The United States has the highest incarceration rate in the world. The millions of people in prison across the country experience numerous health disparities and injustices despite having a constitutional right to health care. In chapter 1, the issues surrounding health inequity in prison are highlighted through two case studies on patient autonomy. From a bioethical standpoint, patient autonomy is integral to a person’s health, yet it is frequently violated in prison in multiple ways, including a lack of informed consent and the censorship of health literature. Greater awareness and advocacy efforts are needed to safeguard patient health within the carceral system.Chapter 2 highlights the importance of incorporating prison health into medical education, where currently few opportunities exist. In recent years, medical school curricula have placed increasing emphasis on the social determinants of health, which include prison health. Service-learning offers a potential means for incorporating prison health education into medical school curricula, as it represents an experiential learning modality that facilitates the formation of relationships between medical students and the surrounding community. The Lewis Katz School of Medicine’s prison health service-learning program was established in collaboration with Prison Health News and serves as one example for how students can learn about the social determinants of health and play a direct role in advocating for marginalized patient populations. / Urban Bioethics

Diversifying the physician workforce is crucial for addressing healthcare disparities. Despite efforts to promote diversity, residency programs still have low representation of Black/African Americans. Our research, drawn from articles in the Temple University Libraries Database and Google Scholar Database up to March 2024, highlights differences in perceptions of program culture and racial diversity between URIM and non-URIM applicants. URIM applicants consider factors such as the authenticity of diversity, equity, and inclusion (DEI) efforts, as well as the racial climate when evaluating programs. Additionally, representation of URIM faculty and residents along with post-interview communication and events are important factors when assessing residency programs. There is limited literature on how Black/African American applicants' preferences influence diversity recruitment efforts. It is imperative for programs to incorporate feedback from URIM applicants to develop effective recruitment strategies and foster cultural shifts. By doing so, we can contribute to a more diverse and inclusive physician workforce capable of more effectively addressing health disparities that disproportionately affect Black/African Americans. / Urban Bioethics

This dissertation explores creating a set of domain-specific learning materials for the biomedical sciences to meet the educational gap in biomedical informatics, while also meeting the call for statisticians advocating for process improvements in other disciplines. Data science educational materials are plenty enough to become a commodity. This provides the opportunity to create domain-specific learning materials to better motivate learning using real-world examples while also capturing intricacies of working with data in a specific domain. This dissertation shows how the use of persona methodologies can be combined with a backwards design approach of creating domain-specific learning materials. The work is divided into three (3) major steps: (1) create and validate a learner self-assessment survey that can identify learner personas by clustering. (2) combine the information from persona methodology with a backwards design approach using formative and summative assessments to curate, plan, and assess domain-specific data science workshop materials for short term and long term efficacy. (3) pilot and identify at how to manage real-time feedback within a data coding teaching session to drive better learner motivation and engagement. The key findings from this dissertation suggests using a structured framework to plan and curate learning materials is an effective way to identify key concepts in data science. However, just creating and teaching learning materials is not enough for long-term retention of knowledge. More effort for long-term lesson maintenance and long-term strategies for practice will help retain the concepts learned from live instruction. Finally, it is essential that we are careful and purposeful in our content creation as to not overwhelm learners and to integrate their needs into the materials as a primary focus. Overall, this contributes to the growing need for data science education in the biomedical sciences to train future clinicians use and work with data and improve patient outcomes. / Doctor of Philosophy / Regardless of the field and domain you are in, we are all inundated with data. The more agency we can give individuals to work with data, the better equipped they will be to bring their own expertise to complex problems and work in multidisciplinary teams. There already exists a plethora of data science learning materials to help learners work with data; however, many are not domain-focused and can be overwhelming to new learners. By integrating in domain specificity to data science education, we hypothesize that we can help learners learn and retain knowledge by keeping them more engaged and motivated. This dissertation focuses on the domain of the biomedical sciences to use best practices on how to improve data science education and impact the field. Specifically, we explore how to address major gaps in data education in the biomedical field and create a set of domain-specific learning materials (e.g. workshops) for the biomedical sciences. We use best educational practices to curate these learning materials and assess how effective they are. This assessment was performed in three (3) major steps including: (1) identify who the learners are and what they already know in the context of using a programming language to work with data, (2) plan and curate a learning path for the learners and assessing materials created for short and long term effectiveness, and (3) pilot and identify at how to manage real-time feedback within a data coding teaching session to drive better learner motivation and engagement. The key findings from this dissertation suggest using a structured framework to plan and curate learning materials is an effective way to identify key concepts in data science. However, just creating the materials and teaching them is not enough for long-term retention of knowledge. More effort for long-term lesson maintenance and long-term strategies for practice will help retain the concepts learned from live instruction. Finally, it is essential that we are careful and purposeful in our content creation as to not overwhelm learners and to integrate their needs into the materials as a primary focus. Overall, this contributes to the growing need for data science education in the biomedical sciences to train future clinicians to use and work with data and improve patient outcomes.

No / to measure general practitioners' knowledge of, confidence with and attitudes to the diagnosis and management of dementia in primary care. Setting: 20 general practices of varying size and prior research experience in Central Scotland, and 16 similarly varied practices in north London. Participants: 127 general practitioners who had volunteered to join a randomised controlled trial of educational interventions about dementia diagnosis and management. Methods: self-completion questionnaires covering knowledge, confidence and attitudes were retrieved from practitioners prior to the educational interventions. Results: general practitioners' knowledge of dementia diagnosis and management is good, but poor awareness of its epidemiology leads to an over-estimate of caseload. Knowledge of local diagnostic and support services is less good, and one third of general practitioners expressed limited confidence in their diagnostic skills, whilst two-thirds lacked confidence in management of behaviour and other problems in dementia. The main difficulties identified by general practitioners were talking with patients about the diagnosis, responding to behaviour problems and coordinating support services. General practitioners perceived lack of time and lack of social services support as the major obstacles to good quality care more often than they identified their own unfamiliarity with current management or with local resources. Attitudes to the disclosure of the diagnosis, and to the potential for improving the quality of life of patients and carers varied, but a third of general practitioners believed that dementia care is within a specialist's domain, not that of general practice. More experienced and male general practitioners were more pessimistic about dementia care, as were general practitioners with lower knowledge about dementia. Those reporting greater difficulty with dementia diagnosis and management and those with lower knowledge scores were also less likely to express attitudes endorsing open communication with patient and carer. Conclusion: educational support for general practitioners should concentrate on epidemiological knowledge, disclosure of the diagnosis and management of behaviour problems in dementia. The availability and profile of support services, particularly social care, need to be enhanced, if earlier diagnosis is to be pursued as a policy objective in primary care.

No / The rise in non-communicable disease as a principal cause of premature mortality and a continuing failure to address health inequalities requires a critical examination of prevailing paradigms in health. In this paper, we offer ecology as an alternative way to view health need and as a guide to action to enhance human health and model a healthy economy. After describing the shortcomings of the prevailing biophysical approach to health, we describe an ecological approach to health that brings to the forefront social and environmental determinants and empowers health workers together with their communities to achieve a health-affirming society and economy.

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Thesis (MPhil)--Stellenbosch University, 2014. / ENGLISH ABSTRACT: Aim - The aim of this study was to explore second year medical students’ perceptions of their early clinical experiences with a view to improving curriculum development so as to enhance early clinical training programmes at Stellenbosch University (SU). Methodology - A qualitative, interpretive study, based on semi-structured focus group discussions with second year medical students was conducted in order to capture the relevant data that would provide information about their attitudes, feelings, beliefs and views on their early clinical learning experiences during their first year of studying medicine at SU. Thirty seven students participated in four focus group discussions after a process of selection of candidates using purposive sampling methods and stratification criteria to obtain the research sample. The interviews were moderated by an external facilitator, and were audiotaped and transcribed verbatim. The data transcripts were analysed and manually coded, and four broad categories with subthemes which illustrated the findings of the study, were identified and decided upon by the researcher and verified by the supervisor. Results - Early clinical exposure was generally positively perceived by students. It fostered a sense of vocation and feeling like real doctors, leaving students motivated and enhancing their learning interest. Early clinical skills training led to students’ professional development, acquiring the technical skills of a doctor, familiarisation with basic clinical terminology, and normal clinical findings which prepared them for later clinical studies. The new setting of practical learning in a simulated environment required students to adapt to small group learning and student clinical demonstrations which developed new learning styles and study skills. Some of the challenges that students encountered in the transition to clinical learning were, understanding the new subject of clinical medicine, having limited background knowledge to acquire basic clinical skills, and student clinical demonstrations. Although the strategy of peer physical examination was perceived to be effective, some ethical dilemmas emerged for students in terms of autonomy, and no opportunities available to practice on female models. Acting as a simulated patient proved to have both positive and negative outcomes on students’ skills acquisition. Factors that had a negative outcome on clinical skills learning were limited practice opportunities due to high student to teacher ratios per clinical session, and the variability of teaching content and practical techniques taught by various clinical tutors with different teaching strategies. The most stressful experience for students was the OSCE since it was a new method of assessment. Stress was attributed to uncertainty about the correct clinical content and techniques resulting from the teaching variability, while performance anxiety during the exam was related to inappropriate examiner behaviour. The OSCE was a positive learning experience because its format simulated the hospital setting which fostered students’ critical thinking abilities and time management. Conclusion - Early clinical exposure and practice have a great impact on junior medical students’ academic growth, and have positive learning outcomes. However, further development by the faculty in the areas of didactic skills, addressing the ethical issues related to student clinical demonstrations, and supporting students to enable a smooth transition to clinical learning will enhance and optimise their early clinical training.

Made available in DSpace on 2015-12-06T23:05:33Z (GMT). No. of bitstreams: 0 Previous issue date: 2005 / O modelo biomédico prevalente no ensino médico sofre sérios questionamentos a partir da metade do século XX, havendo uma transição paradigmática rumo ao atual, de atenção integral do indivíduo. Estas mudanças, que ocorreram em todo o mundo, tiveram reflexos tardios no Brasil, e somente na década de oitenta surgiram movimentos propondo uma reflexão mais profunda sobre a formação médica, no sentido de reduzir as falhas do ensino e qualificar o profissional para a nova realidade que se apresentava. O perfil contemporâneo de formação, preconizado pelas Diretrizes Curriculares Nacionais, é de um profissional capacitado em todas as dimensões da competência profissional, avançando para além das cognitivas e técnicas e incorporando as dimensões afetivas, relacionais, dentre outras. Hoje precisamos de um profissional humanizado e multicompetente, capaz de trabalhar em equipe e ciente de seu papel transformador da sociedade.Neste contexto situa-se essa pesquisa, voltada para a necessidade de estudar o ensino atual de uma especialidade médica – a oftalmologia – para compreender de que forma a inserção do ensino de uma especialidade (em geral isolada no currículo médico) ocorre, frente à necessidade da formação geral do médico. O objetivo deste trabalho é analisar a inserção da oftalmologia em cursos de medicina com currículo disciplinar e não-disiciplinar, a partir de análise documental e de entrevistas realizadas com coordenadores de graduação e com docentes responsáveis pela oftalmologia. Foram estudadas oito escolas de medicina, localizadas no Estado do Rio de Janeiro, São Paulo e Paraná. As entrevistas foram analisadas para apreender as concepções dos sujeitos sobre o ensino, identificando suas características principais. Todos os entrevistados, tanto coordenadores de curso como docentes da especialidade, consideraram que os cursos médicos devem formar um profissional com um perfil geral, em conformidade com as Diretrizes Curriculares Nacionais para os Cursos de Graduação em Medicina, sendo este o contexto no qual a oftalmologia deve ser inserida. Em que pese a oftalmologia, tanto como serviço hospitalar quanto componente curricular, ser relacionada dentre as especialidades cirúrgicas, foi possível depreender que o ensino da mesma no âmbito da formação geral do médico deve considerar essencialmente seus aspectos clínicos. Uma possibilidade de integração da oftalmologia diz respeito à “pulverização” dos conteúdos longitudinalmente no currículo, guardando relação com competências profissionais desenvolvidas por grandes áreas da medicina (clínica, pediatria e medicina comunitária, dentre outras). Os resultados demonstraram a necessidade de reavaliação do espaço da oftalmologia dentro do currículo médico, no sentido de adequar o ensino da especialidade à formação geral do médico. O trabalho finaliza propondo princípios norteadores para a inserção da oftalmologia na graduação médica, numa perspectiva de integração e de atenção integral à saúde. / The biomedical model widely adopted in medical education has been challenged since the second half of 20th.Century. There has been a paradigmatic shift towards a model that aims at integral care of the individual. Those worldwide changes reflected lately in Brazil, and only about 1980 it has been proposed a more deep reflection about medical undergraduation, in order to reduce educational failures and improve the training of professionals towards the new reality. Nowadays, National Curricular Guidelines demand that medical courses graduate doctors with all the dimensions of professional competence, from cognitive and technical to relational and affective, among others. Doctors must be able to work in teams, in a compassionate way, and must be conscious of their social transforming role. This research aims at studying the teaching of a medical specialty – ophthalmology – in order to understand how possible it is to insert a specialty in a generalist curriculum. The objective of the research is to analyze the insertion of ophthalmology in undergraduate medical courses with disciplinary and non-disciplinary curricula, by means of document analyses and interviews with deans and medical teachers responsible for ophthalmology courses. Eight schools in Rio de Janeiro, Sao Paulo and Parana States were investigated. The conceptions of the subject about teaching were apprehended in the interviews. All subjects stated that medical courses must graduate general physicians, according to Curricular Guidelines, and that is the context in which ophthalmology should be taught. Despite being a surgical specialty, emphasis should be put on clinical aspects. Integration with other areas could be attempted by “powdering” its contents longitudinally along the course. Competencies should be developed simultaneously with main fields of medical teaching, such as Internal Medicine, Pediatrics and Community Medicine, among others. The results showed the need of reevaluating the insertion of ophthalmology in medical undergraduate curriculum. Finally the work proposes several principles in order to achieve teaching of the specialty in an integrative perspective. / BV UNIFESP: Teses e dissertações

Background: The United States Preventive Services Task Force guidelines support screening and provision of intensive multi-component behavioral counseling for adults who have obesity. One barrier to providing such counseling is lack of training in medical school. Not much is known about factors associated with medical students’ perceived weight management counseling (WMC) skills or whether preceptors model or teach WMC during primary care clerkships. Methods: A mixed methods approach addressed factors affecting WMC training during primary care clerkships. A secondary analysis of 3rd year medical students (n=730) described students’ perceived WMC skills, attitudes and frequency of engagement in 5As educational experiences. Linear mixed models were used to determine associations between educational experiences and perceived skills. Semi-structured interviews (n=12) and a survey were administered to primary care preceptors (n=77). Interviews described individual, inter-personal and institutional factors associated with preceptors’ WMC. The survey described preceptors’ frequency of modeling WMC behaviors, perceived WMC skills, and attitudes. Results: Students perceived themselves to be moderately skilled (M=2.6, SD=0.05, range 1-4). Direct patient experiences and specific instruction were associated with higher perceived skill. Preceptors support WMC curricula but do not perceive themselves to be experts in WMC. Preceptors perceive themselves to be moderately skilled (M=2.8, SD=0.06, range 1-4) but only sometimes model WMC (M=3.3, SD=0.05, range 1-5) to students during clerkships. Conclusion: Preceptor modeling WMC may not be feasible or necessary during primary care clerkships. Providing specific WMC instruction and working with patients may provide more benefit as they were more strongly associated with students’ perceived skills.

Indiana University-Purdue University Indianapolis (IUPUI) / Background: Gross anatomy is a foundational medical school course upon which other courses and patient care is grounded; however, variability in student performance suggests potential in studying underlying non-academic factors to explain some of these inconsistencies. Thus, this study examined medical students’ implicit theories of intelligence (ITI) and grit in order to better understand student learning outcomes in gross anatomy. Methods: A mixed methods study was conducted using 2nd, 3rd, and 4th year medical students who successfully completed gross anatomy. Students (n=382) completed the ITI Scale and Short Grit Scale in order to identify individual’s ITI and grit scores. Subsequent interviews (n=25) were conducted to explore how medical students set goals, operated while reaching those goals, and monitored their progress in achieving those goals. Results: Entity and incremental theorists with high grit performed significantly better in gross anatomy when compared to those with low grit. Further, highly gritty incremental and entity theorists were hard workers and showed resilience in the face of challenges. Specifically, those with an entity ITI had the central goal of getting an honors grade, while those with an incremental ITI desired to understand and apply their anatomical knowledge. Conversely, low grit individuals became overwhelmed by challenges, were more likely to show an inconsistent work ethic, and questioned their ability to master the material. An individual’s ITI, more so than grit, drove the presence of negative emotions in a medical student, with entity theorists feeling anxious and vulnerable, and incremental theorists feeling fewer negative emotions. Finally, grit level moderated how a medical student would respond to negative emotions, with highly gritty individuals exhibiting more constructive coping mechanisms. Conclusions: These findings suggest that medical students who possess high grit and an incremental theory of intelligence have the most effective learning strategies, set achievable goals, and enlist effective coping mechanisms while learning gross anatomy. The findings and tools used in this study could be incorporated into the medical school admissions process. Finally, findings reinforce the value of examining the ITI and grit of medical students, as they can provide educators with insight regarding important non-academic factors driving learning in gross anatomy.