Richard E. Gallagher

Cancer prevention education in United States medical schools

The Cancer Education Survey collected data from 126 of 128 US Medical Schools on the current status of cancer-related educational activities for undergraduate medical students. The study was conducted by a Supervisory Committee of the American Association for Cancer Education, with funding from the American Cancer Society. The survey obtained data concerning institutional characteristics in support of undergraduate medical student cancer education, ie, administrative structures, current cancer-related curricula, sources of financial support, and anticipated changes in these characteristics. Institutions were also queried on specific topics of cancer prevention, detection, and diagnosis that might be taught as identifiable areas of instruction for medical students. Three-fourths of the institutions had a lecture on the principles of cancer screening, and, among those, nearly three-fourths classified it as a part of a required course or rotation. Detection of common cancers is taught in virtually all institutions. The least likely cancer prevention lecture topics are related to prevention and cessation of smoking, a well-verified cancer risk. Also, no consistent pattern emerges that might indicate that association with a cancer center imparts to a medical school a greater emphasis on delivery of cancer prevention topics.

Interaction analysis as a method for assessing skill in relating to patients: studies on validity

A commonly accepted goal of medical education is to help student physicians learn to interact effectively with patients. However, instruction relative to this objective has traditionally consisted of lecture-demonstrations, assigned reading on the ‘art’ of history-taking, and assignments to interview patients on hospital wards with little opportunity for constructive feedback from instructors. Evaluation of actual student performance has tended to be loose, unstructured, and highly subjective with little effort to assess the reliability or validity of the evaluation procedures (Meadow and Hewitt, 1972). Recently some investigators (Korsch, Gozzi, and Francis, 1968; Hess, 1969; Helfer and Hess, 1970) have developed new instruments based on interaction analysis techniques developed by Withall ( 1949), Bales (1950), and Flanders (1960) for the evaluation of interpersonal skills in medical interviewing. Previous research has shown that interaction analysis can provide a more reliable assessment of student performance in an interview setting than traditional global ratings (Hess. 1969). Reliability is one consideration in the development of an evaluation instrument. An even more important factor which requires investigation is the validity of these procedures. The purpose of this report is to describe the results of initial efforts to assess the validity of interaction analysis as a method for evaluating student effectiveness in relating to patients.

Instructional methods and the use of teaching resources in cancer education curricula

The findings on cancer teaching methodology presented in this abstract come from an American Association for Cancer Education (AACE)/American Cancer Society-sponsored survey of American allopathic medical schools in 1989 and 1990 to determine how and how well cancer is presented in the medical school curriculum. Responses were received from 126 institutional and approximately 1,000 faculty respondents. Approximately one-third (368) of faculty respondents indicated the use of specific learning objectives; utilization does vary across disciplines. The lecture remains the dominant form of instructional method. Computers were reported as an instructional modality by only 16% of the faculty respondents. Prepared audiovisual instructional materials appeared to be widely utilized. Use varied from 86% for 35mm slides to 11% for video discs. Faculty favored the development of new teaching materials for ten topic areas ranging from approximately 40% for early detection and prevention to a low of approximately 25% for rehabilitation and continuing care. The survey identified an underutilization of existing outpatient facilities and tumor registries for cancer teaching purposes. The findings give rise to questions concerning the appropriateness of the match between specific instructional goals and the teaching methods employed. Eight recommendations designed to strengthen cancer training are made.

Survey design and observations relating to cancer education funding

A survey has been conducted of cancer education programs for medical students in United States medical schools by the American Association for Cancer Education with grant support from the Department of Detection and Treatment of the American Cancer Society (formerly the Professional Education Department). Two questionnaires were used, an Educational Resources Questionnaire (ERQ), which 126 of the 128 medical schools completed and returned, and a Faculty and Curriculum Questionnaire (FCQ), which was completed and returned by 1,035 faculty members who had been named as active in undergraduate medical student cancer education by respondents in each school who had been designated by the Deans Office to complete the ERQ. Overall conclusions included: (1) increased coordination of cancer education activities is a major need in many schools; (2) there is widespread interest in the further development of cancer education objectives; (3) development of a national cancer education curriculum is needed; (4) there is interest in the development of improved instructional materials and methods; (5) development of evaluation methods is needed for cancer education programs; and (6) an ongoing funding process is needed to provide support for interdepartmental coordination of cancer education activities. Cancer prevention and detection topics were ranked above cancer treatment in plans for future curriculum emphasis. More detailed conclusions and recommendations are provided in this publication and three subsequent articles in this issue of the Journal of Cancer Education.

Pediatric oncologists' assessment of oncology education in U.S. medical schools: Cancer education survey II

The status of cancer education in U.S. medical schools was reassessed in the Cancer Education Survey II, which was initiated in 1989. One thousand and thirty-five cancer educators from 126 of the countrys 128 medical schools participated, including 65 pediatric oncologists and 36 family physicians. All agreed that the most important aspects of cancer to teach medical students are early detection and cancer prevention; they considered less important electives in basic science, radiation therapy, and surgical oncology. The 101 pediatric oncologists and family physicians believed that more curriculum time should be devoted to cancer epidemiology, psychosocial aspects, and palliative care. Approximately one third of these 101 physicians also expressed the desire to have more teaching materials available in five general areas: patient education about pediatric cancer, nutrition, epidemiology, palliative care, and continuing care. Lay-language information about pediatric cancer, participation in clinical trials, and current cancer research is still needed.

Tobacco Cessation: New Challenges, New Opportunities

Throughout the 1990s tobacco use has continued to expand in the developing world, and patterns of use have begun to shift in developed countries. During this same period, our knowledge of effective tobacco cessation methods has dramatically increased. In this paper, we review global trends in tobacco use, and current strategies for tobacco cessation. Evolving work in genetics, pharmacology, counseling, cessation aides, training, systems approaches, and regulation all have the potential to deliver more effective interventions to more tobacco users. Reducing the worldwide tobacco burden will require complementary efforts to reduce initiation and promote cessation. Until effective tobacco cessation methods are widely disseminated and readily available, the tobacco death toll will continue to rise.

Evaluation of a preparatory community-based prostate health education program.

BACKGROUND Medical organizations are divided on the issue of screening for prostate cancer, yet there is agreement that men should be educated about prostate health. Shared decision making involves patients and practitioners in this process, yet some men need preparatory education prior to the physician encounter. This study assessed the effectiveness of a community prostate health awareness program, focusing on men at risk for prostate cancer. METHODS Participants were given a pretest and a posttest to assess knowledge gains and impact on short-term intentions to address their prostate health. RESULTS There was a statistically significant increase in knowledge. Short-term intentions increased for those participants meeting the inclusion criteria. DISCUSSION Community outreach programs remain an excellent vehicle to educate the public and complement the efforts of health care providers.

Effectiveness of an occupational and environmental medicine curriculum as indicated by evaluation of medical student performance on an objective structured clinical examination.

Medical students must learn to recognize occupational and environmental-related illness. An occupational and environmental medicine curriculum can achieve this goal. The curriculum must be evaluated to ensure that medical students are learning to recognize exposure-related health conditions and to evaluate if this ability correlates with medical interviewing skills. A case, formatted for an Objective Structured Clinical Examination (OSCE), was developed to evaluate student performance on an exposure-related clinical problem. The OSCE results were analyzed to identify the areas that differentiated the students who recognized an exposure-related medical condition from those who did not. We conclude that an OSCE is an effective curriculum evaluation tool to assess whether a core occupational and environmental-related curriculum is contributing to student learning in exposure history-taking and associated clinical reasoning skills.

Evaluating the cancer education program: Examining a range of approaches

The objectives of this article are to provide people who are responsible for cancer education programs with a broadened perspective of the rich array of evaluation strategies available and responsive to the evaluation needs of cancer education programs, and to summarize selected literature resources useful for the development of an evaluation plan. This article reviews limitations found in previous evaluations of medical education programs and provides a descriptive survey of diverse strategies for the evaluation of cancer education programs. The characteristics, requirements, utility, audience, constraints, and resources are presented. Two cancer related case studies are discussed in detail as illustrations of the diversity of strategies available to evaluate cancer education programs.

Responsive evaluation: A personal reaction

Abstract In examining the Responsive Model, a design for program evaluation, I have approached it, not from the point of view of the evaluation theorist, which I am not, but from the point of view of a faculty member in a health sciences institution who has some responsibility for the evaluation of school programs. My comments and reactions are based not only on Dr. Stakes presentation here, but upon other published and unpublished materials of his. My summary of responsive and pre-ordinate evaluation designs which follow are drawn freely from his work.