Sessions In Year Research Articles

Results from “Live Well”, a randomized controlled community-based participatory intervention to prevent obesity in new immigrant mother–child dyads

BackgroundUpon arrival, the prevalence of overweight and obesity is lower in new immigrants than their native counterparts in the U.S. With longer residency in the U.S., these differences converge over time, followed by higher prevalence among immigrants than native U.S. residents. Results from the Live Well project in the Greater Boston area demonstrate the viability of utilizing a culturally adapted, community-based participatory research (CBPR) approach to reduce weight gain among newly immigrated mother–child dyads.MethodsHaitian, Latina, and Brazilian mother–child dyads (n = 390), new to the U.S. (fewer than 10 years) were enrolled in a one- to two-year long CBPR lifestyle intervention that targeted dietary and physical activity behaviors. Attendance was recorded to establish dose. Demographics, anthropometrics, and relevant covariates were collected from participants at baseline, 6, 12, 18, and 24 months. Body Mass Index (BMI) was calculated using objectively measured height and weight. Linear mixed regression models were used to assess change in BMI and BMI z-score of mothers and children respectively.ResultsAt baseline, nearly 75% of mothers and 50% of children were either overweight or obese (BMI ≥ 25.0 and BMI z-score ≥ 85th percentile, respectively). Only 20% of mothers attended all 12 intervention sessions in year 1. Using intent-to-treat analyses, no significant time, intervention, or time × intervention effects were observed for weight change of mothers or children at follow-up. Mothers in the highest quantile (those who attended all 12 intervention sessions) had significant reductions in BMI at 18 months (1.76 units lower, 95%CI: -3.14, -0.37) and 24 months (2.61 units, 95%CI -3.92, -1.29) compared to mothers in the lower quantiles, including those with no exposure. Such dose effects on BMI z-scores were not noted for children.ConclusionsFindings from Live Well demonstrate the viability of utilizing a CBPR approach to address overweight and obesity among immigrant mothers. Given the higher-than-expected prevalence of overweight and obesity among mother–child dyads by ~ 6 years of U.S. residency, and lower maternal participation rates in the intervention, additional research is necessary to identify the optimal intervention length, retention strategies, and approach to jointly support healthy maternal and child weight.

Confidence, Connection & Collaboration: Creating a Scalable Bias Reduction Improvement Coaching Train-the-Trainer Program to Mitigate Implicit Bias across a Medical Center

Problem: Academic medical centers need to mitigate the negative effects of implicit bias with approaches that are empirically-based, scalable, sustainable, and specific to departmental needs. Guided by Kotter’s Model of Change to create and sustain cultural change, we developed the Bias Reduction Improvement Coaching Program (BRIC), a two-year, train-the-trainer implicit bias coaching program designed to meet the increasing demand for bias training across a university medical center. Intervention: BRIC trained a cohort of faculty and staff as coaches during four quarterly training sessions in Year 1 that covered 1) the science of bias, 2) bias in selection and hiring, 3) bias in mentoring, and 4) bias in promotion, retention, and workplace culture. In Year 2, coaches attended two booster sessions and delivered at least two presentations. BRIC raises awareness of bias mitigation strategies in a scalable way by uniquely building capacity through department-level champions, providing programming that addresses the ‘local context,’ and setting a foundation for sustained institutional change. Context: In a U.S. academic medical center, 27 faculty and staff from 24 departments were trained as inaugural BRIC coaches. We assessed outcomes at multiple levels: BRIC coach outcomes (feedback on the training sessions; coach knowledge, attitudes, and skills), departmental-level outcomes (program attendee feedback, knowledge, and intentions) and institutional outcomes (activities to sustain change). Impact: After Year 1, coaches reported high satisfaction with BRIC and a statistically significant increase in self-efficacy in their abilities to recognize, mitigate, and teach about implicit bias. In Year 2, attendees at BRIC coach presentations reported an increase in bias mitigation knowledge, and the majority committed to taking follow-up action (e.g., taking an Implicit Association Test). Coaches also launched activities for sustaining change at the broader university and beyond. Lessons Learned: The BRIC Program indicates a high level of interest in receiving bias mitigation training, both among individuals who applied to be BRIC coaches and among presentation attendees. BRIC’s initial success supports future expansion. The model appears scalable and sustainable; future efforts will formalize the emerging community of practice around bias mitigation and measure elements of on-going institutional culture change.

Telehealth acceptance and commitment therapy for weight loss: Protocol of the WeLNES full scale randomized controlled trial

Behavioral interventions delivered via one-on-one telephone coaching (hereafter referred to as telehealth) for weight loss have had great population-level reach but to date limited efficacy. Acceptance and Commitment Therapy (ACT) has promise to improve behavioral weight loss treatment efficacy by addressing the fundamental challenges of weight loss and maintenance: overeating in response to internal (e.g., stress) and external (e.g., high calorie foods) cues. Here we describe the Weight Loss, Nutrition, and Exercise Study (WeLNES) randomized controlled trial that is testing the efficacy of an ACT-based telehealth coaching intervention for weight loss in comparison to a Standard Behavioral Therapy (SBT)-based telehealth coaching intervention. A total of 398 adults with overweight or obesity are being recruited and randomized to either ACT or SBT telehealth coaching. Participants in both arms are offered twenty-five telehealth coaching sessions in year one and nine booster sessions in year two. All participants receive a Bluetooth-enabled scale to self-monitor weight and a Fitbit Inspire + Fitbit app for tracking diet and physical activity. The primary aim is to determine whether a greater proportion of ACT participants will achieve a clinically significant weight loss of ≥10% compared with SBT participants at 12-months. Secondary outcomes include change in weight from baseline to 6, 12, and 24-months. Whether the effect of ACT on weight loss is mediated by ACT processes and is moderated by baseline factors will also be examined. If ACT proves efficacious, ACT telehealth coaching will offer an effective, broadly scalable weight loss treatment—thereby making a high public health impact.

A cross-programme vertically integrated communication and professionalisation curriculum, adapted from pharmacy for nursing

The Clinical Communication Team at the University of Birmingham are undertaking an ambitious project where students across all healthcare programmes will interact within a single virtual healthcare community – ‘Wood Brooke’ – via simulation activities. The vertical nature of the programme means students can ‘follow’ the illness/life journeys of a series of families that they meet early in the course over a 3–4 year timeframe. Additionally, they can meet and interact with simulated healthcare professionals working in Wood Brooke’s virtual primary, community, and secondary care facilities. Wood Brooke is already well-established throughout our 4-year Pharmacy degree, being integrated into teaching and testing not just for communication, but linked to other clinical aspects of the Programme. We will share our model, and experiences, successes, and challenges. Recently Wood Brooke was adapted for Birmingham’s 3-year BNurs programme as a vertically integrated clinical communication/professionalisation strand. It is well documented that nursing students should be trained in patient-centred communication [1]. Students from Adult, Child, and Mental Health Nursing mix in the sessions for intra-professional learning and breadth of peer support and feedback. Sessions in Year 1 focus on cases relating to three families from Wood Brooke from patient and relative/carer perspectives. Year 2 builds on the simulation to consider intra and interprofessional colleague interactions in community-based and acute settings through telephone and face to face role play simulation. This builds on the 3 family cases introduced in the first year, introducing other members within the family. Year 3 is under development. Feedback from learners about the Programme has been positive. This is not a research project so we will not be presenting ‘data’. A result in progress is rolling Wood Brooke out to other Programmes, including Medicine and Dentistry, as part of curriculum review. Discussion may focus on the potential benefits of healthcare students having shared visibility of patient narratives/experiences where that patient is accessing care under more than one service. Inclusivity and designing a ‘community’ reflective of the population has been central. The vertical development of patient narratives over several years enables adaption of the programme to meet new priorities and needs (including, e.g., shift to remote working for COVID-19, and evolving patient demographics). 1. Gutiérrez-Puertas L, Márquez-Hernández VV, Gutiérrez-Puertas V, Granados-Gámez G, Aguilera-Manrique G. Educational interventions for nursing students to develop communication skills with patients: a systematic review. International journal of environmental research and public health. 2020;17(7):2241.

Dietary intervention influence on physical activity in the Women’s Health Initiative randomized Dietary Modification trial.

10511 Background: In the Women’s Health Initiative (WHI) Dietary Modification (DM) randomized trial, after 8.5 years dietary intervention and 19.5 years cumulative (median) follow-up, dietary intervention participation was associated with a statistically significantly 22% lower breast cancer mortality (P = 0.02). In observational studies, physical activity has been associated with lower breast cancer risk with emerging results now indicating, compared to inactivity, any increase in physical activity has health benefits. Currently, longitudinal data on whether an intervention targeting dietary change influences other health-related behaviors as a gateway effect is limited. To evaluate whether randomization to a dietary intervention was associated with self-directed change in physical activity. Methods: In the WHI DM trial, 48,835 postmenopausal women, ages 50-79 years, with no prior breast cancer and baseline normal mammogram were randomized at 40 US clinical centers to a dietary intervention (19,541) or a comparison group. Dietary goals were to reduce fat intake to 20% of energy and increase intake of vegetable, fruit, and grains addressed in 18 group sessions in year 1 then quarterly. Neither randomization group received specific or ongoing instructions to increase physical activity, but physical activity was referenced in written materials given to the intervention groups in 7 of the 56 sessions. Episodes per week of moderate or vigorous recreational physical activity (MVPA) were collected at baseline and serially through 15.9 years follow-up by self-report questionnaire. Marginal longitudinal logistic regression models were used to assess physically inactive (MVPA = 0) or physically active (MVPA > 0) participants by randomization group. Marginal Poisson regression models estimated mean weekly MVPA by randomization group. Results: 45.6% of participants reported 0 MVPA at baseline which largely persisted throughout follow-up. During cumulative follow-up, relative to the comparison group, dietary intervention group participation was associated with 7% lower physical inactivity rate (odds ratio [OR] 0.93 95% confidence interval [CI] 0.91, 0.95, P < 0.001) and a 4% higher mean MVPA (ratio of means [RM] 1.04 95% CI 1.02, 1.06, P < 0.001). The association between dietary intervention participation with higher physical activity level was stronger with increasing BMI (P-interaction 0.01) and for women with waist circumference ≥ 88 cm (P-interaction 0.02). Conclusions: In conclusion, in a randomized trial setting, a low-fat dietary pattern intervention was associated with a significantly lower physical inactivity rate and significantly higher moderate and vigorous physical activity level which could be associated with health benefits. Clinical trial information: NCT00000611 .

Simulation-Based Course Improves Resident Comfort, Knowledge, and Ability to Manage Surgical Intensive Care Unit Patients

BackgroundSimulation-based education can augment residents' skills and knowledge. We assessed the effectiveness of a simulation-based course for surgery interns designed to improve their comfort, knowledge, and ability to manage common surgical critical care (SCC) conditions. Materials and methodsFor 2 y, all first year residents (n = 31) in general surgery, urology, interventional radiology, and the integrated plastics, vascular, and cardiothoracic surgery training programs at our institution participated in a simulation-based course emphasizing evidence-based management of SCC conditions. Precourse and postcourse surveys and multiple-choice tests, as well as summative simulation tests, assessed interns' comfort, knowledge, and ability to manage SCC conditions. Changes in these measures were assessed with Wilcoxon matched-pairs signed rank tests. Factors associated with summative performance were determined by linear regression. ResultsThe course consisted of four simulation-based teaching sessions in year 1 and six in year 2. The course taught seven of the 18 core SCC conditions in the Surgical Council on Resident Education general surgery curriculum in year 1 and 10 in year 2. Interns' self-reported comfort, knowledge, and ability to manage each condition taught in the course increased (P < 0.02). Their knowledge of each condition, as assessed by written tests, also increased (P < 0.02). Their summative simulation test performance correlated with the number of course sessions attended (P < 0.03) and status as general surgery residents (P < 0.01). ConclusionsA simulation-based SCC training course for surgery interns that emphasizes evidence-based management of SCC conditions improves interns' comfort, knowledge, and ability to manage these conditions.

Elementary school pupils\u2019 co-inventions: products and pupils\u2019 reflections on processes

The study focuses on examining elementary pupils’ (N = 42, 11–13 years old) reflections on collaborative design processes, team collaboration and their co-inventions. Digital and traditional fabrication technologies were used in a 2-year co-invention project containing approximately 16 sessions during year 1 and 11 sessions in year 2. Between the two project periods, the pupils were asked to write a structured essay about their co-invention and design process, and in year 2 they kept journal notes in each team’s design-folder. Each pupil’s structured essay was analyzed with qualitative content analysis that focused on three main aspects: (1) description of the co-invention, (2) progress of the co-invention process and (3) quality of collaboration. Based on the essay analysis, we constructed a “Co-invention Table” with five categories: user, conceptual design, technical design, appearance, and construction. The nature of the 13 pupil-teams’ co-inventions varied greatly, and these co-inventions were divided according to three main functions: (1) improving cleanliness, (2) providing reminders or (3) addressing well-being. The essays provided information on how creative ideas were generated and how critical thinking and evaluation of ideas were crucial in improving ideas for further development. The collaboration was dependent on everyone’s active and equal participation into work and the importance of an adequate division of the labor was highlighted.

We Need a New Approach to Prevent Obesity in Low-Income Minority Populations.

* Abbreviations: COPTR — : Childhood Obesity Prevention and Treatment Research Consortium CPP — : community policy and program CPP-Strat — : community policy and program created to assess either nutrition or physical activity strategy GEMS — : Girls’ Health Enrichment Multi-site Studies HCS — : Healthy Communities Study In the last 2 decades, the National Institutes of Health invested in 2 major multicenter trials aimed at the prevention of obesity in high-risk populations of low-income Hispanic and African American children.1 The trials were the Childhood Obesity Prevention and Treatment Research Consortium (COPTR) and the Girls’ Health Enrichment Multi-site Studies (GEMS). Despite intensive, state-of-the-art, and often creative interventions conducted by seasoned investigators, all 5 of the studies considered below failed to alter the trajectory of weight gain in their participants compared with controls. In this issue of Pediatrics , Moore et al2 describe the most recent of the COPTR studies. This study, conducted in Cleveland, Ohio, is 1 of 4 randomized controlled intervention trials, 2 of which have already been published. In this trial, 360 predominantly African American middle school children (mean age 11.6 years) and their parents were randomly assigned to a HealthyChange intervention, which relied on cognitive behavioral and motivational interviewing strategies that focused on goal setting, problem solving, self-monitoring, and relapse prevention. The control group was a SystemChange intervention that sought to establish family routines, restructured to develop new healthy habits. Both interventions focused on improving diet, physical activity, sleep and stress management, and reducing sedentary behavior. Both interventions included intensive engagement through 25 small-group sessions in the first year, alternating face-to-face and individualized phone sessions in year 2, and 4 face-to-face sessions and 8 individualized phone sessions in year 3. At the end of the 3-year intervention, 90% of enrolled participants remained in the study. No significant differences were observed in annual changes of BMI, waist circumference, or triceps skinfold thickness. Furthermore, no significant differences were observed in diet, physical activity measured by accelerometry, sleep, perceived stress, or cardiometabolic factors. In 2 other COPTR studies that included randomized intensive obesity interventions in low-income, … Address correspondence to William H. Dietz, MD, PhD, Sumner M. Redstone Global Center for Prevention and Wellness, Milken Institute School of Public Health, George Washington University, Room 319, 950 New Hampshire Ave NW, Washington, DC 20052. E-mail: bdietz{at}email.gwu.edu

Evaluation of a novel intervention providing insight into the tobacco industry to prevent the uptake of smoking in school-aged children: a mixed-methods study

ObjectivesEvidence from the US Truth campaign suggests that interventions focusing on tobacco industry practices and ethics may be effective in preventing youth smoking uptake. We developed, piloted and evaluated a...

SHORTHAND AND COGNITION—RESULTS OF A 5 YEAR PILOT STUDY

Background: Cognitive decline is common in the elderly. In a pilot study we test the hypothesis that learning shorthand will preserve cognitive abilities. Shorthand is a special method of writing in short cuts and consist of learning a new “language” and writing speed training. Setting: Ambulatory healthy women from Minden, North Rhine-Westfalia, Germany, independent in all ADLs and IADLs. Methods: We studied a group of 17 right-handed females, mean age 71.8 ± 4.9 years in 2012. A geriatric, extended neuropsychological and clinical assessment was done yearly until January 2017. Training sessions compromise 2 sessions per week in year 1 and 2 followed by 1 session in year 3 to 5. During the study 5 women (2 depression, 1 malignancy, 1 rheumatic disease, 1 move to another city) left the study. Results: Compared to 2012 the assessments in 2016 showed significant improvements in Rey Complex Figure Test (CFM: 76.9 vs 95.1, p=0.0151, and CFQ: 66.1 vs 91.3, p=0.0018) or remained stable without any decline, e.g. MMSE (27.6 vs. 28.6, p=0.053) and others (BAS (p=0.42), SBT (p=0.83), TMT A (p=0.96) + B (p=0.36), Wechsler Memory Scale, Regensburg Word Fluency Test, Test of Attentional Performance). Discussion: Comparing to baseline we found a stable cognitive performance in all participants over 5 years indicating that shorthand learning and training maybe beneficial for preserving cognitive abilities with aging.

THE PHENOMENOLOGICAL MAKE- UP OF SOLO PARENTS’ DEPENDENTS IN REGIONS 2 AND 3 IN THE PHILIPPINES

INTRODUCTION:A solo is any individual who falls under either one of the categories here, who was left alone with the responsibility ofparenthood due to death of (paragraph2 (a) Section3, RA 8972) and parent left solo or alone with the responsibility of parenthood due to abandonment of spouse for at least one year, (paragraph 7 (a) Section 3, RA 8972). Republic Act No. 8972 an act providing for benefits and privileges to solo parents and their children , appropriating funds therefore and for other purposes. Approved on November 07 2000 during the Eleventh Congress Third regular session in year 2000.Parenting behaviors are known to have major impact on children. But it has proven difficult to isolate the specific mechanism of influence (Johnson, et. al., 2012). In this case, parenting lifestyle impact so much on the behavior of their children, especially, if these parents singlehandedly raise their children. The idea of single parenting is a very sensitive issue in family system. It brings risk factor for emotional and behavioral problems in children and adolescents. Family may be defined as A family comprising of a single mother or father having their own dependent children . The single family is created in a number of ways, may be death of one parent, divorce, separation due to job or service condition of the spouse (Inatay, Lifestyle Domains of Single Parents, 2013). Thus, if the dominant care giver is the in which the children have residency with majority of the time. If the parents are separated or divorced children live with their custodial and have visitation with their noncustodial parents, a child will end up with the primary caregiver, usually the mother, and a secondary caregiver, usually the father (Sahu, 2013). Today, one-third of American children - a total of 15 million - are being raised without a father. Nearly more than five million children live without a mother (Andersen, 2013).This research focused on the two sections of the law that give emphasis on the whole picture of a solo dependent who is innocent of the cause among their parents parted ways, who was left alone with the responsibility ofparenthood due to death of (paragraph2 (a) Section3, RA 8972) and parent left solo or alone with the responsibility ofparenthood due to abandonment of spouse for at least one year, (paragraph 7 (a) Section 3, RA 8972). These dependents are pondering why their abandoned them. Solo parenting is often a result of annulment of marriages as decreed by a court or by a church as long as she/he is entrusted with the custody of the children, or the spouse is in jail or is serving sentence for a criminal conviction for at least one year, or due to physical and or mental incapacity of spouse as certified by a public medical practitioner; legal separation or any family member who assumes the responsibility of head of family as a result of the death, abandonment, disappearance or prolonged absence of the parents or solo parents (Sec 3, RA 8972).This research was then conducted due to the stated premises that solo dependents are looking and longing for both care and strong parental love.OBJECTIVES:To identify the lifestyles, experiences, challenges, psycho-social behavior, coping mechanism and aspirations of the solo parents dependents.To be familiar with the challenges, coping mechanism and their aspirations in life.LOCALE OF THE STUDY:This study was conducted at Nueva Ecija University of Science and Technology, Cabanatuan City, Philippines.SCOPE AND LIMITATIONS:The study was focused on the solo dependents, their lifestyles, experiences, psycho -social behavior and academic performance. The study was conducted during the first semester of academic year 2012 - 2013. Only those respondents that qualified for the provisions of paragraph 2(a) and paragraph 7(a), RA 8972 were included. …

Operation Smoke Storm: effectiveness of a school-based smoking prevention intervention providing insight into the tobacco industry

BackgroundAssessment of the US Truth campaign showed that mass media campaigns informing children about tobacco industry practices are effective in preventing smoking uptake. The aim of this study was to assess the potential effectiveness of a school-based intervention, based on the premise of Truth, in reducing ever smoking and susceptibility to smoking among children in the UK. MethodsData come from a pilot study intended to test the acceptability of the intervention and ease of delivery, and to provide preliminary evidence of effectiveness before further assessment in a randomised trial. 445 students in two schools in the East Midlands, UK, completed anonymous questionnaires in Year 7 (ie, aged 11–12 years) and Year 8 (12–13), before and after receiving the Operation Smoke Storm intervention. This intervention consisted of three teacher-led sessions that combined interactive paper-based and audio-visual components in Year 7 and one booster session in Year 8. We used multilevel logistic regression (students nested within schools), adjusted for confounders, to compare the odds of smoking and susceptibility at follow-up in students who received Operation Smoke Storm with 1692 students in eight local schools who were asked identical questions about smoking behaviour as part of another survey but who did not receive the intervention. The study was approved by the University of Nottingham Medical School Research Ethics Committee (reference C13122012 CHS EPH Smoking). FindingsPrevalence of ever smoking or susceptibility to smoking was similar in intervention and control schools in Year 7. In Year 8, 34 students (7·6%) who received Operation Smoke Storm reported ever smoking and 111 (24·9%) reported susceptibility to smoking; 175 students (10·3%) who did not receive Operation Smoke Storm reported ever smoking and 329 (19·4%) reported susceptibility. There was no significant difference in the odds of a combined outcome of ever smoking or susceptibility to smoking in students who received the intervention compared with controls (adjusted odds ratio 1·28, 95% CI 0·83–1·97; p=0·263), and no difference in odds of ever smoking (0·82, 0·42–1·58; p=0·549). InterpretationOperation Smoke Storm does not seem to have reduced smoking and susceptibility to smoking among students aged 12–13 years in two UK schools. Qualitative analysis is ongoing to explore students’ and teachers’ perceptions of Operation Smoke Storm and potential reasons to explain the apparent lack of effectiveness. FundingThe National Institute for Health Research Public Health Research Programme (NIHR PHRP) (project number 11/3010/02). The funder had no role in the writing of the abstract or the decision to submit.

How well do medical students rate and communicate clinical empathy?

Background: This article presents findings from a prospective, longitudinal cohort educational study investigating empathy communication in clinical consultations. It reports on changes in students’ self-report empathy during medical undergraduate training, investigates how well peers can assess student competence in motivational interviewing/brief interventions (MI/BI) skills and explores the relationship between students’ self-report empathy and peer- or tutor-assessments of competence.Methods: 72 medical students completed the Jefferson Scale of Physician Empathy at three time points: at the beginning of their fifth year medical training (Time 1), after a specific MI/BI training session during their fifth year medical training (Time 2) and 1 year later during a revision session in year 6. Competence in BI/MI consultation was assessed using the validated tool Behaviour Change Counselling Index.Results: A significant decline in medical students’ empathy scores was observed from year 5 to year 6, consistent with international findings. Peer assessments and tutor ratings of competence in MI/BI skills performance were moderately correlated, but peer assessments were negatively correlated with medical students’ self-rated empathy. Senior medical students who self-rated as more empathic received lower competence evaluations of MI/BI skills from their peers. Interventions to further investigate teaching and learning of empathy are discussed.

Cross-sectional evaluation of a longitudinal consultation skills course at a new UK medical school

BackgroundGood communication is a crucial element of good clinical care, and it is important to provide appropriate consultation skills teaching in undergraduate medical training to ensure that doctors have the necessary skills to communicate effectively with patients and other key stakeholders. This article aims to provide research evidence of the acceptability of a longitudinal consultation skills strand in an undergraduate medical course, as assessed by a cross-sectional evaluation of students' perceptions of their teaching and learning experiences.MethodsA structured questionnaire was used to collect student views. The questionnaire comprised two parts: 16 closed questions to evaluate content and process of teaching and 5 open-ended questions. Questionnaires were completed at the end of each consultation skills session across all year groups during the 2006-7 academic year (5 sessions in Year 1, 3 in Year 2, 3 in Year 3, 10 in Year 4 and 10 in Year 5). 2519 questionnaires were returned in total.ResultsStudents rated Tutor Facilitation most favourably, followed by Teaching, then Practice & Feedback, with suitability of the Rooms being most poorly rated. All years listed the following as important aspects they had learnt during the session:• how to structure the consultation• importance of patient-centredness• aspects of professionalism (including recognising own limits, being prepared, generally acting professionally).All years also noted that the sessions had increased their confidence, particularly through practice.ConclusionsOur results suggest that a longitudinal and integrated approach to teaching consultation skills using a well structured model such as Calgary-Cambridge, facilitates and consolidates learning of desired process skills, increases student confidence, encourages integration of process and content, and reinforces appreciation of patient-centredness and professionalism.

Case Western Reserve University School of Medicine and Cleveland Clinic

Case Western Reserve University School of Medicine and Cleveland Clinic

Improving residents’ teaching skills: A program evaluation of residents as teachers course

Background: The role of residents as teachers is recognized as an important part of medical education. However, residents may not possess the practical skills needed to teach medical students effectively.Aim: In response to a Liaison Committee on Medical Education citation concerning surgery residents’ teaching skills, the University of Louisville School of Medicine instituted a campus-wide residents as teachers program based on the bringing education and service together curriculum.Methods: This evaluation plan is grounded on Kirkpatrick's four levels model. Levels 1 and 2 data included post-session learner questionnaires (2007 and 2008) and open-ended facilitator questionnaires (2008). Levels 3 and 4 data included third year medical students’ responses to CourseEval® questions on residents as teachers (2005–2006 and 2007–2008) and data from third year medical student focus groups (2008).Results: Levels 1 and 2 data analysis showed statistically significant improvements from session to session in Year I and significant improvements between Years I and II. Levels 3 and 4 data analysis showed third year students’ perceptions of most residents as teachers remained high and improved significantly in the surgery clerkship.Conclusion: Short-term and long-term measures show this curriculum to be successful for an interdisciplinary group of residents.

Does psychological counseling alter the natural history of inflammatory bowel disease?

There is increasing evidence that psychological stress can increase mucosal inflammation and worsen the course of inflammatory bowel disease (IBD). We have now assessed whether psychotherapy by a counselor specially trained in the management of IBD can influence the course of disease. Using retrospective case note review, we compared the course of IBD in 24 patients (13 ulcerative colitis; 11 Crohn's disease), during the year before (year 1) and the year after referral (year 2) for supportive outpatient psychotherapy to an IBD counselor, to that of 24 IBD controls who were matched to individual cases for age, sex, disease, duration of disease, medication at baseline, and for relapse rate in year 1. Counselor assessments were made using a visual analog scale 0-6 (0 denotes poor, 6 excellent response to counseling). The results are shown as median (range). Patients were referred for counseling because of disease-related stress (14 patients), work problems (3), concerns about surgery (5), and bereavement (2); they received 6 (1-13) 1-hour sessions in year 2. In the year after starting counseling (year 2), patients had fewer relapses (0 [0-2]) and outpatient attendances (3.5 [1-10]) than in the year before referral (year 1) (2 [0-5], P = 0.0008; and 6.5 [1-17], P = 0.0006, respectively; furthermore, steroid usage (1 course [0-4] before, 0 [0-2] after, P = 0.005) and relapse-related use of other IBD medications declined during psychotherapy (1 drug [0-5] before, 0 [0-2] after, P = 0.002). There were no differences in any of these measures between years 1 and 2 in the control group. Numbers of hospital admissions did not change between year 1 and 2 in either group. In the 20 patients who attended >1 session counseling helped solve stress-related difficulties (counselor's score 4 [3-5]), the counselor scored them 4 (3-6) overall in psychological well-being after the counseling sessions. IBD-focused counseling may improve not only psychological well-being, but also the course of IBD in individuals with psychosocial stress.

Multifamily Group Treatment for Schizophrenia

Multifamily Group Treatment for Schizophrenia

Students’ and teachers’ perceived and actual verbal interactions in seminar groups

This study set out to examine how much time students and teachers devote to different learning-oriented interactions during seminar sessions and students' and teachers' perceptions about the occurrence and desirability of these interactions. Students and teachers participating in eight seminar group sessions in Year 4 of an undergraduate veterinary curriculum completed an 11-item questionnaire which asked them to rate, on a 5-point Likert scale, the frequency of occurrence and level of desirability of three learning-oriented types of interaction: exploratory questioning; cumulative reasoning, and handling of conflict about knowledge. The questionnaire also invited positive and negative responses to aspects of group interactions and an overall mark (1-10) for the seminars and group interactions. Four group sessions were video-recorded and analysed using a coding scheme. The amount of time devoted to the different interactions was calculated. Both students and teachers gave scores of 3.0-3.5 for frequency of occurrence of exploratory questioning and cumulative reasoning and < 3.0 for occurrence of handling of conflict about knowledge. The desired occurrences of all interaction types were significantly higher than the actual occurrences according to students and teachers. Teachers were responsible for the majority of the interactions (93%). The percentages of session time devoted to teacher-centred cumulative reasoning, exploratory questioning and handling of conflict about knowledge were 65.8%, 15.6% and 3.1%, respectively. Group interactions in seminar groups are dominated by the posing of questions by teachers to students. The moderate occurrence of group interactions as perceived by students and teachers may be explained by the inadequate preparation of teachers and students to stimulate group interactions.

Analysis of verbal interactions in tutorial groups: a process study

Collaborative learning, including problem-based learning (PBL), is a powerful learning method. Group interaction plays a crucial role in stimulating student learning. However, few studies on learning processes in medical education have examined group interactions. Most studies on collaboration within PBL used self-reported data rather than observational data. We investigated the following types of interactions in PBL tutorial groups: learning-oriented interactions (exploratory questioning, cumulative reasoning and handling conflicts about knowledge); procedural interactions, and irrelevant/off-task interactions. The central question concerned how much time is spent on the different types of interaction during group sessions and how the types of interaction are distributed over the meeting. Four tutorial group sessions in Year 2 of the PBL undergraduate curriculum of Maastricht Medical School were videotaped and analysed. The sessions concerned the reporting phase of the PBL process. We analysed the interactions using a coding scheme distinguishing several verbal interaction types, such as questions, arguments and evaluations. Learning-orientated interactions accounted for 80% of the interactions, with cumulative reasoning, exploratory questioning and handling conflicts about knowledge accounting for about 63%, 10% and 7% of the interactions, respectively. Exploratory questioning often preceded cumulative reasoning. Both types occurred throughout the meeting. Handling conflicts mainly occurred after the first 20 minutes. Task involvement in the tutorial groups was high. All types of learning-orientated interactions were observed. Relatively little time was spent on exploratory questions and handling conflicts about knowledge. Problem-based learning training should pay special attention to stimulating discussion about contradictory information.