Clint W. Snyder

Screening for Osteoporosis in Community-Dwelling Adults with Mental Retardation.

Osteoporosis screening of adults ages 40 to 60 who attended community-based adult training centers was conducted utilizing dual-energy X-ray absorptiometry (DEXA) measurements of the calcaneus. Valid measurements were obtained on 107 individuals, a response rate of 94%. One fifth of the sample (21%) had osteoporosis and 34% had osteopenia. On multiple regression analysis, the most significant predictors of BMD were Down syndrome, mobility status, and race. Future studies involving larger samples of middle-age adults with mental retardation/developmental disabilities will clarify the need and optimum age for osteoporosis screening.

Comparison of pregnancy-specific interventions to a traditional treatment program for cocaine-addicted pregnant women

Alcohol and drug use in pregnancy is a significant concern. There is a paucity of treatment programs for substance-abusing pregnant women, especially if indigent. Furthermore, treatment retention is compromised when the drug of choice is crack-cocaine. This paper reports the results of a study comparing treatment retention of cocaine-abusing indigent pregnant women before and after incorporating pregnancy-specific interventions. Audits were performed on 603 charts of women enrolled between 1988 and 1994 in either a traditional treatment program (n = 114) or in the Pregnancy Substance Abuse Program (PSAP) (n = 489). Differences in treatment retention were found between the two treatment groups. Drop-out rates from the inpatient component of treatment were significantly lower in the PSAP group than in the control group (11.3% vs. 38.6%, p < .001). There was a higher rate of completion of outpatient treatment in the PSAP compared to the control group (34.4% vs. 13.5%, p < .005). These results were achieved with a 2-day decreased inpatient stay. Treatment retention improved when specialized interventions were provided, at minimal additional cost. These results have implications for other publicly funded treatment programs.

Humanistic teaching attributes of primary care physicians

Little research exists on the humanistic qualities of the physician as teacher. This study examined the humanistic teaching attributes used by 30 primary care physicians when teaching medical students in the ambulatory setting. Three research questions were addressed: What humanistic teaching behaviors are demonstrated by physician‐teachers? How do these observed behaviors compare with medical students’ perceptions of physician behavior? How do these observed behaviors compare with the physician‐teachers’ perceptions of their own behaviors? Data from direct observation of the clinical teaching encounter between the physician‐teacher and medical student were compared with students’ perceptions of the humanistic behaviors demonstrated by the teacher and the teachers perception of the frequency with which these behaviors were used. Humanistic teaching attributes were observed to occur with moderate to high frequency. Findings are consistent with other studies suggesting little correlation between self‐repor...

Caring for adults with mental retardation: survey of family practice residency program directors.

In their core curriculum guidelines, the Society of Teachers of Family Medicine has recognized the importance of training family physicians in caring for persons with mental retardation. We mailed surveys to all family practice residency directors in the United States, questioning them about experiences and methods used to teach residents about health care needs of adults with mental retardation and the importance of this education. We found that 84% of programs provide residents with one or more experiences, and 60% instruct residents in this area. Most directors ranked this education as very important or important. There was no relationship between type or age of residency program and likelihood that residents were educated about mental retardation. The importance of this education is discussed.

The relationship between teachers’ confidence and use of clinical teaching skills in ambulatory care settings

Background: As medical schools expand their teaching programs into ambulatory care settings, faculty must learn to use new and more effective teaching skills. They must therefore be convinced of the importance of those skills and confident in using them. Purpose: Teachers’ confidence in their own teaching abilities (i.e., self‐efficacy) is examined in this study. Methods: We surveyed 145 primary care faculty about their feelings of confidence in and use of 28 specific teaching skills. Results: Faculty self‐ratings indicated that they were less confident in using learning‐enhancing teaching skills than in using supervisory behaviors that focus on patient care. Degree of confidence was most strongly associated with self‐ratings of frequency of use; physician experience and estimated length of time spent in teaching encounters did not mediate this relation. These findings suggest that physicians’ teaching behaviors may depend largely on their self‐confidence. Conclusions: We suggest that teacher attitudes an...

Patient assessments of adequacy of dialysis and protein nutrition

Nephrologists closely monitor biochemical measurements of adequacy of dialysis and protein nutrition, but little is known about how patients assess adequacy. We sought (1) to determine how hemodialysis patients assess adequacy and (2) to compare patient assessments with objective measures of adequacy. We performed a cross-sectional interview study of 145 patients from two chronic hemodialysis units. Using a structured questionnaire, we asked subjects to assess the amount of dialysis and protein nutrition they were getting. Objective measures of amount of dialysis (Kt/V) and protein nutrition (albumin) were obtained from chart abstraction. We found that only 5% of all subjects thought they were getting less dialysis than they needed, yet 41% were actually receiving inadequate dialysis (Kt/V <1.2). Even among the 60 subjects with Kt/V less than 1.2, only 5% thought they were getting less dialysis than they needed. Similarly, 21% of all subjects thought they were getting less protein nutrition than they needed, yet 28% had inadequate protein nutrition levels (albumin <3.5 g/L). Even among the 41 subjects with albumin less than 3.5 g/L, only 20% thought they were getting less protein nutrition than they needed. In conclusion, patient assessments of adequacy differ greatly from the objective measures that nephrologists use to assess adequacy. Most patients with Kt/V less than 1.2 or albumin less than 3.5 g/L think they are getting adequate dialysis and protein nutrition. Understanding how patients assess adequacy may be an important step in developing interventions to improve the adequacy of dialysis and protein nutrition.

Positive impact of a master of science in applied anatomy program on USMLE Step 1 performance.

In this retrospective study of medical student data from Case Western Reserve University School of Medicine, we examined the impact of the Master of Science in Applied Anatomy (MS) program on medical student performance on the United States Medical Licensing Examination® (USMLE®) Step 1 and Step 2. From 2002 to 2010, 1,142 students matriculated as either students in the medical curriculum (MD group; 1,087 students) or MD students who also participated in the MS program (MD/MS group; 55 students). In addition, students were grouped as in either the Western Reserve Curriculum (2002–2005; WR1) or the Western Reserve 2 Curriculum (2006–2010; WR2). Data were analyzed using SPSS statistical package. The mean Medical College Admission Test® (MCAT®) score of all students increased significantly between the WR1 and WR2 curricula [from 32.48 ± 3.73 to 34.00 ± 2.92 (P < 0.00)], but MD and MD/MS students showed similar mean MCAT scores in each curriculum. In contrast, the mean USMLE Step 1 score for the MD/MS group (241.45 ± 18.90) was significantly higher than that of the MD group (229.93 ± 20.65; P < 0.00). The MD/MS group in the WR2 curriculum showed significantly higher USMLE Step 1 scores than the MD group. No significant difference was observed in the USMLE Step 2 Clinical Knowledge scores between the groups. The results show that MD/MS students performed better on the USMLE Step 1 than MD students in the WR2 curriculum, although MCAT scores were similar between the two groups. Together, these results suggest that medical student participation in the Masters in Applied Anatomy program enhances student performance on the USMLE Step 1. Anat Sci Educ 8: 31–36.

The Palmore Facts on Aging Quiz: Are We Using It Correctly?

Abstract This study assessed geriatric medical educators on the Facts on Aging Quiz (Version 2) (FAQ2) and the relationship of personal or professional characteristics to these scores. A survey with FAQ2 and demographics was administered to attendees at a national geriatric conference. Data from 79 respondents revealed 44% female, mean age of 44 years old, 8.9 years working in geriatrics, and 82% of patient populations 65 years of age or older. The mean and median FAQ2 score was 15 out of 25, with no observable pattern of missed items and no personal or professional characteristics significantly related to FAQ2. Our survey suggests that geriatric medical educators may have knowledge deficits in areas addressed by FAQ2 and that this instrument may not be suited for evaluative use in medical education.

The time has come--a study of geriatric continuing education in Ohio Visiting Nurse Associations.

A majority of nurses working in the community lack formal educational preparation to care for older adults. This study examined the perceived learning needs of Visiting Nurse Association (VNA) executives and agency staff nurses in Ohio related to continuing education in gerontology. Twenty-six executives and 478 staff nurses were asked to complete a gerontologic education survey; 17 executives and 344 staff nurses returned surveys. Findings suggest that few Ohio VNAs have focused on continuing education in gerontology. Indications exist that executives and staff nurses are not always in agreement regarding the importance of content needed for updating gerontological knowledge and skills. Educational and organizational strategies are offered to provide minimal standards for gerontologic professional practice in home care.

Professional Training: Fellows and Faculty as Teachers

This chapter presents issues relevant for the fellow as teacher by describing the components of the clinical teaching encounter and microskills to identify clinical learners, organize a plan for clinical teaching, identify learner’s subtypes, and utilize the RIME approach to understanding learners.