Theoretical framework for implementing a managed care curriculum for continuing medical education--Part I.
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Healthcare reform has created a new working environment for practicing physicians, as economic issues have become inseparably intertwined with clinical practice. Although physicians have recognized this change, and some are returning to school for formal education in business and healthcare administration, formal education may not be practical or desirable for the majority of practicing physicians. Other curriculum models to meet the needs of these professionals should be considered, particularly given the growing interest in continuing education for physicians in the areas of managed care and related aspects of practice management. Currently, no theory-based models for implementing a managed care curriculum specifically for working physicians have been developed. This paper will integrate diffusion theory, instructional systems design theory, and learning theory as they apply to the implementation of a managed care curriculum for continuing medical education. Through integration of theory with practical application, a CME curriculum for practicing physicians can be both innovative as well as effective. This integration offers the benefit of educational programs within the context of realistic situations that physicians can apply to their own work settings. (+info)
Introducing managed care to the medical school curriculum: effect on student attitudes.
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In order to assess the effect of clinical training and didactic instruction on medical student attitudes toward managed care, we conducted a survey of all medical students at the midpoint of their third year clerkships at the University of Massachusetts Medical School. The students were exposed to clinical training in managed care settings and a 2-day required course on the principles underlying managed care. The main outcome measures were student attitudes toward the concepts of managed care, managed care organizations, and future careers in managed care. Students also assessed the attitudes of medical faculty toward managed care. Attitudes of students with previous clinical training in managed care settings did not differ from those of students without such exposure toward the concepts underlying managed care or managed care organizations and were less positive about careers in managed care. Student responses before and after the 2-day course on managed care demonstrated that attitudes moved in a significantly positive direction. Seventy-one percent of students reported that the opinions they had heard from medical faculty about managed care were negative. Preparing medical students to practice medicine effectively in managed care settings will require focused attention on managed care issues in the medical school curriculum and the combined efforts of academic health centers and managed care organizations. (+info)
Pathways: a culturally appropriate obesity-prevention program for American Indian schoolchildren.
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Pathways, a culturally appropriate obesity prevention study for third-, fourth-, and fifth-grade American Indian schoolchildren includes an intervention that promotes increased physical activity and healthful eating behaviors. The Pathways intervention, developed through a collaboration of universities and American Indian nations, schools, and families, focuses on individual, behavioral, and environmental factors and merges constructs from social learning theory with American Indian customs and practices. We describe the Pathways program developed during 3 y of feasibility testing in American Indian schools, with special emphasis on the activities developed for the third grade; review the theoretical and cultural underpinnings of the program; outline the construction process of the intervention; detail the curriculum and physical education components of the intervention; and summarize the formative assessment and the school food service and family components of the intervention. (+info)
Practice and education of nurse anaesthetists.
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A survey was conducted of the anaesthesia services provided by nurses and the education available to them in this field in 107 countries. Among the procedures carried out were general anaesthesia, spinal blocks and tracheal intubation. The implications of the findings for health planning and policy-making are discussed with particular reference to workforce structure and women's involvement in it. (+info)
Tracing the evolution of critical evaluation skills in students' use of the Internet.
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This paper documents the evolving uses of the Internet made by public health graduate students and traces the development of their search methods and critical evaluative criteria. Early in the first semester and again six months later, twenty-four graduate students in a problem-based learning curriculum, which emphasizes evidence-based critical thinking skills, were required to describe their most helpful resources and to evaluate these resources critically. The answers were coded for the types of resources the students used, how frequently they were used, and why they were used. Student perception of the usefulness of resources, especially the Internet, and ability to evaluate these resources critically changed greatly. Initially, 96% of the students stated that the Internet was their most helpful resource. Six months later, these students continued to use the Internet; however, it was not their most useful source. At the later point, students had very specific uses for the Internet. Their most frequently used evaluation criterion was the reliability and objectivity of the source of the information. By the end of the first year of study, the majority of the students demonstrated an understanding of the principles of evidence-based practice and applied them to their research and analysis of information resources. (+info)
Ethics instruction at schools of public health in the United States. Association of Schools of Public Health Education Committee.
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OBJECTIVES: A survey of US schools of public health was undertaken in 1996 and 1997 to obtain a general picture of public health ethics curricula. METHODS: An explanatory letter with a list of questions for discussion was sent to the deans of the accredited US schools of public health. The deans were asked that at least 1 individual at their school who "is most knowledgeable about ethics curricula" review the list of questions and complete an ethics survey contact form. RESULTS: Ethics instruction was required for all students at only 1 (4%) of the 24 schools surveyed, while 7 schools required ethics instruction for some students. Two of the schools had no ethics courses. Ethics instruction was required for all MPH students at 9 (38%) of the schools and for all doctoral students at 4 (17%) of the schools. Most of the schools (19 of 24, or 79%) offered short courses, seminar series, or invited lectures on ethical topics, and 23 (96%) included lectures on ethics topics in other courses such as health law. CONCLUSIONS: Training programs at US schools of public health vary greatly in how much attention is given to ethics instruction. Model curricula in public health ethics should be developed to help fill this gap. (+info)
Rural background and clinical rural rotations during medical training: effect on practice location.
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BACKGROUND: Providing health care services in rural communities in Canada remains a challenge. What affects a family medicine resident's decision concerning practice location? Does the resident's background or exposure to rural practice during clinical rotations affect that decision? METHODS: Cross-sectional mail survey of 159 physicians who graduated from the Family Medicine Program at Queen's University, Kingston, Ont., between 1977 and 1991. The outcome variables of interest were the size of community in which the graduate chose to practise on completion of training (rural [population less than 10,000] v. nonrural [population 10,000 or more]) and the size of community of practice when the survey was conducted (1993). The predictor or independent variables were age, sex, number of years in practice, exposure to rural practice during undergraduate and residency training, and size of hometown. RESULTS: Physicians who were raised in rural communities were 2.3 times more likely than those from nonrural communities to choose to practise in a rural community immediately after graduation (95% confidence interval 1.43-3.69, p = 0.001). They were also 2.5 times more likely to still be in rural practice at the time of the survey (95% confidence interval 1.53-4.01, p = 0.001). There was no association between exposure to rural practice during undergraduate or residency training and choosing to practise in a rural community. INTERPRETATION: Physicians who have roots in rural Canada are more likely to practise in rural Canada than those without such a background. (+info)
Undergraduate and postgraduate orthodontics in Australia.
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Undergraduate orthodontic education in Australian university dental schools reflects a strong British influence. The Australian Dental Council is now responsible for undergraduate course accreditation and the development of a more distinctly Australian model might be expected, although not in isolation from the traditional British and American influences. Postgraduate specialty training has been more directly influenced by the North American dental schools, and specialist registers in the states and territories reflect that influence. The Australian Dental Council will commence accreditation of postgraduate specialty courses in 1999. (+info)