Linda Z. Nieman

Creation and assessment of a structured review course in physical diagnosis for medical residents

AbstractObjective: To evaluate the effects of a course in physical diagnosis on the knowledge, skills, and attitudes of internal medicine trainees. Design: A controlled, prospective assignment of housestaff to a yearlong curricular program, linked to a set of pre- and posttests. House-officers who could not attend the teaching sessions functioned as control subjects. Setting: An internal medicine training program at an urban medical school. Subjects: 56 (86.1%) of 65 eligible internal medicine housestaff (postgraduate years 1 through 3) participated in the intervention and assessment. A comparison group of 14 senior medical students participated in the pretest. Intervention: 12 monthly lectures emphasizing skills useful in emergencies or validated by the literature. Measurements: The pre- and posttests included: 1) a multiple-choice questionnaire to assess knowledge; 2) professional standardized patients to assess selected skills; and 3) Likert-type questionnaires to assess self-motivated learning and attitude toward diagnosis not based on technology. Main results: The residents expressed interest in the program and on a six-point scale rated the usefulness of lectures and standardized patients as 3.5±1.3 and 4.3±1, respectively. For no system tested, however, did they achieve more than 55.2% correct answers (range: 24.2%–55.2%, median =41.04), and their performance did not differ from that of the fourth-year medical students. There was no significant difference in pre/posttest improvement between the control and intervention groups. Conclusions: These data confirm the deficiencies of physical diagnostic skills and knowledge among physicians in training. These deficiencies were not corrected by the classroom lecture series. Improvement in these skills may require a more intense experiential program made part of residency requirements.

Comparison of computer-based learning and seminar teaching of pulmonary auscultation to first-year medical students.

No abstract available.

Comparison of "Fact-Recall" with "Higher-Order" Questions in Multiple-Choice Examinations as Predictors of Clinical Performance of Medical Students.

No abstract available.

Screening to the converted: an educational intervention in African American churches.

BACKGROUND African American women have higher incidences of breast and cervical cancers and African American men present with more advanced stages of colon and prostate cancers than do their non-African American counterparts. Since the church is central to the organization of the African American community, the authors set out to determine whether a church-directed educational project could influence parishioners to obtain cancer screening. METHODS Three African American churches having memberships of 250, 500, and 1,500, respectively, were selected for their different socioeconomic strata: one congregation was composed mostly of working poor, the second was more affluent, and the third consisted primarily of retirees. During a five-week summer period, appropriate literature, health fairs, testimonials by cancer survivors, and visits by representatives of the medical community were used to increase awareness of cancer screening. Surveys regarding cancer-screening behaviors were distributed at the end of church services. Using the guidelines established by the American Cancer Society, individual recommendations for screening examinations were developed and sent to parishioners based on their survey responses. RESULTS Of 437 parishioners surveyed (73% female, 27% male), 75% were 40 years old or older. Many reported up-to-date screening for breast (84%), cervical (78%), colon (62%), and prostate (89%) cancers. The results were remarkably similar in all three churches. Telephone follow-up seven months after the survey directed at the 120 parishioners identified as noncompliant for at least one cancer screening revealed that 49% had obtained the appropriate screenings. CONCLUSIONS These African American churchgoers were well screened compared with estimated national averages, possibly due to previous efforts of the activist ministers in the churches selected. The message for cancer screening is heeded when delivered through the African American church.

An interactive approach to teaching medical students to conduct HIV-risk--assessment interviews.

No abstract available.

Grouping medical students according to Myers‐Briggs principles

The effect of grouping medical students according to Myers‐Briggs principles on group process and test performance in a Microbiology‐Immunology teaching laboratory was assessed. One hundred twenty sophomore students were divided into 24 groups of 5 or 6 students each, half into groups that had complementary types (as defined by Myers‐Briggs principles), the other half into groups that were randomly assigned. Observers rated each group on cohesiveness, task direction, and leadership‐sharing variables, using an interaction‐analysis rating instrument designed as part of the study. Observers could not discern the leaders more often in the Myers‐Briggs complementary groups than in random groups (p = .007), and Myers‐Briggs complementary groups spent more time divided into subgroups, some of which were on task, whereas others were not (p = .006). The other 13 observed variables and the mean examination performance did not differ at p ≤ .05 between the random and complementary groups. Given a structured problem‐...

Defining and accomplishing clinically related objectives in an eight‐hour oncology course for first‐year medical students

Designing a clinically relevant cancer curriculum for freshmen attending medical schools with a traditional curriculum poses the following challenges: (1) there is limited curriculum time; (2) the subject matter is complex. The authors defined some of the responsibilities of the general physician in regard to cancer and six related objectives that first-year students could accomplish in an eight-hour multidisciplinary oncology course. A case-based, modified essay examination required students to demonstrate that they could begin to integrate principles of prevention, screening, diagnosis and staging, and treatment modalities. Ninety percent of the students accomplished the objectives. However, in working up the cancer case, 70% of the students did not mention the physical examination and 53% forgot multidisciplinary consultation. In a curriculum with limited objectives, first-year students can begin to deal efficiently with the complexities of cancer. Evaluation data revealed those objectives and related physician responsibilities requiring reinforcement in subsequent training.

Developing and Assessing the Effectiveness of an HIV Sexual History and Risk Assessment Workshop for Medical Professionals

We performed a randomized prospective study to develop and test the effectiveness of an experiential HIV and sexual history taking workshop for third year medical students. Students were randomized into either an experimental group or a control group. A two-station objective structured clinical examination was conducted as a posttest. Students were evaluated for their ability to gather information regarding HIV risk behaviors and were assessed for their demonstration of positive interpersonal skills. Students in the experimental group performed better than the control group on interview content (p = .001) and interpersonal skills (p = .043). Therefore, an experiential HIV workshop can be an effective means to develop the skills necessary to gather pertinent information regarding HIV risk behaviors, and the skills to communicate sensitively and effectively regarding these behaviors.