Multiple-choice Knowledge Questions Research Articles

Effectiveness of a Clay Pelvic Model: A Hands-on Approach to Understanding Pelvic Floor Anatomy.

Understanding pelvic anatomy is an important part of education during obstetrics and gynecology residency. Traditional teaching methods to learn pelvic anatomy have obstacles and are often costly. We provide a self-constructed clay pelvic model to aid in the mastery of pelvic anatomy for obstetrics and gynecology residents and to estimate whether building a clay pelvic model would increase residents' confidence and knowledge in pelvic anatomy. Each resident constructed a clay pelvic model on a bony pelvis, along with the traditional didactic on pelvic anatomy. Demographics of the participants were obtained, followed by a knowledge test and confidence level and satisfaction surveys. Descriptive analysis and Wilcoxon signed-rank test were used for data analysis. Nine residents (three postgraduate year [PGY]-1, one PGY-2, two PGY-3, three PGY-4) completed the knowledge and confidence questions before and after the simulation, along with the satisfaction survey. The median score from the 10 multiple-choice knowledge questions was 50% (30-70%) on the pretest and 70% (40-100%) on the posttest (P=not significant). Although most residents scored higher on the posttest, two residents scored 10% lower. Overall, 66.7% of residents improved their knowledge scores up to 30% after the simulation session. Self-assessed confidence level scores improved from 2-3 to 4 (1, lowest; 5, highest) for all questions asked (P=.010 to approximately .019). A majority of residents responded with 4 or 5 to the satisfaction statements. A low-budget clay pelvic model is easy to build and did increase residents' confidence in pelvic anatomy knowledge and satisfaction. Self-constructing a clay pelvic model would provide an excellent way of reviewing the major landmarks of pelvic anatomy.

Evaluation of the achievement of hematologists to transfusion medicine education with self-assessment questionnaire in Turkey

Background: Proper clinical use of blood and blood products requires competent theoretical and practical knowledge of transfusion medicine. The Curriculum Development and Standard Determination System Medical Specialization Board is prepared Hematology Specialist Education Core Curriculum in Turkey. In this study, we aimed to determine the access of hematologists to the learning objectives defined by curriculum for the transfusion medicine and the factors affecting it.Methods: Hematologists who have been members of Turkish Hematology Society since 2013 have been included in the study, The survey questions were prepared based on the curriculum for transfusion medicine. The study was applied to hematologists with "survey monkey" application. The questionnaire consisted of a competence self-assessment with Likert scale and theoretical multiple-choice knowledge questions. Results: Of the 213 hematologists, 54 (25%) were included in the study. Hematologists rated their competences in the clinical competence areas as 3,65 ± 0,73 (median 3,60) as "I know but not t a sufficient level". The participants 'perception of competence was "I know, but not at a sufficient level'" with an average of 3.31 ± 0.84 (median3.5) in the blood banking field, while the average in hemapheresis and transfusion medicine was 4.04 ± 0.63 (median 4) as "enough". In interventional procedures, hematologists stated that their vocational competences were 2,79± 0,92 (median 2,93) on average as "I have an idea- I know, but not enough". The correct answer to 13 theoretical questions was an average of 6,96 ± 1,89 (median 7). Hematologists performing blood rotation felt significantly more competent than the physicians who could not do the rotation in the blood bank, blood banking t(52) = -3.9, p < .001 , transfusion medicine and interventional competence t(52) = -2.2, p = .04 . Physicians who believed that they are sufficient in the blood banking area, were more confident in transfusion medicine r(54) = .67, p <.001 and managing interventional procedures r(54) = .85, p <.001. Conclusion: In this study, hematologists generally felt more competent in subjects such as transfusion and therapeutic apheresis, which they often think of as not having enough knowledge in the area of blood banking. Hematologists have been more confident in the field of transfusion medicine as their years of expertise increased, but they did not feel better equipped in the fields of blood banking and interventional competence. The current results suggested that hematologists who are expected to be the blood bank supervisors do not internalize the area of blood banking, are not strong in their competence, and do not want to work in this area unless they are required.In hematology education curriculum, positive revisions in education can be achieved by revising blood banking curriculum and learning objectives, standardizing blood center rotations with content and duration, and support from online distance education programs.

Resident Physician Prescribing Variability Demonstrates Need for Antimicrobial Stewardship in Continuity Clinic: A Pilot Study.

Inappropriate antimicrobial use is common in the outpatient setting but often goes unaddressed by stewardship education. Residents might benefit from directed stewardship education. We conducted a needs assessment of resident knowledge, attitudes, and behaviors regarding antibiotic use and stewardship in outpatient continuity clinics. Internal medicine (IM) residents with continuity clinic at Minneapolis Veterans Affairs Health Care System were eligible. Antimicrobial prescriptions and number of visits were extracted from the Computerized Patient Record System (July 1, 2017-March 31, 2018). Antimicrobial rate (prescriptions per 1000 visits) was calculated for each resident. Results from a resident survey that included demographics, attitudes, and case-based multiple-choice knowledge questions were linked by unique identifier to antimicrobial rate. Prescription and visit data were available for 37 residents. Mean monthly antimicrobial rate was 51 prescriptions per 1000 visits (range 8-239). Surveys were completed by 19 residents (51%). Respondents were 32% female, 32% interns, and 11% international medical graduates. An online resource was most commonly used for prescribing guidance, whereas lectures and small group sessions for residents were rated as the most helpful educational modalities. Many respondents reported being unprepared to perform basic tasks related to antimicrobial stewardship. Median percentage correct was 57% of case-based knowledge questions (interquartile range 50%-71%). Antimicrobial rates among IM residents at a VA outpatient continuity clinic are low and vary by provider. Residents agree with key antimicrobial stewardship concepts but lack preparation in tasks related to antimicrobial stewardship. Knowledge regarding antimicrobial prescribing was low.

Public Awareness and Perceptions of Colorectal Cancer Prevention: a Cross-Sectional Survey

We aimed to investigate awareness of colorectal cancer (CRC) lifestyle risk factors, willingness to participate in CRC screening, and preferences concerning channels for information on CRC prevention in the general population, including the target age of the upcoming Norwegian national CRC screening program. The present study was a cross-sectional online survey of adults aged 39 to 55 years registered as Kantar Web Panel respondents in Norway. The survey included demographic characteristics, multiple choice knowledge questions of lifestyle risk factors for CRC, attitudes towards CRC screening, and preferred channels for receiving information on CRC prevention. Of 4375 participants invited, 2007 (46%) answered the survey. The average number of correctly identified lifestyle risk factors for CRC was 7.3 of ten. Women were significantly more likely than men, and those with university or college education more likely than those with lower education to correctly identify at least eight risk factors (odds ratio, OR = 1.53, 95% confidence interval, CI 1.25–1.87, and OR = 1.51, 95% CI 1.23–1.86, respectively). The number of correctly identified risk factors was positively associated with willingness to participate in CRC screening (P for trend < 0.001). The national public work force and the Norwegian Cancer Society were selected by 76% and 69% of the participants, respectively, to be trustworthy sources of information on CRC prevention. Awareness of CRC risk factors was associated with willingness to participate in CRC screening. The national public work force and Cancer Society can be generally accepted sources of CRC preventive information.

Learning Outcomes From Lecture and an Online Module in the Family Medicine Clerkship.

With younger generations of learners and readily available technology, medical educators are challenged to include active learning methods that may be better for student learning than traditional lecture. Some of these methods, like online modules, can also reduce the demands on clerkship faculty time. We examined how content delivered via interactive, online module compared to traditional lecture for student learning and satisfaction. Third-year family medicine clerkship students completed questionnaires following either an online module or lecture on orofacial pain. We conducted the study over four consecutive rotations, alternating who received the content via classroom lecture or interactive online module. Students completed a questionnaire comprised of six multiple-choice knowledge questions, five questions with a clinical vignette format to assess application of knowledge, and six questions to assess satisfaction with elements of the course. The Centers of Excellence in Pain Education developed the online module and questionnaire. We found no differences in knowledge between the in-person lecture and the online module. However, students who completed the online module performed better on the application questions. Students in the lecture group reported greater satisfaction with the course than students in the online group. Lecture resulted in adequate knowledge recall, but the interactive method resulted in better scores on applying knowledge to new situations. Providing an online module where students can practice applying knowledge is important for higher levels of learning, but it should be noted that satisfaction ratings may decline.

Clinician knowledge, attitudes, and barriers to management of vulvovaginal atrophy: variations in primary care and gynecology.

Vulvovaginal atrophy is a common, but under-recognized condition affecting postmenopausal women. To guide development of an intervention to boost its detection and treatment, we surveyed primary care and gynecology clinicians practicing in an integrated healthcare system. We constructed a three-part survey that contained (1) eight multiple-choice knowledge questions; (2) three Likert-scale questions regarding clinicians' likelihood of assessing for vulvovaginal atrophy symptoms at a routine (well) visit, confidence in advising patients about symptoms and counseling about therapy; and (3) a 12-item check list of potential barriers to diagnosis and treatment. Analyses were performed using multiple regression. Of the 360 clinicians who were sent an e-mail request, 119 (90 primary care, 29 gynecology) completed the survey (33%). Responders and nonresponders did not differ by age, specialty, or clinician type. The proportion with correct responses to knowledge questions differed between primary care (63%) and gynecology (77%) (adjusted mean difference [AMD] =16, 95% CI [10-22]). Primary care clinicians were less likely than gynecology clinicians to assess for symptoms (AMD = 1.04, 95% CI [0.55-1.52]), and were less confident about their ability to advise on symptoms (AMD = 0.66, 95% CI [0.33-0.99]) and to counsel patients about treatment (AMD = 0.76, 95% CI [0.42-1.10]). Lack of time (71%) and educational materials (44%) were the most common barriers to diagnosis and treatment. Primary care and gynecology clinicians differ in their knowledge and confidence in managing vulvovaginal atrophy but report similar practice barriers. Addressing identified knowledge deficits and practice barriers may lead to improved management of vulvovaginal atrophy.

A Hazardous Materials Educational Curriculum Improves Pediatric Emergency Department Staff Skills.

Emergency department (ED) providers require competency in responding to hazardous materials (HAZMAT) events. The optimal strategies to teach HAZMAT response principles to ED providers and to ensure skill retention are not known. Our aim was to design, implement, and evaluate a multifaceted, interprofessional educational curriculum for pediatric ED staff to improve their skills, knowledge, and confidence in responding to a HAZMAT event. In this longitudinal cohort study, we created and assessed a 3-hour educational curriculum comprised of didactics, skills stations, a tabletop exercise, and a simulated multivictim disaster. Learning objectives included critical aspects of pediatric HAZMAT incident response with an emphasis on donning personal protective equipment (PPE). The primary outcome was the number of HAZMAT PPE donning steps correctly completed within 10 minutes at pre- and postcurriculum assessments measured using a 32-item checklist. Secondary outcomes included skill retention at 3 months, change in knowledge assessed using multiple-choice questions, and change in participant confidence. Eighty-one of 84 participants (96%) completed the entire curriculum. Compared to the precurriculum assessment, participants completed more donning steps correctly after the intervention (mean increase = 58%, 95% confidence interval [CI] = 48%-70%). Relative to the baseline, more steps were also correctly completed at 3 months (mean increase = 49%, 95% CI = 38%-61%). Performance on multiple-choice knowledge questions and confidence in skills also significantly increased from the pre- to postcurriculum assessments. A newly developed HAZMAT educational curriculum improved skills-based performance, knowledge, and confidence in PPE and decontamination skills. Brief, multifaceted educational interventions for ED staff can effectively develop sustainable skills needed for uncommon emergency events.

Comics as an educational tool for children with juvenile idiopathic arthritis

BackgroundThis study examined whether the comic book Neta and the Medikidz Explain JIA would improve disease-related knowledge and treatment adherence among patients with juvenile idiopathic arthritis (JIA).MethodsIn this prospective cohort study, JIA patients answered 20 multiple-choice knowledge questions about their disease, before and after reading the comic book. Demographic, clinical, health-related quality of life and adherence data were recorded and correlated to the responses.ResultsWe studied 61 patients with a mean age of 14 ± 3.3 (range 8–18) years, 67% female, 83% Jewish and 17% non-Jewish. Thirty-nine percent had oligoarthritis, 13% systemic, 32% polyarthritis 11% psoriatic and 5% enthesitis-related type JIA. The disease was active in 46%, 40% were treated with biologics/disease modifying anti-rheumatic drugs, and 34% were in remission on medication. Among the 53 patients who completed before and after quizzes, average score increased from 63 to 80% (P < 0.001). Non-Jewish patients initially scored lower than Jewish patients (48%), but their score increased to 79% after reading the comic book. Twenty-seven patients who also completed the quiz 1 year after the first reading retained their knowledge (79%). We did not find a statistically significant correlation between knowledge and age, sex, disease subtype, or Child Health Questionnaire quality of life scores. Adherence to medication use, physical therapy and rheumatology clinic visits were high at baseline; thus, these did not change after reading the comic.ConclusionsThe comic booklet Neta and the Medikidz Explain JIA is a good educational tool for increasing disease-related knowledge in children with JIA.

Lagged Versus Difference Score Regression: An Example From a Community-Based Educational Seminar Evaluation

Objectives. To demonstrate the use of evaluation data in determining the effectiveness of a series of community-based educational seminars designed to educate substance abuse treatment counselors on the latest science regarding the effects of alcohol abuse on diseases of the liver and pancreas; in the process, to highlight the use of difference scores versus lagged regression as alternative approaches to conducting such evaluations. Methods. Data were collected from 338 seminar participants during 4 half-day seminars in 2007, 2009, 2010, and 2014. Pre- and post-seminar data were collected immediately before and after the seminar, approximately 3 hours apart. Survey questions included demographics and a series of multiple-choice knowledge questions that were identical at pre- and posttest. Results. Analyses showed that, on average, participants improved their knowledge by 19.7 percentage points from 0.44 to 0.63, or 44.7%. Factors associated with learning using difference scores revealed that only survey wave (time) was associated with learning. In contrast, lagged regression results showed that in addition to wave, participants who reported attending the seminar because they were required to for their job learned less, whereas those attending because they wanted to learn the material learned more. Education was also significantly associated with knowledge change. Conclusions. This study illustrates that relying on difference score analyses to estimate programmatic effects and changes in knowledge for educational programs can lead to faulty conclusions whereas lagged regression is a better approach to assess program impact.

A web-based training program to support chronic kidney disease screening by community pharmacists.

Background Community pharmacists' role in screening of several chronic diseases has been widely explored. The global health burden of chronic kidney disease is high; however, the progression and adverse outcomes can be prevented or delayed by detecting and treating the disease in its initial stages 1-3. Therefore, a web-based training program was developed to enhance pharmacists' knowledge and skills required to perform a chronic kidney disease screening service in a community setting. Objective The aim of this study was to evaluate the impact of a web-based training program on community pharmacists' knowledge and skills associated with chronic kidney disease screening. As secondary aim, pharmacists' satisfaction with the training program was assessed. Setting Community pharmacy practice. Method A web-based training program was developed by four pharmacists and a nephrologist. Quantitative data was collected by employing a self-administered, web-based questionnaire, which comprised a set of five multiple-choice knowledge questions and one clinical vignette to assess skills. A nine-item Likert scale was used to determine pharmacists' satisfaction with the training program. Main outcome measure Pharmacists' knowledge and skills scores at pre and post-training, reliability of the Likert scale, and the proportion of responses to the individual nine items of the satisfaction survey. Results Fifty pharmacists participated in the pre-questionnaire and 38 pharmacists completed the web-based training and post-questionnaire. Significant differences were observed in the knowledge scores (p<0.001) and skills scores (p<0.001) at pre- and post-training. Cronbach's alpha for the nine-item satisfaction scale was 0.73 and the majority pharmacists (92.1-100%) were satisfied with the various aspects of the training program. Conclusion The web-based training program positively enhanced pharmacists' knowledge and skills associated with chronic kidney disease screening. These findings support further development and widespread implementation of the training program to facilitate health promotion and early identification of chronic kidney disease in a community setting.

Testing with feedback improves recall of information in informed consent: A proof of concept study

ObjectiveThis study investigates whether applying educational testing approaches to an informed consent video for a medical procedure can lead to greater recall of the information presented. MethodsUndergraduate students (n=120) were randomly assigned to watch a 20-min video on informed consent under one of three conditions: 1) tested using multiple-choice knowledge questions and provided with feedback on their answers after each 5-min segment; 2) tested with multiple choice knowledge questions but not provided feedback after each segment; or 3) watched the video without knowledge testing. ResultsParticipants who were tested and provided feedback had significantly greater information recall compared to those who were tested but not provided feedback and to those not tested. The effect of condition was stronger for moderately difficult questions versus easy questions. ConclusionsInserting knowledge tests and providing feedback about the responses at timed intervals in videos can be effective in improving recall of information. Practical implicationProviding informed consent information through a video not only standardizes the material, but using testing with feedback inserted within the video has the potential to increase recall and retention of this material.

Evaluation of the first open-access hepatitis B and safe injection online training course for health professionals in China

BackgroundDespite the high prevalence of chronic hepatitis B virus (HBV) infection in China, HBV infection prevention and long-term care knowledge of health professionals is inadequate. To address this knowledge gap, we developed an open-access evidence-based online training course, "KnowHBV", to train health professionals on prevention of HBV transmission and safe injections. We conducted an evaluation of the course with health professionals in China to examine its effectiveness in improving knowledge and learner’s satisfaction of the course.MethodsBetween July and December 2011, 1015 health professionals from selected hospitals and disease control institutions of Shandong province registered for the course and 932 (92 %) completed the three-module course. Participants’ demographic information, pre- and post-course knowledge test results and learner’s feedback were collected through the course website.ResultsPre-course knowledge assessment confirmed gaps in HBV transmission routes, prevention and long-term care knowledge. Only 50.4 % of participants correctly identified all of the transmission routes of HBV, and only 40.7 % recognized all of the recommended tests to monitor chronically infected persons. The number of participants that answered all six multi-part multiple-choice knowledge questions correctly increased from 183 (19.7 %) before taking the course to 395 (42.4 %) on their first attempt upon completion of the course. Over 90 % of the 898 participants who completed the learner-feedback questionnaire rated the course as ‘good’ or ‘very good’; over 94 % found the course instructional design helpful; 57.5 %, 65.7 % and 68.5 % reported that half or more than half of the course content in modules 1, 2 and 3 respectively provided new information; and 93.2 % of the participants indicated they preferred the online learning over traditional face-to-face classroom learning.ConclusionsThe "KnowHBV" online training course appears to be an effective online training tool to improve HBV prevention and care knowledge of the health professionals in China.

Knowledge of Psychiatric Nurses About the Potentially Lethal Side-Effects of Clozapine

Clozapine is an antipsychotic with superior efficacy in treatment refractory patients, and has unique anti-suicidal properties and a low propensity to cause extrapyramidal side-effects. Despite these advantages, clozapine utilization is low. This can in part be explained by a number of potentially lethal side effects of clozapine. Next to psychiatrists nurses play a crucial role in the long-term management of patients with schizophrenia. It is therefore important that nurses know, inform and monitor patients about the specific side-effects of clozapine. A recent study of psychiatrists published in 2011 has shown that there was a gap in the knowledge about side-effects of clozapine. The knowledge about side-effects of clozapine in nurses has never been studied. This cross-sectional study evaluated the knowledge base regarding the safety of clozapine, and its potential mediators, of psychiatric nurses in 3 psychiatric hospitals in Belgium with a specifically developed questionnaire based on the literature and expert opinion (3 clozapine experts). A total of 85 nurses completed the questionnaire. The mean total score was 6.1 of a potential maximum score of 18. Only 3 of the 18 multiple choice knowledge questions were answered correctly by more than 50% of nurses. Only 24.9% of participants passed the test (>50% correct answers). Nurses working on psychosis units were more likely to pass the test (xx.y% vs yy.z%, p=0.0124). There was a trend that nurses with a lower nursing diploma were more likely to fail the test (p=0.0561). Our study clearly identifies a large gap in the basic knowledge of psychiatric nurses about clozapine and its side-effects. Knowledge could be increased by more emphasis on the topic in nurse's training curricula as well as targeted onsite training. Only 23.5% of participants indicate that there was sufficient information in their basic nursing training.

TF18 Mindfulness in Emergency Medicine

Burnout among medical students is depressingly common. Studies estimate the prevalence of burnout to be anywhere from 40 to 76%. More distressingly, a recent study reported that 9.4% of fourth-year medical students and interns admitted to having suicidal thoughts during the previous two weeks. These findings have prompted a small number of medical schools to create targeted wellness programs for their students. The most promising interventions focus on a concept known as mindfulness training. In particular, students planning a career in emergency medicine may benefit from mindfulness, as the emergency department is often a crowded, chaotic, and uniquely high-stress environment in which to practice. Described here is an innovative wellness curriculum integrated into a four-week emergency medicine clerkship for senior medical students that uses mindfulness techniques to reduce their risk of burnout. After participation in this curriculum, learners will be able to: (1) explain foundational wellness concepts; (2) practice a regular schedule of meditation; (3) create a wellness plan using mindfulness strategies to address their individual risk factors for developing burnout. This curriculum uses self-directed learning theory to build relatedness, competence, and autonomy to cultivate mindfulness. Students have readings and short written assignments prior to each of the four weekly 60-minute classroom sessions. Each session includes techniques to encourage active participation and collaboration, such as icebreakers to create community; brainstorming on current stressors; brief didactics; role-play to foster value; and meditation exercises to promote efficacy. To create the value and skills required for sustained behavioral change, the students also practice a regular schedule of meditation and track their progress via an online journal. Their final assignment is to develop a long-term individual wellness plan using mindfulness techniques. Evaluation takes place on multiple levels. Following completion of the curriculum, learners fill out reaction scales for content, methods, and quality of teaching. Students also complete pre- and post-curriculum forms that include a burnout scale, multiple-choice knowledge questions, and a self-assessment of attitudes and behaviors related to wellness and mindfulness. Six months later, students complete the post-curriculum form again, as well as participate in semi-structured interviews and email correspondence to assess for any sustained changes in knowledge, skills, attitudes, or behavior. This curriculum provides a uniquely flexible and targeted method to address burnout in medical students. It can be adapted for any third- or fourth-year clinical rotation to help all students manage stress, not just those planning a career in emergency medicine. In this way, we can potentially give all of our future physicians the tools to combat burnout during the early years of residency and beyond.

Evaluating Evidence-Based Nutrition Support Practice Among Healthcare Professionals With and Without the Certified Nutrition Support Clinician Credential.

The National Board of Nutrition Support Certification credentials healthcare professionals and certifies that holders of the Certified Nutrition Support Clinician (CNSC) credential have specialized knowledge of safe and effective nutrition support therapy. The purpose of this pilot study was to survey healthcare professionals affiliated with the American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.) regarding their approaches to nutrition support practice using a complex patient case scenario in accordance with established clinical guidelines. An electronic survey was emailed to individuals affiliated with A.S.P.E.N. Eight multiple-choice knowledge questions addressed evidence-based nutrition support practice issues for a patient with progressing pancreatitis. Demographic and clinical characteristic data were collected. Of 48,093 email invitations sent, 4455 (9.1%) responded and met inclusion criteria. Most respondents were dietitians (70.8%) and in nutrition support practice for 10.3 years, and 29.3% held the CNSC credential. Respondents with the CNSC credential answered 6.18 questions correctly compared with 4.56 for non-CNSC respondents (P < .001). For all 8 questions, CNSC respondents were significantly more likely to choose the correct answer compared with non-CNSC respondents (P < .001). Professionals with the CNSC credential scored significantly higher on a complex case-based knowledge assessment of guideline recommendations for the nutrition support treatment of pancreatitis compared with those without a credential.

Association of marketing interactions with medical trainees' knowledge about evidence-based prescribing: results from a national survey.

In recent years, numerous US medical schools and academic medical centers have enacted policies preventing pharmaceutical sales representatives from interacting directly with students. Little is known about how pharmaceutical sales representatives affect trainees' knowledge about pharmaceutical prescribing. To determine whether there is an association between medical trainees' interactions with pharmaceutical promotion and their preferences in medication use. We surveyed a nationally representative sample of first- and fourth-year medical students and third-year residents by randomly selecting at least 14 trainees at each level per school. All trainees were asked how often they used different educational resources to learn about prescription drugs. Among fourth-year students and residents, we posed a series of multiple choice knowledge questions asking about the appropriate initial therapy for clinical scenarios involving patients with diabetes, hyperlipidemia, hypertension, and difficulty sleeping. Evidence-based answers followed widely used clinical guidelines, while marketed-drug answers favored brand-name drugs over generic alternatives. We used survey answers to build an industry relations index assessing each trainee's level of acceptance of pharmaceutical promotion; we used proportional odds logistic regression models to estimate the association between the index and responses to the knowledge questions. The 1601 student (49.0% response rate) and 735 resident (42.9% response rate) respondents reported common use of unfiltered sources of drug information such as Google (74.2%-88.9%) and Wikipedia (45.2%-84.5%). We found that 48% to 90% of fourth-year students and residents accurately identified evidence-based prescribing choices. A 10-point higher industry relations index was associated with 15% lower odds of selecting an evidence-based prescribing choice (odds ratio [OR], 0.85; 95% CI, 0.79-0.92) (P < .001). There was also a significant association between the industry relations index and greater odds of choosing to prescribe brand-name drugs (OR, 1.08; 95% CI, 1.00-1.16) (P = .04). Among physician trainees, our survey showed an association between positive attitudes toward industry-physician interactions and less knowledge about evidence-based prescribing and greater inclination to recommend brand-name drugs. Policies intended to insulate trainees from pharmaceutical marketing may promote better educational outcomes.

How hypertext fosters children’s knowledge acquisition: The roles of text structure and graphical overview

Children in primary and secondary school are asked to go on the Internet for school purposes while research on hypertext has scarcely investigated how children process and learn from hypertext. We therefore examined how hypertext influences children’s knowledge acquisition from expository text. A group of 71 Dutch children (13years old) from one secondary school for pre-university education participated in the study. In a within-subjects design with four conditions, we compared: regular linear text, regular text with overview, hypertext, and hypertext with overview. Children’s (a) navigation (i.e., reading time and navigation pattern) and (b) learning (i.e., multiple choice knowledge questions and mind maps) was measured. Although reading times did not differ, the children navigated less linearly in both hypertext conditions than in the regular text with overview condition. The four types of text led to the same deep understanding as measured on the text base level. Analyses of the mind maps, however, showed the children to construct richer situation models after reading hypertext or hypertext with an overview relative to regular linear text and regular text with overview. We therefore conclude that hypertext fosters a deeper level of information processing when appropriately designed relative to regular linear text.

Knowledge of sickle-cell in a screened population

The aim of this study is to begin to assess the awareness and knowledge of sickle-cell amongst carriers and non-carriers in a screened population of primarily African-Caribbean descent. A structured questionnaire containing 10 multiple-choice knowledge questions on sickle-cell was administered by community interviewers of African-Caribbean descent who did not know the respondents' haemoglobinopathy status. The survey took place in Leicester between the advent of selective screening at ante-natal clinics for sickle-cell in 1989 and the appointment of a haemoglobinopathy counsellor in 1993. One hundred and four people whose blood had been tested recently for sickle-cell (50 consecutive carriers and 54 non-carriers tested after the start date of the project) were identified as subjects for interview. Responses were obtained from 24 carriers (two of whom, it transpired, had sickle-cell anaemia) and 31 non-carriers. No significant differences in levels of sickle-cell awareness were found between carriers and non-carriers. Patterns of inheritance and the range of ethnic groups who carry the sickle-cell trait were least understood. Ethically there are grave problems in screening without systematic counselling, but little haemoglobinopathy counselling is undertaken by generic health professionals in the absence of haemoglobinopathy counsellors. There is considerable demand for leaflets and further counselling, though it is felt unlikely that screening in itself contributes much to raising levels of knowledge.

Carrier screening for cystic fibrosis among Maryland obstetricians before and after the 1997 NIH Consensus Conference.

The 1997 National Institutes of Health (NIH) Consensus Conference on Cystic Fibrosis (CF) testing recommended that carrier screening be offered to all pregnant women and couples planning a pregnancy. We surveyed 492 Maryland Ob-Gyns before and after the consensus conference to: (1) assess whether obstetricians changed their practice regarding CF carrier testing, and (2) identify the factors associated with changing practice patterns, including awareness of the statement, and knowledge about CF. Fifty-six percent (275) responded to the first mail questionnaire and 107 obstetricians responded to both questionnaires. In 1998, only 18% of respondents to the second questionnaire were familiar with the NIH statement, but 43% reported discussing testing with patients with no family history, a significant increase from 1997, when only 20% reported discussing testing. Less than one-third correctly answered six multiple-choice knowledge questions about CF and carrier testing. In multivariate analysis, knowledge and familiarity with the NIH consensus statement were not associated with beginning to discuss CF carrier testing after the CF conference with their patients without a family history.

Evaluating Conservation Education Programs at a South American Zoo

Abstract Zoological parks, nature centers, natural history museums, and related institutions are valuable resources for urban environmental education in developing countries. To determine the effectiveness of conservation education strategies currently in use at such institutions in Colombia, the authors implemented and compared several program formats. A zoo workshop in wildlife conservation targeting elementary school teachers was designed, evaluated, and contrasted with existing programs, including a zoo visit preceded by a slide show, an unstructured visit to the zoo, and a control group. The authors assessed responses from 1,015 fourth-grade students in 26 randomly selected schools in Cali, Colombia. Students in the four experimental groups completed a pretreatment and a posttreatment questionnaire comprising an achievement test with 18 multiple-choice knowledge questions and a 16-statement, 5-point attitude scale. Test results indicated that knowledge and attitude scores of students whose teachers p...