Cyril M. Grum

Effects of educational interventions for self management of asthma in children and adolescents: systematic review and meta-analysis

Abstract Objective To determine the effectiveness of educational programmes for the self management of asthma in children and adolescents. Data sources Databases of the Cochrane Airways Group, PsychINFO, reference lists of review papers, and eligible studies. Review methods Eligible studies were published randomised controlled trials or controlled clinical trials of educational programmes for the self management of asthma in children and adolescents that reported lung function, morbidity, self perception of asthma control, or utilisation of healthcare services. Eligible studies were abstracted, assessed for methodological quality, and pooled with fixed effects and random effects models. Results 32 of 45 identified trials were eligible, totalling 3706 patients aged 2 to 18 years. Education in asthma was associated with improved lung function (standardised mean difference 0.50, 95% confidence interval 0.25 to 0.75) and self efficacy (0.36, 0.15 to 0.57) and reduced absenteeism from school (−0.14, −0.23 to −0.04), number of days of restricted activity (−0.29, −0.33 to −0.09), and number of visits to an emergency department (−0.21, −0.33 to −0.09). When pooled by the fixed effects model but not by the random effects model, education was also associated with a reduced number of nights disturbed by asthma. The effect on morbidity was greatest among programmes with strategies based on peak flow, interventions targeted at the individual, and participants with severe asthma. Conclusions Educational programmes for the self management of asthma in children and adolescents improve lung function and feelings of self control, reduce absenteeism from school, number of days with restricted activity, number of visits to an emergency department, and possibly number of disturbed nights. Educational programmes should be considered a part of the routine care of young people with asthma.

Outcome bias and cognitive dissonance in evaluating treatment decisions

No abstract available.

A Web-based geriatrics portfolio to document medical students' learning outcomes.

OBJECTIVE The University of Michigan Medical School is integrating into its curriculum the attitudes, knowledge, and skills that pertain to the care of older individuals using a defined set of core learning outcomes encompassing all four years. Students will demonstrate proficiency in these outcomes as a graduation requirement. We have developed an individualized, interactive, Web-based geriatrics portfolio to track the acquisition and mastery of these outcomes for students. DESCRIPTION The required learning outcomes in geriatrics are presented to first-year students in their geriatrics portfolio Web page. The outcomes have been adapted from the recommendations published by the American Geriatrics Societys Education Committee.(1) The portfolio cross-references learning outcomes to specific activities in the curriculum. The activities include content given in lectures, multidisciplinary case discussions, standardized patient instructor (SPI) experiences involving older patients, and specific types of patient encounters during the clinical years. The portfolio allows documentation of completion dates of specific activities and the evaluations the student received. Certain activities such as the SPI experiences will include hyperlinks to their descriptions and the information that should be reviewed prior to each activity. The portfolio is integrated with existing administrative databases. Data entry occurs through links (e.g., exam scores), uploading comment forms from the SPI, and direct student input. One novel example of student input is the ability to upload information concerning encounters with older patients that students are recording in personal data assistant templates such that this information maps directly to the appropriate learning outcomes in their portfolios. The portfolio is designed to encourage students to take responsibility for their geriatrics education. Several types of evaluation data are provided, some that are specific to an activity (e.g., SPI feedback) and others that provide global assessments of learning outcomes (e.g., attitude surveys). The Web page can be displayed by the list of outcomes (categorized by attitudes, knowledge, and skills), by medical school year, and by date of completion. In this way, students can see at a glance how they are performing and whether they are up-to-date with completing the required outcomes. DISCUSSION The geriatrics portfolio serves to identify and highlight geriatrics-related content across the four years. Its interactive features make it much more dynamic than a written transcript. Requiring proficiency in learning outcomes related to geriatrics for graduation will clearly convey to students that this information is critically important in their training to become physicians. The individualized evaluation summaries will prove useful to the student because self-directed learning opportunities can be targeted to address weak areas. Evaluation of performances will also aid program directors to appropriately modify the curriculum to address any deficiencies. This innovative Web-based approach to capture learning outcomes that are dispersed throughout a four-year curriculum may also find application in similar curricula (e.g., womens health and end-of-life care).

COMPARISON OF RESIDENT AND MEDICAL STUDENT EVALUATION OF FACULTY TEACHING

Recognizing and rewarding teaching faculty are increasingly important to medical schools and are often hampered by low perceived reliability and validity of measures of teaching ability. The purpose of this study was to cross-validate two independently generated measures of teaching from medical students and residents. A total of 2,318 medical student and 4,425 resident scores for single-item measures of teaching ability for 129 teaching faculty members of a department of internal medicine over a 6-year period were compared. Results showed that average teaching scores were higher for medical students than residents. Rank order of faculty were within 2 quintiles for the two groups for over 90% of faculty. Highly discordant evaluations were seen for only 8% of faculty. The authors conclude the general concordance of two independent measures of teaching ability adds evidence to the existing literature of the validity of single-item measures of teaching ability from two different types of learners.

The influence of vignettes on EKG interpretation by third-year students.

No abstract available.

Internal medicine ambulatory-care-based education: A comparison of three models

No abstract available.

Shifting medical student education to the outpatient setting: what are we losing?

No abstract available.

Computer-based problem solving for primary-care diagnosis in an internal medicine clerkship.

No abstract available.

Multi-site reliability and validity of a diagnostic pattern-recognition knowledge-assessment instrument.

No abstract available.

Identifying the trees in the forest: characteristics of students who demonstrate disparity between knowledge and diagnostic-pattern-recognition skills

No abstract available.