality with the interventions. We estimate that this intervention has also been useful for the training of internal medicine physicians, residents and students.

  11. The Use of Individually Tailored Environmental Supports to Improve Medication Adherence and Outcomes in Schizophrenia

    PubMed Central

    Velligan, Dawn I.; Diamond, Pamela M.; Mintz, Jim; Maples, Natalie; Li, Xueying; Zeber, John; Ereshefsky, Larry; Lam, Yui-Wing F.; Castillo, Desiree; Miller, Alexander L.

    2008-01-01

    Cognitive adaptation training (CAT) is a psychosocial treatment that uses environmental supports such as signs, checklists, alarms, and the organization of belongings to cue and sequence adaptive behaviors in the home. Ninety-five outpatients with schizophrenia (structured clinical interview for diagnosis, Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition) were randomly assigned to (1) Full-CAT (CAT focused on many aspects of community adaptation including grooming, care of living quarters, leisure skills, social and role performance, and medication adherence), (2) Pharm-CAT (CAT focused only on medication and appointment adherence), or (3) treatment as usual (TAU). Treatment lasted for 9 months, and patients were followed for 6 months after the withdrawal of home visits. Medication adherence (assessed during unannounced, in-home pill counts) and functional outcomes were assessed at 3-month intervals. Results of mixed-effects regression models indicated that both CAT and Pharm-CAT treatments were superior to TAU for improving adherence to prescribed medication (P < .0001). Effects on medication adherence remained significant when home visits were withdrawn. Full-CAT treatment improved functional outcome relative to Pharm-CAT and TAU (P < .0001). However, differences for functional outcome across groups decreased following the withdrawal of home visits and were no longer statistically significant at the 6-month follow-up. Survival time to relapse or significant exacerbation was significantly longer in both CAT and Pharm-CAT in comparison to TAU (.004). Findings indicate that supports targeting medication adherence can improve and maintain this behavior. Comprehensive supports targeting multiple domains of functioning are necessary to improve functional outcomes. Maintenance of gains in functional outcome may require some form of continued intervention. PMID:17932089

  12. Teaching public health in UK medical schools: 'things have improved: teaching no longer feels like an expensive hobby'.

    PubMed

    Lyon, Anna K; Hothersall, Eleanor J; Gillam, Steve

    2016-09-01

    Recent policy initiatives in the UK have underlined the importance of public health education for healthcare professionals. We aimed to describe teaching inputs to medical undergraduate curricula, to identify perceived challenges in the delivery of public health teaching and make recommendations that may overcome them. We undertook a cross-sectional survey; questionnaires were sent electronically to 32 teaching leads in academic departments of public health in UK medical schools and followed up by telephone interviews. We obtained a 75% response rate; 13 public health teaching leads were interviewed. We found much variability between schools in teaching methods, curricular content and resources used. Concerns regarding the long-term sustainability of teaching focus on: staffing levels and availability, funding and the prioritization of research over teaching. We give examples of integration of public health with clinical teaching, innovative projects in public health and ways of enabling students to witness public health in action. There is a need to increase the supply of well-trained and motivated teachers and combine the best traditional teaching methods with more innovative approaches. Suggestions are made as to how undergraduate public health teaching can be strengthened. © The Author 2015. Published by Oxford University Press on behalf of Faculty of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  13. Mind-Body Skills Training to Improve Distress Tolerance in Medical Students: A Pilot Study.

    PubMed

    Kraemer, Kristen M; Luberto, Christina M; O'Bryan, Emily M; Mysinger, Erica; Cotton, Sian

    2016-01-01

    Medical students face rigorous and stressful work environments, resulting in high rates of psychological distress. However, there has been a dearth of empirical work aimed at modifying risk factors for psychopathology among this at-risk group. Distress tolerance, defined as the ability to withstand emotional distress, is one factor that may be important in promoting psychological well-being in medical students. Thus, the aim of the current mixed-methods study was (a) to describe changes in facets of distress tolerance (i.e., emotional tolerance, absorption, appraisal, regulation) for medical students who completed a mind-body skills training group, and a no-intervention control group of students; (b) to examine the relationship between changes in psychological variables and changes in distress tolerance; and (c) to report students' perceptions of the mind-body group, with an emphasis on how the group may have affected personal and professional functioning due to improvements in distress tolerance. The mind-body program was an 11-week, 2-hour skills training group that focused on introducing, practicing, and processing mind-body skills such as biofeedback, guided imagery, relaxation, several forms of meditation (e.g., mindfulness), breathing exercises, and autogenic training. Participants were 52 first- and second-year medical students (62.7% female, Mage = 23.45, SD = 1.51) who participated in a mind-body group or a no-intervention control group and completed self-report measures before and after the 11-week period. Students in the mind-body group showed a modest improvement in all distress tolerance subscales over time (ΔM = .42-.53, p = .01-.03, d = .44-.53), whereas the control group showed less consistent changes across most subscales (ΔM = .11-.42, p = .10-.65, d = .01-.42). Students in the mind-body group qualitatively reported an improved ability to tolerate affective distress. Overall, improvements in psychological symptoms were associated with

  14. Improving medication adherence with a targeted, technology-driven disease management intervention.

    PubMed

    Lawrence, David B; Allison, Wanda; Chen, Joyce C; Demand, Michael

    2008-06-01

    Treatment adherence is critical in managing chronic disease, but achieving it remains an elusive goal across many prevalent conditions. As part of its care management strategy, BlueCross BlueShield of South Carolina (BCBSSC) implemented the Longitudinal Adherence Treatment Evaluation program, a behavioral intervention to improve medication adherence among members with cardiovascular disease and/or diabetes. The objectives of this study were to 1) assess the effectiveness of telephonic intervention in influencing reinitiation of medication therapy, and 2) evaluate the rate and timing of medication reinitiation. BCBSSC applied algorithms against pharmacy claims data to identify patients prescribed targeted medications who were 60 or more days overdue for refills. This information was provided to care managers to address during their next patient contact. Care managers received focused training on techniques for medication behavior change, readiness to change, motivational interviewing, and active listening. Training also addressed common barriers to adherence and available resources, including side effect management, mail order benefits, drug assistance programs, medication organizers, and reminder systems. Overdue refills were tracked for 12 months, with medication reinitiation followed for an additional 3 months. In the intervention group, 94 patients were identified with 123 instances of late medication refills. In the age- and gender-matched comparison group, 61 patients were identified with 76 late refills. The intervention group had a significantly higher rate of medication reinitiation (59.3%) than the control group (42.1%; P < 0.05). Time to reinitiation was significantly shorter in the intervention group, 59.5 (+/- 69.0) days vs. 107.4 (+/- 109) days for the control group (P < 0.05). This initiative demonstrated that a targeted disease management intervention promoting patient behavior change increased the number of patients who reinitiated therapy after a

  15. Guideline implementation and patient-tailoring strategies to improve medication adherence for schizophrenia.

    PubMed

    Hudson, Teresa J; Owen, Richard R; Thrush, Carol R; Armitage, Tracey L; Thapa, Purushottam

    2008-01-01

    greater at 2 of the VA networks as compared to the third network. These data suggest that a patient-centered strategy to identify and overcome barriers to adherence can improve adherence to antipsychotic medications.

  16. Value-Based Benefit Design to Improve Medication Adherence for Employees with Anxiety or Depression.

    PubMed

    Reid, Kimberly J; Aguilar, Kathleen M; Thompson, Eric; Miller, Ross M

    2015-01-01

    Through reduced out-of-pocket costs and wellness offerings, value-based benefit design (VBBD) is a promising strategy to improve medication adherence and other health-related outcomes across populations. There is limited evidence, however, of the effectiveness of these policy-level changes among individuals with anxiety or depression. To assess the impact of a multifaceted VBBD policy that incorporates waived copayments, wellness offerings, and on-site services on medication adherence among plan members with anxiety or depression, and to explore how this intervention and its resulting improved adherence affects other health-related outcomes. A retrospective longitudinal pre/post design was utilized to measure outcomes before and after the VBBD policy change. Repeated measures statistical regression models with correlated error terms were utilized to evaluate outcomes among employees of a self-insured global health company and their spouses (N = 529) who had anxiety or depression after the VBBD policy change. A multivariable linear regression model was chosen as the best fit to evaluate a change in medication possession ratio (MPR) after comparing parameters for several distributions. The repeated measures multivariable regression models were adjusted for baseline MPR and potential confounders, including continuous age, sex, continuous modified Charlson Comorbidity Index, and the continuous number of prescriptions filled that year. The outcomes were assessed for the 1 year before the policy change (January 1, 2011, through December 31, 2011) and for 2 years after the change (January 1, 2012, through December 31, 2013). The primary outcome was a change in MPR. The secondary outcomes included healthcare utilization, medical or pharmacy costs, the initiation of medication, generic medication use, and employee absenteeism (the total number of sick days). The implementation of the VBBD strategy was associated with a significant increase in average MPR (0.65 vs 0.61 in

  17. Value-Based Benefit Design to Improve Medication Adherence for Employees with Anxiety or Depression

    PubMed Central

    Reid, Kimberly J.; Aguilar, Kathleen M.; Thompson, Eric; Miller, Ross M.

    2015-01-01

    Background Through reduced out-of-pocket costs and wellness offerings, value-based benefit design (VBBD) is a promising strategy to improve medication adherence and other health-related outcomes across populations. There is limited evidence, however, of the effectiveness of these policy-level changes among individuals with anxiety or depression. Objectives To assess the impact of a multifaceted VBBD policy that incorporates waived copayments, wellness offerings, and on-site services on medication adherence among plan members with anxiety or depression, and to explore how this intervention and its resulting improved adherence affects other health-related outcomes. Methods A retrospective longitudinal pre/post design was utilized to measure outcomes before and after the VBBD policy change. Repeated measures statistical regression models with correlated error terms were utilized to evaluate outcomes among employees of a self-insured global health company and their spouses (N = 529) who had anxiety or depression after the VBBD policy change. A multivariable linear regression model was chosen as the best fit to evaluate a change in medication possession ratio (MPR) after comparing parameters for several distributions. The repeated measures multivariable regression models were adjusted for baseline MPR and potential confounders, including continuous age, sex, continuous modified Charlson Comorbidity Index, and the continuous number of prescriptions filled that year. The outcomes were assessed for the 1 year before the policy change (January 1, 2011, through December 31, 2011) and for 2 years after the change (January 1, 2012, through December 31, 2013). The primary outcome was a change in MPR. The secondary outcomes included healthcare utilization, medical or pharmacy costs, the initiation of medication, generic medication use, and employee absenteeism (the total number of sick days). Results The implementation of the VBBD strategy was associated with a significant

  18. Curricular intervention increases adolescents' knowledge about asthma: a randomized trial.

    PubMed

    Coelho, Ana Carla C; Souza-Machado, Carolina de; Oliveira, Thiara S de; Santos, Tássia Natalie N Dos; Cruz, Álvaro A; Souza-Machado, Adelmir

    2017-09-06

    To evaluate the impact of a curricular intervention concerning the knowledge about asthma among adolescents from a public school. This was a randomized, controlled trial study on a curricular intervention in asthma, carried out with asthmatic and non-asthmatic adolescents. The study participants were divided into a curricular intervention group for asthma (IG), and a control group with traditional curriculum (CG). Topics related to asthma were included in the curriculum, such as the disease concept, triggering factors, treatment, symptoms, action plan, and beliefs in popular myths about the disease. These topics were evaluated through a questionnaire with scores ranging from 0 to 20 points, expressed by the mean score. The acquisition of knowledge was evaluated 90 days and 540 days after the start of the intervention (baseline), by applying the mixed linear model for analysis of associations. 181 students participated in the study (IG=101 and CG=80). As shown by their scores before the intervention; the students were unaware about asthma (IG: x¯=10.7±2.9vs. CG: x¯=11.5±2.7 points), its treatment (IG: x¯=1.6±0.9vs. CG: x¯=1.6±0.8 points), and reported beliefs in popular myths about the disease (IG: x¯=1.5±1.1vs. CG: x¯=1.7±1.1 points). After the intervention, the IG showed higher overall knowledge (GI: x¯=15.5±3.1 points), as well as knowledge about the treatment (GI: x¯=2.5±1.0 points), and two times more knowledge in the field "beliefs in popular myths about the disease" when compared to the CG. A greater probability of achieving satisfactory knowledge about asthma was noted in the IG (RR=3.5), with NTT=2.0. The inclusion of the asthma topic in the curriculum improved knowledge about the disease in a subgroup of students. Copyright © 2017 Sociedade Brasileira de Pediatria. Published by Elsevier Editora Ltda. All rights reserved.

  19. A Population Intervention to Improve Outcomes in Children With Medical Complexity.

    PubMed

    Noritz, Garey; Madden, Melissa; Roldan, Dina; Wheeler, T Arthur; Conkol, Kimberly; Brilli, Richard J; Barnard, John; Gleeson, Sean

    2017-01-01

    Children with medical complexity experience frequent interactions with the medical system and often receive care that is costly, duplicative, and inefficient. The growth of value-based contracting creates incentives for systems to improve their care. This project was designed to improve the health, health care value, and utilization for a population-based cohort of children with neurologic impairment and feeding tubes. A freestanding children's hospital and affiliated accountable care organization jointly developed a quality improvement initiative. Children with a percutaneous feeding tube, a neurologic diagnosis, and Medicaid, were targeted for intervention within a catchment area of >300 000 children receiving Medicaid. Initiatives included standardizing feeding tube management, improving family education, and implementing a care coordination program. Between January 2011 and December 2014, there was an 18.0% decrease (P < .001) in admissions and a 31.9% decrease (P < .001) in the average length of stay for children in the cohort. Total inpatient charges were reduced by $11 764 856. There was an 8.2% increase (P < .001) in the percentage of children with weights between the fifth and 95th percentiles. The care coordination program enrolled 58.3% of the cohort. This population-based initiative to improve the care of children with medical complexity showed promising results, including a reduction in charges while improving weight status and implementing a care coordination program. A concerted institutional initiative, in the context of an accountable care organization, can be part of the solution for improving outcomes and health care value for children with medical complexity. Copyright © 2017 by the American Academy of Pediatrics.

  20. Does teaching non-technical skills to medical students improve those skills and simulated patient outcome?

    PubMed

    Hagemann, Vera; Herbstreit, Frank; Kehren, Clemens; Chittamadathil, Jilson; Wolfertz, Sandra; Dirkmann, Daniel; Kluge, Annette; Peters, Jürgen

    2017-03-29

    The purpose of this study is to evaluate the effects of a tailor-made, non-technical skills seminar on medical student's behaviour, attitudes, and performance during simulated patient treatment. Seventy-seven students were randomized to either a non-technical skills seminar (NTS group, n=43) or a medical seminar (control group, n=34). The human patient simulation was used as an evaluation tool. Before the seminars, all students performed the same simulated emergency scenario to provide baseline measurements. After the seminars, all students were exposed to a second scenario, and behavioural markers for evaluating their non-technical skills were rated. Furthermore, teamwork-relevant attitudes were measured before and after the scenarios, and perceived stress was measured following each simulation. All simulations were also evaluated for various medical endpoints. Non-technical skills concerning situation awareness (p<.01, r=0.5) and teamwork (p<.01, r=0.45) improved from simulation I to II in the NTS group. Decision making improved in both groups (NTS: p<.01, r=0.39; control: p<.01, r=0.46). The attitude 'handling errors' improved significantly in the NTS group (p<.05, r=0.34). Perceived stress decreased from simulation I to II in both groups. Medical endpoints and patients´ outcome did not differ significantly between the groups in simulation II. This study highlights the effectiveness of a single brief seminar on non-technical skills to improve student's non-technical skills. In a next step, to improve student's handling of emergencies and patient outcomes, non-technical skills seminars should be accompanied by exercises and more broadly embedded in the medical school curriculum.

  1. Does teaching non-technical skills to medical students improve those skills and simulated patient outcome?

    PubMed Central

    Herbstreit, Frank; Kehren, Clemens; Chittamadathil, Jilson; Wolfertz, Sandra; Dirkmann, Daniel; Kluge, Annette; Peters, Jürgen

    2017-01-01

    Objectives The purpose of this study is to evaluate the effects of a tailor-made, non-technical skills seminar on medical student’s behaviour, attitudes, and performance during simulated patient treatment. Methods Seventy-seven students were randomized to either a non-technical skills seminar (NTS group, n=43) or a medical seminar (control group, n=34). The human patient simulation was used as an evaluation tool. Before the seminars, all students performed the same simulated emergency scenario to provide baseline measurements. After the seminars, all students were exposed to a second scenario, and behavioural markers for evaluating their non-technical skills were rated. Furthermore, teamwork-relevant attitudes were measured before and after the scenarios, and perceived stress was measured following each simulation. All simulations were also evaluated for various medical endpoints. Results Non-technical skills concerning situation awareness (p<.01, r=0.5) and teamwork (p<.01, r=0.45) improved from simulation I to II in the NTS group. Decision making improved in both groups (NTS: p<.01, r=0.39; control: p<.01, r=0.46). The attitude ‘handling errors’ improved significantly in the NTS group (p<.05, r=0.34). Perceived stress decreased from simulation I to II in both groups. Medical endpoints and patients´ outcome did not differ significantly between the groups in simulation II. Conclusions This study highlights the effectiveness of a single brief seminar on non-technical skills to improve student’s non-technical skills. In a next step, to improve student’s handling of emergencies and patient outcomes, non-technical skills seminars should be accompanied by exercises and more broadly embedded in the medical school curriculum. PMID:28355594

  2. Co-Curricular Engagement for Non-Traditional Online Learners

    ERIC Educational Resources Information Center

    Fontaine, Sherry J.; Cook, Shawn M.

    2014-01-01

    Engagement in co-curricular activities is a means of educating the whole student, providing an opportunity for the integration of academic, professional, and personal development. Residential programs offer students campus-based, co-curricular experiences that foster the development of student knowledge and personal development outside of the…

  3. Curricular Critique of an Environmental Education Policy: Implications for Practice

    ERIC Educational Resources Information Center

    Karrow, Douglas D.; Fazio, Xavier

    2015-01-01

    This paper provides a curricular critique of an environmental education policy framework called "Acting Today, Shaping Tomorrow" (Ontario Ministry of Education, 2009). Answers to the following two curricular questions: "What should be taught?" and "How it should be taught?" frame the critique. Scrutiny of the latter…

  4. 49 CFR 25.455 - Textbooks and curricular material.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 49 Transportation 1 2013-10-01 2013-10-01 false Textbooks and curricular material. 25.455 Section 25.455 Transportation Office of the Secretary of Transportation NONDISCRIMINATION ON THE BASIS OF SEX... Basis of Sex in Education Programs or Activities Prohibited § 25.455 Textbooks and curricular...

  5. Curricular Deliberation about "Hamlet": An Exercise in the Practical.

    ERIC Educational Resources Information Center

    Siegel, Judith Susan

    This study attempts to clarify and exploit Joseph Schwab's recent and current work on "practical" and "eclectic" curriculums in a simulated deliberation about a concrete curricular question, How might "Hamlet" be taught to one group of high school juniors? By exemplifying curricular deliberation, it aims to clarify…

  6. A Systemic Approach to Creating and Implementing Curricular Innovation.

    ERIC Educational Resources Information Center

    Dean, Carol D.; Acker-Hocevar, Michele; Laible, Julie C.

    This study examined university curricular reform, explaining how teacher education programs must create innovative curricular redesign to promote the development of students' critical thinking, problem solving, and decision making skills. The study highlighted a school of education in the process of curriculum redesign, using observation,…

  7. Curricular Deliberation about "Hamlet": An Exercise in the Practical.

    ERIC Educational Resources Information Center

    Siegel, Judith Susan

    This study attempts to clarify and exploit Joseph Schwab's recent and current work on "practical" and "eclectic" curriculums in a simulated deliberation about a concrete curricular question, How might "Hamlet" be taught to one group of high school juniors? By exemplifying curricular deliberation, it aims to clarify…

  8. Co-Curricular Engagement for Non-Traditional Online Learners

    ERIC Educational Resources Information Center

    Fontaine, Sherry J.; Cook, Shawn M.

    2014-01-01

    Engagement in co-curricular activities is a means of educating the whole student, providing an opportunity for the integration of academic, professional, and personal development. Residential programs offer students campus-based, co-curricular experiences that foster the development of student knowledge and personal development outside of the…

  9. Does Detracking Work? Evidence from a Mathematics Curricular Reform

    ERIC Educational Resources Information Center

    Domina, Thurston; Penner, Andrew M.; Penner, Emily K.; Conley, AnneMarie

    2012-01-01

    In this paper, the authors investigate the consequences of curricular intensification by examining changes in the social organization of schooling and student achievement in one California school district. The authors' analyses consider the following three research questions: (1) What effect did 8th grade curricular intensification have on…

  10. Preservice Teachers' Belief Systems toward Curricular Outcomes for Physical Education

    ERIC Educational Resources Information Center

    Kulinna, Pamela Hodges; Brusseau, Timothy; Ferry, Matthew; Cothran, Donetta

    2010-01-01

    This study was grounded in the belief systems and physical activity literature and investigated preservice teachers' belief systems toward curricular outcomes for physical education programs. Preservice teachers (N = 486; men = 62%, women = 38%) from 18 U.S. colleges/universities shared their beliefs about curricular outcomes. Preservice teachers…

  11. Memorandum on the use of information technology to improve medication safety.

    PubMed

    Ammenwerth, E; Aly, A-F; Bürkle, T; Christ, P; Dormann, H; Friesdorf, W; Haas, C; Haefeli, W E; Jeske, M; Kaltschmidt, J; Menges, K; Möller, H; Neubert, A; Rascher, W; Reichert, H; Schuler, J; Schreier, G; Schulz, S; Seidling, H M; Stühlinger, W; Criegee-Rieck, M

    2014-01-01

    Information technology in health care has a clear potential to improve the quality and efficiency of health care, especially in the area of medication processes. On the other hand, existing studies show possible adverse effects on patient safety when IT for medication-related processes is developed, introduced or used inappropriately. To summarize definitions and observations on IT usage in pharmacotherapy and to derive recommendations and future research priorities for decision makers and domain experts. This memorandum was developed in a consensus-based iterative process that included workshops and e-mail discussions among 21 experts coordinated by the Drug Information Systems Working Group of the German Society for Medical Informatics, Biometry and Epidemiology (GMDS). The recommendations address, among other things, a stepwise and comprehensive strategy for IT usage in medication processes, the integration of contextual information for alert generation, the involvement of patients, the semantic integration of information resources, usability and adaptability of IT solutions, and the need for their continuous evaluation. Information technology can help to improve medication safety. However, challenges remain regarding access to information, quality of information, and measurable benefits.

  12. Improving medication safety in UK care homes: challenges and current perspective.

    PubMed

    Fahrni, Mathumalar Loganathan; Franklin, Bryony Dean; Rawaf, Salman; Majeed, Azeem

    2014-02-01

    In the UK, there are policy and regulatory concerns regarding the governance of care homes and healthcare provision within these homes. From a public health perspective, these issues can pose significant challenges to the provision of safe and quality medication use services to care home residents. The objective of this paper is to highlight an important and neglected issue for the growing population of institutionalized older adults. We reviewed relevant literature for the years 2000 to present and identified recent efforts undertaken to improve medication safety standards in UK care homes. We consider the limitations and reasons for the National Health Service's restricted role and lack of leadership in providing medical services for this institutionalized population. The efforts taken by the Department of Health and other healthcare authorities targeting medication safety in care homes are also highlighted. In order to improve the quality of healthcare, specifically in areas related to medication safety and quality use of medicines, interventions need to be taken by the national government and similarly by local authorities and NHS commissioners.

  13. Improvement of medical content in the curriculum of biomedical engineering based on assessment of students outcomes.

    PubMed

    Abdulhay, Enas; Khnouf, Ruba; Haddad, Shireen; Al-Bashir, Areen

    2017-08-04

    Improvement of medical content in Biomedical Engineering curricula based on a qualitative assessment process or on a comparison with another high-standard program has been approached by a number of studies. However, the quantitative assessment tools have not been emphasized. The quantitative assessment tools can be more accurate and robust in cases of challenging multidisciplinary fields like that of Biomedical Engineering which includes biomedicine elements mixed with technology aspects. The major limitations of the previous research are the high dependence on surveys or pure qualitative approaches as well as the absence of strong focus on medical outcomes without implicit confusion with the technical ones. The proposed work presents the development and evaluation of an accurate/robust quantitative approach to the improvement of the medical content in the challenging multidisciplinary BME curriculum. The work presents quantitative assessment tools and subsequent improvement of curriculum medical content applied, as example for explanation, to the ABET (Accreditation Board for Engineering and Technology, USA) accredited biomedical engineering BME department at Jordan University of Science and Technology. The quantitative results of assessment of curriculum/course, capstone, exit exam, course assessment by student (CAS) as well as of surveys filled by alumni, seniors, employers and training supervisors were, first, mapped to the expected students' outcomes related to the medical field (SOsM). The collected data were then analyzed and discussed to find curriculum weakness points by tracking shortcomings in every outcome degree of achievement. Finally, actions were taken to fill in the gaps of the curriculum. Actions were also mapped to the students' medical outcomes (SOsM). Weighted averages of obtained quantitative values, mapped to SOsM, indicated accurately the achievement levels of all outcomes as well as the necessary improvements to be performed in curriculum

  14. Community pharmacy automatic refill program improves adherence to maintenance therapy and reduces wasted medication.

    PubMed

    Matlin, Olga S; Kymes, Steven M; Averbukh, Alice; Choudhry, Niteesh K; Brennan, Troyen A; Bunton, Andred; Ducharme, Timothy A; Simmons, Peter D; Shrank, William H

    2015-11-01

    Automatic prescription refill programs are a popular means of improving medication adherence. A concern is the potential for prescription drug wastage and unnecessary healthcare spending. We evaluated the impact of an automatic refill program on patterns of medication use. Retrospective propensity score matched cohort study with multivariable generalized linear modeling. The setting of the study was a pharmacy benefit manager administering benefits for patients of retail pharmacies. Participants included patients on medication for chronic conditions; those receiving a 30-day supply (n = 153,964) and a 90-day supply (n = 100,394) were analyzed separately. The intervention was the automatic prescription refill program. Measures included medication possession ratio (MPR) and average days excess at the time of refill. The results are reported across 11 therapeutic classes. Overall, patients receiving 30-day supplies of medication in the automatic refill program had an MPR that was 3 points higher than those not in the refill program; among those receiving 90-day fills and in the refill program, the MPR was 1.4 points higher (P < .001 for both 30- and 90-day fills). The MPR was higher for members in the refill program across all therapeutic classes. Limiting our analysis to members receiving more than 365 days of medication, we found that patients who received 30-day fills and enrolled in the automatic refill program had 2.5 fewer days' oversupply than those in the control group, whereas automatic refill patients receiving 90-day supplies had 2.18 fewer days' oversupply than the controls (P < .001 for both 30- and 90-day fills). For this pharmacy provider, automatic refill programs result in improved adherence without adding to medication oversupply.

  15. Pilot Study to Test the Effectiveness of Different Financial Incentives to Improve Medication Adherence.

    PubMed

    Garza, Kimberly B; Owensby, Justin K; Braxton Lloyd, Kimberly; Wood, Elizabeth A; Hansen, Richard A

    2016-01-01

    Medication nonadherence affects health care costs, morbidity, and mortality. Concepts from behavioral economics can guide the development of interventions to improve medication adherence. To measure the relative effectiveness of 2 behavioral economic-based incentive structures to improve medication adherence. This randomized controlled trial compared adherence among participants taking antihypertensive or antihyperlipidemic medications randomized to usual care (UC), guaranteed pay-out (GPO) incentives, or lottery incentives. Daily adherence was measured over a 90-day period using electronic caps (Medication Event Monitoring System [MEMS]). The GPO group received $30 up-front in a virtual account, with $0.50 deducted for each missed dose. Lottery group participants were eligible for a weekly $50 drawing, but only if they had taken their medication as prescribed all week. An electronic survey assessed self-reported adherence. Statistical analysis included descriptive statistics, paired t tests, ANOVA, and Pearson's correlations. In all, 36 participants were randomized (UC, n = 11; GPO, n = 14; lottery, n = 11). Mean percentage (±SD) of days adherent during the incentive period was highest in the lottery group (96% ± 5%), followed by the GPO group (94% ± 9%) and the UC group (94% ± 9%). There were no statistically significant differences among groups (P > 0.05). MEMS-measured adherence was not significantly correlated with a patient's self-reported adherence (P > 0.05) at baseline but was correlated at 90-day follow-up (P < 0.001). Although no statistically significant differences in adherence were demonstrated in this small sample of highly adherent participants, larger studies in a more diverse population or with other medications might show otherwise. © The Author(s) 2015.

  16. Information technology interventions to improve medication safety in primary care: a systematic review.

    PubMed

    Lainer, Miriam; Mann, Eva; Sönnichsen, Andreas

    2013-10-01

    Improving medication safety has become a major topic in all clinical settings. Information technology (IT) can play an important role to prevent adverse drug events (ADEs), but data on the effectiveness of IT interventions are controversial. The objective of this paper is to provide a systematic review about the effects of IT interventions on medication safety in primary care. PubMed, International Pharmaceutical Abstracts, EMBASE, Cochrane Database of Systematic Reviews, handsearching reference lists from full-text articles. Randomized controlled trials (RCTs), if interventions based on IT, performed in primary care and outcomes reported on medication safety. Data extraction Study characteristics and outcome data independently extracted by two reviewers. Disagreement resolved by discussion with a third reviewer. Out of 3918 studies retrieved, 10 RCTs met the inclusion criteria. Of the six studies evaluating computerized provider order entry (CPOE) with clinical decision support (CDS) only 3 studies effectively reduced unsafe prescribing. Both pharmacist-led IT interventions decreased the prescription of potentially inappropriate medication or unsafe prescribing in pregnancy. No reduction of ADEs was achieved by a web program or a TeleWatch system intervention. Only 5 of 10 RCTs revealed a reduction of medication errors. CPOE with CDS was effective if targeted at a limited number of potentially inappropriate medications. The positive results of pharmacist-led IT interventions indicate that IT interventions with inter-professional communication appear to be effective. The unequivocal results of the included RCTs stress the necessity of rigorous evaluation prior to large-scale implementation.

  17. The Importance of Medication Errors Reporting in Improving the Quality of Clinical Care Services

    PubMed Central

    Elden, Nesreen Mohamed Kamal; Ismail, Amira

    2016-01-01

    Introduction: Medication errors have significant implications on patient safety. Error detection through an active management and effective reporting system discloses medication errors and encourages safe practices. Objectives: To improve patient safety through determining and reducing the major causes of medication errors (MEs), after applying tailored preventive strategies. Methodology: A pre-test, post-test study was conducted on all inpatients at a 177 bed hospital where all medication procedures in each ward were monitored by a clinical pharmacist. The patient files were reviewed, as well. Error reports were submitted to a hospital multidisciplinary committee to identify major causes of errors. Accordingly, corrective interventions that consisted of targeted training programs for nurses and physicians were conducted. Results: Medication errors were higher during ordering/prescription stage (38.1%), followed by administration phase (20.9%). About 45% of errors reached the patients: 43.5% were harmless and 1.4% harmful. 7.7% were potential errors and more than 47% could be prevented. After the intervention, error rates decreased from (6.7%) to (3.6%) (P≤0.001). Conclusion: The role of a ward based clinical pharmacist with a hospital multidisciplinary committee was effective in recognizing, designing and implementing tailored interventions for reduction of medication errors. A systematic approach is urgently needed to decrease organizational susceptibility to errors, through providing required resources to monitor, analyze and implement effective interventions. PMID:27045415

  18. Improving Confidence in Competencies for International Medical Trips Using a Curriculum with Simulation.

    PubMed

    Birckhead, Brandon J; Mullikin, Trey C; Zubair, Adeel S; Alniemi, Dema; Franz, Walter B; Bachman, John W

    2015-01-01

    Many incoming medical and undergraduate students seek out international medical mission trips to supplement their education and training. However, few have the necessary skills to perform simple clinical tasks such as taking vital signs or conducting an initial patient interview. We conducted a small pilot study to assess the impact of simulation exercises on teaching incoming first-year medical students and undergraduate students basic clinical skills and teamwork. Our study population consisted of nine incoming medical students and 11 undergraduate students who participated in a training session involving simulated tasks prior to taking a medical mission trip to Nicaragua. Participants completed a survey before and after the simulation and at the end of the trip. All 20 indicated the simulation was effective in teaching clinical and team-building skills. In addition, the simulation exercise improved participants' confidence in their ability to perform certain clinical tasks and work as a team prior to the mission trip. We concluded that simulation is effective for incoming medical and undergraduate students and can be used prior to global health trips to increase their confidence in performing tasks required for a successful experience.

  19. Educational strategies aimed at improving student nurse's medication calculation skills: a review of the research literature.

    PubMed

    Stolic, Snezana

    2014-09-01

    Medication administration is an important and essential nursing function with the potential for dangerous consequences if errors occur. Not only must nurses understand the use and outcomes of administering medications they must be able to calculate correct dosages. Medication administration and dosage calculation education occurs across the undergraduate program for student nurses. Research highlights inconsistencies in the approaches used by academics to enhance the student nurse's medication calculation abilities. The aim of this integrative review was to examine the literature available on effective education strategies for undergraduate student nurses on medication dosage calculations. A literature search of five health care databases: Sciencedirect, Cinahl, Pubmed, Proquest, Medline to identify journal articles between 1990 and 2012 was conducted. Research articles on medication calculation educational strategies were considered for inclusion in this review. The search yielded 266 papers of which 20 meet the inclusion criteria. A total of 5206 student nurse were included in the final review. The review revealed educational strategies fell into four types of strategies; traditional pedagogy, technology, psychomotor skills and blended learning. The results suggested student nurses showed some benefit from the different strategies; however more improvements could be made. More rigorous research into this area is needed.

  20. Effectiveness of training intervention to improve medical student’s information literacy skills

    PubMed Central

    2016-01-01

    This study aimed to assess the efficiency of delivering a 4-month course of “effective literature search” among medical postgraduate students for improving information literacy skills. This was a cross-sectional study in which 90 postgraduate students were randomly selected and participated in 12 training sessions. Effective search strategies were presented and the students’ attitude and competency concerning online search were measured by a pre- and post-questionnaires and skill tests. Data were analyzed by SPSS version 16 using t-test. There was a significant improvement (p=0.00), in student’s attitude. The mean (standard deviation [SD]) was 2.9 (0.8) before intervention versus the mean (SD) 3.9 (0.7) after intervention. Students’ familiarity with medical resources and databases improved significantly. The data showed a significant increase (p=0.03), in students’ competency score concerning search strategy design and conducting a search. The mean (SD) was 2.04 (0.7) before intervention versus the mean (SD) 3.07 (0.8) after intervention. Also, students’ ability in applying search and meta search engine improved significantly. This study clearly acknowledges that the training intervention provides considerable opportunity to improve medical student’s information literacy skills. PMID:27907985

  1. Effectiveness of training intervention to improve medical student's information literacy skills.

    PubMed

    Abdekhoda, Mohammadhiwa; Dehnad, Afsaneh; Yousefi, Mahmood

    2016-12-01

    This study aimed to assess the efficiency of delivering a 4-month course of "effective literature search" among medical postgraduate students for improving information literacy skills. This was a cross-sectional study in which 90 postgraduate students were randomly selected and participated in 12 training sessions. Effective search strategies were presented and the students' attitude and competency concerning online search were measured by a pre- and post-questionnaires and skill tests. Data were analyzed by SPSS version 16 using t-test. There was a significant improvement (p=0.00), in student's attitude. The mean (standard deviation [SD]) was 2.9 (0.8) before intervention versus the mean (SD) 3.9 (0.7) after intervention. Students' familiarity with medical resources and databases improved significantly. The data showed a significant increase (p=0.03), in students' competency score concerning search strategy design and conducting a search. The mean (SD) was 2.04 (0.7) before intervention versus the mean (SD) 3.07 (0.8) after intervention. Also, students' ability in applying search and meta search engine improved significantly. This study clearly acknowledges that the training intervention provides considerable opportunity to improve medical student's information literacy skills.

  2. Video as a tool for improving tracheal intubation tasks for emergency medical and trauma care.

    PubMed

    Mackenzie, Colin F; Xiao, Yan; Hu, Fu-Ming; Seagull, F Jacob; Fitzgerald, Mark

    2007-10-01

    We illustrate how audio-video data records can improve emergency medical care, using airway management to show how such video data may help to identify unsafe acts, accident precursors, and latent and systems failures and to evaluate performance. This was a retrospective analysis of videos of real patient resuscitation in a trauma center. Participant care providers reviewing their own videos of tracheal intubation identified failures to use diagnostic equipment, fixation errors, and team and communication errors. Neutral expert observers noted team coordination failures and poor error recovery. Comparison with a consensus guideline for a tracheal intubation task/communication pathway showed that communications were unclear or not made, and key tasks were omitted by team members. Differences were detected between performance of tracheal intubation in elective and emergency circumstances. Revised practices ("3 Cs": clinical examination, communication, carbon dioxide) mitigated task performance and communication deficiencies. Video is complementary to traditional quality improvement methods for improving performance in airway management and emergency medical and trauma care, assessing standard operating procedures, and reviewing communications. Video data identify performance details not found in quality improvement approaches, including medical record review or recall by participant care providers. Weaknesses in using video for data include lengthy video review processes, poor audio, and the inability to adequately analyze events outside the field of view. Opportunities are to use video audit for quality improvement of other emergency tasks. Video buffering reduces personnel requirements for capture and simplifies data extraction. Medicolegal and confidentiality threats are significant.

  3. Improved diagonal queue medical image steganography using Chaos theory, LFSR, and Rabin cryptosystem.

    PubMed

    Jain, Mamta; Kumar, Anil; Choudhary, Rishabh Charan

    2017-06-01

    In this article, we have proposed an improved diagonal queue medical image steganography for patient secret medical data transmission using chaotic standard map, linear feedback shift register, and Rabin cryptosystem, for improvement of previous technique (Jain and Lenka in Springer Brain Inform 3:39-51, 2016). The proposed algorithm comprises four stages, generation of pseudo-random sequences (pseudo-random sequences are generated by linear feedback shift register and standard chaotic map), permutation and XORing using pseudo-random sequences, encryption using Rabin cryptosystem, and steganography using the improved diagonal queues. Security analysis has been carried out. Performance analysis is observed using MSE, PSNR, maximum embedding capacity, as well as by histogram analysis between various Brain disease stego and cover images.

  4. Improving core medical training--innovative and feasible ideas to better training.

    PubMed

    Tasker, Fiona; Dacombe, Peter; Goddard, Andrew F; Burr, Bill

    2014-12-01

    A recent survey of UK core medical training (CMT) training conducted jointly by the Royal College of Physicians (RCP) and Joint Royal College of Physicians Training Board (JRCPTB) identified that trainees perceived major problems with their training. Service work dominated and compromised training opportunities, and of great concern, almost half the respondents felt that they had not been adequately prepared to take on the role of medical registrar. Importantly, the survey not only gathered CMT trainees' views of their current training, it also asked them for their 'innovative and feasible ways to improve CMT'. This article draws together some of these excellent ideas on how the quality of training and the experience of trainees could be improved. It presents a vision for how CMT trainees, consultant supervisors, training programme directors, clinical directors and managers can work together to implement relevant, feasible and affordable ways to improve training for doctors and deliver the best possible care for patients. © 2014 Royal College of Physicians.

  5. Cognitive aid use improves transition of care by graduating medical students during a simulated crisis.

    PubMed

    Bauer, Brooke; Rebel, Annette; Dilorenzo, Amy; Schell, Randall M; Dority, Jeremy S; Lukens, Faith; Sloan, Paul A

    2016-01-01

    Residents are expected to have transition of care (ToC) skills upon entering graduate medical education. It is unclear whether experience and training during medical school is adequate. The aim of the project was to assess: 1) graduating medical students' ability to perform ToC in a crisis situation, and 2) whether using a cognitive aid improves the ToC quality. The authors developed simulation scenarios for rapid response teams and a cognitive aid to assist in the ToC during crisis situations. Graduating medical students were enrolled and randomly divided into teams of three students, randomly assigned into one of two groups: teams using a cognitive aid for ToC (CA), or not using a cognitive aid (nCA). In the scenario, teams respond to a deteriorating patient and then transfer care to the next provider after stabilization. Three faculty reviewed the recording to assess completeness of the ToC and the overall quality. A completeness score was expressed as a fraction of the maximum score. Statistical analysis was performed using a t-test and Mann-Whitney U test. A total of 112 senior medical students participated: CA n=19, nCA n=17. The completeness score of the ToC and overall quality improved when using the cognitive aid (completeness score: CA 0.80±0.06 vs. nCA 0.52±0.07, p<0.01; ToC quality: CA 3.16±0.65 vs. nCA 1.92±0.56, p<0.01). Participants' rating of knowledge and comfort with the ToC process increased after the simulation. The completeness of information transfer during the ToC process by graduating medical students improved by using a cognitive aid in a simulated patient crisis.

  6. Cognitive aid use improves transition of care by graduating medical students during a simulated crisis.

    PubMed

    Bauer, Brooke; Rebel, Annette; Dilorenzo, Amy; Schell, Randall M; Dority, Jeremy S; Lukens, Faith; Sloan, Paul A

    2016-01-01

    Background Residents are expected to have transition of care (ToC) skills upon entering graduate medical education. It is unclear whether experience and training during medical school is adequate. Objective The aim of the project was to assess: 1) graduating medical students' ability to perform ToC in a crisis situation, and 2) whether using a cognitive aid improves the ToC quality. Methods The authors developed simulation scenarios for rapid response teams and a cognitive aid to assist in the ToC during crisis situations. Graduating medical students were enrolled and randomly divided into teams of three students, randomly assigned into one of two groups: teams using a cognitive aid for ToC (CA), or not using a cognitive aid (nCA). In the scenario, teams respond to a deteriorating patient and then transfer care to the next provider after stabilization. Three faculty reviewed the recording to assess completeness of the ToC and the overall quality. A completeness score was expressed as a fraction of the maximum score. Statistical analysis was performed using a t-test and Mann-Whitney U test. Results A total of 112 senior medical students participated: CA n=19, nCA n=17. The completeness score of the ToC and overall quality improved when using the cognitive aid (completeness score: CA 0.80±0.06 vs. nCA 0.52±0.07, p<0.01; ToC quality: CA 3.16±0.65 vs. nCA 1.92±0.56, p<0.01). Participants' rating of knowledge and comfort with the ToC process increased after the simulation. Conclusion The completeness of information transfer during the ToC process by graduating medical students improved by using a cognitive aid in a simulated patient crisis.

  7. Cognitive aid use improves transition of care by graduating medical students during a simulated crisis

    PubMed Central

    Bauer, Brooke; Rebel, Annette; Dilorenzo, Amy; Schell, Randall M.; Dority, Jeremy S.; Lukens, Faith; Sloan, Paul A.

    2016-01-01

    Background Residents are expected to have transition of care (ToC) skills upon entering graduate medical education. It is unclear whether experience and training during medical school is adequate. Objective The aim of the project was to assess: 1) graduating medical students’ ability to perform ToC in a crisis situation, and 2) whether using a cognitive aid improves the ToC quality. Methods The authors developed simulation scenarios for rapid response teams and a cognitive aid to assist in the ToC during crisis situations. Graduating medical students were enrolled and randomly divided into teams of three students, randomly assigned into one of two groups: teams using a cognitive aid for ToC (CA), or not using a cognitive aid (nCA). In the scenario, teams respond to a deteriorating patient and then transfer care to the next provider after stabilization. Three faculty reviewed the recording to assess completeness of the ToC and the overall quality. A completeness score was expressed as a fraction of the maximum score. Statistical analysis was performed using a t-test and Mann-Whitney U test. Results A total of 112 senior medical students participated: CA n=19, nCA n=17. The completeness score of the ToC and overall quality improved when using the cognitive aid (completeness score: CA 0.80±0.06 vs. nCA 0.52±0.07, p<0.01; ToC quality: CA 3.16±0.65 vs. nCA 1.92±0.56, p<0.01). Participants’ rating of knowledge and comfort with the ToC process increased after the simulation. Conclusion The completeness of information transfer during the ToC process by graduating medical students improved by using a cognitive aid in a simulated patient crisis. PMID:27435838

  8. Research on an Improved Medical Image Enhancement Algorithm Based on P-M Model.

    PubMed

    Dong, Beibei; Yang, Jingjing; Hao, Shangfu; Zhang, Xiao

    2015-01-01

    Image enhancement can improve the detail of the image and so as to achieve the purpose of the identification of the image. At present, the image enhancement is widely used in medical images, which can help doctor's diagnosis. IEABPM (Image Enhancement Algorithm Based on P-M Model) is one of the most common image enhancement algorithms. However, it may cause the lost of the texture details and other features. To solve the problems, this paper proposes an IIEABPM (Improved Image Enhancement Algorithm Based on P-M Model). Simulation demonstrates that IIEABPM can effectively solve the problems of IEABPM, and improve image clarity, image contrast, and image brightness.

  9. Method of Improved Fuzzy Contrast Combined Adaptive Threshold in NSCT for Medical Image Enhancement.

    PubMed

    Zhou, Fei; Jia, ZhenHong; Yang, Jie; Kasabov, Nikola

    2017-01-01

    Noises and artifacts are introduced to medical images due to acquisition techniques and systems. This interference leads to low contrast and distortion in images, which not only impacts the effectiveness of the medical image but also seriously affects the clinical diagnoses. This paper proposes an algorithm for medical image enhancement based on the nonsubsampled contourlet transform (NSCT), which combines adaptive threshold and an improved fuzzy set. First, the original image is decomposed into the NSCT domain with a low-frequency subband and several high-frequency subbands. Then, a linear transformation is adopted for the coefficients of the low-frequency component. An adaptive threshold method is used for the removal of high-frequency image noise. Finally, the improved fuzzy set is used to enhance the global contrast and the Laplace operator is used to enhance the details of the medical images. Experiments and simulation results show that the proposed method is superior to existing methods of image noise removal, improves the contrast of the image significantly, and obtains a better visual effect.

  10. An integrated pharmacy-based program improved medication prescription and adherence rates in diabetes patients.

    PubMed

    Brennan, Troyen A; Dollear, Timothy J; Hu, Min; Matlin, Olga S; Shrank, William H; Choudhry, Niteesh K; Grambley, William

    2012-01-01

    A substantial threat to the overall health of the American public is nonadherence to medications used to treat diabetes, as well as physicians' failure to initiate patients' use of those medications. To address this problem, we evaluated an integrated, pharmacy-based program to improve patients' adherence and physicians' initiation rates. The study included 5,123 patients with diabetes in the intervention group and 24,124 matched patients with diabetes in the control group. The intervention consisted of outreach from both mail-order and retail pharmacists who had specific information from the pharmacy benefit management company on patients' adherence to medications and use of concomitant therapies. The interventions improved patients' medication adherence rates by 2.1 percent and increased physicians' initiation rates by 38 percent, compared to the control group. The benefits were greater in patients who received counseling in the retail setting than in those who received phone calls from pharmacists based in mail-order pharmacies. This suggests that the in-person interaction between the retail pharmacist and patient contributed to improved behavior. The interventions were cost-effective, with a return on investment of approximately $3 for every $1 spent. These findings highlight the central role that pharmacists can play in promoting the appropriate initiation of and adherence to therapy for chronic diseases.

  11. Improved medication use in long-term care: building on the consultant pharmacist's drug regimen review.

    PubMed

    Harjivan, Chandresh; Lyles, Alan

    2002-04-01

    Elderly and long-term care (LTC) patients often require complex medication regimens that increase their risk of adverse drug events or suboptimal pharmacotherapy. Currently, oversight of medication use in LTC facilities consists of a federally mandated monthly audit, the drug regimen review (DRR), performed by a consultant pharmacist, and yearly onsite government surveys. Although the DRR's purpose is to improve drug use and to avoid adverse drug events, the Centers for Medicare and Medicaid Services's (CMS) current DRR guidelines focus on a limited selection of medications and indications rather than on patient outcomes. An expanded model building on CMS's survey guidelines and the American Society of Consultant Pharmacists' Fleetwood Model is proposed to improve oversight of medication use. The proposed model includes using consultant pharmacists with demonstrated geriatric pharmacotherapy expertise, direct patient assessments by the pharmacist, increased interaction among healthcare professionals, evidence-based practices, and explicit patient outcome assessments. It is both feasible and timely: (1) the LTC prospective payment system aligns financial incentives between payers and providers; and (2) the Institute of Medicine has made quality improvement and error reduction a priority.

  12. Method of Improved Fuzzy Contrast Combined Adaptive Threshold in NSCT for Medical Image Enhancement

    PubMed Central

    Yang, Jie; Kasabov, Nikola

    2017-01-01

    Noises and artifacts are introduced to medical images due to acquisition techniques and systems. This interference leads to low contrast and distortion in images, which not only impacts the effectiveness of the medical image but also seriously affects the clinical diagnoses. This paper proposes an algorithm for medical image enhancement based on the nonsubsampled contourlet transform (NSCT), which combines adaptive threshold and an improved fuzzy set. First, the original image is decomposed into the NSCT domain with a low-frequency subband and several high-frequency subbands. Then, a linear transformation is adopted for the coefficients of the low-frequency component. An adaptive threshold method is used for the removal of high-frequency image noise. Finally, the improved fuzzy set is used to enhance the global contrast and the Laplace operator is used to enhance the details of the medical images. Experiments and simulation results show that the proposed method is superior to existing methods of image noise removal, improves the contrast of the image significantly, and obtains a better visual effect. PMID:28744464

  13. Problem Based Learning (PBL) - An Effective Approach to Improve Learning Outcomes in Medical Teaching.

    PubMed

    Preeti, Bajaj; Ashish, Ahuja; Shriram, Gosavi

    2013-12-01

    As the "Science of Medicine" is getting advanced day-by-day, need for better pedagogies & learning techniques are imperative. Problem Based Learning (PBL) is an effective way of delivering medical education in a coherent, integrated & focused manner. It has several advantages over conventional and age-old teaching methods of routine. It is based on principles of adult learning theory, including student's motivation, encouragement to set goals, think critically about decision making in day-to-day operations. Above all these, it stimulates challenge acceptance and learning curiosity among students and creates pragmatic educational program. To measure the effectiveness of the "Problem Based Learning" as compared to conventional theory/didactic lectures based learning. The study was conducted on 72 medical students from Dayanand Medical College & Hospital, Ludhiana. Two modules of problem based sessions designed and delivered. Pre & Post-test score's scientific statistical analysis was done. Student feed-back received based on questionnaire in the five-point Likert scale format. Significant improvement in overall performance observed. Feedback revealed majority agreement that "Problem-based learning" helped them create interest (88.8 %), better understanding (86%) & promotes self-directed subject learning (91.6 %). Substantial improvement in the post-test scores clearly reveals acceptance of PBL over conventional learning. PBL ensures better practical learning, ability to create interest, subject understanding. It is a modern-day educational strategy, an effective tool to objectively improve the knowledge acquisition in Medical Teaching.

  14. Using total quality management approach to improve patient safety by preventing medication error incidences(*).

    PubMed

    Yousef, Nadin; Yousef, Farah

    2017-09-04

    Whereas one of the predominant causes of medication errors is a drug administration error, a previous study related to our investigations and reviews estimated that the incidences of medication errors constituted 6.7 out of 100 administrated medication doses. Therefore, we aimed by using six sigma approach to propose a way that reduces these errors to become less than 1 out of 100 administrated medication doses by improving healthcare professional education and clearer handwritten prescriptions. The study was held in a General Government Hospital. First, we systematically studied the current medication use process. Second, we used six sigma approach by utilizing the five-step DMAIC process (Define, Measure, Analyze, Implement, Control) to find out the real reasons behind such errors. This was to figure out a useful solution to avoid medication error incidences in daily healthcare professional practice. Data sheet was used in Data tool and Pareto diagrams were used in Analyzing tool. In our investigation, we reached out the real cause behind administrated medication errors. As Pareto diagrams used in our study showed that the fault percentage in administrated phase was 24.8%, while the percentage of errors related to prescribing phase was 42.8%, 1.7 folds. This means that the mistakes in prescribing phase, especially because of the poor handwritten prescriptions whose percentage in this phase was 17.6%, are responsible for the consequent) mistakes in this treatment process later on. Therefore, we proposed in this study an effective low cost strategy based on the behavior of healthcare workers as Guideline Recommendations to be followed by the physicians. This method can be a prior caution to decrease errors in prescribing phase which may lead to decrease the administrated medication error incidences to less than 1%. This improvement way of behavior can be efficient to improve hand written prescriptions and decrease the consequent errors related to administrated

  15. [Quality assurance and quality improvement in medical practice. Part 1. Definition and importance of quality in medical practice].

    PubMed

    Godény, Sándor

    2012-01-22

    In Hungary, financing of healthcare has decreased relative to the GDP, while the health status of the population is still ranks among the worst in the European Union. Since healthcare financing is not expected to increase, the number of practicing doctors per capita is continuously decreasing. In the coming years, it is an important question that in this situation what methods can be used to prevent further deterioration of the health status of the Hungarian population, and within this is the role of the quality approach, and different methods of quality management. In the present and the forthcoming two articles those standpoints will be summarized which support the need for the integration of quality assurance in the everyday medical practice. In the first part the importance of quality thinking, quality management, quality assurance, necessity of quality measurement and improvement, furthermore, advantages of the quality systems will be discussed.

  16. Porcine wet lab improves surgical skills in third year medical students.

    PubMed

    Drosdeck, Joseph; Carraro, Ellen; Arnold, Mark; Perry, Kyle; Harzman, Alan; Nagel, Rollin; Sinclair, Lynnsay; Muscarella, Peter

    2013-09-01

    Medical students desire to become proficient in surgical techniques and believe their acquisition is important. However, the operating room is a challenging learning environment. Small group procedural workshops can improve confidence, participation, and performance. The use of fresh animal tissues has been rated highly among students and improves their surgical technique. Greater exposure to surgical procedures and staff could positively influence students' interest in surgical careers. We hypothesized that a porcine "wet lab" course for third year medical students would improve their surgical skills. Two skills labs were conducted for third year medical students during surgery clerkships in the fall of 2011. The students' surgical skills were first evaluated in the operating room across nine dimensions. Next, the students performed the following procedures during the skills lab: (1) laparotomy; (2) small bowel resection; (3) splenectomy; (4) partial hepatectomy; (5) cholecystectomy; (6) interrupted abdominal wall closure; (7) running abdominal wall closure; and (8) skin closure. After the skills lab, the students were re-evaluated in the operating room across the same nine dimensions. Student feedback was also recorded. Fifty-one participants provided pre- and post-lab data for use in the final analysis. The mean scores for all nine surgical skills improved significantly after participation in the skills lab (P ≤ 0.002). Cumulative post-test scores also showed significant improvement (P = 0.002). Finally, the student feedback was largely positive. The surgical skills of third year medical students improved significantly after participation in a porcine wet lab, and the students rated the experience as highly educational. Integration into the surgery clerkship curriculum would promote surgical skill proficiency and could elicit interest in surgical careers. Copyright © 2013 Elsevier Inc. All rights reserved.

  17. Has the inclusion of a longitudinally integrated communication skills program improved consultation skills in medical students? A pilot study

    PubMed Central

    Shah, Sameena; Andrades, Marie; Basir, Fasia; Jaleel, Anila; Azam, Iqbal; Islam, Muhammad; Ahmed, Rashida

    2016-01-01

    Background: Evidence highlights a lack of communication skills in doctors leading to dysfunctional consultations. To address this deficit, a private medical college instituted curricular reforms with inclusion of a longitudinal communication skills program. A pilot study was undertaken to evaluate the effectiveness of this program by comparing the consultation skills of medical students of this college with a medical college without a communication skills program. Methods: A 4-station Objective Structured Clinical Examination (OSCE) was conducted in the third and final year. Mann–Whitney U-test was used to compare the difference in the distribution between OSCE stations total and construct scores. Results: At the end of the third year, 21 (31.34%), students of the study site (medical college 1 [college with integrated longitudinal communication skills program]) and 31 (46.26%) students from the comparison site (medical college 2 [comparable college without communication skills program]) consented. Medical college 1 achieved a significantly higher overall mean total station score of 68.0% (standard deviation [SD] =13.5) versus 57.2% (SD = 15.4) (P < 0.001). Significantly higher mean scores were achieved on three stations. At the end of the final year, 19 students (29.3%) from medical college 1 and 22 (34%) students from medical college 2 consented. The difference in overall mean total station score reduced from 9.2% to 7.1% (70.2) (SD = 13.7) versus 63.1 (SD = 15.2) (P = 0.004). The mean scores of both colleges decreased in “Patient presenting with Hepatitis C Report” station (P values 0.004 and 0.775) and in “Patient Request for Faith Healing Therapy in Diabetes Mellitus” station (P values 0.0046 and 0.036), respectively. Conclusion: Longitudinal communication skills in an undergraduate curriculum positively impacted consultation skills. Community-based training and faculty development are required to develop effective patient-centered consultation skills

  18. An improved approach to followup care for the urological patient: drop-in group medical appointments.

    PubMed

    Fletcher, Sophie G; Clark, Sean J; Overstreet, Dana L; Steers, William D

    2006-09-01

    To increase prompt access to routine office visits the concept of the group appointment was developed in the primary care setting. Drop-in group medical appointments have been piloted at our department. We hypothesized that 1) efficiency could be improved by seeing 6 to 14 patients at 1 appointment, 2) access to appointment times would increase and 3) patient satisfaction would be enhanced with 60 minutes of didactic contact and discussion with the urologist. Patients were invited to participate in a drop-in group medical appointment. Appointments were made based on sex and not on diagnosis. A 60-minute group teaching session was followed by a private 2 to 5-minute physical examination or further testing, as indicated. Confidential satisfaction surveys were administered to drop-in group medical appointment participants and patients seen at traditional individual (solo) appointments. Results were compared. From September 22, 2003 to August 30, 2004, 279 patients attended a drop-in group medical appointment. Mean patient age was 63 years and 142 patients were 65 years or older. Most diagnoses were prostate cancer, erectile dysfunction, benign prostatic hyperplasia, incontinence, neurogenic bladder and chronic discomfort syndromes. Of the patients 287 were surveyed, including 177 at drop-in group medical appointments and 110 at solo appointments. Patient satisfaction with the drop-in group medical appointment format was as high as that of solo patients with 87% of drop-in group medical appointment patients rating their experience as excellent or very good vs 88% by solo patients. Drop-in group medical appointments can be implemented successfully in a urological practice with high patient satisfaction despite the sensitive nature of topics discussed. Ideal patients are those with chronic or complex conditions and those requiring repetitive discussions, such as elderly individuals.

  19. Improving medication adherence among community-dwelling seniors with cognitive impairment: a systematic review of interventions.

    PubMed

    Kröger, Edeltraut; Tatar, Ovidiu; Vedel, Isabelle; Giguère, Anik M C; Voyer, Philippe; Guillaumie, Laurence; Grégoire, Jean-Pierre; Guénette, Line

    2017-08-01

    Background Medication non-adherence may lead to poor therapeutic outcomes. Cognitive functions deteriorate with age, contributing to decreased adherence. Interventions have been tested to improve adherence in seniors with cognitive impairment or Alzheimer disease (AD), but high-quality systematic reviews are lacking. It remains unclear which interventions are promising. Objectives We conducted a systematic review to identify, describe, and evaluate interventions aimed at improving medication adherence among seniors with any type of cognitive impairment. Methods Following NICE guidance, databases and websites were searched using combinations of controlled and free vocabulary. All adherence-enhancing interventions and study designs were considered. Studies had to include community dwelling seniors, aged 65 years or older, with cognitive impairment, receiving at least one medication for a chronic condition, and an adherence measure. Study characteristics and methodological quality were assessed. Results We identified 13 interventions, including six RCTs. Two studies were of poor, nine of low/medium and two of high quality. Seven studies had sample sizes below 50 and six interventions focused on adherence to AD medication. Six interventions tested a behavioral, four a medication oriented, two an educational and one a multi-faceted approach. Studies rarely assessed therapeutic outcomes. All but one intervention showed improved adherence. Conclusion Three medium quality studies showed better adherence with patches than with pills for AD treatment. Promising interventions used educational or reminding strategies, including one high quality RCT. Nine studies were of low/moderate quality. High quality RCTs using a theoretical framework for intervention selection are needed to identify strategies for improved adherence in these seniors.

  20. [Pedagogical Professional Development of Medical Teachers: The Experience of NOVA Medical School / Universidade Nova de Lisboa].

    PubMed

    Marques, Joana; Rosado-Pinto, Patrícia

    2017-03-31

    To be a college teacher requires a permanent effort in developing specific competencies, namely in the pedagogical domain. This paper aims both to describe the pedagogical professional development program offered by the Medical Education Office of NOVA Medical School of Universidade Nova de Lisboa and to analyse its role in the enhancement of reflection around curriculum and teaching practice. Description of the pedagogical programme offered between 2010 and 2016. We focused the analysis on different kinds of data - opinions of the participants in the training programme (questionnaire before and after the training); pedagogical products elaborated by the participants in the programme - design of lessons, modules or curricular units; questionnaire sent in 2016 to NOVA Medical School teachers responsible for the curricular units, about the contribution of their disciplines to the accomplishment of the core learning outcomes of the NOVA Medical School medical graduates. The pedagogical training needs identified by the teachers focused mainly on improving practice, critically analysing the curriculum and sharing experiences. Globally the training programme was deeply appreciated and considered very good by 97% of the participants. The lesson plans delivered showed that the teachers were able to integrate and apply the concepts developed during the training. The answers from the 46 faculty responsible for the curricular units (the majority of them had attended the Medical Education Office training programme) highlighted their capacity to critically approach content and pedagogical strategies within their disciplines as well as their contribution to the main goals of the medical curriculum. The results underlined the importance of a pedagogical training focused on the critical analysis of curriculum and pedagogical practice. On the other hand, the pedagogical products analyzed revealed great mastery by teachers of the content and pedagogical strategies present in the

  1. Cross Curricular Teaching and Learning in the Secondary School... Science. Cross-Curricular Teaching and Learning in...

    ERIC Educational Resources Information Center

    Byrne, Eleanor; Brodie, Marilyn

    2012-01-01

    This book brings together ongoing debates about personalised learning, creativity and ICT in education, with a cross-curricular focus, and establishes a principled framework for cross-curricular teaching and learning in Science. It identifies a range of key issues and aims to strengthen in-school science practices by introducing ways of teaching…

  2. Improving mental health service users' with medical co-morbidity transition between tertiary medical hospital and primary care services: a qualitative study.

    PubMed

    Cranwell, Kate; Polacsek, Meg; McCann, Terence V

    2016-07-26

    Mental health service users have high rates of medical co-morbidity but frequently experience problems accessing and transitioning between tertiary medical and primary care services. The aim of this study was to identify ways to improve service users' with medical co-morbidity care and experience during their transition between tertiary medical hospitals and primary care services. Experience-based co-design (EBCD) qualitative study incorporating a focus group discussion. The study took place in a large tertiary medical service, incorporating three medical hospitals, and primary care services, in Melbourne, Australia. A purposive sample of service users and their caregivers and tertiary medical and primary care clinicians participated in the focus group discussion, in August 2014. A semi-structured interview guide was used to inform data collection. A thematic analysis of the data was undertaken. Thirteen participants took part in the focus group interview, comprising 5 service users, 2 caregivers and 6 clinicians. Five themes were abstracted from the data, illustrating participants' perspectives about factors that facilitated (clinicians' expertise, engagement and accessibility enhancing transition) and presented as barriers (improving access pathways; enhancing communication and continuity of care; improving clinicians' attitudes; and increasing caregiver participation) to service users' progress through tertiary medical and primary care services. A sixth theme, enhancing service users' transition, incorporated three strategies to enhance their transition through tertiary medical and primary care services. EBCD is a useful approach to collaboratively develop strategies to improve service users' with medical co-morbidity and their caregivers' transition between tertiary medical and primary care services. A whole-of-service approach, incorporating policy development and implementation, change of practice philosophy, professional development education and support for

  3. Reducing Unplanned Medical Oncology Readmissions by Improving Outpatient Care Transitions: A Process Improvement Project at the Cleveland Clinic.

    PubMed

    Montero, Alberto J; Stevenson, James; Guthrie, Amy E; Best, Carolyn; Goodman, Lindsey Martin; Shrotriya, Shiva; Azzouqa, Abdel-Ghani; Parala, Armida; Lagman, Ruth; Bolwell, Brian J; Kalaycio, Matt E; Khorana, Alok A

    2016-05-01

    Reducing 30-day unplanned hospital readmissions is a national policy priority. We examined the impact of a quality improvement project focused on reducing oncology readmissions among patients with cancer who were admitted to palliative and general medical oncology services at the Cleveland Clinic. Baseline rates of readmissions were gathered during the period from January 2013 to April 2014. A quality improvement project designed to improve outpatient care transitions was initiated during the period leading to April 1, 2014, including: (1) provider education, (2) postdischarge nursing phone calls within 48 hours, and (3) postdischarge provider follow-up appointments within 5 business days. Nursing callback components included symptom management, education, medication review/compliance, and follow-up appointment reminder. During the baseline period, there were 2,638 admissions and 722 unplanned 30-day readmissions for an overall readmission rate of 27.4%. Callbacks and 5-day follow-up appointment monitoring revealed a mean monthly compliance of 72% and 78%, respectively, improving over time during the study period. Readmission rates declined by 4.5% to 22.9% (P < .01; relative risk reduction, 18%) during the study period. The mean direct cost of one readmission was $10,884, suggesting an annualized cost savings of $1.04 million with the observed reduction in unplanned readmissions. Modest readmission reductions can be achieved through better systematic transitions to outpatient care (including follow-up calls and early provider visits), thereby leading to a reduction in use of inpatient resources. These data suggest that efforts focused on improving outpatient care transition were effective in reducing unplanned oncology readmissions. Copyright © 2016 by American Society of Clinical Oncology.

  4. A Traditionally Administered Short Course Failed to Improve Medical Students’ Diagnostic Performance

    PubMed Central

    Noguchi, Yoshinori; Matsui, Kunihiko; Imura, Hiroshi; Kiyota, Masatomo; Fukui, Tsuguya

    2004-01-01

    BACKGROUND Quite often medical students or novice residents have difficulty in ruling out diseases even though they are quite unlikely and, due to this difficulty, such students and novice residents unnecessarily repeat laboratory or imaging tests. OBJECTIVE To explore whether or not a carefully designed short training course teaching Bayesian probabilistic thinking improves the diagnostic ability of medical students. PARTICIPANTS AND METHODS Ninety students at 2 medical schools were presented with clinical scenarios of coronary artery disease corresponding to high, low, and intermediate pretest probabilities. The students’ estimates of test characteristics of exercise stress test, and pretest and posttest probability for each scenario were evaluated before and after the short course. RESULTS The pretest probability estimates by the students, as well as their proficiency in applying Bayes's theorem, were improved in the high pretest probability scenario after the short course. However, estimates of pretest probability in the low pretest probability scenario, and their proficiency in applying Bayes's theorem in the intermediate and low pretest probability scenarios, showed essentially no improvement. CONCLUSION A carefully designed, but traditionally administered, short course could not improve the students’ abilities in estimating pretest probability in a low pretest probability setting, and subsequently students remained incompetent in ruling out disease. We need to develop educational methods that cultivate a well-balanced clinical sense to enable students to choose a suitable diagnostic strategy as needed in a clinical setting without being one-sided to the “rule-in conscious paradigm.” PMID:15109340

  5. Faculty promotions in medical institutions in India: Can we improve the criteria?

    PubMed

    Dhulkhed, Vithal Krishna; Kurdi, Madhuri S; Dhulkhed, Pavan V; Ramaswamy, Ashwini H

    2016-11-01

    Research publications are desirable for academic promotion in medical colleges as per the current rules of the Medical Council of India (MCI). These rules reflect an endeavour to improve the academic standards. We strongly believe that every medical college teacher should conduct true research and contribute to good peer-reviewed publications. However, it is felt that the MCI rule has the potential to lead to undesirable consequences, and the quality of teaching and learning could take a back-seat. There is an urgent need to adopt more objective criteria and better guidelines as followed by well-known global institutes. In our own country, the University Grants Commission has formulated specific guidelines for this purpose in the form of Academic Performance Indicators which, it appears, are not taken into consideration by the MCI. This article discusses the adverse impact of the rule and suggests ways for the adoption of a more scientific assessment system for faculty appointment and promotion.

  6. Faculty promotions in medical institutions in India: Can we improve the criteria?

    PubMed Central

    Dhulkhed, Vithal Krishna; Kurdi, Madhuri S; Dhulkhed, Pavan V; Ramaswamy, Ashwini H

    2016-01-01

    Research publications are desirable for academic promotion in medical colleges as per the current rules of the Medical Council of India (MCI). These rules reflect an endeavour to improve the academic standards. We strongly believe that every medical college teacher should conduct true research and contribute to good peer-reviewed publications. However, it is felt that the MCI rule has the potential to lead to undesirable consequences, and the quality of teaching and learning could take a back-seat. There is an urgent need to adopt more objective criteria and better guidelines as followed by well-known global institutes. In our own country, the University Grants Commission has formulated specific guidelines for this purpose in the form of Academic Performance Indicators which, it appears, are not taken into consideration by the MCI. This article discusses the adverse impact of the rule and suggests ways for the adoption of a more scientific assessment system for faculty appointment and promotion. PMID:27942051

  7. Do educational interventions improve prescribing by medical students and junior doctors? A systematic review

    PubMed Central

    Ross, Sarah; Loke, Yoon K

    2009-01-01

    Our aim was to review systematically the literature on educational interventions to improve prescribing by medical students and junior doctors. MEDLINE, EMBASE, Educational Resource Information Center, British Education Index, PsycINFO, CINAHL, TIMELIT, Cochrane Trials Database and grey literature were searched. Inclusion criteria were: educational interventions to improve medical student and/or junior doctors' prescribing, in primary or secondary care settings, and published after 1990. After screening 3189 records, we retrieved 11 controlled and four ‘before-and-after’ trials. Ten controlled trials showed improvements in the scores of the intervention group on written scenarios or clinical examination stations, but one study in junior doctors showed no effect on real-life prescription errors. Only one intervention [the World Health Organization (WHO) Good Prescribing Guide, in six randomized trials] had been tested in a variety of international settings and across a range of students at different levels. All four ‘before-and-after’ trials reported significant improvements in written tests or clinical stations. However, most studies tested only small numbers of participants and were affected by a range of methodological flaws. There is only moderate evidence in the literature to inform medical schools about how to prepare medical students for the challenges of prescribing. The WHO Good Prescribing Guide is the only model that has been widely used and shown to improve prescribing. Although it is based on sound principles, there is a need for further development. Robust methods of assessment are required to show clearly whether particular teaching interventions are successful. PMID:19594535

  8. Integrated Medical Model (IMM) Optimization Version 4.0 Functional Improvements

    NASA Technical Reports Server (NTRS)

    Arellano, John; Young, M.; Boley, L.; Garcia, Y.; Saile, L.; Walton, M.; Kerstman, E.; Reyes, D.; Goodenow, D. A.; Myers, J. G.

    2016-01-01

    The IMMs ability to assess mission outcome risk levels relative to available resources provides a unique capability to provide guidance on optimal operational medical kit and vehicle resources. Post-processing optimization allows IMM to optimize essential resources to improve a specific model outcome such as maximization of the Crew Health Index (CHI), or minimization of the probability of evacuation (EVAC) or the loss of crew life (LOCL). Mass and or volume constrain the optimized resource set. The IMMs probabilistic simulation uses input data on one hundred medical conditions to simulate medical events that may occur in spaceflight, the resources required to treat those events, and the resulting impact to the mission based on specific crew and mission characteristics. Because IMM version 4.0 provides for partial treatment for medical events, IMM Optimization 4.0 scores resources at the individual resource unit increment level as opposed to the full condition-specific treatment set level, as done in version 3.0. This allows the inclusion of as many resources as possible in the event that an entire set of resources called out for treatment cannot satisfy the constraints. IMM Optimization version 4.0 adds capabilities that increase efficiency by creating multiple resource sets based on differing constraints and priorities, CHI, EVAC, or LOCL. It also provides sets of resources that improve mission-related IMM v4.0 outputs with improved performance compared to the prior optimization. The new optimization represents much improved fidelity that will improve the utility of the IMM 4.0 for decision support.

  9. Pilot of a National Inpatient Medication Chart in Australia: improving prescribing safety and enabling prescribing training.

    PubMed

    Coombes, Ian D; Reid, Carol; McDougall, David; Stowasser, Danielle; Duiguid, Margaret; Mitchell, Charles

    2011-08-01

    Prescribing errors are common and are caused by multiple factors. Standard medication charts have been recommended by British and Australian Health services. A study of a standard medication chart in five hospitals in one state of Australia significantly reduced prescribing errors. A standard medication chart developed in one area can be adopted through a collaborative process and successfully implemented across a diverse country resulting in similar reductions in prescribing errors. Three of the four stages of the prescribing process (information gathering, decision making and communication of instructions) can be improved by the use of an improved standard medication chart. The introduction of a standard medication chart has enabled development of standard prescribing education programmes. To establish whether a standard national inpatient medication chart (NIMC) could be implemented across a range of sites in Australia and reduce frequency of prescribing errors and improve the completion of adverse drug reaction (ADR) and warfarin documentation. A medication chart, which had previously been implemented in one state, was piloted in 22 public hospitals across Australia. Prospective before and after observational audits of prescribing errors were undertaken by trained nurse and pharmacist teams. The introduction of the chart was accompanied by local education of prescribers and presentation of baseline audit findings. RESULTS After the introduction of the NIMC, prescribing errors decreased by almost one-third, from 6383 errors in 15,557 orders, a median (range) of 3 (0-48) per patient to 4293 in 15,416 orders, 2 (0-45) per patient (Wilcoxon Rank Sum test, P < 0.001). The documentation of drugs causing previous ADRs increased significantly from 81.9% to 88.9% of drugs (χ(2) test, P < 0.001). The documentation of the indication for warfarin increased from 12.1 to 34.3% (χ(2) test, P= 0.001) and the documentation of target INR increased from 10.8 to 70.0% (χ(2

  10. Improving integrated general medical and mental health services in community-based practices.

    PubMed

    Kilbourne, Amy M; Irmiter, Cheryl; Capobianco, Jeff; Reynolds, Kathleen; Milner, Karen; Barry, Kristen; Blow, Frederic C

    2008-09-01

    The historical fragmentation of physical and mental health services has impeded efforts to improve quality and outcomes of care for persons with mental disorders. However, there is little information on effective strategies that might reduce fragmentation and improve integrated services within non-academic, community-based healthcare settings. Twenty-three practices from across the U.S. participated in a learning community meeting designed to identify barriers to integrated care and strategies for reducing such barriers. Barriers were initially identified based on a quantitative survey of organizational factors. Focus groups were used to elaborate on barriers to integrated care and to identify strategies for reducing barriers that are feasible in community-based settings. Participants identified key barriers, including administrative (e.g., lack of common medical records for mental health and general medical conditions), financial (e.g., lack of reimbursement codes to bill for mental health and general medical care in the same setting), and clinical (e.g., lack of an integrated care protocol). Top strategies recommended by participants included templates (i.e., for memoranda of understanding) to allow providers to work across practice settings, increased medical record security to enable a common medical record between mental health and general medical care, working with state Medicaid agencies to establish integrated care reimbursement codes, and guidance in establishing workflows between different providers (i.e., avoid duplication of tasks). Strategies to overcome barriers to integrated care may require cooperation across different organizational levels, including administrators, providers, and health care payers in order for integrated care to be established and sustained over time.

  11. Sustainability of improvements in medication adherence through a mobile health intervention.

    PubMed

    McGillicuddy, John W; Taber, David J; Mueller, Martina; Patel, Sachin; Baliga, Prabhakar K; Chavin, Kenneth D; Sox, Luke; Favela, April P; Brunner-Jackson, Brenda M; Treiber, Frank A

    2015-09-01

    Context-Very few patient-centered, theory-guided programs for medication adherence and blood pressure control have been conducted in kidney transplant recipients. Objective-To evaluate preliminary indications of sustainability of improved blood pressure in kidney transplant recipients 12 months after completion of a 3-month randomized controlled trial of a mobile health pilot program to improve blood pressure and medication adherence. Participants and Design-A total of 18 of the 19 trial participants were contacted and all consented to inclusion in the retrospective analysis of their medical records showing their clinic-recorded systolic blood pressures at 3, 6, and 12 months following participation in the 3-month trial of a medical regimen self-management intervention. Results-A significant group difference in systolic blood pressure was observed longitudinally, indicating that the intervention group, as compared with the standard-care group, exhibited lower clinic-measured systolic blood pressures at the 12-month posttrial follow-up visit (P= .01). At 12-month follow-up, success in establishing and sustaining control of systolic blood pressure (<131 mm Hg) was greater in the intervention group (50%) than in the control group (11%). Conclusion-Patients in the intervention group continued to exhibit lower systolic blood pressure than did patients in the control group 12 months after the trial ended, suggesting that the intervention may have a durable impact on blood pressure control that most likely reflects sustained medication adherence. These findings will aid in the development of an adequately powered randomized controlled trial to address the sustainable impact of the intervention program on medication adherence and blood pressure control.

  12. Adherence to medication in patients with dementia: predictors and strategies for improvement.

    PubMed

    Arlt, Sönke; Lindner, Reinhard; Rösler, Alexander; von Renteln-Kruse, Wolfgang

    2008-01-01

    Measures to facilitate patient medication adherence should be considered an integral part of the comprehensive care of older patients with multiple diseases. However, impairment of cognitive functions and dementia, in particular, may substantially compromise adherence behaviour. Therefore, a literature review was performed to identify factors associated with adherence to medication in patients with cognitive impairment or dementia, and to discuss strategies for improvement of non-adherence. Evidence-based information on how to deal with adherence to medication in patients with dementia is scarce because of a lack of specific studies. However, there is increasing knowledge about factors influencing medication adherence behaviour in older age, and emerging insight into the relationships between adherence behaviour and cognitive capacity, memory and executive function, in particular. Nevertheless, understanding elderly persons' strategies for maintaining regular use of even complex drug regimens is still limited. Progress of research in this field is needed. It is notable that measures to improve adherence consist of combinations of educational interventions and cognitive support but assessment of study participants' cognitive function is rare. In clinical practice, awareness of non-adherence as a result of cognitive impairment is relatively low. The most important step is early detection of cognitive impairment when this is impacting negatively on medication management. A practical geriatric screening test is recommended to identify memory problems and further functional impairments associated with cognitive impairment. Performance-based assessments might be useful for screening medication management capacity, in addition to a careful drug history, inspection of all medicines used (including over-the-counter drugs) and proxy information. However, no feasible screening methods have as yet found their way into clinical practice. Patients with impaired executive

  13. Psychiatry resident-led tutorials increase medical student knowledge and improve national board of medical examiners shelf exam scores.

    PubMed

    McKean, A J S; Palmer, B A

    2015-06-01

    Psychiatry residents have tremendous potential as educators. The authors envisioned residents as small-group tutors, efficiently assessing and correcting knowledge deficits using cases with discussion prompts and teaching points. They empirically tested whether this improves knowledge acquisition. Senior residents delivered eight tutorials during clerkship, which covered child and adolescent psychiatry, anxiety, mood, psychotic, cognitive, and substance use disorders. A 50-item multiple-choice quiz was administered at the beginning and end of clerkship. National Board of Medical Examiners (NBME) shelf exam scores from intervention year were compared to the 4 years prior to resident involvement. Mean score on the initial quiz was 34.5 ± 3.7 and 41.8 ± 3.5 on second attempt (p < 0.001). Mean score for NBME psychiatry subject exam during intervention year was 83.2 ± 8.9 and for the four prior years was 78.0 ± 9.3, which was significant (p = 0.002). Resident-led tutorials provide an effective means of increasing psychiatric knowledge and improving performance on NBME subject exams.

  14. INCREASED ADHERENCE TO CFF PRACTICE GUIDELINES FOR PULMONARY MEDICATIONS CORRELATES WITH IMPROVED FEV1

    PubMed Central

    Moore, Brooke M.; Laguna, Theresa A.; Liu, Meixia; McNamara, John J.

    2013-01-01

    BACKGROUND CFF practice guidelines recommend patients ≥ age 6 use dornasealfa and hypertonic saline daily, and those ≥ age 6 colonized with P. aeruginosa use inhaled tobramycin and oral azithromycin to improve lung function and reduce pulmonary exacerbations. A decline in FEV1 was noted in our 2008 CF Center Report. We hypothesized that increasing adherence to prescribing guidelines for these pulmonary medications would improve mean FEV1. METHODS This was a quality improvement project completed at a US CF center. CFF practice guidelines were reviewed with the center physicians. Patients were identified that were eligible to receive recommended therapies and it was determined whether they were prescribed the therapies. Baseline FEV1 data was collected. Adherence rates and FEV1 were followed quarterly for 1 year. Providers received a quarterly report card with adherence rates, mean FEV1 compared to colleagues, and a list of eligible patients that were not prescribed recommended therapies. RESULTS 92 patients were included. At baseline, the overall adherence rate was 59%. Overall adherence increased quarterly (p=<0.001). Each quarter there was improvement in adherence to prescribing for each medication (p<0.001). Except in quarter 1, FEV1 increased quarterly (p=0.092). There was moderate correlation (r=0.533) between improved adherence and improved FEV1. CONCLUSIONS Educating clinicians about guidelines, providing feedback on adherence to guidelines, and monitoring prescribing patterns improves prescribing adherence. FEV1 showed improvement after months of sustained adherence, trending towards significance. Longer follow-up is necessary to determine if improved prescribing adherence translates into improved FEV1 or slows rate of decline in FEV1. PMID:22997186

  15. Scaffolding knowledge integration through curricular depth

    NASA Astrophysics Data System (ADS)

    Clark, Douglas Burton

    The three interconnected levels of this research characterize how students develop deeper understanding in a complex science topic. The first investigation analyzes the impact of progressively more streamlined versions of the Computer as Learning Partner (CLP) curriculum. This cross-semester investigation analyzes subject matter posttest data for 3000 students who studied one of four versions of the CLP curriculum. The second investigation follows 50 students across their 8th grade CLP semester and into high school. This within-semester analysis maps the knowledge integration of two fairly successful and two less successful students in addition to focusing on the entire cohort. The third investigation analyzes student learning across a novel five-day laboratory/simulation project. Together, these cross-semester, within-semester, and project-level analyses clarify the paths through which students integrate their ideas in response to instruction that emphasizes knowledge integration. To facilitate these analyses, this research develops three new ways to represent connections among student ideas. Summary Tables present accessible overviews of case study students' progress in core topic areas across each interview. Distilled Interview Tables enumerate ideas held at each level of sophistication, displaying trends in sophistication and integration of ideas, clarifying contradictions, and identifying appearance of new ideas. Conceptual Element Maps chart connections and level of integration in further detail, highlighting the paths through which students reorganize and connect the elements within their conceptual ecologies and highlighting areas of strength and weakness. These new representations aid in the identification of appropriate targeted curricular interventions. In addition to the methodological contributions, this work makes theoretical contributions to the conceptual change literature and the depth of coverage literature. Contributions to the conceptual change

  16. Does the inclusion of 'professional development' teaching improve medical students' communication skills?

    PubMed

    Joekes, Katherine; Noble, Lorraine M; Kubacki, Angela M; Potts, Henry W W; Lloyd, Margaret

    2011-06-27

    This study investigated whether the introduction of professional development teaching in the first two years of a medical course improved students' observed communication skills with simulated patients. Students' observed communication skills were related to patient-centred attitudes, confidence in communicating with patients and performance in later clinical examinations. Eighty-two medical students from two consecutive cohorts at a UK medical school completed two videoed consultations with a simulated patient: one at the beginning of year 1 and one at the end of year 2. Group 1 (n = 35) received a traditional pre-clinical curriculum. Group 2 (n = 47) received a curriculum that included communication skills training integrated into a 'professional development' vertical module. Videoed consultations were rated using the Evans Interview Rating Scale by communication skills tutors. A subset of 27% were double-coded. Inter-rater reliability is reported. Students who had received the professional development teaching achieved higher ratings for use of silence, not interrupting the patient, and keeping the discussion relevant compared to students receiving the traditional curriculum. Patient-centred attitudes were not related to observed communication. Students who were less nervous and felt they knew how to listen were rated as better communicators. Students receiving the traditional curriculum and who had been rated as better communicators when they entered medical school performed less well in the final year clinical examination. Students receiving the professional development training showed significant improvements in certain communication skills, but students in both cohorts improved over time. The lack of a relationship between observed communication skills and patient-centred attitudes may be a reflection of students' inexperience in working with patients, resulting in 'patient-centredness' being an abstract concept. Students in the early years of their medical

  17. Does the inclusion of 'professional development' teaching improve medical students' communication skills?

    PubMed Central

    2011-01-01

    Background This study investigated whether the introduction of professional development teaching in the first two years of a medical course improved students' observed communication skills with simulated patients. Students' observed communication skills were related to patient-centred attitudes, confidence in communicating with patients and performance in later clinical examinations. Methods Eighty-two medical students from two consecutive cohorts at a UK medical school completed two videoed consultations with a simulated patient: one at the beginning of year 1 and one at the end of year 2. Group 1 (n = 35) received a traditional pre-clinical curriculum. Group 2 (n = 47) received a curriculum that included communication skills training integrated into a 'professional development' vertical module. Videoed consultations were rated using the Evans Interview Rating Scale by communication skills tutors. A subset of 27% were double-coded. Inter-rater reliability is reported. Results Students who had received the professional development teaching achieved higher ratings for use of silence, not interrupting the patient, and keeping the discussion relevant compared to students receiving the traditional curriculum. Patient-centred attitudes were not related to observed communication. Students who were less nervous and felt they knew how to listen were rated as better communicators. Students receiving the traditional curriculum and who had been rated as better communicators when they entered medical school performed less well in the final year clinical examination. Conclusions Students receiving the professional development training showed significant improvements in certain communication skills, but students in both cohorts improved over time. The lack of a relationship between observed communication skills and patient-centred attitudes may be a reflection of students' inexperience in working with patients, resulting in 'patient-centredness' being an abstract concept

  18. Learning to improve medical decision making from imbalanced data without a priori cost.

    PubMed

    Wan, Xiang; Liu, Jiming; Cheung, William K; Tong, Tiejun

    2014-12-05

    In a medical data set, data are commonly composed of a minority (positive or abnormal) group and a majority (negative or normal) group and the cost of misclassifying a minority sample as a majority sample is highly expensive. This is the so-called imbalanced classification problem. The traditional classification functions can be seriously affected by the skewed class distribu