Erica Brownfield

Direct-to-consumer drug advertisements on network television: an exploration of quantity, frequency, and placement.

Prescription and over-the-counter (OTC) drug advertisements that appear on television are among the most common forms of health communication reaching the U.S. public, but no studies to date have explored the quantity, frequency, or placement of these ads on television. We explored these questions by recording all programs and advertisements that appeared on network television in a southeastern city during a selected week in the summer of 2001 and coding each prescription and OTC drug ad for its frequency, length, and placement by time of day and television program genre. A total of 18,906 ads appeared in the 504-hour sample, including 907 OTC drug ads (4.8%) and 428 prescription (Rx) drug ads (2.3%), which together occupied about 8% of all commercial airtime. Although OTC drug ads were more common, Rx drug ads on average were significantly longer. Direct-to-consumer drug ads appeared most frequently during news programs and soap operas and during the middle-afternoon and early-evening hours. Overall, we found that direct-to-consumer drug advertisements occupy a large percentage of network television commercial advertising and, based on time and program placement, many ads may be targeted specifically at women and older viewers. Our findings suggest that Americans who watch average amounts of television may be exposed to more than 30 hours of direct-to-consumer drug advertisements each year, far surpassing their exposure to other forms of health communication.

Reducing disparities in breast cancer survival: a Columbia University and Avon Breast Cancer Research and Care Network Symposium.

On November 8th, 2001, faculty from Universities, government and non-profit community organizations met to determine how, separately and together, they could address disparities in survival of women with breast cancer in the diverse patient populations served by their institutions. Studies and initiatives directed at increasing access had to date met modest success. The day was divided into three sections, defining the issues, model programs, government initiatives and finally potential collaborations. By publishing these proceedings, interested readers will be aware of the ongoing programs and studies and can contact the investigators for more information. The Avon Foundation funded this symposium to bring together interested investigators to share programmatic experiences, data and innovative approaches to the problem.

Through the Looking Glass: How Reflective Learning Influences the Development of Young Faculty Members

Background: Faculty development is needed that will influence clinical teachers to better enable them to transmit humanistic values to their learners and colleagues. Purpose: We sought to understand the processes whereby reflective learning influenced professional growth in a convenience sample of young faculty members. Methods: We analyzed appreciative inquiry narratives written over 4 years using the constant comparative method to identify major underlying themes and develop hypotheses concerning how reflective learning influenced participants in the faculty development program. Six of the participants and the facilitator were participant observers in the qualitative analysis. Results: Group support, validation, and cohesion led to adoption of common values that informed the professional development of the participants over 4 years of the study. Common values influenced the group members as they progressed in their careers. Conclusions: Faculty development programs that focus on humanism and reflective learning can facilitate the growth of young faculty members by influencing their values and attitudes at crucial phases of their careers.

Patient communication during handovers between emergency medicine and internal medicine residents.

BACKGROUND Communication failures are a key cause of medical errors and are particularly prevalent during handovers of patients between services. OBJECTIVE To explore current perceptions of effectiveness in communicating critical patient information during admission handovers between emergency medicine (EM) residents and internal medicine (IM) residents. METHODS Study design was a survey of IM and EM residents at a large urban hospital. Residents were surveyed about whether critical information was communicated during patient handovers. Measurements included comparisons between IM and EM residents about their perceptions of effective communication of key patient information and the quality of handovers. RESULTS Ninety-three percent of EM residents (50 of 54) and 80% of IM residents (74 of 93) responded to the survey. The EM residents judged their handover performance to be better than how their IM colleagues assessed them on most questions. The IM residents reported that one-half of the time, EM residents provided organized and clear information, whereas EM residents self-reported that they did so most of the time (80%-90%). The IM residents reported that 25% of handovers were suboptimal and resulted in admission to an inappropriate level of care, and 10% led to harm or delay in care. The EM residents reported suboptimal communication was less common (5%). On the global assessment of whether the admission handover provided the information needed for good patient care, IM residents rated the quality of the handover data lower than did responding EM residents. CONCLUSIONS There are gaps in communicating critical patient information during admission handovers as perceived by EM and IM residents. This information can form the basis for efforts to improve these handovers.

Assessment of medical students: Can one global question be meaningful?

There are inherent challenges and barriers to produce meaningful assessment and feedback for students. One major challenge is faculty members’ unwillingness to assign low scores and write constructive, or what might be viewed as negative comments about students (Roman & Trevino 2006; Mazor et al. 2007). Failing to convey concerns about trainee performance not only does the trainee a disservice by giving false hope, but also does a disservice to patients and society. One question, ‘‘Would you want this student participating in the care of a loved one?’’ was added to the traditional assessment form of students rotating on the medicine clerkship. This question was based on the American Board of Internal Medicine Peer and Patient Assessments of Physicians. Physician evaluators were given three possible responses to this question: ‘‘yes’’, ‘‘no’’, or no answer. We then compared the responses by looking for a difference in ratings of knowledge, skills, and professionalism on the traditional assessment form. 1435 assessments of 151 students were analyzed. Evaluators rarely identified that they would not want a student participating in the care of a loved one (9 or 0.6% of assessment). More interesting, a number of evaluators did not answer the question (46 or 3.2%). The scores given by the evaluators on all measures were significantly lower for the group of students with a ‘‘no’’, but also with no answer as compared to students with a unanimous ‘‘yes’’. This may indicate that when physicians assessing students do not fill in sections of an assessment form, it may be meaningful and indicate significant concern about the student’s performance (‘‘concern by omission’’). While one might argue that adding a global question to the assessment did nothing more but correlate to the traditional questions, we argue that any unanswered global question requires further investigation. To be provocative, one might use an assessment form with just one global question, with the caveat that the evaluator must include a descriptive narrative that supports their answer as to whether or not they would want the student participating in the care of a loved one. Making assessment forms less complex, and allowing evaluators more time to thoughtfully document their opinions of student performance would be much more meaningful to everyone.

A short palliative care experience: beginning to learn

medical education is expanding; however, tools to assist with evaluation and feedback are lacking. A reflective writing curriculum innovation was introduced into the Doctoring course in the 2 years of pre-clinical education at the Warren Alpert Medical School of Brown University during the 2005–2006 academic year. The Doctoring course teaches clinical skills and professionalism through integrating instruction in medical interviewing, physical diagnosis, cultural competence and medical ethics. The course structure includes large-group didactic sessions, small-group processing and skill instruction, one-to-one, community-based doctor mentoring for skills practice, and reflective writing assignments. Within this course, 19 structured reflective writing exercises (‘field notes’ and reflections on case writeups) are required of medical students and guided individualised written feedback from an interdisciplinary faculty team is provided. The interactive reflective writing paradigm of guided faculty feedback on students’ reflective writing to promote reflection has recently been described. Why the idea was necessary Curriculum initiatives that include reflective writing have created the need for a valid, reliable evaluative tool that can be effectively applied to assess the student’s reflective level and its development. Various frameworks for assessing RC have been described, although definitions of reflection levels abound and existing measures can be challenging in their application. Publications on the utility of reflective writing in medical education have been largely anecdotal or based on student self-report. What was done We devised a reflection rubric for determining student reflection levels within reflective writing exercises. Our reflection rubric emerged from both a comprehensive analysis of the literature evaluating the reflection construct and the synthesis of existing reflection measure instruments, and resulted in a more concise, user-friendly format. The rubric consists of five levels of reflection, for each of which clear and thorough criteria are provided (based on the integration of literature definitions). The criteria include such features as writing from the ‘I’ or ‘we’ perspective, moving from description to reflection and introspection, attending to emotions, and displaying transformative learning. Levels are as follows (bracketed descriptors adhere to Doctoring course evaluation guidelines):

Interweaving Curriculum Committees: A New Structure to Facilitate Oversight and Sustain Innovation.

Undergraduate medical education curricula have increased in complexity over the past 25 years; however, the structures for administrative oversight of those curricula remain static. Although expectations for central oversight of medical school curricula have increased, individual academic departments often expect to exert control over the faculty and courses that are supported by the department. The structure of a gover nance committee in any organization can aid or inhibit that organization’s functioning. In 2013, following a major curriculum change in 2007, the Emory University School of Medicine (EUSOM) implemented an “interwoven” configuration for its curriculum committee to better oversee the integrated curriculum. The new curriculum committee structure involves a small executive committee and 10 subcommittees. Each subcommittee performs a specific task or oversees one element of the curriculum. Members, including students, are appointed to two subcommittees in a way that each subcommittee is composed of representatives from multiple other subcommittees. This interweaving facilitates communication between subcommittees and also encourages members to become experts in specific tasks while retaining a comprehensive perspective on student outcomes. EUSOM’s previous structure of a single committee with members representing individual departments did not promote cohesive management. The interwoven structure aligns neatly with the goals of the integrated curriculum. Since the restructuring, subcommittee members have been engaged in discussions and decisions on many key issues and expressed satisfaction with the format. The new structure corresponds to EUSOM’s educational goals, although the long-term impact on student outcomes still needs to be assessed.

Clinician-Educators as Dual Professionals: A Contemporary Reappraisal.

Physicians who teach face unique responsibilities and expectations because they must educate learners while simultaneously caring for patients. Recently this has become even more difficult as the environment for clinician–educators has been undermined by public antipathy toward both the education profession and the medicine profession. Erosion of public confidence in both professions is evidenced by three trends. First, the democratizing nature of the Internet and the availability of technical knowledge to laypeople have encroached on the domain of professional knowledge. Second, the responsibility of a professional to make decisions has been undercut by legal interpretations regarding how physicians are paid for patient care and how teachers are evaluated on performance. And finally, altruistic motivations in both professions have been called into question by external forces promoting “accountability” rather than trusting professionals to act for the best interest of their patients or students. In this climate of increasing accountability and decreasing trust for professionals, clinician–educators can best serve patients and learners through transdisciplinary collaboration with professional educators. Clinician–educators should rely on professional educators for judgment and specialized knowledge in the field of education rather than embodying both professions by themselves. Health care practice has become more team oriented; health care education should do likewise to counteract the social and political trends eroding public confidence in medicine and education. Relying on collaboration with education professionals constitutes a substantial change to how clinician–educators define themselves, but it holds the best promise for medical training in the current social milieu.

339 MULTIMEDIA INTERVENTION TO INCREASE BREAST CANCER SCREENING AMONG WOMEN WITH LOW HEALTH LITERACY.

Purpose Though mammography screening can decrease breast cancer mortality, actual mammography screening remains low. Health literacy may be a barrier to obtaining a mammogram. There is conflicting evidence as to which method is the most effective in educating low-literate women and increase mammography screening. The objective of this research was to evaluate the effectiveness of a multimedia breast cancer education program compared to a standard breast cancer brochure among women with low health literacy. Methods Minority women between the ages of 50 and 69 who were patients of the urgent care clinic of a large urban hospital and who had not received a mammogram within the previous year were recruited by a research assistant from August 2003-2004. Baseline questionnaires and health literacy assessments were administered. Information on income, education level, general health, and mammography status were collected. Health literacy levels were assessed using the 66-item Rapid Estimate of Adult Literacy in Medicine (REALM) screening instrument. Participants were randomized into the brochure or multimedia CD group. Post-test questionnaires were administered immediately after completing the intervention. Results 56 women participated in the study, with 21 in the multimedia group and 35 in the brochure group. Groups did not differ significantly by race/ethnicity, marital status, income, education, health literacy level, or past mammography history. There were no significant differences at baseline between the groups for breast cancer/screening knowledge, likelihood of obtaining a mammogram, cancer beliefs, perceived cancer risk, perceived treatment response efficacy, and barriers to obtaining a mammogram. There were no significant differences between groups at post-test for knowledge, beliefs, response efficacy, and barrier scores. Those in the multimedia group had higher likelihood mean scores (18.29) than those in the brochure group (17.09) (p = .058), indicating greater intention to obtain a mammogram. No significant differences were found between groups in the number of women who obtained mammograms within 9 months of receiving the intervention, however. Conclusions Future research is needed to replicate the study with a larger sample size. Lower-cost health education materials, such as brochures and videos, may be more appropriate educational tools until the efficacy of multimedia interventions in low-literacy populations have been proven.