Incorporating and evaluating an integrated gender-specific medicine curriculum: a survey study in Dutch GP training

Contains fulltext : 80246.pdf (publisher's version ) (Open Access)BACKGROUND: We recently set standards for gender-specific medicine training as an integrated part of the GP training curriculum. This paper describes the programme and evaluation of this training. METHODS: The programme is designed for GP registrars throughout the 3-year GP training. The modules emphasize interaction, application, and clinically integrated learning and teaching methods in peer groups. In 2005 - 2008, after completion of each tutorial, GP registrars were asked to fill in a questionnaire on a 5-point Likert scale to assess the programme's methods and content. GP registrars were also asked to identify two learning points related to the programme. RESULTS: The teaching programme consists of five 3-hour modules that include gender themes related to and frequently seen by GPs such as in doctor-patient communication and cardiovascular disease. GP registrars evaluated the training course positively. The written learning points suggest that GP registrars have increased their awareness of why attention to gender-specific information is relevant. CONCLUSION: In summary, gender-specific medicine training has been successfully integrated into an existing GP training curriculum. The modules and teaching methods are transferable to other training institutes for postgraduate training. The evaluation of the teaching programme shows a positive impact on GP registrars' gender awareness

On n-partite tournaments with unique n-cycle

Communication assessment in real-life consultations is a complex task. Generic assessment instruments help but may also have disadvantages. The generic nature of the skills being assessed does not provide indications for context-specific behaviour required in practice situations; context influences are mostly taken into account implicitly. Our research questions are: 1. What factors do trained raters observe when rating workplace communication? 2. How do they take context factors into account when rating communication performance with a generic rating instrument? Nineteen general practitioners (GPs), trained in communication assessment with a generic rating instrument (the MAAS-Global), participated in a think-aloud protocol reflecting concurrent thought processes while assessing videotaped real-life consultations. They were subsequently interviewed to answer questions explicitly asking them to comment on the influence of predefined contextual factors on the assessment process. Results from both data sources were analysed. We used a grounded theory approach to untangle the influence of context factors on GP communication and on communication assessment. Both from the think-aloud procedure and from the interviews we identified various context factors influencing communication, which were categorised into doctor-related (17), patient-related (13), consultation-related (18), and education-related factors (18). Participants had different views and practices on how to incorporate context factors into the GP(-trainee) communication assessment. Raters acknowledge that context factors may affect communication in GP consultations, but struggle with how to take contextual influences into account when assessing communication performance in an educational context. To assess practice situations, raters need extra guidance on how to handle specific contextual factors

Spatial sensory organization and body representation in pain perception

Pain is a subjective experience that protects the body. This function implies a special relation between the brain mechanisms underlying pain perception and representation of the body. All sensory systems involve the body for the trivial reason that sensory receptors are located in the body. The nociceptive system of detecting noxious stimuli comprises two classes of peripheral afferents, Aδ and C nociceptors, that cover almost the entire body surface. We review evidence from experimental studies of pain in humans and other animals suggesting that Aδ skin nociceptors project to a spatially-organised, somatotopic map in the primary somatosensory cortex. While the relation between pain perception and homeostatic regulation of bodily systems is widely acknowledged, the organization of nociceptive information into spatial maps of the body has received little attention. Importantly, the somatotopic neural organization of pain systems can shed light on pain-related plasticity and pain modulation. Finally, we show that the neural coding of noxious stimuli, and consequent experience of pain, are both strongly influenced when cognitive representations of the body are activated by viewing the body, as opposed to viewing another object — an effect we term ‘visual analgesia’. We argue that pain perception involves some of the representational properties of exteroceptive senses, such as vision and touch. Pain, however, has the unique feature that the content of representation is the body itself, rather than any external object of perception. We end with some suggestions regarding how linking pain to body representation could shed light on clinical conditions, notably chronic pain

Communicatie rondom ontslag van terminale patiënten

The written discharge summary is the main vector of communication and serves as a critical method of patient information transfer between hospitalist and primary care provider. It is a shown challenge to timely delivery and completeness of a discharge letter, especially when it involves patients in palliative care or with a limited life expectancy. Despite the implementation of standardized letters and guidelines. Personalized interactive information transfer of hospital discharge summary between hospitalist and primary care provider should include a written as well as the strong consideration of an oral transmission. This should ensure continuity of care and limit deficiencies in content and availability of critical medical information. Joint responsibility of continuous care instead of simply a transfer

Quality of discharge summary for patients with limited life expectancy

The written discharge summary is the main vector of communication and serves as a critical method of patient information transfer between hospitalist and primary care provider. It is a shown challenge to timely delivery and completeness of a discharge letter, especially when it involves patients in palliative care or with a limited life expectancy. Despite the implementation of standardized letters and guidelines. Personalized interactive information transfer of hospital discharge summary between hospitalist and primary care provider should include a written as well as the strong consideration of an oral transmission. This should ensure continuity of care and limit deficiencies in content and availability of critical medical information. Joint responsibility of continuous care instead of simply a transfer.</p

Identifying residents' educational needs to optimising postgraduate medical education about shared decision-making

Objective: To investigate how to optimise resident engagement during workplace learning of shared decision -making (SDM) by understanding their educational needs. Methods: A qualitative multicentre study was conducted using video-stimulated interviews with 17 residents in General Practice. Video recordings of residents' recent clinical encounters were used to facilitate reflection on their educational needs. Results: Data analysis resulted in five themes regarding residents' educational needs for learning SDM: acquiring knowledge and skills needed to perform SDM; practising SDM; reflection and feedback; longitudinal and inte-grated training; and awareness and motivation for performing SDM. Conclusion: Residents expressed a need for continuous attention to be paid to SDM during postgraduate medical education. That would help them engage in two parallel learning processes: acquiring the knowledge and skills necessary to perform SDM, and practising SDM in the clinical workplace. Alignment between the educational curriculum, workplace learning and resident learning activities is essential to operationalise SDM attitude, knowledge and skills into clinical performance. Practice Implications: The identified educational needs provide ingredients for fostering the development of SDM proficiency. The findings suggest that residents and clinical supervisors need parallel training to bridge the gap between education and clinical practice when learning SDM.</p

Large-area n-Type PERT solar cells featuring rear p+ emitter passivated by ALD Al2O3

We present large-area n-type PERT solar cells featuring a rear boron emitter passivated by a stack of ALD Al2O3 and PECVD SiOx. After illustrating the technological and fundamental advantages of such a device architecture, we show that the Al2O3/SiOx stack employed to passivate the boron emitter is unaffected by the rear metallization processes and can suppress the Shockley-Read-Hall surface recombination current to values below 2 fA/cm2, provided that the Al2O3 thickness is larger than 7 nm. Efficiencies of 21.5% on 156-mm commercial-grade Cz-Si substrates are demonstrated in this study, when the rear Al2O3/SiOx passivation is applied in combination with a homogeneous front-surface field (FSF). The passivation stack developed herein can sustain cell efficiencies in excess of 22% and Voc above 685 mV when a selective FSF is implemented, despite the absence of passivated contacts. Finally, we demonstrate that such cells do not suffer from light-induced degradation