Thesis (M.S.)--University of Michigan, 1996. / Includes bibliographical references.

Thesis (M.S.)--University of Michigan, 1980.

Thesis (M.S.)--University of Michigan, 1980.

This thesis explores the support of learning through reflection, in the context of medical students and practitioners, working through a series of simulated consultations involving the diagnosis and management of chronic illness. A model of the medical consultative process was defined, on which a web-based patient simulation was developed. This simulation can be accessed over the Internet using commonly available web-browsers. It enables users to interact with a virtual patient by taking a history, examining the patient, requesting and reviewing investigations, and choosing appropriate management strategies. The virtual patient can be reviewed over a number of consultations, and the patient outcome is dependant on the management strategy selected by the user. A second model was also developed, that adds a layer of reflection over the consultative process. While interacting with the virtual patient users are asked to formulate and test their hypotheses. Simple tools are included to encourage users to record their observations and thoughts for further learning, as well as providing links to web-based library resources. At the end of each consultation, users are asked to review their actions and indicate whether they think their actions were critical, relevant, or not relevant to the diagnosis and management of the patient in light of their current knowledge. Users also have the opportunity to compare their activity to their peers or an expert in the case under study. Three formal cycles of evaluation were undertaken during the design and development of the software. A number of clinicians were involved in the initial design to ensure there was an appropriate structure that matched clinical practice. Formative evaluation was conducted to review the usability of the application, and based on user feedback a number of changes were made to the user interface and structure of the application. A third, end user, evaluation was undertaken using a single case concerning the diagnosis and management of hypertriglyceridaemia in the context of Type 1B Glycogen Storage Disease. This evaluation involved ten medical students, five general practitioners and two specialists. The evaluation involved observation using a simplified think-aloud, as well as administration of a questionnaire. Users were engaged by the simulation, and were able to use the application with only a short period of training. Usability issues still exist with respect to the processing of natural language input, especially when asking questions of the virtual patient. Until such time that natural language recognition is able to provide satisfactory performance, alternative, list-based, methods of interaction will be required. Evaluation involving medical students, general practitioners, and specialist medical practitioners demonstrated that reflection can be supported and encouraged by providing appropriate tools, as well as by judiciously interrupting the consultative process and providing time for reflection to take place. Reflection could have been further enhanced if users had been educated on reflection as a learning modality prior to using SIMPRAC. Further work is also required to improve the simulation environment, improve the interfaces for supporting reflection, and further define the benefits of using this approach for medical education and professional development with respect to learning outcomes and behavioural change.

This thesis explores the support of learning through reflection, in the context of medical students and practitioners, working through a series of simulated consultations involving the diagnosis and management of chronic illness. A model of the medical consultative process was defined, on which a web-based patient simulation was developed. This simulation can be accessed over the Internet using commonly available web-browsers. It enables users to interact with a virtual patient by taking a history, examining the patient, requesting and reviewing investigations, and choosing appropriate management strategies. The virtual patient can be reviewed over a number of consultations, and the patient outcome is dependant on the management strategy selected by the user. A second model was also developed, that adds a layer of reflection over the consultative process. While interacting with the virtual patient users are asked to formulate and test their hypotheses. Simple tools are included to encourage users to record their observations and thoughts for further learning, as well as providing links to web-based library resources. At the end of each consultation, users are asked to review their actions and indicate whether they think their actions were critical, relevant, or not relevant to the diagnosis and management of the patient in light of their current knowledge. Users also have the opportunity to compare their activity to their peers or an expert in the case under study. Three formal cycles of evaluation were undertaken during the design and development of the software. A number of clinicians were involved in the initial design to ensure there was an appropriate structure that matched clinical practice. Formative evaluation was conducted to review the usability of the application, and based on user feedback a number of changes were made to the user interface and structure of the application. A third, end user, evaluation was undertaken using a single case concerning the diagnosis and management of hypertriglyceridaemia in the context of Type 1B Glycogen Storage Disease. This evaluation involved ten medical students, five general practitioners and two specialists. The evaluation involved observation using a simplified think-aloud, as well as administration of a questionnaire. Users were engaged by the simulation, and were able to use the application with only a short period of training. Usability issues still exist with respect to the processing of natural language input, especially when asking questions of the virtual patient. Until such time that natural language recognition is able to provide satisfactory performance, alternative, list-based, methods of interaction will be required. Evaluation involving medical students, general practitioners, and specialist medical practitioners demonstrated that reflection can be supported and encouraged by providing appropriate tools, as well as by judiciously interrupting the consultative process and providing time for reflection to take place. Reflection could have been further enhanced if users had been educated on reflection as a learning modality prior to using SIMPRAC. Further work is also required to improve the simulation environment, improve the interfaces for supporting reflection, and further define the benefits of using this approach for medical education and professional development with respect to learning outcomes and behavioural change.

Thesis (M.S.)--University of Michigan, 1985.

Un nombre croissant de professionnels qui pratiquent l'éducation thérapeutique du patient s'interrogent sur leurs pratiques et considèrent qu'une éducation qui vise seulement une meilleure compliance ou adhésion au traitement par la transmission d'informations en rapport avec la maladie et le traitement est inefficace et fortement réductrice de la personne malade. Ces professionnels considèrent que dans le cadre de la relation de soins, les patients doivent avoir une place pour exprimer leurs préférences et leurs réticences, ce qu'ils espèrent pour eux et ce qui est difficile pour eux dans leur vie de tous les jours, afin de participer au choix des modalités de leur traitement, qui acquiert alors un statut de traitement « proposé » et «négocié », plutôt que «prescrit» par le médecin. Une telle relation de soins, qui s'appuie sur un patient-sujet, s'inspire d'une philosophie humaniste qui affirme le droit à l'auto-détermination de chaque individu et qui reconnaît à chaque personne la capacité et le désir d'être l'acteur de sa vie. Dans une telle perspective, la finalité de l'éducation est de permettre aux patients d'exercer un meilleur contrôle sur leur vie, et pas seulement sur leur maladie et leur traitement. Il est courant d'utiliser le terme de « empowerment » pour désigner ce processus par lequel une personne malade, au départ d'une situation ou d'un sentiment d'impuissance (powerlessness), augmente sa capacité à identifier et satisfaire ses besoins, résoudre ses problèmes et mobiliser ses ressources, de manière à avoir le sentiment de contrôler sa propre vie. Afin de mieux comprendre dans quelle mesure les soignants peuvent effectivement contribuer à l'empowerment des patients atteints de maladie chronique, la signification de l'empowerment du patient a été explorée par une double approche : 1. exploration de la signification de l'empowerment en tant qu'expérience vécue par des patients atteints de maladie chronique : 40 entretiens qualitatifs semi-dirigés ; 12 maladies représentées ; méthodes d'analyse inspirées de la phénoménologie et de la théorisation ancrée (grounded theory). 2. exploration de la signification de l'empowerment en tant que concept utilisé à des fins de recherche ou de pratique : revue de littérature portant sur 55 articles scientifiques parus entre 1995 et 2006 ; analyse qualitative de contenu. Alors que les résultats de la revue de littérature présentent les finalités de l'empowerment comme étant essentiellement la capacité de participation dans la relation de soins et un sentiment de maîtrise quant à l'adoption et au maintien de comportements d'auto-soins, l'analyse des entretiens montre que les situations ou sentiments d'impuissance à partir desquels un processus d'empowerment est susceptible d'émerger dépassent largement ces questions. En effet, les personnes malades expriment souvent être ou avoir été confrontées à des sentiments d'insécurité et de rupture d'identité, qui ont été (ou non) à l'origine d'un processus de transformation personnelle, au cours duquel un effort de dissociation identitaire visant à développer ou maintenir un sentiment de maîtrise était accompagné d'un travail de réconciliation identitaire, marqué par la capacité de "lâcher prise" et une recherche de sens, visant à acquérir un plus grand sentiment de cohérence.

Diss. (sammanfattning) Umeå : Univ., 2002. / Härtill 5 uppsatser.

Thesis equivalent (M.P.H.)--University of Michigan, 1947.

Thesis (M.S.)--University of Michigan, 1971.