Adequacy of Communicating Results From Screening Mammograms to African American and White Women

Objective. We examined whether African American women were as likely as White women to receive the results of a recent mammogram and to self-report results that matched the mammography radiology report (i.e., were adequately communicated). We also sought to determine whether the adequacy of communication was the same for normal and abnormal results. Methods. From a prospective cohort study of mammography screening, we compared self-reported mammogram results, which were collected by telephone interview, to results listed in the radiology record of 411 African American and 734 White women who underwent screening in 5 hospital-based facilities in Connecticut between October 1996 and January 1998. Using multivariate logistic regression, we identified independent predictors of inadequate communication of mammography results. Results. It was significantly more common for African American women to experience inadequate communication of screening mammography results compared with White women, after adjustment for sociodemographic, access-to-care, biomedical, and psychosocial factors. Abnormal mammogram results resulted in inadequate communication for African American women but not White women (P\u3c.001). Conclusions. African American women may not be receiving the full benefit of screening mammograms because of inadequate communication of results, particularly when mammography results are abnormal

The Canadian Perinatal Network: A National Network Focused on Threatened Preterm Birth at 22 to 28 Weeks\u27 Gestation

Objective: The Canadian Perinatal Network (CPN) maintains an ongoing national database focused on threatened very preterm birth. The objective of the network is to facilitate between-hospital comparisons and other research that will lead to reductions in the burden of illness associated with very preterm birth. Methods: Women were included in the database if they were admitted to a participating tertiary perinatal unit at 22+0 to 28+6 weeks\u27 gestation with one or more conditions most commonly responsible for very preterm birth, including spontaneous preterm labour with contractions, incompetent cervix, prolapsing membranes, preterm prelabour rupture of membranes, gestational hypertension, intrauterine growth restriction, or antepartum hemorrhage. Data were collected by review of maternal and infant charts, entered directly into standardized electronic data forms and uploaded to the CPN via a secure network. Results: Between 2005 and 2009, the CPN enrolled 2524 women from 14 hospitals including those with preterm labour and contractions (27.4%), short cervix without contractions (16.3%), prolapsing membranes (9.4%), antepartum hemorrhage (26.0%), and preterm prelabour rupture of membranes (23 0%) The mean gestational age at enrolment was 25.9 ± 1.9 weeks and the mean gestation age at delivery was 29.9 ± 5.1 weeks; 57.0% delivered at \u3c 29 weeks and 75.4% at \u3c 34 weeks. Complication rates were high and included serious maternal complications (26 7%), stillbirth (8.2%), neonatal death (16.3%), neonatal intensive care unit admission (60 7%), and serious neonatal morbidity (35 0%). Conclusion: This national dataset contains detailed information about women at risk of very preterm birth. It is available to clinicians and researchers who are working with one or more CPN collaborators and who are interested in studies relating processes of care to maternal or perinatal outcomes

A comparison of medical students and program directors\u27 perceived skill needs for internship\u27

Introduction: Stakeholders in the training of subinterns have varying perspectives on priorities for this important clinical experience. Existing assessments of student goals and internal medicine residency program directors opinions on expectations for readiness to function as an intern have not been compared. Research questions: What have previously gathered surveys indicated about student and program directors priorities for the subinternship rotation? What are the areas of difference and common ground between these assessments? Methods: Students starting internal medicine subinternship at the University of New Mexico between April 2010 and April 2012 and at Ohio State University between July 2012 and July 2013 were surveyed regarding their goals for the rotation. Responses were grouped and tabulated based on thematic analysis. In 2010, the Clerkship Directors in Internal Medicine (CDIM) subinternship task force performed a survey of internal medicine clerkship directors to identify skills expected in new interns. 36 items were scored to reflect perceived level of priority. Additionally, \u27free text\u27 responses could be entered. These were compiled into a separate list of common themes. Results: 40 students completed the survey at the University of New Mexico and 175 at Ohio State University. The goals most often written were increasing medical knowledge (n=186), management skills (105), radiology/EKG interpretation (52), procedures (46), pharmacology (43), efficiency (43), medical emergencies (30), laboratory usage (28), ordering (25) and physical exam skills (18). 282 of 377 program directors completed the 2010 CDIM subinternship task force survey. The highest overall priorities were: time management (n=345), knowing when to seek assistance (315), communicating with nurse/nurse triage (251), communicating in a culturally sensitive manner (227), information management (226), coordinating care with other health care workers (206), ethics of informed consent (204), providing an organized written sign-out (204), providing an organized verbal sign-out (200) and facility in using electronic databases (199). Discussion: Students\u27 and program directors\u27 goals for their subinternship rotation provides useful information about perceived gaps and areas of growth potential. Data gathered in 2013 suggests students mainly want to increase medical knowledge and develop skills in patient management, including operational tasks. Program directors ranked development of recognizing situations and communication skills as the most important domains for new internal medicine interns. These responses may reflect experience with problems borne from lack of these skills. Not surprisingly, both groups surveyed gave a moderate to high level of importance to efficiency.\u2

Interprofessional education in the internal medicine clerkship: results from a national survey

PURPOSE: Growing data support interprofessional teams as an important part of medical education. This study describes attitudes, barriers, and practices regarding interprofessional education (IPE) in internal medicine (IM) clerkships in the United States and Canada. METHOD: In 2009, a section on IPE was included on the Clerkship Directors in Internal Medicine annual survey. This section contained 23 multiple-choice questions exploring both core and subinternship experiences. Data were analyzed using descriptive statistics and Rasch analysis. RESULTS: Sixty-nine of 107 institutional members responded to the survey (64% response rate). Approximately 68% of responding clerkship directors believed that IPE is important to the practice of IM. However, only 57% believed that it should become a part of the undergraduate clinical curriculum. The three most significant barriers to IPE in the IM clerkship were scheduling alignment, time in the existing curriculum, and resources in time and money. Although more than half of respondents felt IPE should be included in the clinical curriculum, 81% indicated that there was no formal curriculum on IPE in their core IM clerkship, and 84% indicated that there was no formal curriculum during IM subinternship rotations at their institution. CONCLUSIONS: There is limited penetration of IPE into one of the foundational clinical training episodes for medical students in Liaison Committee for Medical Education-accredited schools. This may be related to misperceptions of the relative value of these experiences and limitations of curricular time. Learning in and from successful models of interprofessional teams in clinical practice may help overcome these barriers