Background: Dementia diagnosis and management is increasing in importance in the training of future family physicians. This research evaluated the effects of a dementia education program on family medicine residents’ knowledge, attitudes and confidence with respect to dementia assessment and management. A questionnaire was developed and validated for these purposes. Additionally, a focus group was conducted with family physicians to generate recommendations for improving dementia education in family medicine residency programs. Methods: The questionnaire consisted of a knowledge-based component, a component ascertaining preferences working with various age groups, and an attitudinal/comfort component. Test-retest reliability was assessed, in addition to validity by way of cognitive interviews. A content validity matrix was also completed. Family medicine residents participating in the dementia education program were asked to complete the questionnaire at baseline, interim and following program completion. Willing residents also participated in program feedback interviews. After approximately three months, residents completed the questionnaire for long-term follow-up. Differences in scores were examined between the participants and a comparison group of family medicine residents without program exposure. Qualitative data from the feedback interviews and the focus group were transcribed and analyzed for common themes. Results: Each questionnaire component demonstrated high internal consistency (Cronbach’s α: 0.83-0.91) and high intraclass correlation coefficients (0.74-0.91). Residents who had participated in the program scored significantly higher on the knowledge component compared to residents who did not, in addition to reporting greater comfort. Qualitative data indicated that residents found the program to be a valuable part of their residency education. Focus group results indicate that family physicians recommend the provision of early positive experiences facilitated by mentors, through a competency-based curriculum. Discussion: The developed questionnaire is a reliable measure for assessing dementia knowledge, attitudes and confidence. Results from the dementia education program show that it is effective in improving family medicine residents’ knowledge on dementia diagnosis and management, as well as in increasing comfort levels. Qualitative data from feedback interviews indicate strong endorsement of the program by its participants. Recommendations generated from the focus group were found to be relevant to dementia education and potentially more broadly to geriatric education.

Thesis (Ph. D.)--University of Missouri-Columbia, 2001. / Typescript. Vita. Includes bibliographical references (leaves 249-259). Also available on the Internet.

Thesis (Ph. D.)--University of Missouri-Columbia, 2001. / Typescript. Vita. Includes bibliographical references (leaves 249-259). Also available on the Internet.

Healthcare in the United States experienced a remarkable transformation during the late 19th and early 20th centuries. While this transformation is well documented in descriptive historical accounts there are few empirical studies investigating the mechanisms through which reform was disseminated or the affects of the reform on healthcare. To this end, this dissertation examines four issues related to changes in the American healthcare industry during the early 1900's.Chapter 2 examines changes in medical education. This chapter provides a qualitative analysis of motivations behind the medical education reforms in America and an empirical analysis of the shakeout of medical schools that occurred from 1905 to 1920. Licensing laws and medical school reviews were found to have influenced exiting decisions of many medical schools. Reform of medical education in America was followed by a disproportionate decline of physician supply in rural areas. Along these lines, Chapter 3 provides a case study of the geographic distribution of physicians during the early 20th Century. Data on individual physicians was compiled to analyze variation in physician counts across counties and to investigate out-migration of rural county physicians. This analysis indicates physicians were drawn more and more to areas offering better financial opportunities, greater access to medical facilities, and more opportunity for professional contact.It is unclear to what extent patients initially benefited from the changes in medicine. Chapters 4 and 5 focus on one aspect of this issue by examining the impact of physicians on mortality rates. Chapter 4 utilizes the individual physician data from Chapter 3 to assess whether variation in physician counts explain variation in infant and non-infant mortality rates across counties. Estimates indicate that physicians were still unable to reduce mortality in the early 1920's. Chapter 5 focuses on the impact on maternal mortality resulting from the transition of childbirth during the first half of the 20th Century from the home to the hospital setting. Using hospital beds as a proxy for medical inputs, regression analysis revealed that the transition may have contributed to more maternal deaths until the introduction of sulfa drugs in the late 1930's.

The surgical culture values certainty and confidence, and this was proposed to be a source of internal conflict for surgeons, particularly during times of stress and uncertainty. Surgeons previously described the need to manage their image during these times, putting on an external appearance that is inconsistent internally. As part of a larger program of research on surgical judgment and decision making, this study used a constructivist grounded theory approach to explore 15 general surgery trainees’ perceptions and experiences of impression management during moments of decision making. Residents described their perceived expectations in training, and the impression management strategies they used to appear as though they were meeting them in circumstances when they were not. Participants described those who did not meet these expectations as branded the ‘struggling resident’. Concerns about one’s impression had implications for residents’ evaluations, learning opportunities, decision making, and wellness.

The surgical culture values certainty and confidence, and this was proposed to be a source of internal conflict for surgeons, particularly during times of stress and uncertainty. Surgeons previously described the need to manage their image during these times, putting on an external appearance that is inconsistent internally. As part of a larger program of research on surgical judgment and decision making, this study used a constructivist grounded theory approach to explore 15 general surgery trainees’ perceptions and experiences of impression management during moments of decision making. Residents described their perceived expectations in training, and the impression management strategies they used to appear as though they were meeting them in circumstances when they were not. Participants described those who did not meet these expectations as branded the ‘struggling resident’. Concerns about one’s impression had implications for residents’ evaluations, learning opportunities, decision making, and wellness.

Background: Dementia diagnosis and management is increasing in importance in the training of future family physicians. This research evaluated the effects of a dementia education program on family medicine residents’ knowledge, attitudes and confidence with respect to dementia assessment and management. A questionnaire was developed and validated for these purposes. Additionally, a focus group was conducted with family physicians to generate recommendations for improving dementia education in family medicine residency programs. Methods: The questionnaire consisted of a knowledge-based component, a component ascertaining preferences working with various age groups, and an attitudinal/comfort component. Test-retest reliability was assessed, in addition to validity by way of cognitive interviews. A content validity matrix was also completed. Family medicine residents participating in the dementia education program were asked to complete the questionnaire at baseline, interim and following program completion. Willing residents also participated in program feedback interviews. After approximately three months, residents completed the questionnaire for long-term follow-up. Differences in scores were examined between the participants and a comparison group of family medicine residents without program exposure. Qualitative data from the feedback interviews and the focus group were transcribed and analyzed for common themes. Results: Each questionnaire component demonstrated high internal consistency (Cronbach’s α: 0.83-0.91) and high intraclass correlation coefficients (0.74-0.91). Residents who had participated in the program scored significantly higher on the knowledge component compared to residents who did not, in addition to reporting greater comfort. Qualitative data indicated that residents found the program to be a valuable part of their residency education. Focus group results indicate that family physicians recommend the provision of early positive experiences facilitated by mentors, through a competency-based curriculum. Discussion: The developed questionnaire is a reliable measure for assessing dementia knowledge, attitudes and confidence. Results from the dementia education program show that it is effective in improving family medicine residents’ knowledge on dementia diagnosis and management, as well as in increasing comfort levels. Qualitative data from feedback interviews indicate strong endorsement of the program by its participants. Recommendations generated from the focus group were found to be relevant to dementia education and potentially more broadly to geriatric education.

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This study examined diagnostic problem solving and post-problem reflection in medical students, residents, and experts. Participants worked on three internal medicine cases from the computer-based learning environment, BioWorld. The analyses focused on general performance measures, problem solving operators and knowledge states, and post-problem reflection activities. Verbal protocol data was collected and examined using a coding scheme developed and implemented with the N-Vivo software. Students and residents differed in overall diagnostic accuracy, and significant differences were found in solution time and the number of utterances made for cases of varying difficulty. Differences in the use of operators and knowledge states are highlighted, although the groups were quite similar on many measures. The experts spent considerably more time working on case history information, consistently engaged in planning, and always generated the correct diagnosis (among others) in response to case history information. During post-problem reflection students used more case history data than residents. Expert models highlight the experts' problem solving cycle that consisted of reviewing data, identifying hypotheses, and planning. Post-questionnaire results indicate that participants found the cases to be interesting, useful for learning, but not especially difficult. Finally, several implications are drawn for the future development of BioWorld for medical training.

The growth of medical anthropology as a distinct sub-discipline has opened up many new roles for anthropologists within the medical field, and identified an ever wider range of mutual interests. In this study the anthropologists role as a teacher in the basic medical curriculum is examined in order to determine whether "broad and general relevance" exists between the two fields. / Field data is analyzed from 2 1/2 years active participation teaching at a newly founded medical school in the North Mexican industrial of Monterrey, Nuevo Leon. Information on institutions history and social structures, student values and attitudes toward the professional medical milieu, and responses to specific teaching material is discussed as components of the decision making process which led to role definition. The differences between classroom and field teaching of anthropology were explored in connection with an urban vaccination campaign and an experimental field course in a bi-ethnic rural community of the sierra tarahumara (Chihuahua). The medical school is seen as a reflection of the community and professional context which surrounds it, and the need to make anthropological teaching congruent to its particular needs and circumstances is stressed. / The study concludes that general relevance has not yet been achieved due to the lack of a definable clinical role for the anthropologist, and unresolved conflicts between the biological and anthropological models of man.