Ready or Not, Here They Come: Acting Interns’ Experience and Perceived Competency Performing Basic Medical Procedures

OBJECTIVE: To assess acting interns’ (AI’s) experience with and perceived level of competency performing 6 basic medical procedures. DESIGN: Fourth-year medical students at the University of Cincinnati (UCCOM) are required to complete 2 AI rotations in Internal Medicine. All AIs in 2003–2004 (n = 150) and 2004–2005 (n = 151) were asked to complete a survey about whether during each of their rotations they had performed and felt competent performing the following procedures: phlebotomy, intravenous (IV) catheter insertion, arterial blood gas (ABG), nasogastric (NG) tube insertion, lumbar puncture (LP), and Foley catheter insertion. RESULTS: Four hundred sixty-seven of 601 possible surveys (across both years and both rotations) were completed (78% response rate). During both rotations, relatively few students performed the procedures, ranging from 9% for Foley catheter insertion (24/208) to 50% for both ABG and NG tube insertion (130/259). The two procedures most often performed were ABG (range 46–50%) and NG tube insertion (range 42–50%). Feelings of competency varied from 12% (LP) to 82% (Foley catheter). Except for LP, if students performed a procedure at least once, they reported feeling more competent (range 85% for ABG to 96% for Foley catheter insertion). Among the students who performed LP during a rotation, many still did not feel competent performing LPs: 23 (74%) in rotation 1 and 20 (40%) in rotation 2. CONCLUSION: Many fourth-year students at UCCOM do not perform basic procedures during their acting internship rotations. Procedural performance correlates with feelings of competency. Lumbar puncture competency may be too ambitious a goal for medical students

Understanding, predicting, and influencing recycling behavior: The future generation.

In light of the current waste crisis, it is critical that we begin attempts to influence attitudes, beliefs, and behaviors regarding waste recycling. In the first study, a decision-making model, the Theory of Reasoned Action (TRA), was tested to explain recycling behavior. The TRA purports that behavior can be explained directly by behavioral intentions and indirectly by attitudes and beliefs about the behavioral act. The second study incorporated two types of interventions (educational and feedback) developed to modify recycling attitudes, beliefs, and behavioral intentions and thereby enhance recycling behavior. A questionnaire comprising the concepts of the Theory of Reasoned Action (TRA) was administered to 4,682 first-year students at The University of Michigan. Baseline data were gathered from 3,706 out of 4,682 students (80% response rate). Of those 3,706 students, 1,604 students also completed the follow-up questionnaire (34% response rate overall). Using a quasi-experimental design, eight residence halls were matched on size and randomly assigned to one of four intervention conditions (two halls per group): (1) recycling education, (2) feedback about recycling behavior, (3) education plus feedback, or (4) control. The intervention period lasted 5 months. A path analytic technique used in the first study indicated that the TRA was useful in explaining self-reported recycling behavior. The respondent's rated importance of recycling compared to other social issues mediated the relationship between attitudes, beliefs, and behavioral intentions. To evaluate the data from the second study, a multiple comparison using an a priori Scheffe' procedure was used. Results showed that there were no significant group differences in terms of the students' attitudes, beliefs, rated importance, recycling knowledge, or behavioral intentions. Students receiving monthly feedback pertaining to the amount of material recycled in their residence, however, reported participating in recycling to a greater degree than those receiving only the educational intervention or nothing at all (p $<$.001). Overall, findings from the two studies suggest that there is a relationship between an individual's recycling attitudes, beliefs, and behavior. In addition, feedback and educational intervention strategies appear useful in enhancing recycling behavior.Ph.D.Environmental scienceHealth Sciences, EducationHealth and Environmental SciencesPublic healthUniversity of Michigan, Horace H. Rackham School of Graduate Studieshttp://deepblue.lib.umich.edu/bitstream/2027.42/128685/2/9124011.pd

The Ophthalmic Clinical Evaluation Exercise (OCEX)

PURPOSE: New concise tools must be developed to assess reliably and validly the core residency competencies identified by the Accreditation Council for Graduate Medical Education. PARTICIPANTS: Eighteen content experts (residency program directors). METHODS: A 1-page Ophthalmic Clinical Exercise Examination (OCEX) checklist, for use during observed resident-patient interactions, was developed by an American Board of Ophthalmology taskforce. The OCEX checklist was sent to 18 content experts for their review and constructive comments. RESULTS: Experts\u27 comments were incorporated, establishing face and content validity. CONCLUSIONS: The OCEX has face and content validity. It can be used to assess a resident\u27s patient care skills, medical knowledge, and interpersonal skills. Reliability and predictive validity still need to be determined

Stress and exercise among the Japanese elderly

This study seeks to replicate and extend research on the stress process by examining the relationships among stress, social support, physical exercise, and depressive symptoms with data provided by a recent nationwide survey of older adults in Japan. The findings reveal that more frequent physical exercise is associated with less psychological distress. Moreover, the data suggest that some (but not all) types of stressors tend to diminish the frequency of physical activity. Finally, and perhaps most important, the results reveal that social support tends to promote more frequent exercise. This can occur in two ways. First, more emotional support was related to better exercise habits. In addition, negative interaction was also associated with more frequent exercise, suggesting that informal social sanctions can foster positive health behaviors.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/30781/1/0000434.pd

Intimate Partner Violence: What Are Physicians’ Perceptions?

Background: Intimate partner violence (IPV) is common in primary care; 11% to 22% of women experienced physical abuse in the past year. Older women experience IPV as well, but it is often undetected. This study examined primary care providers’ awareness about IPV in older women, including their screening practices and management. Methods: Interviews and focus groups were conducted with 44 primary care providers. Thematic analysis was used to identify common themes. Results: Providers fell along a continuum of thoroughness for identifying and managing IPV in older women, ranging from suboptimal to thorough identification of IPV and suboptimal to thorough management of the patient. In addition to the barriers commonly reported about IPV screening in younger women, providers described limited understanding of the diagnoses commonly associated with IPV, frustration with older women’s unwillingness to disclose problems and ask for help, and limited community services that accommodate older women with IPV. Providers recommended that communities sponsor public awareness campaigns about IPV as a problem for all women and that aging and IPV agencies work together. Conclusions: Continued provider training about IPV should include information on identifying older victims and appropriate management options. Participants stressed the importance of community efforts to raise awareness and improve resources available for older women who are victims of IPV

Intimate Partner Violence: What Are Physicians’ Perceptions?

Background: Intimate partner violence (IPV) is common in primary care; 11% to 22% of women experienced physical abuse in the past year. Older women experience IPV as well, but it is often undetected. This study examined primary care providers’ awareness about IPV in older women, including their screening practices and management. Methods: Interviews and focus groups were conducted with 44 primary care providers. Thematic analysis was used to identify common themes. Results: Providers fell along a continuum of thoroughness for identifying and managing IPV in older women, ranging from suboptimal to thorough identification of IPV and suboptimal to thorough management of the patient. In addition to the barriers commonly reported about IPV screening in younger women, providers described limited understanding of the diagnoses commonly associated with IPV, frustration with older women’s unwillingness to disclose problems and ask for help, and limited community services that accommodate older women with IPV. Providers recommended that communities sponsor public awareness campaigns about IPV as a problem for all women and that aging and IPV agencies work together. Conclusions: Continued provider training about IPV should include information on identifying older victims and appropriate management options. Participants stressed the importance of community efforts to raise awareness and improve resources available for older women who are victims of IPV

Professionalism Deficits Among Medical Students: Models of Identification and Intervention

Objective: This study compares the instruments and interventions utilized to identify and remediate unprofessional behaviors in medical students across U.S. psychiatry clerkships. Methods: A 20-item questionnaire was distributed to 120 psychiatry clerkship directors and directors of medical student education, in the U.S., inquiring into the procedures utilized for identifying, monitoring, and remediating unprofessional behaviors among medical students during their psychiatry clerkship. Results: Fifty seven (47.5%) clerkship directors responded to the questionnaire. Professionalism is evaluated by 96% of the clerkships with the most frequent goals being to provide feedback to students and to specifically identify problematic behaviors. Seventy percent of the clerkships identify one to three students per year with unprofessional behaviors that warrant intervention. The majority (86%) of the respondents note that unprofessional behaviors may impede the advancement of students during their medical education. A recommendation for a mental health evaluation occurs in at least 76% of cases. Dismissal from medical school for unprofessional behaviors is most likely recommended based on the severity and/or repetitiveness of the acts. Conclusions: There is concordance among clerkship directors regarding the importance of identifying unprofessional behaviors among medical students although there exists a range of modalities for monitoring, remediating, and disciplining such behaviors. Copyright © 2005 Academic Psychiatry

Professionalism Deficits Among Medical Students: Models of Identification and Intervention

Objective: This study compares the instruments and interventions utilized to identify and remediate unprofessional behaviors in medical students across U.S. psychiatry clerkships. Methods: A 20-item questionnaire was distributed to 120 psychiatry clerkship directors and directors of medical student education, in the U.S., inquiring into the procedures utilized for identifying, monitoring, and remediating unprofessional behaviors among medical students during their psychiatry clerkship. Results: Fifty seven (47.5%) clerkship directors responded to the questionnaire. Professionalism is evaluated by 96% of the clerkships with the most frequent goals being to provide feedback to students and to specifically identify problematic behaviors. Seventy percent of the clerkships identify one to three students per year with unprofessional behaviors that warrant intervention. The majority (86%) of the respondents note that unprofessional behaviors may impede the advancement of students during their medical education. A recommendation for a mental health evaluation occurs in at least 76% of cases. Dismissal from medical school for unprofessional behaviors is most likely recommended based on the severity and/or repetitiveness of the acts. Conclusions: There is concordance among clerkship directors regarding the importance of identifying unprofessional behaviors among medical students although there exists a range of modalities for monitoring, remediating, and disciplining such behaviors. Copyright © 2005 Academic Psychiatry