Providing health information to the general public: a survey of current practices in academic health sciences libraries*

A questionnaire was mailed to 148 publicly and privately supported academic health sciences libraries affiliated with Association of American Medical Colleges (AAMC)–accredited medical schools in the United States and Canada to determine level of access and services provided to the general public. For purposes of this study, “general public” was defined as nonaffiliated students or health care professionals, attorneys and other nonhealth-related professionals, patients from affiliated or other hospitals or clinics, and general consumers. One hundred five (71%) libraries responded. Results showed 98% of publicly supported libraries and 88% of privately supported libraries provided access to some or all of the general public. Publicly supported libraries saw greater numbers of public patrons, often provided more services, and were more likely to circulate materials from their collections than were privately supported libraries. A significant number of academic health sciences libraries housed a collection of consumer-oriented materials and many provided some level of document delivery service, usually for a fee. Most allowed the public to use some or all library computers. Results of this study indicated that academic health sciences libraries played a significant role in serving the information-seeking public and suggested a need to develop written policies or guidelines covering the services that will be provided to minimize the impact of this service on primary clientele.

Projecto na comunidade : uma experiência pedagógica extra-hospitalar no curso da Faculdade de Medicina de Lisboa

O ensino pré-graduado extra-hospitalar é uma necessidade há muito assumida pelas escolas de medicina do mundo desenvolvido. Na Faculdade de Medicina de Lisboa, pelo menos desde 1987, o centro de saúde tem sido utilizado como um espaço docente equivalente ao hospital. O «Projecto na Comunidade» ocorreu entre 1996 e 1998. A sua descrição e avaliação são aqui apresentadas.

O sistema PBL, problem-based learning, no ensino de medicina no Brasil : análise bibliográfica sobre a sua execução

Introdução: Entre as estratégias de ensino e aprendizagem utilizadas nas práticas pedagógicas, a Problem Based Learning (PBL) (Aprendizagem Baseada em Problemas) é utilizada desde 1960, em especial nos cursos de Medicina. Mesmo sendo uma estratégia valiosa, um dos seus obstáculos é a pouca prática dos alunos em atividades autodirigidas, pesquisa e construção coletiva do conhecimento. Objetivo: Rastrear elementos constitutivos da PBL através de dados colhidos em artigos pesquisados em sítios de divulgação científica; Avaliar, nos estudos selecionados, os aspectos positivos e negativos que estejam relacionados com a metodologia do Sistema PBL aplicada ao ensino médico no Brasil. Metodologia: Estudo bibliográfico de 13 textos utilizando um modelo de desconstrução, denominada Análise Textual Discursiva (ATD) que consiste em: transformação dos artigos em pedaços menores; análise textual; identificação de padrões convergentes e divergentes em relação a PBL; organização e síntese dos dados, culminando com a elaboração de estratégia adaptativa da PBL para o curso de Medicina. Resultados: Foram encontradas 116 citações que convergiam para referências positivos acerca da metodologia PBL e 40 citações que divergiam acerca dos pontos positivos. Os aspectos positivos como o desenvolvimento de atitudes e habilidades; desenvolvimento de competências anteriores ao curso; efeitos positivos depois de terminada a graduação, como autonomia de estudo e a articulação entre currículo e realidade profissional, representam pontos a serem reforçados na aula. Em contraponto, foi observado que dentre os negativos a não compreensão do papel do professor como tutor; necessidade de conteúdo formal tradicional pelos alunos e a expectativa que o professor retire as suas dúvidas são pontos a serem evitados. Conclusões: A metodologia PBL deverá servir como metodologia ativa para aproveitar ao máximo as habilidades que os alunos já apresentam, potencializando o aprendizado na educação médica em sala de aula. Palavras-Chave: PBL; curso de medicina; metodologia ativa; educação médica.

Report,

"Published for the Conference of Professors of Preventive Medicine as Part 2 of the Journal of Medical Education, October, 1953."

International abstracts of surgery.

"Clinical Congress of Surgeons of North America, sixth annual session, Boston, October 25 to 29, 1915" (various pagings) consisting primarily of section, "The hospitals and medical schools of Boston," inserted at end of vol. 21.

Early practical experience and the social responsiveness of clinical education: Systematic review

Objectives To find how early experience in clinical and community settings (early experience) affects medical education, and identify strengths and limitations of the available evidence. Design A systematic review rating, by consensus, the strength and importance of outcomes reported in the decade 1992-2001. Data sources Bibliographical databases and journals were searched for publications on the topic, reviewed under the auspices of the recently formed Best Evidence Medical Education (BEME) collaboration. Selection of studies All empirical studies (verifiable, observational data) were included, whatever their design, method, or language of publication. Results Early experience was most commonly provided in community settings, aiming to recruit primary care practitioners for underserved populations. It increased the popularity of primary care residencies, albeit among self selected students. It fostered self awareness and empathic attitudes towards ill people, boosted students' confidence, motivated them, gave them satisfaction, and helped them develop a professional identity. By helping develop interpersonal skills, it made entering clerkships a less stressful experience. Early experience helped students learn about professional roles and responsibilities, healthcare systems, and health needs of a population. It made biomedical, behavioural, and social sciences more relevant and easier to learn. It motivated and rewarded teachers and patients and enriched curriculums. In some countries,junior students provided preventive health care directly to underserved populations. Conclusion Early experience helps medical students learn, helps them develop appropriate attitudes towards their studies and future practice, and orientates medical curriculums towards society's needs. Experimental evidence of its benefit is unlikely to be forthcoming and yet more medical schools are likely to provide it. Effort could usefully be concentrated on evaluating the methods and outcomes of early experience provided within non-experimental research designs, and using that evaluation to improve the quality of curriculums.

Assessing professionalism: theory and practice

Professional attitudes and behaviours have only recently been explicitly recognized by medical educators as legitimate and necessary components of global competence, although the idea of Fitness to Practice has always presupposed acceptable professional behaviour. Medical schools have recently begun to introduce teaching and assessment of professionalism, including attitudes and behaviours. Partly as a result of the difficulty of assessment in this area, selection of students is receiving greater attention, in the pursuit of globally competent graduates. However, selection processes may be overrated for this purpose. Assessing actual attitudes and behaviour during the course is arguably a better way of ensuring that medical graduates are competent in these areas. I argue that judgments about attitudinal and behavioural competence are legitimate, and need be no more arbitrary than those made about scientific or clinical knowledge and skills, but also that these judgments should be restricted to what is agreed to be unacceptable behaviour, rather titan attempting to rate attitudes and behaviour positively. This model introduces students to the way in which their behaviours will be judged in their professional lives by registration authorities. These theoretical positions are illustrated by a recent case of academic failure based on inadequate attitudes and behaviours.

Palliative care training: a survey of physicians in Australia and Europe

The purpose of this paper is to present data about the level and background characteristics of physicians' training in palliative care in Australia (AU), Belgium (BE), Denmark (DK), Italy (IT), the Netherlands (NL), Sweden (SE) and Switzerland (CH) (n=16,486). The response rate to an anonymous questionnaire differed between countries (39%-68%). In most countries approximately half of all responding physicians had any formal training in palliative care (median: 3-10 days). Exceptions were NL (78%) and IT (35%). The most common type of training was a postgraduate course. Physicians in nursing home medicine (only in NL), geriatrics, oncology (not in NL), and general practice had the most training. In all seven countries, physicians with such training discussed options for palliative care and options to forgo life-sustaining treatment more often with their patients than did physicians without. Irrespective of earlier palliative care training, 87%-98% of the physicians wanted extended training.

Percepção da equipe de saúde, discentes e usuários sobre a comunicação com indivíduos surdos na atenção primária

The study aimed to identify in the professionals and students of health courses that work in a health Basic Unit in the city of Natal/RN their perceptions of the care of deaf patients, and with the population's needs with hearing loss in relation to health care. This is a cross-sectional, exploratory, descriptive study, conducted between April to July 2014, with a population composed of 21 health professionals, 17 students and 8 deaf users. For data collection, we used a structured questionnaire with open and closed questions applied to groups composed of health professionals (doctors, dentists, nurses and health workers) and students of medical schools, nursing, physical education, nutrition and social service. The professionals/students answered a semi-structured questionnaire with open and closed questions concerning the possible difficulties the care of the deaf and hearing impaired. Data collection with deaf users was conducted through filmed interview for the Brazilian Sign Language (Libras) could be interpreted as to the Portuguese by the researcher. With the latter it was conducted a survey of their reactions when looking for a care in the health service. Regarding the profile of identification of the subjects, it was analyzed by simple descriptive statistics (absolute and relative frequencies). The open questions were analyzed through the content analysis technique which allowed the categorization process preserving all the points raised in the discussion so that the lines were representative of the whole. When asked about the professionals and students attitude used to communicate with deaf patients possible the following categories emerged: the "writing", the "gestures" and the "third party assistance". With regard of the deaf, when asked about their experiences in seeking care in health, the elucidated categories were: "quality of care to the hearing impaired", "communication with the hearing impaired adequacy" and "dependence on third parties." The closed questions were measured and adapted to the 5 degrees of variation Likert Scale, which comprised three of these issues: degree of difficulty in communication to meet a patient with hearing loss (minimum to great difficulty); feeling of comfort while using sign language (minimum to severe discomfort); and knowledge of the Law 10.436, which provides for the Brazilian Sign Language (Libras) (low knowledge to entirely clear). The data collected with professionals and students revealed some misunderstanding and discomfort in health care for deaf patients, reality also evidenced in the opinion of the deaf participants. This study revealed problems in communication, resulting in negative consequences in serving this population. This diagnosis may be relevant to public policy development and curriculum guidelines essential to the training of health professionals, inclusion and improving assistance to deaf.

A simulação como método de ensino de habilidades no curso de medicina: relato de uma experiência com punção lombar

The teaching of the lumbar puncture (LP) technique with simulator is not well systematized in the curricula of medical schools. Studies show that training in the simulator provides learning technical skills, acquisition and retention of knowledge, improve self-confidence of the learner and enables the transfer to clinical practice. We intend this study to introduce simulated training in LP in medical course at the Universidade Federal do Rio Grande do Norte evaluating the experience taking into account quantitative aspects (performance on standardized tests) and qualitative (perception of the students regarding the method and the teaching process learning). The study was conducted in two phases. In the first phase practical training in PL was introduced in the 3rd year of medical school. Seventy-seven students were trained in small groups, guided by a checklist developed in the model Objective Structured Assessment of Technical Skill (OSATS), at this moment they knew they were not under performance evaluation. They were also asked whether they had prior chances to make an LP in patients. At the end of the first phase the students evaluated training in the following areas: teaching technique, simulator realism, time available per group, number of participants per group and relevance to medical practice. In the second phase, two years later, 18 students trained in first stage performed a new LP on the mannequin simulator, and its performance was evaluated through the same checklist of training in order to verify the technical retention. In addition, they answered a multiple choice test about practical aspects of the LP technique. Each participant received individual feedback on their performance at the end of their participation in the study. In the first phase of the study we found that only 4% of students had performed a lumbar puncture in patients until the 3rd year. The training of LP technique with simulator mannequin was considered relevant and the teaching methods was thoroughly evaluated. In the second phase, all participants were successful in implementing the lumbar puncture on the mannequin simulator, compliance with the most steps in a reasonable time, suggesting that would be able to perform the procedure in a patient.

To what extent does the Health Professions Admission Test-Ireland predict performance in early undergraduate tests of communication and clinical skills? – An observational cohort study

Background: Internationally, tests of general mental ability are used in the selection of medical students. Examples include the Medical College Admission Test, Undergraduate Medicine and Health Sciences Admission Test and the UK Clinical Aptitude Test. The most widely used measure of their efficacy is predictive validity.A new tool, the Health Professions Admission Test- Ireland (HPAT-Ireland), was introduced in 2009. Traditionally, selection to Irish undergraduate medical schools relied on academic achievement. Since 2009, Irish and EU applicants are selected on a combination of their secondary school academic record (measured predominately by the Leaving Certificate Examination) and HPAT-Ireland score. This is the first study to report on the predictive validity of the HPAT-Ireland for early undergraduate assessments of communication and clinical skills. Method. Students enrolled at two Irish medical schools in 2009 were followed up for two years. Data collected were gender, HPAT-Ireland total and subsection scores; Leaving Certificate Examination plus HPAT-Ireland combined score, Year 1 Objective Structured Clinical Examination (OSCE) scores (Total score, communication and clinical subtest scores), Year 1 Multiple Choice Questions and Year 2 OSCE and subset scores. We report descriptive statistics, Pearson correlation coefficients and Multiple linear regression models. Results: Data were available for 312 students. In Year 1 none of the selection criteria were significantly related to student OSCE performance. The Leaving Certificate Examination and Leaving Certificate plus HPAT-Ireland combined scores correlated with MCQ marks.In Year 2 a series of significant correlations emerged between the HPAT-Ireland and subsections thereof with OSCE Communication Z-scores; OSCE Clinical Z-scores; and Total OSCE Z-scores. However on multiple regression only the relationship between Total OSCE Score and the Total HPAT-Ireland score remained significant; albeit the predictive power was modest. Conclusion: We found that none of our selection criteria strongly predict clinical and communication skills. The HPAT- Ireland appears to measures ability in domains different to those assessed by the Leaving Certificate Examination. While some significant associations did emerge in Year 2 between HPAT Ireland and total OSCE scores further evaluation is required to establish if this pattern continues during the senior years of the medical course.

Die Verknüpfung von systematischem und fallorientiertem Lernen in Lern-Informationssystemen

Der vorliegende Aufsatz beschäftigt sich mit der Konzeption von Lern-Informationssystemen (LIS) unter besonderer Berücksichtigung der Verknüpfung von systematischem und fallorientiertem Lernen. Lern-Informationssysteme heben sich strukturell und funktional deutlich von den Lern-Managementsystemen (LMS) ab. Während ein LMS die administrativen Funktionalitäten stark betont, sehen die LIS ihren Schwerpunkt in der flexiblen und größtenteils dynamischen Bereitstellung von unterschiedlichen Anwendungsszenarien für den Lernenden. Erreicht wird die Dynamik und Flexibilität durch die Grundkonstrukte des LIS, die so genannten Module. Module enthalten neben dem zu vermittelnden Wissen Vor- und Nachbedingungen als logische Beschreibungen ihrer Inhalte bzw. der Voraussetzung ihrer Anwendbarkeit. Der Aufbau eines LIS wird anhand eines bestehenden und eingesetzten Lernsystems zum Thema der koronaren Herzkrankheit erklärt. Neben einer kurzen Einführung in die Theorie der LIS werden Anwendungsszenarien für systematisches Lernen und die Darstellung von Fällen und deren Verbindung zu Wissenseinheiten dargestellt. Für die Repräsentation der Daten eines Falles wird zurück gegriffen auf das an der Universität Regensburg entwickelte Fall-Schema MedicCaseML.(DIPF/Orig.)

Multimediale, interaktive und patientennahe Lehrszenarien in der medizinischen Ausbildung

MeduMobile ist ein im Rahmen der Ausschreibung „Notebook-University“ vom bmb+f gefördertes Projekt. Ziel des Projektes ist es, die Ausbildung am Krankenbett im Medizinstudium zu verbessern, indem bestimmte Lehrveranstaltungen mit Hilfe von WLAN und Notebook ubiquitär auf dem Campus verfügbar gemacht werden. Hierzu werden neue, so genannte OnCall-Lehrszenarien entwickelt und erprobt, bei denen die auf Abruf bereit stehenden Medizinstudierenden alarmiert und zur Teilnahme gebeten werden, wenn akute und/oder seltene Fälle in die Klinik eingeliefert werden. Die Studierenden nehmen aktiv an den vielfach interdisziplinären Lehrveranstaltungen teil. Der Unterricht findet vor, während und nach der Live-Session statt. Der Hochschullehrer und die Studierenden können den Fall gemeinsam besprechen und die Diagnose bzw. Therapie u.a. an Hand bildgebender Verfahren (CT, Mikroskop, Röntgen, Ultraschall, ...) erarbeiten. Parallel dazu können die Studierenden Lehrmaterialen aus multimedialen Datenbanken, Medline und Internet nutzen sowie eigene Videokonferenzen für die Gruppenarbeit einsetzen. Eine solche Lehrveranstaltung kann somit mehrere didaktische Elemente beinhalten: instruktives, konstruktives, kognitives und kooperatives Lernen. An der Erprobung nehmen etwa 80 Studierende an Veranstaltungen aus 8 Fachgebieten teil. Es werden Studien zur Evaluation des didaktischen Mehrwerts sowie technischer und organisatorischer Qualität durchgeführt. Endgültige Ergebnisse werden Ende 2003 vorliegen.(DIPF/Orig.)