Mildly dyskaryotic smear results: does it matter what women know?
BACKGROUND: As of 1992, all women in the UK who have a first mildly dyskaryotic cervical smear are placed under surveillance for 6 months rather than being referred for immediate colposcopy. OBJECTIVES: We aimed to explore the relationship between anxiety and understanding about mild dyskaryotic, and to propose and discuss a method of analysing free text comments written by participants in studies based on structured questionnaires. METHODS: The freely scripted text of 236 women who had completed a questionnaire as part of a randomized controlled trial to assess the impact of an educational package was analysed. Randomization group status was concealed. Texts expressing similar views were grouped together and categorized. A matrix was drawn up to encompass the categories, and the comments were reallocated accordingly. RESULTS: Examination of the free text revealed two dimensions, concern and knowledge. There were no differences with respect to the apparent level of concern between the two randomization groups. However, comments from the intervention group were significantly more likely to have been classified as expressing good or vague knowledge than those from women in the control group. CONCLUSION: Although the educational intervention improved women's knowledge about the meaning of an abnormal smear result, this better knowledge was not correlated with less anxiety about the result. The free text analysis was a useful supplement to the main trial questionnaires. It demonstrated the existence of a range of understanding about cervical dyskaryosis, of anxieties relating to the receipt of such a result and the degree of interest women showed in acquiring further information. (+info)
Awareness of and attitude of elderly subjects regarding health care and welfare in rapidly ageing population in Japan.
OBJECTIVES: We aimed to obtain information on the degree of knowledge and understanding about the current systems of health care and welfare held by the elderly, in order to achieve comprehensiveness in family practice. METHOD: We conducted a study on the awareness of healthy elderly persons by direct interview. The study was carried out in Kuni Village in a remote mountainous region in Japan, where the elderly population accounts for 24.8% of the total population. The subjects were self-dependent in their daily living activities and were aged 65 years and older. RESULTS: The subjects' knowledge of health care and welfare systems was generally good, and the degree of their utilization of these systems was also good. But 83.3% of those who did not want to utilize the welfare system indicated their preference to depend on their family for support. CONCLUSION: Family physicians must endeavour to offer comprehensive care to their patients by including these systems for rapidly ageing communities. (+info)
The role of curriculum in influencing students to select generalist training: a 21-year longitudinal study.
To determine if specific curricula or backgrounds influence selection of generalist careers, the curricular choices of graduates of Mount Sinai School of Medicine between 1970 and 1990 were reviewed based on admission category. Students were divided into three groups: Group 1, those who started their first year of training at the School of Medicine; Group 2, those accepted with advanced standing into their third year of training from the Sophie Davis School of Biomedical Education, a five-year program developed to select and produce students likely to enter primary care fields; and Group 3, those accepted with advanced standing into the third year who spent the first two years at a foreign medical school. All three groups took the identical last two years of clinical training at the School of Medicine. These were no significant differences with respect to initial choice of generalist training programs among all three groups, with 46% of the total cohort selecting generalist training. Of those students who chose generalist programs, 58% in Group 1, 51% in Group 2, and 41% in Group 3 remained in these fields rather than progressing to fellowship training. This difference was significant only with respect to Group 3. However, when an analysis was performed among those students providing only primary care as compared to only specialty care, there were no significant differences. Analysis by gender revealed women to be more likely to select generalist fields and remain in these fields without taking specialty training (P < .0001). Differentiating characteristics with respect to choosing generalist fields were not related to either Part I or Part II scores on National Board Examinations or selection to AOA. However, with respect to those specific specialties considered quite competitive (general surgery, obstetrics and gynecology, and ophthalmology), total test scores on Part I and Part II were significantly higher than those of all other students. The analysis indicated that, despite the diverse characteristics of students entering the third year at the School of Medicine, no one group produced a statistically greater proportion of generalists positions than any other, and academic performance while in medical school did not have a significant influence on whether a student entered a generalist field. (+info)
Evaluation of patients' knowledge about anticoagulant treatment.
OBJECTIVE: To develop a questionnaire to evaluate patients' knowledge of anticoagulation. DESIGN: Anonymous self completed questionnaire study based on hospital anticoagulant guidelines. SETTING: Anticoagulant clinic in a 580 bed district general hospital in London. SUBJECTS: 70 consecutive patients newly referred to the anticoagulant clinic over six months. MAIN MEASURES: Information received by patients on six items of anticoagulation counselling (mode of action of warfarin, adverse effects of over or under anticoagulation, drugs to avoid, action if bleeding or bruising occurs, and alcohol consumption), the source of such information, and patients' knowledge about anticoagulation. RESULTS: Of the recruits, 36 (51%) were male; 38(54%) were aged below 46 years, 22(31%) 46-60, and 10(14%) over 75. 50 (71%) questionnaires were returned. In all, 40 respondents spoke English at home and six another language. Most patients reported being clearly advised on five of the six items, but knowledge about anticoagulation was poor. Few patients could correctly identify adverse conditions associated with poor control of anticoagulation: bleeding was identified by only 30(60%), bruising by 23(56%), and thrombosis by 18(36%). Only 26(52%) patients could identify an excessive level of alcohol consumption, and only seven (14%) could identify three or more self prescribed agents which may interfere with warfarin. CONCLUSION: The questionnaire provided a simple method of determining patients' knowledge of anticoagulation, and its results indicated that this requires improvement. IMPLICATIONS: Patients' responses suggested that advice was not always given by medical staff, and use of counselling checklists is recommended. Reinforcement of advice by non-medical counsellors and with educational guides such as posters or leaflets should be considered. Such initiatives are currently being evaluated in a repeat survey. (+info)
Is peer tutoring beneficial in the context of school resuscitation training?
First year pupils at a Cardiff comprehensive school were trained in cardiopulmonary resuscitation, 106 by the teacher only and 137 by the teacher assisted by older pupils (peer tutoring). Scores in a multiple choice theory test and in practical skill assessment showed no significant difference between instruction methods, but boys taught by the teacher assisted by older pupils expressed less willingness to resuscitate in an emergency than girls instructed by either method (P < 0.01). Girls had higher scores in the multiple choice paper (P < 0.025) and in the skills assessment (P < 0.01). Those pupils who reported some prior knowledge of resuscitation techniques performed better during skill assessment than novice trainees (P < 0.025). (+info)
Correlating fibreoptic nasotracheal endoscopy performance and psychomotor aptitude.
We have investigated the correlation between the scores attained on computerized psychometric tests, measuring psychomotor and information processing aptitudes, and learning fibreoptic endoscopy with the videoendoscope. Sixteen anaesthetic trainees performed two adaptive tracking tasks (ADTRACK 2 and ADTRACK 3) and one information management task (MAZE) from the MICROPAT testing system. They then embarked on a standardized fibreoptic training programme during which they performed 15 supervised fibreoptic nasotracheal intubations on anaesthetized oral surgery patients. There was a significant correlation between the means of the 15 endoscopy times and both ADTRACK 2 (r = -0.599, P = 0.014) and ADTRACK 3 (r = -0.589, P = 0.016) scores. The correlation between the means of the 15 endoscopy times and MAZE scores was not significant. The ratios of the mean endoscopy time for the last seven endoscopies to the mean endoscopy time for the first seven endoscopies were not significantly correlated with ADTRACK 2, ADTRACK 3 or MAZE scores. Psychomotor abilities appeared to be determinants of trainees' initial proficiency in endoscopy, but did not appear to be determinants of trainees' rates of progress during early fibreoptic training. (+info)
The UMDS MSc in general practice: attainment of intended outcomes.
BACKGROUND: The United Medical and Dental School's (UMDS's) MSc in general practice is one of the longest running courses of its kind. Although descriptive accounts of such courses have been published, little is known about their outcomes. AIM: To measure the extent to which graduates feel they have personally achieved 16 intended outcomes derived from the course objectives, and to record current academic activities, particularly teaching and research. METHOD: A postal questionnaire to graduates of the UMDS MSc in General Practice. RESULTS: The response rate was 93%. Of the 71 responders, 23 have gone on to register for or complete other degrees or diplomas. Over two-thirds of responders had an academic commitment following the MSc. Two-thirds were currently engaged in research and over half reported having had work accepted for publication. The majority of graduates confirmed the attainment of all 16 outcomes, although outcomes related to personal achievements were endorsed more strongly than those related to service delivery. CONCLUSION: UMDS graduates are making a significant contribution to their discipline and are unanimous in describing the course as an important event in their personal development. As a result of this study, the course organizers are seeking to increase the links between academic study and everyday practice. (+info)
Medical education in the USA--adult-friendly?
In the United States of America, the Area Health Education Center (AHEC) system of training residents has allowed high-quality postgraduate education to flourish. This paper describes the evolution of the AHECs in the context of medical education over the past 50 years. The arrangements for programme administration and design, resident assessment and appraisal, training of trainers in educational methods, and the accreditation of training programmes are discussed. The fast-evolving UK postgraduate education scene can learn some useful lessons from the US system. (+info)