The Pre-entry Program at UTMSH: Effect on Academic Performance of First-Year Medical Students

Introduction: The Pre-Entry Program at The University of Texas Medical School at Houston is presented to assist entering students who are judged to be at risk for academic difficulty. It requires a significant commitment of time on the part of faculty, staff and students. The effectiveness of this program needs to be evaluated. [See PDF for complete abstract]

Analysis of a disaster medical track for the Certificate in Emergency Management and Preparedness Program at the University of Texas at Dallas

Since the tragic events of September 11, 2001, the United States has engaged in building the infrastructure and developing the expertise necessary to protect its borders and its citizens from further attacks against its homeland. One approach has been the development of academic courses to educate individuals on the nature and dangers of subversive attacks and to prepare them to respond to attacks and other large-scale emergencies in their roles as working professionals, participating members of their communities, and collaborators with first responders. An initial review of the literature failed to reveal any university-based emergency management courses or programs with a disaster medical component, despite the public health significance and need for such programs. In the Fall of 2003, The School of Management at The University of Texas at Dallas introduced a continuing education Certificate in Emergency Management and Preparedness Program. This thesis will (1) describe the development and implementation of a new Disaster Medical Track as a component of this Certificate in Emergency Management and Preparedness Program, (2) analyze the need for and effectiveness of this Disaster Medical Track, and (3) propose improvements in the track based on this analysis. ^

Prioritizing Residents' Needs: On the Creation of a Residents as Teachers and Leaders Program

Introduction: Residents are responsible for the majority of medical student teaching and directly supervise, instruct, and evaluate students. Many organizations now recommend that residency training programs include venues specifically designed to develop resident teaching skills. [See PDF for abstract].

Master of Education in Teaching Program with an Emphasis in the Health Sciences

Introduction: Concerns about the quality of physician education have changed current medical education practices. Learners must demonstrate competency in core areas, rather than solely participating in educational activities. Academic medical institutions are challenged with identifying leaders to direct curricular and evaluation reforms. An innovative partnership between the University of Houston College of Education and Baylor College of Medicine, the University of Texas Medical School at Houston, and the University of Texas Dental Branch at Houston offers a Masters of Education in Teaching degree with an emphasis in Health Sciences. Courses encompass fundamental areas including curriculum, instruction, technology, measurement, research design and statistics. [See PDF for complete abstract]

Using 'Generic Abilities' to Foster Professionalism in a Post-Professional Program

Introduction To be successful in a profession, persons must have mastery of professional affective behaviors in addition to that profession’s core knowledge base. Health care delivery is more than just developing a good plan of care. The effective health care provider also will have good interpersonal and communication skills, have a commitment to learning, act professionally and responsibly, and have abilities in problem solving and critical thinking. But, these behaviors and characteristics are not taught directly in a professional program. This presentation will demonstrate how these ‘generic abilities’ have been incorporated in a post-professional program and how they can be used in other professional health care, professional development, and leadership programs. [See PDF for complete abstract]

Evaluation and Model of a Clinical Librarian Program

Clinical medical librarianship is entering its second decade, but little evaluative data has accrued in the literature. Variations from the original programs and novel new approaches have insured the survival of the program so far. The clinical librarian (CL) forms a vital link between the library and the health care professional, operating as an important information transfer agent. However, to further insure the survival of these vital programs, hard evaluative evidence is needed. The University of Texas Medical Branch (UTMB) at Galveston began a CL Program in 1978/79. An extensive three-year pre/post evaluation study was conducted using a specifically developed evaluation model, which, if adopted by others, will provide the needed comparative data. Both a pilot study, or formative evaluation, and a summative evaluation were conducted. The results of this evaluation confirmed many of the conclusions reported by other CL programs. Eight hypotheses were proposed at the beginning of this study. Data were collected and used to support acceptance or rejection of the null hypotheses, and conclusions were drawn according to the results. Implications relevant to the study conclusions and future trends in medical librarianship are also discussed in the closing chapter.

Reducing liver cancer disparities: a community-based hepatitis-B prevention program for Asian-American communities

OBJECTIVES: Several Asian-American groups are at a higher risk of dying of liver diseases attributable to hepatitis-B infection. This culturally diverse community should be well informed of and protected against liver diseases. The present study assesses the knowledge of hepatitis B before and after a hepatitis-B educational program and determines the infection status of an Asian community. METHODS: Nine Asian communities of Montgomery County, MD, enrolled in the hepatitis-B prevention program between 2005 and 2006. They attended culturally tailored lectures on prevention, completed self-administered pre- and posttests, and received blood screening for the disease. RESULTS: More than 800 Asian Americans participated in the study. Knowledge of prevention was improved after educational delivery. The average infection rate was 4.5%, with Cambodian, Thai, Vietnamese, Chinese and Korean groups having higher infection rates. The age group of 36-45 had the highest percentage of carriers (9.1%). CONCLUSION: Many Asian groups, particularly those of a southeast Asian decent, were subject to a higher probability of hepatitis-B infection. At an increased risk are first-generation Asian immigrants, groups with low immunization rates and those aged 36-45. The findings provide potential directions for focusing preventive interventions on at-risk Asian communities to reduce liver cancer disparities.

The physician's perception of medical error and its application to the development of an educational training tool.

It is becoming clear that if we are to impact the rate of medical errors it will have to be done at the practicing physician level. The purpose of this project was to survey the attitude of physicians in Alabama concerning their perception of medical error, and to obtain their thoughts and desires for medical education in the area of medical errors. The information will be used in the development of a physician education program.

PANEL DISCUSSION: "Medical Ethics, Eugenics, and the Holocaust"

A panel discussion moderated by Dr. Thomas R. Cole, McGovern Chair in Medical Humanities and Director of the John P. McGovern Center for Humanities and Ethics at the University of Texas Health Science Center in Houston. Panelists include: Rabbi Samuel E. Karff, Rabbi Emeritus of Congregation Beth Israel and Associate Director of the John P. McGovern Center for Humanities and Ethics and Visiting Professor in the Department of Family Medicine at the University of Texas Health Science Center at the Texas Medical Center. Cardinal DiNardo, the second Archbishop of the Archdiocese of Galveston-Houston and the first cardinal archbishop from a diocese in the Southern United States. Dr. Sheldon Rubenfeld, Clinical Professor of Medicine at Baylor College of Medicine. He is Board Certified in Internal Medicine and in Endocrinology, Diabetes, and Metabolism, and is a Fellow in both the American College of Physicians and the American College of Endocrinology. Dr. Rubenfeld has taught "Healing by Killing: Medicine During the Third Reich" for three years and "Jewish Medical Ethics" for seven years at Baylor College of Medicine. He created a six-month program about Medicine and the Holocaust at Holocaust Museum Houston, including an exhibit entitled How Healing Becomes Killing: Eugenics, Euthanasia, Extermination and a series of lectures by distinguished speakers entitled "The Michael E. DeBakey Medical Ethics Lecture Series".

BMP-SIGNALING REGULATES A COMMON TRANSCRIPTIONAL PROGRAM TO CONTROL FACIAL FORM AND SKELETAL MORPHOGENESIS

Much of the craniofacial skeleton, such as the skull vault, mandible and midface, develops through direct, intramembranous ossification of the cranial neural crest (CNC) derived progenitor cells. Bmp-signaling plays critical roles in normal craniofacial development, and Bmp4 deficiency results in craniofacial abnormalities, such as cleft lip and palate. We performed an in depth analysis of Bmp4, a critical regulator of development, disease, and evolution, in the CNC. Conditional Bmp4 overexpression, using a tetracycline regulated Bmp4 gain of function allele, resulted in facial form changes that were most dramatic after an E10.5 Bmp4 induction. Expression profiling uncovered a signature of Bmp4 induced genes (BIG) composed predominantly of transcriptional regulators controlling self-renewal, osteoblast differentiation, and negative Bmp autoregulation. The complimentary experiment, CNC inactivation of Bmp2, Bmp4, and Bmp7, resulted in complete or partial loss of multiple CNC derived skeletal elements revealing a critical requirement for Bmp-signaling in membranous bone and cartilage development. Importantly, the BIG signature was reduced in Bmp loss of function mutants indicating similar Bmp-regulated target genes underlying facial form modulation and normal skeletal morphogenesis. Chromatin immunoprecipitation (ChIP) revealed a subset of the BIG signature, including Satb2, Smad6, Hand1, Gadd45g and Gata3 that was bound by Smad1/5 in the developing mandible revealing direct, Smad-mediated regulation. These data indicate that Bmp-signaling regulates craniofacial skeletal development and facial form by balancing self-renewal and differentiation pathways in CNC progenitors.

A Multi- Faceted, Intensive Family Preservation Program Evaluation

This evaluation of a county intensive family preservation services (ifps) program makes several important methodological contributions to assessing post-treatment placement patterns of ifps clients. It is the first published ifps evaluation that utilizes an interval-level, overall measure of restrictiveness of placement, and one of the few that has followed placement patterns for a full two-years after treatment. The study is also a good example of complementing placement data with measures of family health and stability, and with qualitative feedback from former ifps clients. Finally, this study demonstrates the potential for doing methodologically sound evaluations of local ifps programs.

An Examination of Treatment Fidelity in an Intensive Family Preservation Program

Most models of intensive family preservation services are based on providing flexible services to reduce risk and keep families together. This study examined 40 cases served by a public agency Family Preservation Unit in 1992-1993, in order to assess the provision of hard, soft and enabling services in the program and whether their provision matched the program model. The relationships of these services to program outcomes, in terms of child removal, new reports of abuse or neglect, and family gains in resources and strengths, are also assessed.

An Innovative Family Preservation Program in an African American Community: Longitudinal Analysis

This paper presents a secondary analysis of data from a longitudinal evaluation of a community-based family preservation program in Portland, Oregon, designed for and by African Americans. Families served by the Family Enhancement Program (FEP) resemble chronically neglecting families in terms of numbers of children and length of contact with child protective services. Six- and twelve-month follow-ups for FEP clients were compared to data on families served by the Oregon State Office of Services to Children and Families (SOSCF). The author found that FEP families are more likely than SOSCFfamilies to show greater improvement between the pretest scores and the posttest scores for number of days in placement, number of placements, and number of founded maltreatment reports.

Diffusion and implementation of a tobacco prevention program: A replication study

Tobacco use is a major health hazard, and the onset of tobacco use occurs almost entirely in the teenage years. For this reason, schools are an ideal site for tobacco prevention programs. Although studies have shown that effective school-based tobacco prevention programs exist, all too frequently these programs are not used. In order for effective programs to achieve their potential impact, strategies for speeding the diffusion of these programs to school districts and seeing that, once adopted, programs are implemented as they are intended, must be developed and tested.^ This study (SC2) set out to replicate the findings of an earlier quasi-experimental study (The Smart Choices Diffusion Study, or SC1) in which strategies based on diffusion theory and social learning theory were found to be effective in encouraging adoption and implementation of an effective tobacco prevention program in schools. To increase awareness and encourage adoption, intervention strategies in both studies utilized opinion leaders, messages highlighting positive aspects of the program, and modeling of benefits and effective use through videotape and newsletters. To encourage accurate implementation of the curriculum, teacher training for the two studies utilized videotaped modeling and practice of activities by teachers. SC2 subjects were 38 school districts that make up one of Texas' 20 education service regions. These districts had served as the comparison group in SC1, and findings for the SC1 comparison and intervention groups were utilized as historic controls.^ SC2 achieved a 76.3% adoption rate and found that an average of 84% of the curriculum was taught with an 82% fidelity to methods utilized by the curriculum. These rates and rates for implementation of dissemination strategies were equal to or greater than corresponding rates for SC1. The proportion of teachers implementing the curriculum in SC2 was found to be equal to SC1's video-trained districts but lower than the SC1 workshop-trained group.^ SC2's findings corroborate and support the findings from the earlier study, and increase our confidence in its findings. Taken together, the findings from SC2 and SC1 point to the effectiveness of their theory-based intervention strategies in encouraging adoption and accurate implementation of the tobacco prevention curriculum. ^

Evaluation of a date rape prevention program for new students in a university setting

The purpose of this study was to design, implement and evaluate the effectiveness of a date rape prevention program among new students at Rice University. Six-hundred and fifteen new students were randomly assigned to one of eight residential colleges or dormitories. The distribution of students to each of the dormitories was carried out in accordance with a stratified random sampling procedure. The study population was divided into strata based on ethnicity, gender, geographical region, and academic major. The number of students randomly assigned to each of the eight dormitories was approximately 75. After this procedure was completed, each of the colleges was randomly selected to either the intervention or control group. A randomized pretest and posttest control group design was used to assess changes in attitudes, self-efficacy, and behavior with regard to date rape. All participants were given an anonymous pretest and posttest measuring attitudes, self-efficacy, and behavior immediately prior to and following the intervention. The intervention group attended the play Scruples, designed to promote date rape prevention, after which they were immediately posttested. After this initial posttest the intervention group also participated in an interactive group role-playing activity led by trained peer instructors. The control group was pretested and subject to the placebo intervention of a multiculturalism play and was posttested immediately afterwards. Later in the week this group saw the Scruples play only. Both control and intervention groups were sent a two month follow-up survey questionnaire, to measure any changes in attitudes, self-efficacy, and behavior over time. As hypothesized students who saw the play Scruples showed a change in attitudes immediately posttest but no difference in self-efficacy or behavior. The two month follow-up survey showed no change in attitudes, self-efficacy, or behavior. There was a difference at pretest in males and females attitudes, with males showing significantly more rape tolerant attitudes than females. Thus, the proposed research findings will provide a better understanding of the attitudes that perpetuate date rape, and will inform strategies for prevention programs. ^