Posts Tagged ‘basic’
Training of patient and consumer representatives in the basic competencies of evidence-based medicine: a feasibility study
Background:Evidence based medicine (EBM) has become standard approach in medicine. Patients and health authorities increasingly claim active patient roles in decision making. Education to cope with these roles might be useful. We investigated the feasibility, acceptability and possible impact of EBM training courses for patient and consumer representatives.Methods:We designed a generic one week EBM course based on previous experience with EBM courses for non medical health professionals. A course specific competence test has been developed and validated to measure EBM skills. Formative and summative evaluation of the course comprised: 1) EBM skills; 2) individual learning goals; 3) self reported implementation after six months using semi-structured interviews; 4) group based feedback by content analysis. EBM skills’ achievement was compared to results gathered by a group of undergraduate University students of Health Sciences and Education who had attended a comparable EBM seminar.Results:Fourteen EBM courses were conducted including 161 participants without previous EBM training (n=54 self-help group representatives, n=64 professional counsellors, n=36 patient advocates, n=7 others); 71% had a higher education degree; all but five finished the course. Most participants stated personal learning goals explicitly related to practicing EBM such as acquisition of critical appraisal skills (n=130) or research competencies (n=67). They rated the respective relevance of the course on average with 80% (SD 4) on a visual analogue scale ranging from 0 to 100%.Participants passed the competence test with a mean score of 14.7 (SD 3.0, n=123) out of 19.5 points. The comparison group of students achieved a mean score of 14.4 (SD 3.3, n=43). Group based feedback revealed increases of self confidence, empowerment through EBM methodology and statistical literacy, and acquisition of new concepts of patient information and counselling. Implementation of EBM skills was reported by 84 of the 129 (65%) participants available for follow-up interviews. Barriers included lack of further support, limited possibilities to exchange experiences, and feeling discouraged by negative reactions of health professionals.Conclusions:Training in basic EBM competencies for selected patient and consumer representatives is feasible and accepted and may affect counselling and advocacy activities. Implementation of EBM skills needs support beyond the training course.
The influence of regional basic science campuses on medical students’ choice of specialty and practice location: a historical cohort study
Background:Indiana University School of Medicine (IUSM) employs eight regional basic science campuses, where half of the students complete their first two years of medical school. The other half complete all four years at the main campus in Indianapolis. The authors tested the hypothesis that training at regional campuses influences IUSM students to pursue primary care careers near the regional campuses they attended.Methods:Medical school records for 2,487 graduates (classes of 1988-1997) were matched to the 2003 American Medical Association Physician Masterfile to identify the medical specialty and practice location of each graduate. Multivariate logistic regression was performed to assess the effect of regional campus attendance on students’ choice of medical specialty and practice location, while simultaneously adjusting for several covariates thought to affect these career outcomes.Results:Compared to Indianapolis students, those who attended a regional campus were somewhat more likely to be white, have parents with middle class occupations, and score slightly lower on the Medical College Admission Test. Any such differences were adjusted for in the regression models, which predicted that four of the regional campuses were significantly more likely than Indianapolis to produce family practitioners, and that five of the regional campuses were significantly more likely than the others to have former students practicing in the region. When analyzed collectively, attendance at any regional campus was a significant predictor of a primary care practice located outside the Indianapolis metropolitan area.Conclusions:Attending a regional campus for preclinical training appears to increase the likelihood of practicing primary care medicine in local communities.
Towards a basic endoscopic evaluation of swallowing in acute stroke ? identification of salient findings by the inexperienced examiner
Background:Dysphagia is common after stroke. Fiberoptic endoscopic evaluation of swallowing (FEES) is a powerful tool for dysphagia assessment. The purpose of this study was to assess whether a previously established endoscopic examination protocol based on the identification of typical findings indicative of stroke ? related dysphagia may be learned and adopted by clinicians so far inexperienced in this field.Methods:After receiving a structured lecture on this topic, participants were asked to rate video sequences of endoscopic swallowing examinations of acute stroke patients. The first part of the testing (“single findings-rating”) comprised of 16 single sequences, the second part (“complete examination-rating”) presented the key sequences of 8 complete examinations. Before the second part was started, results of the first were discussed.Results:At the “single findings-rating” 88.8% of video-sequences were assessed correctly, while at the “complete examination-rating” the average performance had improved to 96%. Furthermore, no overlooking of relevant pathologies was noted in the second part of the testing.Conclusion:This study suggests that the presented endoscopic examination protocol is reliably interpreted by inexperienced clinicians after a short lecture and may therefore easily and successfully be adopted in dysphagia management of acute stroke care.
Towards a basic endoscopic evaluation of swallowing in acute stroke – identification of salient findings by the inexperienced examiner
Background:Dysphagia is common after stroke. Fiberoptic endoscopic evaluation of swallowing (FEES) is a powerful tool for dysphagia assessment. The purpose of this study was to assess whether a previously established endoscopic examination protocol based on the identification of typical findings indicative of stroke – related dysphagia may be learned and adopted by clinicians so far inexperienced in this field.Methods:After receiving a structured lecture on this topic, participants were asked to rate video sequences of endoscopic swallowing examinations of acute stroke patients. The first part of the testing (“single findings-rating”) comprised of 16 single sequences, the second part (“complete examination-rating”) presented the key sequences of 8 complete examinations. Before the second part was started, results of the first were discussed.Results:At the “single findings-rating” 88.8 % of video-sequences were assessed correctly, while at the “complete examination-rating” the average performance had improved to 96%. Furthermore, no overlooking of relevant pathologies was noted in the second part of the testing. Conclusion:This study suggests that the presented endoscopic examination protocol is reliably interpreted by inexperienced clinicians after a short lecture and may therefore easily and successfully be adopted in dysphagia management of acute stroke care.
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