The patient-physician interactions as seen by undergraduate medical students.
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CONTEXT: The interaction between a physician and his or her patient is complex and occurs by means of technical performance and through a personal relationship. OBJECTIVE: To assess the interaction between the medical professional and his or her patient with the participation of medical students assuming a role as observers and participants in a medical appointment in an outpatient office. DESIGN: Questionnaire interview study. SETTING: General Medicine outpatient offices, Hospital das Clinicas, Faculty of Medicine, University of Sao Paulo. PARTICIPANTS: Medical students performed an ethnographical technique of observation, following 199 outpatient medical appointments with Clinical Medicine Residents. MAIN MEASUREMENTS: A questionnaire filled out by observer students measured the physician's attitudes towards patients, as well as patients' expectations regarding the appointment and his or her understanding after its completion. RESULTS: Patients showed higher enthusiasm after the appointment (4.47 +/- 0.06 versus 2.62 +/- 0.10) (mean +/- SEM), as well as some negative remarks such as in relation to the waiting time. The time spent in the consultation was 24.66 +/- 4.45 minutes (mean +/- SEM) and the waiting time was 123.09 +/- 4.91 minutes. The physician's written orientation was fairly well recalled by the patient when the doctor's letter could be previously understood. CONCLUSION: Patients benefit from physicians who keep the focus on them. In addition, this program stimulated the students for their accomplishment of the medical course. (+info)
Association between mental health screening by self-report questionnaire and insomnia in medical students.
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Epidemiological research points to the high prevalence of psychiatric disorders among insomniacs. We carried out a cross-sectional study with medical students with the aim of evaluating the association between insomnia and suspicion of psychiatric disorder; 302 medical students were included (184 males and 118 females; mean age = 20.47+/-1.89 years). The main association was tested by logistic regression analysis. The overall prevalence of positivity in a screening test for psychiatric disorder was 22.19%; and of insomnia, 28.15%. Difficulty initiating sleep (OR=3.45), difficulty maintaining sleep (OR=7.61), falling asleep later (OR=1.99) and waking up earlier (OR=1.91) were associated with suspicion of psychiatric disorder. As a group, the variables difficulty initiating sleep, difficulty maintaining sleep, falling asleep after 11 pm, and waking up before 6 am presented an odds ratio of 5.96 for positivity in the screening for psychiatric disorder. Furthermore, difficulty maintaining sleep (OR=2.24) was associated with "being female," and falling asleep later (OR=0.43) was associated with "being male". These results underscore the importance of determining in what cases difficulty sleeping may have severe clinical repercussions or affect performance. (+info)
That's another story: narrative methods and ethical practice.
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This paper examines the use of case studies in ethics education. While not dismissing their value for specific purposes, the paper shows the limits of their use. While agreeing that case studies are narratives, although rather thin stories, the paper argues that the claim that case studies could represent reality is difficult to sustain. Instead, the paper suggests a way of using stories in ethics teaching that could be more real for students, while also giving them a way of thinking about their own professional practices. The paper shows how the method can be used to develop a more critical and reflective practice for students in the health care professions. Some immediate problems with the method are discussed. (+info)
Translation of nutritional sciences into medical education: the Nutrition Academic Award Program.
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For the past 40 y the scientific community has decried the inadequacy of the training of physicians and other health professionals in the subject of human nutrition. In 1997 the National Heart, Lung, and Blood Institute developed the Nutrition Academic Award (NAA) Program, an initiative to improve nutrition training across a network of US medical schools. The purpose of this funding, which began in 1998, is to support the development and enhancement of nutrition curricula for medical students, residents, and practicing physicians to learn principles and practice skills in nutrition. The NAA recipients developed the Nutrition Curricular Guide for Training Physicians, a plan to incorporate clinical guidelines into physician practice skills, create educational and assessment practice tools, and evaluate curricula, materials, and teaching tools. Dissemination of NAA activities and materials will be facilitated by a national website, presentations and publications, and consultants and advisors from the NAA nutrition education programs. The NAA Program constitutes a major new effort to enhance nutrition knowledge and skills among health care providers and to effectively apply the science of human nutrition to clinical medicine. This article describes the purpose and aims of the NAA Program, the organizational structure of the network of recipients, a profile of the recipients and individual programs at 21 medical schools, the various strategies to overcome barriers in training physicians in human nutrition, and collaborative and dissemination efforts. (+info)
Student perceptions of osteopathic manipulative treatment after completing a manipulative medicine rotation.
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Recent studies have demonstrated a decline in the use of osteopathic manipulative treatment (OMT) by osteopathic physicians, reflecting a trend that may begin in medical school. The authors used a questionnaire to examine the teaching and use of OMT in five rotations and the perceptions of 86 graduating osteopathic medical students of their experiences following their core manipulative medicine rotation. Most students indicated that they applied osteopathic principles sometimes (39.5%) or often (29.1%) during rotations. Forty-three percent of students rated their ability to apply osteopathic principles as average. The number of students who indicated that they rarely used OMT during their rotations was 31 (36.0%) for internal medicine, 21 (24.4%) for surgery, 23 (26.7%) for pediatrics, and 24 (27.9%) for obstetrics/gynecology. When asked why OMT was not used during a rotation, 47.2% of respondents cited time constraints, and 21.7% stated that their attending physicians discouraged the use of OMT. These results demonstrate a distinction between students' perceived level of osteopathic principles and skills and their application during clinical rotations. (+info)
Teaching clinical informatics to third-year medical students: negative results from two controlled trials.
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BACKGROUND: Prior educational interventions to increase seeking evidence by medical students have been unsuccessful. METHODS: We report two quasirandomized controlled trials to increase seeking of medical evidence by third-year medical students. In the first trial (1997-1998), we placed computers in clinical locations and taught their use in a 6-hour course. Based on negative results, we created SUMSearch, an Internet site that automates searching for medical evidence by simultaneous meta-searching of MEDLINE and other sites. In the second trial (1999-2000), we taught SUMSearch's use in a 5(1/2)-hour course. Both courses were taught during the medicine clerkship. For each trial, we surveyed the entire third-year class at 6 months, after half of the students had taken the course (intervention group). The students who had not received the intervention were the control group. We measured self-report of search frequency and satisfaction with search quality and speed. RESULTS: The proportion of all students who reported searching at least weekly for medical evidence significantly increased from 19% (1997-1998) to 42% (1999-2000). The proportion of all students who were satisfied with their search results increased significantly between study years. However, in neither study year did the interventions increase searching or satisfaction with results. Satisfaction with the speed of searching was 27% in 1999-2000. This did not increase between studies years and was not changed by the interventions. CONCLUSION: None of our interventions affected searching habits. Even with automated searching, students report low satisfaction with search speed. We are concerned that students using current strategies for seeking medical evidence will be less likely to seek and appraise original studies when they enter medical practice and have less time. (+info)
Between two worlds medical student perceptions of humor and slang in the hospital setting.
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OBJECTIVE: Residents frequently use humor and slang at the expense of patients on the clinical wards. We studied how medical students react to and interpret the "appropriateness" of derogatory and cynical humor and slang in a clinical setting. DESIGN: Semistructured, in-depth interviews. SETTING: Informal meeting spaces. PARTICIPANTS: Thirty-three medical students. MEASUREMENTS: Qualitative content analysis of interview transcriptions. MAIN RESULTS: Students' descriptions of the humorous stories and their responses reveal that students are able to take the perspective of both outsiders and insiders in the medical culture. Students' responses to these stories show that they can identify the outsider's perspective both by seeing themselves in the outsider's role and by identifying with patients. Students can also see the insider's perspective, in that they identify with residents' frustrations and disappointments and therefore try to explain why residents use this kind of humor. Their participation in the humor and slang--often with reservations--further reveals their ability to identify with the perspective of an insider. CONCLUSIONS: Medical students describe a number of conflicting reactions to hospital humor that may enhance and exacerbate tensions that are already an inevitable part of training for many students. This phenomenon requires greater attention by medical educators. (+info)
A follow-up survey of alcohol consumption and knowledge in medical students.
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We surveyed a medical school's students' drinking habits and knowledge 12 years after a previous survey. In this current survey from two academic years, final year students drank less than second year students did. Women in their second year drank as much as men. Overall, 28% of students drank more than the safe limits; 27% of students were problem drinkers, as measured by the CAGE questionnaire, and 52%, as measured by the AUDIT questionnaire. The proportion of students not drinking any alcohol rose from 6% in the previous survey to 27% in the current survey, possibly due to context and demographic changes. In spite of this difference, there have been no statistically significant reductions in either unsafe drinking levels or CAGE scores over 12 years. A third of students overestimated the safe levels of drinking. All medical schools should write and implement an alcohol policy. (+info)