The population health performance of medical students at two medical schools

Public Health and medicine are complimentary disciplines dedicated to the health and well-being of humankind. Worldwide, medical school accreditation bodies require the inclusion of population health in medical education. In 2003, the Institutes of Medicine (IOM) recommended that all medical students receive basic public health training in population-based prevention. The purpose of this study was to (1) examine the public health clinical performance of third-year medical students at two independent medical schools, (2) compare the public health clinical practice performance of the schools, and (3) identify underlying predictors of high and low public health clinical performance at one of the medical schools. ^ This study is unique in its analysis and report of observed medical student public health clinical practices. The cohort consisted of 751 third-year medical students who completed a required clinical performance exam using trained standardized patients. Medical student performance scores on 24 consensus public health items derived from nine patient cases were analyzed.^ The analysis showed nearly identical results for both medical schools at the 60%, 65%, and 70% pass rate. Students performed poorly on items associated with prevention, behavioral science, and surveillance. Factors associated with high student performance included being from an underrepresented minority, matching to a primary care residency, and high class ranking. A review of medical school curriculum at both schools revealed a lack of training in four public health domains. Nationally, 32% of medical students reported inadequate training in public health in the year 2006.^ These findings suggest more dedicated teaching time for public health domains is needed at the medical schools represented in this study. Finally, more research is needed to assess attainment of public health knowledge and skills for medical students nationwide if we are to meet the recommendations of the IOM. ^

Corporate decision-making: A case study of decision support systems and financial performance in health care organizations

The purpose of this study was twofold: (1) To describe the relation of the intensity of DSS implementation to financial performance as an empirical exploration of improved performance at the organizational level. (2) To describe the relation of the intensity of DSS implementation to the type of organizational decision culture. A multiple case study design was utilized to compare three groups of paired cases. A pattern matching strategy was applied in this study. Four predictions were specified and compared to the empirical data. A progressively upward trend in the scores was predicted for the following theoretical relationships. (1) The greater the number of DSSs, the higher the sophistication index. (2) The greater the number of DSSs, the higher the financial ratios. (3) The greater the number of DSSs, the higher the culture score. (4) The higher the culture score, the higher the financial ratios. The data did not support any of the predicted trends except the relation between the number of DSSs and the financial ratios. The Income/Revenue ratio indicates the efficiency of a company's operations. One would expect that this ratio would be most affected by the operational and financial decision support systems. The majority of the systems measured in the study supported decisions tangential to the patient service areas. The evidence suggested that the type and number of decision support systems affects the bottom line. ^

AROUSAL, FATIGUE AND MENTAL PERFORMANCE: THE EFFECTS OF FASTING ON COGNITION

This study examined the effects of skipping breakfast on selected aspects of children's cognition, specifically their memory (both immediate and one week following presentation of stimuli), mental tempo, and problem solving accuracy. Test instruments used included the Hagen Central/Incidental Recall Test, Matching Familiar Figures Test, McCarthy Digit Span and Tapping Tests. The study population consisted of 39 nine-to eleven year old healthy children who were admitted for overnight stays at a clinical research setting for two nights approximately one week apart. The study was designed to be able to adequately monitor and control subjects' food consumption. The design chosen was the cross-over design where randomly on either the first or second visit, the child skipped breakfast. In this way, subjects acted as their own controls. Subjects were tested at noon of both visits, this representing an 18-hour fast.^ Analysis focused on whether or not fasting for this period of time affected an individual's performance. Results indicated that for most of the tests, subjects were not significantly affected by skipping breakfast for one morning. However, on tests of short-term central and incidental recall, subjects who had skipped breakfast recalled significantly more of the incidental cues although they did so at no apparent expense to their storing of central information. In the area of problem-solving accuracy, subjects skipping breakfast at time two made significantly more errors on hard sections of the MFF Test. It should be noted that although a large number of tests were conducted, these two tests showed the only significant differences.^ These significant results in the areas of short-term incidental memory and in problem solving accuracy were interpreted as being an effect of subject fatigue. That is, when subjects missed breakfast, they were more likely to become fatigued and in the novel environment presented in the study setting, it is probable that these subjects responded by entering Class II fatigue which is characterized by behavioral excitability, diffused attention and altered performance patterns. ^