Measurement of Inhaled Corticosteroid Adherence in Inner-City, Minority Children with Persistent Asthma by Parental Report and Integrated Dose Counter

Parents often overreport adherence to asthma treatment regimens making accurate assessment of medication adherence in clinical practice difficult. This study was conducted to compare two adherence assessment methods clinicians may choose from when assessing patient inhaled corticosteroid (ICS) adherence: parental report and dose counter measurements of metered-dose inhaler (MDI) actuation. Participants included children (N = 50) with persistent asthma and their parents (N = 50). At enrollment, children received a new, marked ICS at the dose prescribed by their physician. Thirty days following enrollment, we measured ICS adherence by parental report and objectively, with a dose counter. Parental report overestimated ICS adherence when compared to dose counter. We found a statistically significant overall difference between parental report and objectively measured adherence. A dose counter that most ICS inhalers are equipped with may be a more reliable alternative measure of ICS adherence in a clinical practice setting

First, There Was Pedagogy And Then Came Andragogy

The assertion that first, there was pedagogy and then came andragogy, is simultaneously true and misleading. What is pedagogy? What is andragogy? Which preceded the other? And what, if anything, does any of this have to do with medical education? In this article, we will explore the answers to these questions, review the historical bases for the pedagogical and andragogical paradigms, and discuss learning theories and their relevancy to teaching and learning in medicine.

Trends in the Financing of United States Medical Schools: 1970-1999

We examined 30-year trends in the financing of allopathic medical schools in the United States using data from the Annual Medical School Questionnaire administered to United States medical schools. We calculated relative proportions for total revenues derived from different sources. Federal support for teaching/training/public service represented 18.8% of total revenues in 1970-1971, but only 0.3% of total revenues in 1998-1999. The proportion of revenues derived from state/localgovernment appropriations also declined across this period. In contrast, the proportion of revenues derived from medical services increased substantially. The proportion of revenues derived from tuition/fees, gifts, and endowments remained constant

Undergraduate medical education: Thoughts on future challenges

BACKGROUND: There is considerable uncertainty about the future of undergraduate medical education in the face of several important challenges. This paper highlights many of the complexities of the challenges facing medical school leadership today. DISCUSSION: A major challenge facing medical education in the United States is the erosion of the clinical environment, the loss of clinical revenues and all its attendant consequences, including pressures for increased faculty productivity in an environment that is increasingly managed. These pressures have squeezed the time for teaching out of the system. Another challenge is how to incorporate all the new and emergent domains of knowledge into the existing curriculum. There is also a need to incorporate technological advancements into the delivery of teaching. SUMMARY: Undergraduate medical education in the United States must respond to a multitude of challenges if it is to remain vibrant in the 21(st) century

Predicting residents' performance: A prospective study

BACKGROUND: Objective criteria for predicting residents' performance do not exist. The purpose of this study was to test the hypothesis that global assessment by an intern selection committee (ISC) would correlate with the future performance of residents. METHODS: A prospective study of 277 residents between 1992 and 1999. Global assessment at the time of interview was compared to subsequent clinical (assessed by chief residents) and cognitive performance (assessed by the American Board of Pediatrics in-service training examination). RESULTS: ISC ratings correlated significantly with clinical performance at 24 and 36 months of training (r = 0.58, P < .001; and r = 0.60, P < .001 respectively). ISC ratings also correlated significantly with in-service exam scores in the 1(st), 2(nd), and 3(rd) years of training (r = 0.35, P = .0016; r = 0.39, P = 0.0003; r = 0.50, P = 0.005 respectively). CONCLUSIONS: Global assessment by an ISC predicted residents' clinical and cognitive performances

Tuberculin Skin Testing in Children

In 1996, the American Academy of Pediatrics (AAP) recommended targeted tuberculin skin testing (TST) of children while discouraging routine TST of children without risk factors for tuberculosis (TB). Recent studies have provided evidence in support of the targeted TST and recommendations that favor risk assessment over universal screening with TST. While evidence for targeted TB testing exists and benefits of screening programs are clear, administrative logistics could be a greater issue. The challenge for public health and school officials is to develop a screening program that avoids stigmatization of the at-risk group. Until then, pediatric healthcare providers will continue to have a key role in identifying children at risk for latent TB infection by using the AAP-endorsed risk-assessment questionnaire and should screen children with TST only when >1 risk factor is present

Ozuah P: Career Decision-Making among Pediatric Residents

Abstract- Background: Knowledge of the timing and process of residents ’ career decisionmaking could improve mentoring, career counseling and subspecialty recruitment efforts. However, knowledge about the timing of career decisions made by pediatric residents is lacking. Objective: To examine the timing of career decision-making among pediatric residents. Methods: We conducted a cross-sectional survey of a convenience sample of pediatric residents using a modified National Survey of Attitudes and Choices in Medical Education and Training questionnaire. Participants were asked about career plans, the timing of career decisions, and significant influences on these decisions. Results: Participants included 355 pediatric residents. Seventy-three percent had made a career decision. Of residents at least in the third post-graduate year, 40 % of pediatric residents made career decisions during the second year of residency, and a cumulative 76 % had made their decisions by the end of that year. Conclusions: This information about the timing of career decisions made by pediatric residents could help time educational opportunities, mentoring and career counseling activities, and recruitment efforts