Victor R. Neufeld

A Randomized Trial of Continuing Medical Education

To determine whether continuing medical education affects the quality of clinical care, we randomly allocated 16 Ontario family physicians to receive or not receive continuing-education packages covering clinical problems commonly confronted in general practice. Over 4500 episodes of care, provided before and after study physicians received continuing education, were compared with preset clinical criteria and classified according to quality. Although objective tests confirmed that the study physicians learned from the packages, there was little effect on the overall quality of care. When the topics were of relatively great interest to the physicians, the control group (who did not receive the packages) showed as much improvement as did the study group. When the topics were not preferred, however, the documented quality of care provided by study physicians rose (P less than 0.05) and differed from that provided by control physicians (P = 0.01). Finally, there was no spillover effect on clinical problems not directly covered by the program. In view of the trend toward mandatory continuing education and the resources expended, it is time to reconsider whether it works.

Clinical problem‐solving by medical students: a cross‐sectional and longitudinal analysis

The evolution of clinical reasoning in medical students was studied. A cross‐sectional sample consisted of randomly‐selected medical students from three classes. Additionally, twenty‐two students were observed at yearly intervals from the preclerkship period to the first post‐graduate year. Subjects were observed in a clinical examination of a simulated patient, and their thought processes were abstracted from a ‘stimulated recall’ of the videotaped encounter.

The McMaster M.D. Program: A Case Study of Renewal in Medical Education.

This paper presents four aspects of health professions education at McMaster University: (1) a review of the key elements of the history and distinctive approach of the Doctor of Medicine (M.D.) program; (2) a description of the process and substance of curriculum change over the past decade, focusing on a major revision of the M.D. program that began in 1983; (3) a summary of the findings of follow-up studies of McMaster M.D. program graduates; and (4) an analysis of the current context within which the Faculty of Health Sciences (of which the M.D. program is a part) is operating and a description of strategies for renewal that are being implemented. The evidence and experience to date support the assertion that satisfactory–and in some ways special–physicians can be prepared using the “McMaster approach” to medical education, but that continuous review and periodic major revisions of the educational program are both necessary and possible; they must occur in concert with developments in other sectors of Faculty of Health Sciences activities.

Educating future physicians for Ontario

In 1987, Ontarios physicians conducted a strike, ultimately not successful, over the issue of “extra billing.” The fact that the Ontario public did not support this action reflected a major gap between the professions view of itself and the publics view of the profession. In 1990, the provinces five medical schools launched a collaborative project to determine more specifically what the people of Ontario expect of their physicians, and how the programs that prepare future physicians should be changed in response. The authors report on the first five years of that ongoing project. Consumer groups were asked to state their views concerning the current roles of physicians, future trends that would affect these roles, changes in roles they wished to see, and suggestions for changes in medical education. Methods used included focus groups, key informant interviews, an extensive literature review, and surveys, including a survey of health professionals. Concurrently, inter-university working groups prepared tools and strategies for strengthening faculty development, assessing student performance, and preparing future leadership for Ontarios medical education system. Eight specific physician roles were identified: medical expert, communicator, collaborator, health advocate, learner, manager (“gatekeeper”), scholar, and “physician as person.” Educational strategies to help medical students learn to assume these eight roles were then incorporated into the curricula of the five participating medical schools. The authors conclude that the project shows that it is feasible to learn specifically what society expects of its physicians, to integrate this knowledge into the process of medical education reform, and to implement major curriculum changes through a collaborative, multi-institutional consortium within a single geopolitical jurisdiction.

Network of community-oriented educational institutions for the health sciences

No abstract available.

A randomized trial of librarian educational participation in clinical settings.

In order to evaluate the librarians educational role in patient care settings, an information service was provided for health professionals, patients, and families by two part-time clinical librarians. Eight clinical areas were randomly selected from a pool of settings which met predetermined entry criteria. Four of these settings were randomly allocated to the experimental maneuver (that is, the clinical librarian service), and four were control settings. Results showed that the clinical librarians were accepted by health professionals and that services to all groups were viewed as successful. Significant differences in information-seeking patterns were found between study and control groups of health professionals. In particular, the study group was more likely to use the library for direct patient care and rated the librarian and library resources more highly as sources of information. This time-limited and education-oriented model would be useful for settings in which a full-time librarian program is not feasible.

Setting educational priorities for learning the concepts of population health

Summary. Following the World Health Organizations policy of ‘Health for All by the Year 2000′, doctors are increasingly being seen as health care providers to populations of patients, in addition to their more traditional role as doctors to individuals in a one‐to‐one encounter. In order for doctors to take on this expanded role, they must learn the knowledge and skills appropriate to population health. In this paper, we propose a method of educational priority‐setting which allows educational planners to identify those diseases and adverse health conditions most appropriate for studying the concepts of population health. Using the Measurement Iterative Loop of Tugwell and colleagues as a framework, a table of Priority Illness Conditions was developed and compared with a previous priority list developed from a survey of clinical teachers at the McMaster University Medical School. Discussion of the implications for this approach in setting educational priorities at undergraduate, postgraduate and continuing medical education levels is presented, along with a review of possible shortcomings and caveats in using this approach.

Evaluation of Health Sciences Education Programs: Program and (Student) Assessment at McMaster University

The evaluation of a health sciences education program and methods of assessment of health sciences students are so interrelated, each affecting the other, that an attempt should be made to address at least some of the major issues in one chapter.

Health implications of small arms and light weapons in eastern Uganda.

Abstract Injuries due to small arms and light weapons (SALW) are common in developing countries with ongoing collective violence, or those that exist in a post-conflict state. Uganda has a long history of armed conflict, but little quantitative evidence is available about the extent of the problem of SALW. We performed a review of all injuries due to SALW at Mbale Regional Hospital in eastern Uganda for the six-year period 1998–2003. Using a standardised questionnaire, we recorded information from over 200 cases concerning the characteristics of the victim, the incident, the weapon used and the care received. The majority involved males and occurred in the context of conflict within tribal communities, or armed robberies throughout the region. Each injury is of significant cost to the healthcare system and to the victim. Prevention, through limiting the availability of the ‘vector’ of disease (SALW), is a key part of the solution to this problem.

The Potential and Organization of Health Intelligence Units

Is the role of the university in society simply to generate, interpret, and transmit new knowledge? Or will universities come out of the “ivory tower” and join in meaningful partnerships with community leaders and governments, to resolve society’s present and future problems? Medical schools are part of the university, so these questions apply. As they are also linked with the health care system in carrying out education and research, questions about the mission of the medical schools, the health of the people, and the allocation of resources to deal with the determinants of health are interrelated. Medical schools require a capacity for the analysis and interpretation of health information in order to deal adequately with these issues.