Confidence In Aspects Research Articles

The effect of co-regulation on English public speaking self-efficacy in collaborative oral presentations.

This study investigated the influence of co-regulation on public speaking self-efficacy in the context of collaborative oral presentations. A total of 237 students enrolled in an English course at a university in China took part in the research. The factor analysis findings revealed that learners' co-regulation in public speaking encompass five components: co-planning, co-monitoring, co-evaluation, effort regulation, and help-seeking. Public speaking self-efficacy, on the other hand, pertains to learners' confidence in aspects including the topic, language use, organization, and delivery during public speaking engagements. The path analysis demonstrated that co-planning was a significant predictor of students' self-efficacy in terms of the topic and organization. Moreover, the co-monitoring strategy exhibited direct and positive correlations with language and topic self-efficacy. Similarly, the co-evaluation strategy showed direct and positive relationships with language, delivery, and organization self-efficacy. Furthermore, both effort regulation and help-seeking strategies were found to have direct and positive impacts on organization self-efficacy. This study offers valuable implications for educators, trainers, and individuals aiming to enhance their public speaking self-efficacy in collaborative environments.

Boosting Confidence: Enhancing Spinal Cord Stimulator Needle and Lead Placement Through Simulation Training.

Background This pilot study aims to examine the effectiveness of a spinal cord stimulator (SCS) simulator training system in improving theconfidence of pain fellows in SCS placement. Methodology Five Ukrainian physicians (neurologists, neurosurgeons, and an anesthesiologist) completed a 10-item survey regarding their confidence in various aspects of SCS placement and their opinions on how effective SCS models were for educational purposes. After placing SCS leads using the SCS simulator, the physicians took the same survey again. The Mann-Whitney U test was used to determine if there was a significant difference in total scores pre and post-simulator training.The software PAST (PAleontological STatistics) was used for statistical analysis. Results Overall, five participants had a 38% statistically significant increase in survey scores before and after the intervention (mean: 4.2 vs. 6.2, p = 0.0055). With regards to each item of the survey, participants had a significantly increased confidence in driving leads (2.6 vs. 5.2, p = 0.008) and in overall technical skills for the SCS procedure after the training (2.8 vs. 5.2, p = 0.0188). Although the other eight survey items were not statistically significant (p > 0.05), participants had a 28% increase in confidence when inserting epidural needles, a 20% increase in interpreting simulated X-rays, a 32% increase in navigating challenging anatomical variations, a 12% increase in identifying key anatomical landmarks, a 20% increase in ensuring the correct placement of the lead, or a 53% increase in preparedness for performing an SCS procedure in a real clinical setting. The participant's perspective on how valuable the stimulator training was for enhancing procedural skills increased by 38% and how well the simulator replicated real-life SCS procedure increased by 52%, although both were statistically insignificant (p > 0.05). Conclusions This pilot study shows that the utilization of simulated neuromodulation training is a viable means of augmenting neuromodulation education by increasing physician's confidence in aspects of the SCS placement procedure. The extent to which simulator training improves procedural skills in a real-life SCS placement needs to be investigated further.

TP8.2.26 A new simulation-based course to improve trauma management by junior doctors

Abstract Aims Trauma calls at small hospitals are often attended by small and/or junior teams, especially overnight. The quality of primary surveys was subjectively observed to be extremely variable, sufficient to cause concern about patient safety. In addition, the introduction of the ‘ward trauma call’ for falls was generating anxiety amongst juniors. I recognised an unmet need and gained permission from the Director of Medical Education to create a half-day ‘Introduction to Trauma’ simulation-based course. Method A sample group of Foundation doctors attended a pilot course. Confidence in aspects of trauma management was assessed using Likert scales. Results Pre-course results indicated doctors were reasonably confident with their A-E assessments (63% moderately or very confident) but lacked confidence in trauma skills such as using a scoop. After the course 100% reported increased confidence about what will happen in a trauma call, and 63% reported increased confidence in their A-E assessments. Increased confidence was also widely reported in trauma skills (e.g. log roll 88%), how to manage a ward trauma call (100%), and where to find further guidance (100%). Conclusions This pilot demonstrated that a small group simulation-based teaching intervention can significantly increase the confidence of foundation doctors in all aspects of their role in trauma management. The most notable increases were in trauma equipment use and in managing ward trauma, suggesting these are areas where foundation doctors lack guidance or experience. The course is now part of trust induction for new foundation doctors.

School-Based Speech-Language Pathologists: Confidence in Augmentative and Alternative Communication Assessment.

Purpose The purpose of this study was to examine confidence levels and identify predictors of increased confidence of school-based speech-language pathologists (SLPs) relative to different aspects of the augmentative and alternative communication (AAC) assessment process. Method Surveys were completed by 272 school-based SLPs. Questions were designed to capture demographic information and confidence in areas of assessment such as student capabilities, participation, and feature matching. Results There were variable levels of confidence across aspects of assessment. Respondents were less confident in tasks related to assessing students with severe physical impairments and incorporating aspects related to cultural and linguistic diversity in their assessment. SLPs were more confident assessing student participation and unaided communication. Additionally, respondents had less confidence in matching the features of high-tech speech-generating devices to their students. Self-identification as an AAC specialist, years of experience, percentage of caseload of students with complex communication needs, and length of longest continuing education experiences all contributed to predicting confidence in most areas of assessment. However, years of experience did not contribute to predicting confidence in feature matching. Conclusions Results from this study acknowledge that SLPs are likely to have varied degrees of confidence in aspects of assessment related to preparation, clinical experience, and self-identification of specialty. Findings from this study support increasing training opportunities in AAC assessment. As specialization was the strongest predictor of confidence, further research should investigate the characteristics and preparation of self-identified AAC specialists. This is an important first step in pinpointing ways to increase confidence in school-based SLPs.

Moving Evidence-Informed Assessment and Management of Behavioral and Psychological Symptoms of Dementia into the Real World: Training Family and Staff Caregivers in the DICE Approach

ObjectiveTo investigate the impact of a one-day training program on caregivers’ confidence and knowledge in managing aspects of dementia care. DesignOne-day caregiver training program featuring: 1) an interactive, multi-media format; 2) a companion manual; and 3) a “brain-storming” session at the end of the day that utilized attendees’ real-world cases where the use of the DICE (Describe, Investigate, Create, and Evaluate) approach was illustrated “live.” SettingThree different geographical sites in Michigan. ParticipantsFamily (n = 40) and professional (paid; n = 140) caregivers (total n = 180) for people with dementia. MeasuresPre- and post self-ratings related to confidence in aspects of dementia care management before and directly after the training. ResultsComparing self-ratings pre- and post-training, more than 50% of family caregivers showed improvement in confidence post-training on 11 of 12 items with significant improvement in 4 items. Among professionals, more than 50% of caregivers showed improved confidence on 3 of 12 items, with 4 items showing significant improvement. Family caregivers were significantly more likely than professionals to show improved confidence on 6 of 12 items. ConclusionsThe number of people with dementia and their family caregivers is large and growing every day with the aging of the population. Living well with dementia is the goal. Current care systems are inadequate and lead to multiple poor outcomes. Innovative solutions like the DICE Approach with delivery methods including a manual and interactive training can put the key components of good dementia care at the fingertips of the people who need it most.

Children's expectations and episodic reports over 12 weeks: Influences on memory for a specially designed pediatric examination

SummaryThis investigation extended work on the linkage between knowledge and remembering by exploring the relation between generic and episodic memory representations. Thirty 6‐year‐old children experienced a mock physical examination with some expected components omitted and other unexpected actions included. Immediately and again after 12 weeks, the children reported the event, answered questions about what usually happens in an examination, and rated their confidence in aspects of their reports. They remembered more typical than atypical present components, that is, those included in the examination, and, over time, falsely reported more typical than atypical actions. The children produced intrusions of expected‐but‐omitted medical features at the delay but with lower confidence ratings than they provided for correctly recalled items. Performance on a source monitoring task was associated with aspects of the children's confidence ratings for intrusions. The findings provide evidence that the relation between episodic and generic representations is dynamic and suggest that the capacity to differentiate between them contributes to the development of accurate eyewitness memory.

A Group Visit for High-Risk Pediatric Asthma Patients: A Quality Improvement Initiative to Improve Asthma Care.

Asthma disproportionately affects poor and minority children. Limited parental knowledge and confidence in asthma management, as well as stress from chronic illness, may contribute to poor outcomes. Novel approaches for providing care are essential for this vulnerable population. Our objective was to evaluate the feasibility and impact of an asthma group visit for high-risk children. Our primary care practice cares for more than 2600 children with asthma. The majority have public insurance. Children classified as high risk (≥1 asthma-related emergency department visit/hospitalization in the preceding 2 years) were eligible. Children received brief physical examinations, medication review, and updated Asthma Action Plans. Educational sessions were held for children and parents. Pre and post surveys were used to assess parents' experience and changes in confidence in asthma management. Twenty children and their parents participated. Mean parent confidence scores (5-point Likert-type scale, 5 indicating greatest confidence) improved in managing their child's asthma symptoms (3.60, 4.40, P ≤ .005), managing their child's asthma medications (3.85, 4.30, P ≤ .005), using their child's Asthma Action Plan (3.79, 4.45, P ≤ .02), communicating with the school about their child's food allergies (4.32, 4.72, P ≤ .03), and helping their child relax to reduce emotional triggers of asthma (3.25, 4.47, P ≤ .01). All families reported that they would return to a group visit. Group visits are feasible for providing care, education, and peer support to a vulnerable population. Parents expressed satisfaction and improved confidence in aspects of asthma management. Group visits have the potential to improve asthma outcomes for high-risk families.

The Development of Japanese Novice EFL Learners' Confidence in Aspects of L2 Writing : The Effects of a Process-oriented Approach

The Development of Japanese Novice EFL Learners' Confidence in Aspects of L2 Writing : The Effects of a Process-oriented Approach

HIV PrEP and PEP in Graduate Medical Education: A Novel Curriculum

BackgroundHIV pre-exposure prophylaxis (PrEP) is highly effective but underutilized. Medical trainees cite a need for additional PrEP training. We established a pilot curriculum focused on key PrEP and post exposure prophylaxis (PEP) components with these objectives: identify candidates eligible for PrEP/PEP; appropriate monitoring on treatment; STI screening of at-risk patients; treatments for common STIs. To our knowledge, this is the first description of a formalized curriculum for medical trainees in PrEP/PEP.MethodsThe Oval Center is a comprehensive sexual health clinic in Bronx, New York, focusing on STI and PrEP/PEP. Participant learners include internal medicine residents and I.D. fellows who choose the center as a 2-week clinical elective and/or additional continuity site. The curriculum is composed of 3 core components: 1) patient care, 2) didactics (2 sessions by ID faculty focused on practice guidelines), 3) directed readings (current treatment guidelines/seminal papers). Learners completed a pre- and/or post-training confidential questionnaire that assessed confidence in components of PrEP/PEP and STI care on a 5-point Likert scale.Results8 learners have completed the curriculum to date: 4 fellows and 4 residents. All learners reported high confidence in aspects of STI and PrEP care, for example, in conducting appropriate STI screening and treatment and recommending and monitoring patients on PrEP (median score 5). Preliminary pre-post analysis of 4 learners demonstrated the greatest increase in confidence in addressing health needs of the LGBTQ population (median Δ1.5), and recommending and monitoring patients on PEP (median Δ2)ConclusionThis pilot demonstrates that a curriculum focused on PrEP/PEP is feasible. Preliminary analysis demonstrates that learners had high confidence in prescribing PrEP/PEP and treating common STIs, although numbers were small. Plans to expand the curriculum are currently underway. Rigorous curriculum evaluation is ongoing, including pre-post analysis of all participant learners and evaluation of curriculum impact on behavioral outcomes, such as change in learners’ self-reported rates of PrEP prescribing. Prompt dissemination of this or similar models may help improve PrEP/PEP uptake and STI care for future providers.Disclosures All authors: No reported disclosures.

Quality improvement training for core medical and general practice trainees: a pilot study of project participation, completion and journal publication.

Small-scale quality improvement projects are expected to make a significant contribution towards improving the quality of healthcare. Enabling doctors-in-training to design and lead quality improvement projects is important preparation for independent practice. Participation is mandatory in speciality training curricula. However, provision of training and ongoing support in quality improvement methods and practice is variable. We aimed to design and deliver a quality improvement training package to core medical and general practice specialty trainees and evaluate impact in terms of project participation, completion and publication in a healthcare journal. A quality improvement training package was developed and delivered to core medical trainees and general practice specialty trainees in the west of Scotland encompassing a 1-day workshop and mentoring during completion of a quality improvement project over 3 months. A mixed methods evaluation was undertaken and data collected via questionnaire surveys, knowledge assessment, and formative assessment of project proposals, completed quality improvement projects and publication success. Twenty-three participants attended the training day with 20 submitting a project proposal (87%). Ten completed quality improvement projects (43%), eight were judged as satisfactory (35%), and four were submitted and accepted for journal publication (17%). Knowledge and confidence in aspects of quality improvement improved during the pilot, while early feedback on project proposals was valued (85.7%). This small study reports modest success in training core medical trainees and general practice specialty trainees in quality improvement. Many gained knowledge of, confidence in and experience of quality improvement, while journal publication was shown to be possible. The development of educational resources to aid quality improvement project completion and mentoring support is necessary if expectations for quality improvement are to be realised.

A survey of senior equine management: Owner practices and confidence

Senior equines (16 years and over) comprise a significant proportion of the global equine population and there is concern that their management practices may not be entirely appropriate, particularly given recent evidence to suggest an under recognition of disease for which alterations are necessary to ensure optimal care. However, there has been minimal research to investigate the appropriateness of senior equine care and how capable their carers׳ are in providing care. Consequently, this study used a survey approach to investigate the management practices and health care provision for senior equines. A series of Likert type questions were used to assess respondent confidence in aspects of management regimes, recognition of age associated equine conditions, and perceived importance of nutrition advice sources, using a scale of 1–5 (1 being low and 5 high confidences). In addition, a combination of multiple response and open questions was used to report management practices in place. The survey was administered to those enrolled on a massive open online equine nutrition course and received 1342 responses. Results indicated an encouraging provision of care for senior equines, with associated high carer confidence in management regimes and concerted effort to understand and fulfill their senior equines requirements. However, the study highlighted key areas of requirements for owner education. In particular, the combined lack of frequent body condition monitoring and low confidence in disease recognition and supplement feeding. There was also a prevalence of suboptimal strategic worming and dry hay feeding. Given that veterinarians were consistently considered as the most important advice source it is likely that they will have an important role to play in the education that is required.

M271 A Survey Of Trainee Experiences In Interstitial Lung Disease

Interstitial lung disease (ILD) is a major area of respiratory medicine It is important that trainees gain competence and confidence in this area. Methods A survey of BTS trainee members was conducted in November 2013 to examine training provision in ILD, including trainee’s opportunities, experience and confidence in aspects of ILD. Results There were 104 respondents out of a possible 574. 33% of respondents were not expecting any subspecialty clinics in ILD in the course of their training. 42% of trainees expect to spend 3 months or less attending specialist clinics. Trainee attendance at MDTs is far from guaranteed, with 45% expecting to attend less than half during their period in these hospitals. The majority of trainees are trained in performing BAL for cell differential analysis (73%) and transbronchial biopsies (84%), however only 48% are confident performing transbronchial biopsies. Confidence interpreting investigation results increases with the frequency these are performed. The self rated knowledge in a range of subject areas was also assessed and demonstrated that most areas were moderately well understood, however knowledge of the less frequently encountered IIPs was rated lower. 54% of trainees felt their ILD training was inadequate for SCE preparation. 94% would value a BTS Short Course on ILD to improve their knowledge and confidence. Discussion This survey highlights areas where there are clear opportunities to enhance the training of registrars in ILDs. It is worth noting that some of the data is in conflict with previous BTS surveys in this area and there is the possibility of self-selection bias in the response population. Whilst most trainees are trained in performing relevant procedures, their confidence interpreting the results of common investigations in ILD is low. To give evidence of training and competence in this area, deaneries may wish to consider requesting logbook evidence of procedures related to ILD, in addition to evidence of ILD MDT attendance. There is undoubtedly a need for a BTS short course on ILD for trainees.

Nurse practitioner prescribing practice in Australia: Confidence in aspects of medication management

The findings of the 2010 national survey of nurse practitioner (NP) prescribing in Australia related to confidence in prescribing are reported. A significant correlation between years endorsed as a NP and prescribing confidence was found. NPs in Australia were significantly more confident in the prescribing aspects of commencing a new medication than adjusting or ceasing a medication prescribed by others. These findings are discussed in relation to promotion of the quality use of medicines and identification of potential strategies to promote the ongoing positive evolution of NP practice in Australia.

Can Onsite Presentations Led by Physical Therapist Students Increase Clinicians’ Confidence in Aspects of Evidence-Based Practice? A Pilot Study

Purpose: The purpose of this study was to compare impact of 3 different types of onsite physical therapist student-led presentations on participants' reported confidence in various skills related to EBP.Subjects. Fifty-two physical therapists from 6 outpatient orthopedic clinics participated.Materials and Methods. Six clinics were randomly assigned to 1 of 3 presentation types: topic-specific presentation (TP, n = 20); evidence-based practice (EBP) interactive education session (ED, n = 12); or EBP education handout (HO, n = 20). Data were collected from 1 prepresentation and 2 postpresentation (at 1 and 6 months after intervention) surveys. Data analysis utilized demographic summaries, cross-tabulations, frequencies, Friedman analyses of variance (ANOVA), and Kruskal-Wallis tests for survey data.Results. Pre presentation (PRE): Groups were demographically similar and did not differ in survey responses. Over 95% of all participants agreed that EBP is essential to physical therapy practice. Lack of time was most frequently identified barrier to use of EBP (92%). One (POST1) and 6 (POST6) months post presentation: Significant improvements were found from PRE to POSTl in ED group in confidence in understanding published research, and these improvements were maintained at POST6. The HO group demonstrated significantly improved confidence in ability to locate published research from PRE to POST1. No differences were found in TP group across time. A large majority of all participants reported that it was helpful to have information provided to them and that student presenters were knowledgeable and trustworthy regarding information presented. Nearly two thirds reported gaining new skills or information from presentation, and most agreed that future student-led, EBP-related presentations would be beneficial.Conclusions. Participants in this study consider EBP essential to physical therapy practice, but identified numerous barriers that may prevent EBP implementation. Student-led presentations designed to educate clinicians on methods of locating and understanding published research (ED and HO) produced several significant pre-presentation to post-presentation differences in participants' confidence in these skills. The majority of participants felt presentations were beneficial and that students provided useful information.Clinical Relevance. The academic environment affords PT students with most up-to-date, evidence-based information, and students are required to be proficient in locating, understanding, analyzing, and implementing published research. Some clinicians may lack these skills; this lack has been identified as a barrier to EBP implementation. The results of this pilot study are a positive indication that PT students may be able to provide clinicians with information and training that may improve their confidence in locating and understanding published research. This may be an early but important step toward achieving American Physical Therapy Association's vision to improve profession's implementation of EBP.Key Words: Evidence-based practice, Student-led presentations, Clinical presentations.INTRODUCTIONEvidence-based practice (EBP), the conscientious, explicit, and judicious use of current best evidence in making decisions about care of individual patients,1(p71) is at forefront of discussions about future of physical therapy. The American Physical Therapy Association (APTA) has identified EBP as one of 6 key elements for achieving vision of autonomous practice by year 2020.2 Clinician-identified barriers have been shown to make implementation of EBP difficult.3'12 This has contributed to a gap between knowledge available through published evidence and actual clinical practice. Many strategies have been suggested to bridge this gap and allow physical therapists to consistently use EBP in their professional setting. …

Identifying Informational Needs of Pathologists in the Diagnosis of Myelodysplastic Syndromes (MDS)

AbstractAbstract 4242MDS are a heterogeneous group of hematopoietic stem cell disorders whose incidence appears to be increasing. Establishing the diagnosis of MDS requires careful morphologic review of the peripheral blood, bone marrow (BM) aspirate and biopsy and correlation with clinical findings. The role of the pathologist in the diagnosis of MDS is vital. The purpose of this study was to describe current practice patterns and barriers facing both general pathologists and hematopathologists regarding the diagnosis of MDS and to identify areas for continuing education for all pathologists who diagnose MDS. Methods:The study used several methods to collect data including literature review, nominal group technique focus groups, and a case based survey. The survey was distributed during March and April 2012 via fax and email to 5,490 general pathologists and hematopathologists practicing in the US. Responses were received from 233 general pathologists and hematopathologists, of which 130 completed the survey. A final sample of 72 general pathologists and 53 hematopathologists were used in the analysis, giving a response rate of 2.3%. Respondents to the survey were given a small remuneration for their time. Results:As expected, experience with MDS was higher in hematopathologists than general pathologists. Hematopathologists evaluated an average of nine BM aspirates and biopsies per week, whereas general pathologists evaluated an average of 2 per week. Confidence in aspects of MDS diagnosis was also higher among hematopathologists, with 76% being very confident in their ability to classify and report MDS (vs. 33% of general pathologists) and 79% very confident in distinguishing MDS from other hematopoietic disorders (vs. 39% of general pathologists).Regarding general practice patterns, the majority of both groups requires and reviews clinical data for every hematology case (77% hematopathologists, 79% general pathologists). Both groups cited poor quality bone marrow specimens as a much more significant barrier than lack of clinical information or access to technology (fig 1). Only a subset of both groups reported having standardized protocols in their institution for the diagnosis and work-up of MDS (36% hematopathologists and 32% general pathologists). The hematopathologists more frequently had a checklist in place for clinicians to ensure that sufficient and appropriate samples are collected at the time of bone marrow biopsy (62% versus 39% for general pathologists). Most general pathologists (63%) and hematopathologists (55%) do not use the International Prognostic Scoring System (IPSS). Accordingly, most are not aware of the components that comprise the IPSS.The case based survey showed some practice similarities and differences between the groups. The vast majority of both hematopathologists and general pathologists use the current WHO (2008) classification system (96% hematopathologists and 92% general pathologists). The most obvious difference between the groups was in ordering FISH testing for possible MDS. Among those who selected FISH in the hematopathology group, greater than 90% selected probes for chromosomes 5, 7, 8 and 20. There was greater variability in the probes ordered by general pathologists. Most notably chromosome 8 was selected by 58% of general pathologists and BCR-ABL was selected by 29% of general pathologists (vs. 8% in the hematopathologists group). Conclusion:The results of the study suggest there are continuing education opportunities for these pathologists to ensure more standardized diagnostic evaluation for MDS. The need for more standardized protocols for the work-up of patients for MDS was voiced by both general pathologists and hematopathologists. Pathologists may also benefit from more clinically oriented continuing education, to include topics such as the International Prognostic Scoring System (IPSS) and other validated prognostic classification systems. [Display omitted] Disclosures:Sagatys:CE Outcomes, LLC: Consultancy. Berger:Celgene Corporation: Celgene Stock Other, Employment. Merwin:Patti Merwin: Company Stock Other, Employment. Sugrue:Celgene Corporation: Employment, Equity Ownership.

Effects of an Interprofessional Rural Rotation on Nursing Student Interest, Perceptions, and Intent

Purpose Rural areas are in critical need of nurses to meet the health needs of their residents. The problem under investigation in this study was whether a semester-long interdisciplinary rural rotation changed nursing students’ interest in rural health, perceptions of their performance of selected nursing skills, and their intention to practice in a rural community. Sample Two hundred forty eight (248) senior level baccalaureate students completed pre- and post-rotation surveys. 53.6% of students reported an increased interest in rural health. Findings Significant differences were found in students’ confidence in aspects of their performance including recognizing cultural differences, community assessment, community participation, meeting the unique needs of rural patients, identifying barriers to care, and identifying the impact of socioeconomic status on health. Students who attended high school in a rural community, expressed increased interest in rural health, and evaluated the rotation favorably were more likely to practice in a rural state after graduation (p < .05). Conclusions The findings have implications for changes in nursing education. A more comprehensive approach to rural health may be needed to attract students to nursing practice in rural communities. Key Words : Rural, Nursing education, Nursing practice, Intention

Material man is not an island: Coping with cultural fracture

Consumer acculturation is important to visitors crossing cultural borders, but the role of possessions on visitors' ability to cope in a host environment is less well understood. Two-stage structural equation modelling is employed to understand the relationship of possession centrality, lifestyle behaviours, purchases, and possession ownership on cultural fracture experiences. The possessions that educational visitors bring from home and goods they purchase once in the host culture relate positively to cultural fracture, demonstrating possible anchoring effects of possessions brought from home and the culturally disorientating effects of making purchases in a host cultural space. Possession centrality, or the skill and confidence in aspects of consumption and possession use, is principal in alleviating the experiences of cultural fracture. Visitors possessing higher levels of possession centrality experience less fracture than those with lower levels of possession centrality. This study highlights how consumption-related competencies function as acculturation mechanisms.

Where Have All the Women Gone?

It is a pleasure to be here this evening at the end of that which I know has been a stimulating and challenging set of panel discussions on lawyers and the legal profession in the twenty-first century. I do not intend to revisit your discussions of earlier today. When thinking about the perspective I might offer this evening, I reflected upon my time as Minister of Justice and Attorney General of Canada as it related to your conference theme. Ministers of Justice are regularly faced with the assertion that the public is losing, or worse, has lost, confidence in the justice system and in key participants within the system, particularly lawyers (and to a much lesser degree judges). The public continues to express a high degree of confidence in the police. There have been many surveys, polls, and focus groups done, both in Canada and around the world, regarding confidence in aspects of the justice system...

General practitioner views on barriers and facilitators to implementation of the Asthma 3+ Visit Plan

The Asthma 3+ Visit Plan is an initiative to promote organised asthma care in general practice. This study aimed to identify factors associated with uptake of the plan by general practitioners, and their views on barriers and facilitators to implementation of the plan. Postal survey sent to a random sample of GPs. 315 GPs in five Divisions of General Practice in metropolitan Sydney, surveyed sequentially between 1 October 2002 and 31 May 2003. Awareness and use of the Asthma 3+ Visit Plan; GP and practice factors associated with use of the plan; and GP views on barriers and facilitators to implementing the plan. The response rate was 55.7%, and 72.1% of participants were male; participants' mean age was 50.5 years. Most GPs (91.2%) were aware of the plan and and 44.9% had used it. GP and practice factors associated with use of the plan were use of the six-step Australian Asthma Management Plan, confidence in aspects of asthma care, practice accreditation, sign-up for asthma incentives, and computerisation. Major barriers to implementing the plan were workload/paperwork and administrative complexities. Patient factors that influenced completion of the plan were their concept of the severity of their asthma, compliance with follow-up, and patient attitudes towards asthma care. The perceived workload and administrative complexity of the asthma incentives are barriers to uptake. Factors relating to the illness rather than social factors are seen as the most important influences on completion of the plan by patients.

Toward a definition of HIV expertise: a survey of experienced HIV physicians.

Medical care for human immunodeficiency virus (HIV)-infected persons has grown increasingly complex, yet few studies have examined experienced HIV physicians' views about current HIV medical care. The objective of this study was to examine the relationship between physicians' HIV experience, self-perceived expertise, and confidence with providing 18 aspects of HIV medical care and between confidence in aspects of care and medical specialty. At geographically diverse, HIV continuing medical education programs conducted in the fall of 1999, 359 currently practicing HIV physicians completed a written survey measuring participants' demographic characteristics, experience, HIV expertise, and level of confidence providing essential aspects of HIV care. Participants currently managed a median of 50 HIV-infected patients with a career total of 300. Significant correlations were found between experience and expertise items and experience and 15 of 18 confidence items. Confidence levels varied from 11% to 85% highly confident across 18 aspects of HIV care. Physicians' confidence with providing aspects of HIV care varied by the three predominant specialty groups (infectious diseases, internal medicine, and family practice/general medicine). Physicians who have informally specialized in HIV care reported a range of self-perceived expertise and confidence, indicating the complexity of HIV medical care today. Our results suggest that even the most experienced HIV physicians in the United States continue to benefit from more experience and that each medical specialty examined in this study brings its own set of skills needed to provide optimal HIV care. This study constitutes a first step toward defining and formalizing HIV medical care.