Does teaching during a general practice consultation affect patient care?
(25/2287)
BACKGROUND: General practice differs from hospital medicine in the personal nature of the doctor-patient relationship and in the need to address social and psychological issues as well as physical problems. Recent changes in undergraduate medical education have resulted in more teaching and learning taking place in general practitioner (GP) surgeries. AIM: To explore patients' experiences of attending a surgery with a medical student present. METHOD: A questionnaire was designed, based on semi-structured interviews. Questionnaires were posted to patients who had attended teaching surgeries in London and Newcastle-upon-Tyne. RESULTS: Four hundred and eighty questionnaires were sent; of these, 335 suitable for analysis were returned. The response rate in Newcastle was 79%, and in London 60%. Ninety-five per cent of responders agreed that patients have an important role in teaching medical students. Patients reported learning more and having more time to talk, however, up to 10% of responders left the consultation without saying what they wanted to say and 30% found it more difficult to talk about personal matters. CONCLUSION: The presence of a student has a complex effect on the general practice consultation. Future developments in medical education need to be evaluated in terms of how patient care is affected as well as meeting educational aims. (+info)
Fraud, misconduct or normal science in medical research--an empirical study of demarcation.
(26/2287)
OBJECTIVES: To study and describe how a group of senior researchers and a group of postgraduate students perceived the so-called "grey zone" between normal scientific practice and obvious misconduct. DESIGN: A questionnaire concerning various practices including dishonesty and obvious misconduct. The answers were obtained by means of a visual analogue scale (VAS). The central (two quarters) of the VAS were designated as a grey zone. SETTING: A Swedish medical faculty. SURVEY SAMPLE: 30 senior researchers and 30 postgraduate students. RESULTS: Twenty of the senior researchers and 25 of the postgraduate students answered the questionnaire. In five cases out of 14 the senior researchers' median was found to be clearly within the interval of the grey zone, compared with three cases for the postgraduate students. Three examples of experienced misconduct were provided. Compared with postgraduate students, established researchers do not call for more research ethical guidelines and restrictions. CONCLUSION: Although the results indicate that consensus exists regarding certain obvious types of misconduct the response pattern also indicates that there is no general consensus on several procedures. (+info)
Challenges of teaching physiology in a PBL school.
(27/2287)
A problem-based learning (PBL) curriculum was introduced at McMaster University more than three decades ago. Not many schools have adopted the system despite its distinct advantages. The present paper examines the challenges of teaching physiology in a PBL curriculum and gleans through the literature supporting PBL. It appears that one of the reasons why PBL is not becoming readily acceptable is the lack of concrete reports evaluating the curricular outcomes. The suggestion (R.E. Thomas. Med Educ. 31:320-329, 1997) to standardize and internationalize all components of validated PBL curricula is quite valid. A database needs to be generated that can be easily accessed by traditional institutions to see the rationality and easy implementation of the PBL curriculum. (+info)
Report of the worldwide survey on teaching physiology.
(28/2287)
This report by George G. Somjen, for the Commission on Teaching Physiology, International Union of Physiological Sciences, presents a summary of answers received to a questionnaire concerning the state of Physiology Teaching. One hundred seventeen responses have been received from fifty countries. The results have been tabulated and contain information about the teaching methods and resources as well as the commitment in time and effort by the teaching staff. Free-ranging, sometimes pithy, comments made by the respondents have been excerpted and are included. (+info)
Attitudes toward managed care and cost containment among primary care trainees at 3 training sites.
(29/2287)
OBJECTIVE: To study the attitudes of entering first year (Y1) and graduating third year (Y3) primary care physician trainees from 3 different training program sites (a university hospital system site [UHS], a large staff-model health maintenance organization managed care system site [MCS], and a large public hospital system site [PHS]) toward selected aspects of managed care. DESIGN: A self-administered questionnaire was used in a cross-sectional study. PARTICIPANTS AND OUTCOME MEASURES: Participants were all Y1 and Y3 primary care trainees in internal medicine, pediatrics, and family medicine programs from 3 training program sites. Survey questions dealt with attitudes toward health services, managed care cost containment, and the role of the physician in society. RESULTS: Of eligible primary care trainees (n = 218), 91% completed the instrument. Trainees at the MCS generally held more positive views of managed care systems than trainees at the UHS or PHS. Internal medicine trainees held more negative attitudes towards managed care systems than trainees in pediatrics or family medicine. UHS and PHS trainees more often thought that managed care systems interfere with the doctor-patient relationship and that these systems are more concerned with economics than in providing quality patient care. Approximately one quarter of the Y1 trainees at all sites thought that reducing the cost of healthcare is beyond the control of doctors. No Y3 trainee at the PHS believed that reducing costs was beyond the control of doctors. The majority of trainees endorsed routine peer review of clinical decisions to control healthcare costs. Most trainees believed that managed care systems will eventually predominate and that physician independence is being impaired. CONCLUSION: The data suggest that attitudes of internal medicine, family medicine, and pediatric trainees toward various aspects of managed care vary not only by their year of training but also by their training environment. Thus, managed care educational programs for trainees should consider both the baseline attitudes of trainees and characteristics of the training site itself. (+info)
Gay and lesbian physicians in training: a qualitative study.
(30/2287)
BACKGROUND: Gay and lesbian physicians in training face considerable challenges as they become professionalized. Qualitative research is necessary to understand the social and cultural factors that influence their medical training. In this study we explored the significance of gay or lesbian identity on the experiences of medical training using naturalistic methods of inquiry. METHODS: Semi-structured interviews, focus groups and an e-mail listserv were used to explore professional and personal issues of importance to 29 gay and lesbian medical students and residents in 4 Canadian cities. Data, time, method and investigator triangulation were used to identify and corroborate emerging themes. The domains explored included career choice, "coming out," becoming a doctor, the environment and career implications. RESULTS: Gay or lesbian medical students and residents experienced significant challenges. For all participants, sexual orientation had an effect on their decisions to enter and remain in medicine. Once in training, the safety of a variety of learning environments was of paramount importance, and it affected subsequent decisions about identity disclosure, residency and career path. Respondents' assessment of professional and personal risk was influenced by the presence of identifiable supports, curricula inclusive of gay and lesbian sexuality and health issues and effective policies censuring discrimination based on sexual orientation. The need for training programs to be proactive in acknowledging and supporting diversity was identified. INTERPRETATION: Considerable energy and emotion are spent by gay and lesbian medical students and residents navigating training programs, which may be, at best, indifferent and, at worst, hostile. (+info)
A study of stress in medical students at Seth G.S. Medical College.
(31/2287)
BACKGROUND: It is usually observed that medical students undergo tremendous stress during various stages of the MBBS course. There is a high rate of suicide among them. METHODS: To determine incidence of stress and factors controlling stress in medical students at various stages of MBBS course at Seth G S Medical college, 238 students (First year 98, Second 76, Third 64) were asked to complete a questionnaire on personal data (gender, stay at hostel, mode of travel, time spent in travel every day, medium of study in school, place of school education.), Stress inducing factors, Zung's depression scale, ways of coping, stress relievers, perceived social support and personality type. Statistical tests used were ANOVA, critical ratio and Student's 't' test. RESULTS: Majority of medical students (175/238--73%) perceived stress. Stress was found to be significantly more in Second and Third MBBS students rather than First MBBS levels (p < 0.05). Stress was not found to differ significantly on the basis of sex, stay at hostel, model of travel, time spent in travel every day, medium of study in school, place of school education. Stress was found to be significantly more in students having more than 95% of marks at 12th Standard as compared to others. Academic factors were greater perceived cause of stress in medical students. There was no significant difference in the students at different levels of MBBS regarding academic factors and social factors as a stress inducing factors. Physical factors were found to be significantly more in Second and Third MBBS students as compared to First MBBS students. Emotional factors were found to be significantly more in First MBBS students as compared to Second & Third MBBS students. Stress was more common in medical students who have dominant strategy of coping as positive reappraisal, accepting responsibility and planful problem solving. Stress was less common in medical students at Seth G S Medical College who have dominant strategy of coping as escaping and distancing from difficult situation. Family and Friend as perceived social supports were more in Second MBBS than First MBBS medical students. Stress was not found to be significantly more in students having their personality factor contributing to stress (Type A--52/67) as compared to others (Type B--123/171). This indicates that the stress was not trait oriented but was process oriented (p = NS). CONCLUSION: Stress in medical students is common and is process oriented. It is more in second and third year. Academic factors are greater perceived cause of stress in medical students at Seth G S medical college. Emotional factors are found to be significantly more in First MBBS. It is dependent on person's ways of coping and social support. (+info)
Career and parenting satisfaction among medical students, residents and physician teachers at a Canadian medical school.
(32/2287)
BACKGROUND: Studies of career and parenting satisfaction have focused separately on medical students, residents and practising physicians. The objective of this study was to compare satisfaction across a spectrum of stages of medical career. METHODS: A survey of incoming medical students, current medical students, residents and physician teachers at the University of Saskatchewan was conducted in the spring of 1997. Response rates were 77% (43/56), 81% (177/218), 65% (134/206) and 39% (215/554) respectively. Factors assessed in the stepwise regression analysis were the effect of sex, parenting and level of training on the likelihood of recommending parenting to medical students or residents, and on parenting dissatisfaction, job dissatisfaction, career dissatisfaction and the importance of flexibility within the college program to accommodate family obligations. RESULTS: More male than female physician teachers had partners (92% v. 81%, p < 0.01) and were parents (94% v. 72%, p < 0.01). Female physician teachers spent equal hours per week at work compared with their male counterparts (mean 52 and 58 hours respectively) and more than double the weekly time on family and household work (36 v. 14 hours, p < 0.01). Physician teachers were the most likely respondents to recommend parenting to residents and their peers. Residents were the most dissatisfied with their parenting time. At all career stages women were less likely than men to recommend parenting, were more dissatisfied with the amount of time spent as parents and were more likely to regard flexibility within the college program as beneficial. There were no sex-related differences in job dissatisfaction and career dissatisfaction. However, married women were more dissatisfied with their jobs than were married men. Job dissatisfaction was greatest among medical students, and career dissatisfaction was greatest among residents. INTERPRETATION: The optimal timing of parenthood appears to be upon completion of medical training. Women were less likely to recommend parenting, less satisfied with the time available for parenting and more likely to value flexibility within the college program to accommodate family needs. These differences did not translate into women experiencing more job or career dissatisfaction. (+info)