Comparison of two training strategies for essential newborn care in Brazil.
OBJECTIVE: To compare the effectiveness of two training strategies for improving essential newborn care in the state of Pernambuco, Brazil. METHODS: Eight hospitals were selected, divided into two groups of four, and paired by geographical, structural, and functional characteristics. Doctors and nurses working at hospitals in Group 1 were given a conventional 5-day training course. Those in Group 2 were given the same manual used by Group 1 but the training course was organized as self-directed learning, with the participants having 5 weeks to complete the course. Participants' knowledge was tested at baseline, immediately after the course, and 3-6 months later. Participants' practices were observed before training and 3-6 months after training during 20 births and by interviewing 20 mothers before discharge at each hospital. FINDINGS: Not all participants completed all of the tests. The scores on the tests of knowledge improved more among those in Group 2 than those in Group 1 when the answers were classified as right or wrong, but there was no difference between groups when a scoring method was used that classified answers as correct, partially correct, incorrect, or missing. Practices related to thermal control after birth improved among those in Group 2 after training but practices related to thermal control on the ward worsened. The promotion of breastfeeding improved in both groups. CONCLUSION: There was no difference between the two training strategies, although self-directed learning was cheaper than conventional training. Neither strategy brought about the expected improvements in the quality of care. Other interventions in addition to training may be needed to improve care. (+info)
Determinants of cardiac function: simulation of a dynamic cardiac pump for physiology instruction.
A computer model is described that simulates the cardiac cycle of a mammalian heart. The model emphasizes the pressure-volume plot as a teaching tool to explain the behavior of the heart as a pump. It exhibits realistic responses to changes in preload, afterload, contractility, and heart rate while displaying time-dependent changes in pressure and volume in addition to the pressure versus volume plot. It differs from previous models by graphing these parameters on a beat-to-beat basis, allowing visualization of the dynamic adaptation of the pumping heart to various stimuli. A system diagram is also included to further promote student understanding of the physiology of cardiac function. The model is useful for teaching this topic to medical, graduate, or undergraduate students. It may also be used as a self-directed computer laboratory exercise. (+info)
Real-time, evidence-based medicine instruction: a randomized controlled trial in a neonatal intensive care unit.
PURPOSE: The study assesses potential for improving residents' evidence-based medicine searching skills in MEDLINE through real-time librarian instruction. SUBJECTS: Ten residents on a rotation in a neonatal intensive care unit participated. METHODOLOGY: Residents were randomized into an instruction and a non-instruction group. Residents generated questions from rounds and searched MEDLINE for answers. Data were collected through observation, search strategy analysis, and surveys. Librarians observed searches and collected data on questions, searching skills, search problems, and the test group's instruction topics. Participants performed standardized searches before, after, and six-months after intervention and were scored using a search strategy analysis tool (1 representing highest score and 5 representing lowest score). Residents completed pre- and post-intervention surveys to measure opinions about MEDLINE and search satisfaction. RESULTS: Post-intervention, the test group formulated better questions, used limits more effectively, and reported greater confidence in using MEDLINE. The control group expressed less satisfaction with retrieval and demonstrated more errors when limiting. The test and control groups had the following average search scores respectively: 3.0 and 3.5 (pre-intervention), 3.3 and 3.4 (post-intervention), and 2.0 and 3.8 (six-month post-intervention). CONCLUSION: Data suggest that measurable learning outcomes were achieved. Residents receiving instruction improved and retained searching skills six-months after intervention. (+info)
Physical activity intervention: a transtheoretical model-based intervention designed to help sedentary young adults become active.
Physical activity levels in young adults are low. Research supports the use of the Transtheoretical Model of behaviour change (TM) in designing physical activity interventions. This study used a pre-post randomized control design to investigate the effectiveness of a self-instructional intervention for helping sedentary young adults to initiate physical activity. Post-intervention, significantly more of the experimental group (80%), in comparison to the control group (68%), improved their exercise stage of change (SOC) from baseline (P < 0.05). Discriminant analyses revealed that discrimination between stage improvement/non-improvement was possible using the processes of change data. Stage improvers scored significantly higher on all of the behavioral and four out of five of the cognitive processes of change. For stage improvers, the processes of self-re-evaluation and self-liberation were most frequently used, whilst social liberation was used significantly more by the experimental than the control group. This inexpensive, self-instructional intervention, based on the TM and the 'active living message', is an effective method of assisting sedentary young adults to progress through the exercise SOC. (+info)
The Modular Resource Center: integrated units for the study of the anatomical sciences in a problem-based curriculum.
The Modular Resource Center (MRC) at the College of Veterinary Medicine at Cornell University was created in 1993 as a way to provide visual resources in support of a newly implemented problem-based curriculum in which the anatomical sciences are taught primarily in the first tutorial-based course, The Animal Body. Over two dozen modules have been created specifically in support of this course, whereas additional modules have been created in support of other basic science courses. The basic unit of organization of the MRC is a module presented in a carrel that provides students a way to study, either alone or in groups, a given topic. The topic is presented through a script and an integrated set of anatomical materials including plastinated dissected specimens, vascular casts, skeletal preparations, models, radiographs, histological slides, and photo- and electron micrographs. The key feature of this resource center is that it is not a museum; rather it is more analogous to an interactive library, that can be used for reference, study, and review, not only by veterinary students but also by faculty, interns, residents, and undergraduates. A unique aspect is that all materials have been made by veterinary students working with faculty during the summer. Although started as a resource in support of a tutorial-based curriculum, the MRC has evolved over a decade into an anatomy resource that would be highly valued in any curricular format. (+info)
Enhancing the dental histology curriculum using computer technology.
The predominant difference between the histology offered to dental students and that taken by other health care professionals is the emphasis placed on the oral tissues. The oral histology component of the dental curriculum is commonly handled in one of three ways, all delivering far more detailed information than the often less than one hour that a typical medical histology course spends on the oral cavity and its component tissues. Overall, three general curricular styles can be defined: 1) dental histology is taught by medical or dental faculty as a separate course, the oral histology component being a separate course taught by either faculty group; 2) medical and dental students take histology together in a single class with the oral histology component taught separately by faculty from either college; and 3) both basic and oral histology is taught within a single semester, the format used at the University of Kentucky College of Dentistry. The oral histology topics are similar in all of the course formats, regardless of whether they occur as a stand-alone course or are merged with basic histology. The main portion of this paper will describe a self-study, non-microscope-based laboratory experience designed to complement this fused topic course. Self-study labs using digital media are becoming more popular across both medical and dental histology curricula, specifically with the oral histology component where the histological skills for preparing these tissues are rapidly disappearing from many schools. This paper describes a typical syllabus for a fused course, outlining the topics for basic and oral histology, and demonstrates how the laboratory portion has been enhanced using digital technology. (+info)
Sonographic training in rheumatology: a self teaching approach.
OBJECTIVE: To evaluate a self teaching approach to be followed by a novice without previous practical experience in musculoskeletal ultrasonography. METHODS: The novice was given short general training (two hours) by an experienced sonographer focusing on the approach to the ultrasound equipment, and asked to obtain the best sonographic images of different anatomical areas as similar as possible to the "gold standard" pictures in the online version of the guidelines for musculoskeletal ultrasonography in rheumatology (free access at http://www.sameint.it/eular/ultrasound). At the end of each scanning session, both novice and tutor scored "blindly" all the images from 0 (the lowest quality) to 10 (the highest quality), with a minimum quality score of 6 considered acceptable for standard clinical use. The tutor then explained how to improve the quality of the pictures. Fourteen consecutive inpatients (seven with rheumatoid arthritis, three with psoriatic arthritis, two with reactive arthritis, and two with osteoarthritis) and five healthy subjects were examined. Ultrasound examinations were performed with a Diasus (Dynamic Imaging Ltd, Livingston, Scotland, UK) using two broadband linear probes of 5-10 and 8-16 MHz frequency. RESULTS: Sonographic training lasted one month and included 30 scanning sessions (24 hours of active scanning). 243 images were taken of the selected anatomical areas. The mean time required to produce each image was 6 minutes (SD 4.2; range 1-30). At the end of the training, the novice scored >/=6 for each standard scan. CONCLUSION: A novice can obtain acceptable sonographic images in 24 non-consecutive hours of active scanning after an intensive self teaching programme. (+info)
PROGRAMMED INSTRUCTION: NEW BOTTLE FOR REDISCOVERED WINE.
Programmed instruction is attracting attention at all educational levels. While this approach is new, the educational principles it incorporates are well established: instructional goals are defined in advance, the content is meticulously organized, active student participation is demanded, immediate feedback is provided to students, and each instructional unit is subjected to testing and revision. With its established effectiveness as a vehicle for introducing new topics, and for providing remedial and supplementary instruction, it can free the medical teacher to devote his time to matters which are more deserving of his attention, such as identifying and responding to individual student needs, exploring complex concepts, and working directly with students to provide a model and critical supervision. A more important potential contribution of programming may be that it has reminded us of sound educational precepts which deserve our attention in all forms of instruction. (+info)