Jeanne K. Heard

Autoradiographic and ultrastructural studies of areas of spinal cord occupied by Schwann cells and Schwann cell myelin

Schwann cells, peripheral-type myelin and connective tissue elements develop within the dorsal portion of the X-irradiated spinal cord in immature rats. Factors controlling the distribution of these elements within the irradiated site are not fully understood. In the present study [3H]thymidine autoradiography was used to examine proliferative activities of cells in these areas occupied by peripheral nervous system components, and correlative ultrastructural evaluations were made. At 15 and 20 days post-irradiation (P-I), the Schwann cells occupied the dorsolateral portions of the dorsal funiculi, and heavily labeled cells occurred throughout these areas. By 25 days P-I the Schwann cells extended ventrally into the depths of the dorsal funiculi and into the dorsal gray matter, and labeled cells were concentrated in the deeper portions of these areas. Ultrastructurally, the Schwann cells and peripheral-type myelin were more mature in the superficial portions where proliferative activity was diminished. In contrast, much less mature, peripheral-type myelin occurred in the depths where the labeled cells were concentrated. At 30 and 45 days P-I, labeled cells were much less frequent but usually occurred in the depths when observed. Similarly, a dorsal-ventral gradient in maturity of peripheral-type myelin was evident ultrastructurally. By 60 and 90 days P-I, labeling was rare, and mature Schwann cell myelin was present throughout the areas. Astrocytes and their processes were less numerous in regions invaded by Schwann cells, as compared to controls, and studies are in progress to evaluate the relationships between these glial elements and intraspinal peripheral nervous system components.

An analysis of printed breast cancer information for African American women

BACKGROUND The 1995-1998 Delta Project was designed to increase breast cancer screening among disadvantaged African American women with limited literacy skills by educating their health care professionals about breast health. The research team intended to provide onsite training and appropriate educational materials; however, they found no suitable materials. This article presents the results of an assessment of available materials and defines the need for suitable materials. METHODS Nineteen organizations that develop cancer-related publications submitted materials intended for African American audiences. Sixty-one documents were examined for readability and cultural sensitivity. The Flesch Reading Ease (FRE), Flesch-Kincaid (F-K), and Cultural Sensitivity Assessment Tools (CSAT) were used in testing. RESULTS The mean FRE score of 65 yielded a F-K mean grade level of 7.5 (desired level: 3.5). Using CSAT, 16 documents (26%) were eliminated because they had no visuals. Twenty-two publications (37%) were culturally sensitive for all audiences and 19 (31%) were for white audiences. Four (6%) pieces specifically addressed African American women. CONCLUSIONS Printed educational materials on breast cancer do not adequately provide information to undereducated, economically disadvantaged African American women.

Developing and Testing Lay Literature About Breast Cancer Screening for African American Women

Written materials about breast cancer screening for African American women with low literacy skills are needed. Available materials were not at or below third-grade reading levels, were not culturally sensitive, and were not accurate in illustrating correct breast self-examination (BSE) techniques. Focus groups representing the target population helped the authors design a pamphlet describing how to perform BSE and a motivational picture book to help women overcome barriers to screening. The authors chose a food theme for the cover of the pamphlet written at a third-grade level and suggested a photographic version. In the motivational book, two women address barriers to screening and replace myths and fears with facts and actions. Data from 162 women showed that they learned from both the photographic and illustrated versions. Women in the photographic group found significantly more lumps in the silicone models, so the authors chose that version to use in final testing. Finally, nurses pretested a group of patients before they reviewed the materials and post-tested another group after they reviewed them. The group who had reviewed the materials had greater knowledge of and intent to follow the guidelines and received higher scores on BSE techniques.

Using standardized patients to teach breast evaluation to sophomore medical students

In response to the current emphasis on health maintenance and disease prevention, the authors developed a comprehensive education program in which sophomore medical students interview a standardized patient about breast problems and risk factors, receive one-on-one instruction from the standardized patient during the clinical breast examination, and practice recommendations for screening and instruction in breast self-examination. In this pilot study sophomore students who underwent the comprehensive education program were compared with students who received the traditional, didactic instruction and practiced on plastic breast models. The students who received the didactic instruction had mean scores on a multiple-choice knowledge-base pretest and posttest of 54.6% and 76.8%, respectively. The students who participated in the comprehensive education program had mean pretest and posttest scores of 51.2% and 78.5%, respectively. All students participated in a practical test of the clinical breast examination during an objective structured clinical examination. The students who had received the didactic instruction scored 69.9% (mean), compared with 84.1% for the students who had had the comprehensive education program. The comprehensive breast education program teaches medical students about risk factors, screening recommendations, and clinical breast examination more effectively than do traditional didactic methods.

An Institutional System to Monitor and Improve the Quality of Residency Education

Purpose. This study sought to investigate whether an institutions Graduate Medical Education Committee (GMEC) could develop a system of continuous quality improvement of its residency programs using an annual survey provided by the institution for all residents. Method. Beginning in 2000, residents were surveyed annually about their educational and work environments. The GMEC determined standards of performance for the items on the survey based on four areas commonly cited by the Accreditation Council for Graduate Medical Education: supervision, feedback/evaluation, scholarly time, and duty hours. Residency program directors submitted action plans to improve those areas rated below the standard by the residents in the program. Results. The 2000 survey served as baseline. In 2001, residency programs met the standard for 55.2% of the items, and 18 programs submitted 67 action plans. In 2002, programs met the standard for 80.6% of the items. For the items below standard, programs showed improvement in 14.9% and declined in 4.5% of the items compared with baseline. Six of the 18 programs had accreditation site visits during the study period. Five received no citations in the targeted areas. The sixth program was visited three months after it developed action plans for its six deficient areas. It received citations for two of the six areas. Conclusion. An institution that sponsors residency programs can develop and sustain an effective system to continuously monitor and evaluate its programs and improve the educational quality as evidenced by successful accreditation decisions.

Commentary: the ACGME: public advocacy before resident advocacy.

In their insightful and provocative analysis in this issue, Drs. Lypson, Hamstra, and Colletti propose that the Accreditation Council for Graduate Medical Education (ACGME), with some modifications in process, might assume the role of unions or other collective bargaining units for residents. They make valid observations about aspects of the ACGME Institutional Requirements that pertain to resident safety and well-being and the environment in which residents learn and participate in care. To understand the nature of these requirements, the authors reiterate the ACGMEs role as an educational accreditor and the philosophical basis for its accreditation function. The authors conclude that the ACGME cannot and will not replace resident unions, associations, or other groups where residents perceive the need arising for the presence of these organizations.

Educational development program for residency program directors and coordinators.

Background: Residency program directors and program coordinators have increasing demands placed on them by accrediting agencies and require educational development specifically tailored to their needs. Description: We created, piloted, and evaluated an educational development program consisting of 10 sessions spanning 1 year for program directors and a parallel set of sessions for program coordinators. Evaluation: On average, more than half the residency programs participated in the sessions. Programs improved in residency activities related to their programs handbook, interviewing, evaluations, rotation descriptions, and program evaluation. They did not improve in educational scholarly activities. Program directors and coordinators indicated that the program improved their skills, and they would recommend the program for others. Conclusions: This 10-session program improved important elements of residency education and was favorably received.

commentary: Trust, Accountability, and Other Common Denominators in Modernizing Medical Training

Modernization of specialist training in a competency-based framework is not unique to the United States. In the following commentary, the authors explore the current environment within which graduate medical education (GME) in the United States operates, using the perspective framework developed by Wallenburg and colleagues from the Netherlands: the accountability perspective, the educational perspective, the work-life balance perspective, and the trust-based perspective. In this exploration, they identify factors within and beyond the medical profession that shape GME in the United States and influence the Accreditation Council for Graduate Medical Education, the professional self-regulatory body charged with setting standards and assessing compliance for allopathic GME in the United States. The authors conclude that the modernization of medical education examined by Wallenburg and colleagues must be approached with the needs of future trainees and patients in mind.

General characteristics and experiences of specialized standardized patients: Breast teaching associate professionals

BACKGROUND Standardized patients and teaching associates provide, reinforce, and evaluate the teaching of clinical skills to students and health care providers. As new needs and roles emerge for this method of teaching and evaluation, information is needed for recruitment, training, and retention. METHODS This article addresses the general characteristics and experiences of 12 Breast Teaching Associate Professionals (BTAPs) in a two-year NCI-funded study aimed to improve breast cancer screening practices of rural primary health care providers in Eastern Arkansas. RESULTS Areas of focus are demographic characteristics, motivations for serving as BTAPs, their perceptions of the advantages and disadvantages of the BTAP role, and the influence or impact the role had on their own health behaviors or personal lives. CONCLUSION The evolving commitment to the value of this method of teaching and to health care education on this campus became stronger for many of the women as participation continued into other projects with further learning and specialization.

Global ratings versus checklist scoring in an OSCE.

No abstract available.