Brian Mavis

Self-Efficacy and OSCE Performance Among Second Year Medical Students

Competent performance requires not only requisite knowledge and skills but also beliefs of personal efficacy to use both effectively. This study examined the confidence of second-year medical students regarding their OSCE performance. Students completed an OSCE at the end of their second year of medical school; their performance was rated using checklists containing key items. Ten minutes prior to the OSCE, students completed a brief survey, which included 31 items sampling confidence in performing various clinical skills required in the OSCE. In addition, students assessed their preparedness and their anxiety, and reported the number of hours they studied in preparation for the OSCE. A total of 82 identifiable surveys (73 %) were used in this analysis. Students with high self-efficacy were more likely to score above the mean OSCE performance compared to low self-rated students (71% versus 51%), however self-efficacy was not significantly correlated to OSCE performance. A causal path model was constructed to predict OSCE performance. Performance in the clinical skills and biomedical science curricula both were related to perceived anxiety, which was related to self-efficacy. Preparedness was predicated on self-efficacy and itself predicted performance. Knowledge also had a strong direct link to performance. Performance is more than having the requisite abilities. Performance was found to be the product of complex relationships between skills and knowledge, mediated by perceptions of anxiety, self-confidence and preparedness. The model illustrates the importance of realistic self-appraisal for competent performance.

Physicians and Hospice Care: Attitudes, Knowledge, and Referrals

Underutilization of hospice care continues to be a public health issue in the United States. Physician barriers related to incorrect knowledge and unfavorable attitudes have been hypothesized as part of the explanation. We conducted a mail survey of 264 area physicians, obtaining a response rate of 72% (n = 190). The survey examined attitudes toward, knowledge about, and perceptions of benefits and barriers to hospice care. Physicians demonstrated very positive attitudes toward hospice. They had correct knowledge about some aspects of hospice, but were uncertain about correct answers on the majority of items. They had erroneous knowledge on few items. Physicians perceived many benefits to hospice care, and identified patient and family readiness as the major barriers to earlier hospice referrals. Demographic and practice variables were related to responses on few of the survey items. These findings have many implications for outreach strategies for physicians as well as future research.

Postal surveys versus electronic mail surveys: The tortoise and the hare revisited

The advent of computer-based technology has led to a consideration of change in research methods that exploit the advantages of computer-mediated communications. In survey research, electronic mail (e-mail) has anecdotally shown particular promise as a data collection tool. This article compares traditional postal and nontraditional e-mail surveys within the context of a larger listserv evaluation project in terms of overall return rate, distribution of survey returns over time, response to initial and follow-up mailings, representativeness of respondent groups, thoroughness of survey completion, and the likelihood of respondents to include additional written comments. In summary, whereas postal surveys were shown to be superior to e-mail surveys with regard to response rate, all things being equal, the decision of which to use may be situation-specific, dependent on issues such as survey cost, desire for convenience and timeliness in data collection, and need for higher response rates, among others.

Factors Predicting Attendance at Self-Help Groups after Substance Abuse Treatment: Preliminary Findings.

Some researchers and clinicians believe that only a fairly homogeneous subset of substance abusers are likely to affiliate with self-help groups, whereas others argue that self-help groups appeal to a wide range of persons and that selective referral of clients to self-help may be premature. This study followed 201 treated substance abusers for 6 months and found that contrary to prevailing opinion, Blacks and women were more likely to attend self-help groups and the measures of social stability did not predict attendance. In accord with other investigations, this study found that persons who attended the groups had more severe problems in several domains. Implications for clinical referral policies are discussed.

The longitudinal stability of the Addiction Severity Index.

The Addiction Severity Index (ASI) is a structured interview widely used by substance abuse clinicians and researchers for client screening, determining treatment needs, and assessing treatment outcomes. Previous researchers have evaluated inter-rater agreement, test-retest reliability, and concurrent validity. The present report describes the stability of ASI scores in longitudinal work. In the context of an ongoing treatment outcome evaluation study involving seven assessors, inter-rater agreement, inter-rater reliability, as well as intra- and inter-rater accuracy were assessed repeatedly during a 2-year period. The results show the scores derived from the ASI to be stable across assessors and over time. The relationship between stable scores and resources required for training are discussed.

The research productivity of faculty in family medicine departments at U.S. medical schools: a national study.

Purpose To determine the research productivity of faculty in family medicine departments at U.S. medical schools, as well as the individual and environmental characteristics and prior socializing experiences predictive of research productivity. Method In 2000, a 43-item questionnaire was mailed to 796 faculty to obtain descriptive data toward formulating a conceptual model of the research productivity of family medicine faculty. Prior to model construction and testing through full-model regression, the model’s factors were reduced through factor analysis. Results A total of 474 questionnaires (63%) were returned. Eighty-percent of respondents spent a half-day or less per week on research; on average they produced less than one scholarly product per year. Few had research experience, nor could identify a research agenda or current research project. Mixed messages were perceived related to research, both at institutional and disciplinary levels. In testing a conceptual model, psychological and cognitive characteristics were most predictive of research productivity, along with time spent on research. Psychological and cognitive factors included enhancing research skills, establishing a definable research agenda, fostering research networks, having multiple research projects underway, maintaining in-depth knowledge of a research area, and clearly understanding research expectations for promotion and tenure. Conclusion The clinical and academic demands on family medicine faculty reduce the likelihood that they will engage in research. These demands prevent the development of a critical mass to provide mentorship and networking necessary for research productivity. Resources are needed to recruit faculty with an interest in research and to provide faculty development in research skills, mentorship, and networking.

Hospice and primary care physicians: Attitudes, knowledge, and barriers

Underuse of hospice services is a significant problem in the United States. Primary care physicians constitute an increasing referral base and have been hypothesized to be important barriers to increased use. We conducted a mail survey of 131 primary care physicians (overall response rate of 72 percent), examining their attitudes toward, knowledge about, and perceived benefits and barriers to hospice care. Physicians demonstrated very favorable attitudes towards hospice. They had correct knowledge about most aspects of hospice, and, where they did not, they were far more likely to be uncertain than erroneous. Primary care physicians perceived many benefits to hospice care and identified patient and family readiness as the major barrier to earlier hospice referrals. A significant subgroup had concerns about problems in interacting with hospices. There were very few differences between family practitioners and general internists. These findings have many implications for directing collaborative efforts between primary care physicians and hospices to improve end-of-life care.

Substance Abuse Prognosis with an Additional Psychiatric Diagnosis: Understanding the Relationship

Patients with alcohol and other substance abuse problems have poorer prognoses if there is a concomitant psychiatric diagnosis. However, because severity of psychiatric problems contributes more than the specific psychiatric diagnosis to prognosis, the nature of the interaction between substance abuse treatment outcome and an accompanying psychiatric diagnosis can be questioned. In this article an attempt is made to understand the poor-prognosis-with-psychiatric-diagnosis interaction through a literature review and an analysis of various problem areas that clients bring to substance abuse treatment. Problem areas were measured with a variety of instruments. The results show that groups that vary in severity of psychiatric problems also differ in severity of problems in other areas. As there is no doubt that such dual diagnosis patients pose a considerable treatment challenge, the implications of these findings for theoretical consideration and treatment planning are discussed.

Graduating medical students' competencies and educational experiences in palliative care

Palliative care involves an interdisciplinary approach to patient care and specific clinical skills. Little prior research on palliative care education has involved medical students, and the few reported studies focus mainly on student attitudes. This study describes a needs assessment of senior medical students based on a newly developed competency-based palliative care curriculum. Prior to graduation, 102 senior students were mailed an anonymous survey with four parts: a self-assessment of attitudes, knowledge, and skills; adequacy of instruction; exposure to specific clinical experiences; and demographic information. The response rate was 47%. While attitudinal goals were strongly endorsed by students, they were less confident with regards to knowledge and skills. Ratings varied across the five content areas of the curriculum. The results suggest a need for educational efforts more focused on specific clinical competencies as well as systematic evaluation of student competencies.

Key modifiable factors in weight maintenance: Fat intake, exercise, and weight cycling

OBJECTIVE This 6- to 42-month follow-up study of a 6-month worksite weight control intervention examined predictors of weight maintenance, with a focus on those that could be modified. SUBJECTS Twenty-nine participants, 14 men and 15 women, from a behavior modification program completed follow-up measurements. MAIN OUTCOME MEASURES Height, weight, waist-to-hip ratio, food and beverage intake from a 3-day food record, weight history, social support and physical activity were the main outcome measures. RESULTS One third of the participants maintained their weight losses within 2 kg at follow-up, although all had higher relative weights at follow-up than immediately after the program. High daily fat consumption (r = .40) and reduced time in physical activity (r = .34) correlated with increased relative weight at follow-up (P < .05). APPLICATION Because previous weight cycling was so strongly related to weight loss maintenance (r = .55), potential weight program participants should learn and practice the weight maintenance behaviors of reduced dietary fat and regular exercise, independently of and before weight reduction attempts.