Pro-and-anti Immigration Activities in Iowa\u27s 4th Congressional Districts: A Community Capitals Framework Perspective

The foreign-born immigrant population in Iowa is increasing. Across Iowa’s 4th Congressional District, communities that have never had statistically significant populations of non-Anglos have in recent decades experienced dramatic influxes of predominantly Latino immigrants. Today, Latinos comprise upwards of 25 percent of the population of some counties and well over 35 percent of the population of many towns. At the same time, many other communities in Iowa’s 4th Congressional District remain almost exclusively white. How are communities responding? This research centers on the statements and activities of individual and group actors representing various market, state, and civil society sectors, examining which community resources are mobilized by what groups and the extent to which their actions are motivated by social capital or ideology. The Community Capitals Framework provides the analytic context with which one-on-one interviews and secondary data sources are analyzed to explore pro-and-anti immigration networks and activities and the extent to which these groups mobilize community capitals to create welcoming or unwelcoming communities. Understanding these networks, actions and motivations is critical in informing sustainable and appropriate community development efforts in this district as well as other regions in the United States with similar historically dominant Anglo populations recently experiencing increases in immigrant populations

Brief report: Beyond clinical experience: Features of data collection and interpretation that contribute to diagnostic accuracy

BACKGROUND: Clinical experience, features of data collection process, or both, affect diagnostic accuracy, but their respective role is unclear. OBJECTIVE, DESIGN: Prospective, observational study, to determine the respective contribution of clinical experience and data collection features to diagnostic accuracy. METHODS: Six Internists, 6 second year internal medicine residents, and 6 senior medical students worked up the same 7 cases with a standardized patient. Each encounter was audiotaped and immediately assessed by the subjects who indicated the reasons underlying their data collection. We analyzed the encounters according to diagnostic accuracy, information collected, organ systems explored, diagnoses evaluated, and final decisions made, and we determined predictors of diagnostic accuracy by logistic regression models. RESULTS: Several features significantly predicted diagnostic accuracy after correction for clinical experience: early exploration of correct diagnosis (odds ratio [OR] 24.35) or of relevant diagnostic hypotheses (OR 2.22) to frame clinical data collection, larger number of diagnostic hypotheses evaluated (OR 1.08), and collection of relevant clinical data (OR 1.19). CONCLUSION: Some features of data collection and interpretation are related to diagnostic accuracy beyond clinical experience and should be explicitly included in clinical training and modeled by clinical teachers. Thoroughness in data collection should not be considered a privileged way to diagnostic succes

Effectiveness of a training program in supervisors' ability to provide feedback on residents' communication skills

Teaching communication skills (CS) to residents during clinical practice remains problematic. Direct observation followed by feedback is a powerful way to teach CS in clinical practice. However, little is known about the effect of training on feedback skills in this field. Controlled studies are scarce as well as studies that go beyond self-reported data. The aim of the study was to develop and assess the effectiveness of a training program for clinical supervisors on how to give feedback on residents' CS in clinical practice. The authors designed a pretest-posttest controlled study in which clinical supervisors working in two different medical services were invited to attend a sequenced and multifaceted program in teaching CS over a period of 6-9months. Outcome measures were self-perceived and observed feedback skills collected during questionnaires and three videotaped objective structured teaching encounters. The videotaped feedbacks made by the supervisors were analysed using a 20-item feedback rating instrument. Forty-eight clinical supervisors participated (28 in the intervention, 20 in the control group). After training, a higher percentage of trained participants self-reported and demonstrated statistically significant improvement in making residents more active by exploring residents' needs, stimulating self-assessment, and using role playing to test strategies and checking understanding, with effect sizes ranging from 0.93 to 4.94. A training program on how to give feedback on residents' communication skills was successful in improving clinical supervisors' feedback skills and in helping them operate a shift from a teacher-centered to a more learner-centered approac

Les adolescents ont droit au secret médical : pourquoi la LAMal n'en tient-elle pas compte?

Dès lors que le législateur et les tribunaux reconnaissent le droit à l'auto-détermination du patient mineur et le droit au respect de la sphère privée du patient mineur, ils devraient logiquement assurer la réalisation de ses droits dans le domaine de l'assurance