Self-reported evaluation of competencies and attitudes by physicians-in-training before and after a single day legislative advocacy experience

BACKGROUND: Advocacy is increasingly being recognized as a core element of medical professionalism and efforts are underway to incorporate advocacy training into graduate and undergraduate medical school curricula. While limited data exist to quantify physician attitudes toward advocacy, even less has been done to assess the knowledge, skills, and attitudes of future physicians. The purpose of this study was to assess students’ experiences and attitudes toward legislative advocacy, cutting out using a convience sample. METHODS: A paper survey based on previously validated surveys was administered to a convenience sample of premedical and medical student participants attending a National Advocacy Day in Washington, DC, in March 2011, both before and after their advocacy experiences. Responses were anonymous and either categorical ( or ordinal, using a 5-point Likert scale. Data were analyzed statistically to evaluate demographics and compare changes in pre- and post-experience attitude and skills. RESULTS: Data from 108 pre-advocacy and 50 post-advocacy surveys were analyzed yielding a response rate of 46.3%. Following a single advocacy experience, subjects felt they were more likely to contact their legislators about healthcare issues (p = 0.03), to meet in person with their legislators (p < 0.01), and to advocate for populations' health needs (p = 0.04). Participants endorsed an increased perception of the role of a physician advocate extending beyond individual patients (p = 0.03). Participants disagreed with the statement that their formal curricula adequately covered legislative healthcare advocacy. Additionally, respondents indicated that they plan to engage in legislative advocacy activities in the future (p < 0.01). CONCLUSIONS: A one-time practical advocacy experience has a positive influence on students’ knowledge, skills and attitudes towards legislative advocacy. Practical experience is an important method of furthering medical education in advocacy and further research is necessary to assess its impact in a broader population

Healthcare Reform and the Next Generation: United States Medical Student Attitudes toward the Patient Protection and Affordable Care Act

CONTEXT: Over one year after passage of the Patient Protection and Affordable Care Act (PPACA), legislators, healthcare experts, physicians, and the general public continue to debate the implications of the law and its repeal. The PPACA will have a significant impact on future physicians, yet medical student perspectives on the legislation have not been well documented. OBJECTIVE: To evaluate medical students' understanding of and attitudes toward healthcare reform and the PPACA including issues of quality, access and cost. DESIGN, SETTING, AND PARTICIPANTS: An anonymous electronic survey was sent to medical students at 10 medical schools (total of 6982 students) between October-December 2010, with 1232 students responding and a response rate of 18%. MAIN OUTCOME MEASURES: Medical students' views and attitudes regarding the PPACA and related topics, measured with Likert scale and open response items. RESULTS: Of medical students surveyed, 94.8% agreed that the existing United States healthcare system needs to be reformed, 31.4% believed the PPACA will improve healthcare quality, while 20.9% disagreed and almost half (47.7%) were unsure if quality will be improved. Two thirds (67.6%) believed that the PPACA will increase access, 6.5% disagreed and the remaining 25.9% were unsure. With regard to containing healthcare costs, 45.4% of participants indicated that they are unsure if the provisions of the PPACA will do so. Overall, 80.1% of respondents indicated that they support the PPACA, and 78.3% also indicated that they did not feel that reform efforts had gone far enough. A majority of respondents (58.8%) opposed repeal of the PPACA, while 15.0% supported repeal, and 26.1% were undecided. CONCLUSION: The overwhelming majority of medical students recognized healthcare reform is needed and expressed support for the PPACA but echoed concerns about whether it will address issues of quality or cost containment

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SIGLECopy held by FIZ Karlsruhe; available from UB/TIB Hannover / FIZ - Fachinformationszzentrum Karlsruhe / TIB - Technische InformationsbibliothekDEGerman

SIRT3 expression levels are associated with outcome in patients not receiving chemotherapy.

<p>Kaplan-Meier survival analyses, stratified by chemotherapy status, were performed. Patients who did not receive chemotherapy and expressed low levels of cytoplasmic SIRT3 in their tumours were more likely to (a) relapse quicker (p = 0.05 11.8 vs 30.7 months) and (b) die earlier (p = 0.014, 14.6 vs 34.7 months) than patients who expressed high levels of SIRT3. Conversely there was no significant difference in outcome as measured by (c) time to recurrence or (d) time to death in terms of SIRT3 expression in patients who received chemotherapy.</p

Panel demonstrating antibody specificity for SIRT1-7.

<p>For each sirtuin antibody a negative control (antibody diluent only) is illustrated, along with a tissue core stained with the antibody. Antibody specificity was validated via the use of blocking peptide to compete with tissue staining, or IHC on formalin-fixed paraffin embedded cell pellets treated with resveratrol.</p

Chemotherapy improves outcome in patients with low SIRT3 tumour levels.

<p>Patients with low SIRT3 expression who received chemotherapy had (a) a longer time to recurrence (20 vs 11.8 months, p = 0.057) and (b) a longer time to death (27.9 vs 14.6 months, p = 0.032) than those who did not receive chemotherapy. Conversely, patients who expressed high levels of SIRT3 and were treated with chemotherapy had (a) a shorter time to relapse (14.3vs 30.7 months, p = 0.159) and (b) a shorter time to death (18.3 vs 34.7 months, p = 0.148) than those who did not receive chemotherapy, though this did not reach statistical significance. </p

Representative figures of SIRT1-7 immunohistochemistry on pancreatic tumour tissue.

<p>Examples of pancreatic tumours expressing both low and high levels of SIRT1-7 are shown.</p

Sirtuin Histoscores.

<p>Table showing the median histoscores for each of the sirtuins in the PDAC tissue cohorts.</p><p>Sirtuin Histoscores.</p

SIRT7 may act as a prognostic factor for patients with pancreatic cancer.

<p>Survival analysis of the entire cohort did not reveal any significant differences in (a) disease-free survival or (b) disease-specific survival time between patients whose tumours had low or high SIRT7 nuclear expression. However, it was apparent from the survival plots that there was a division of the low/high SIRT7 expression lines at approximately 12–14 months. Analysis was therefore performed on the subset of patients that survived longer than 12 months (n = 44). Patients with low SIRT7 nuclear expression exhibited (c) a shorter disease-free survival time (p = 0.028, 20.1 vs 38 months) and (d) a decrease in disease-specific time (p = 0.026, 26.9 vs 43.1 months) than patients whose tumour expressed high SIRT7 levels.</p