Asthma cannot be cured, but it can be managed. Asthma management is a public health issue that is complex. Medication, asthma triggers, age, and the environment are all factors that impact asthma management. There is a gap in research in terms of what lifestyle characteristics need to be in place in order for adults to manage asthma. Shaw found that posture care is a lifestyle variable that should be explored as it relates to asthma management in older adults. The Life University Clinic (Marietta, GA) sees asthmatic patients daily and teaches them about a posture care routine through a program called Straighten Up. Based on the health belief model, this study explored how the Straighten Up routine exercises impacted asthma management in adult asthmatic patients with severe asthma (n =304 ). Ordinal regression and logistic regression was used to analyze the relationships between using the Straighten Up posture exercises (independent variable) for 3 months with 3 dependent variables: patients' sleep patterns (night time awakenings due to asthma), use of quick relief medication, and hospitalizations (ER Visits) due to asthma. Straighten Up posture exercises reduced night time sleep interruptions, but not hospitalizations due to asthma or the use of quick relief medications. For persons with asthma, Straighten Up could be an additional tool to manage their asthma and reduce the known impacts of sleep deprivation including accidents, memory loss, and heart disease. For organizations who serve asthmatics, Straighten Up could be an additional resource to share with the population they serve. As a result of this study, Straighten Up exercises are recommended for adult asthmatics with severe asthma as part of their asthma management plan.

This case study examines the emergence of an autonomy-oriented assessment culture in Pediatric residency education in the School of Medicine at Queen’s University. Through a case study approach this research explores how an assessment system to capture residents’ performance in the clinical environment was initiated, how that process supported a shift in assessment cultural, and how assessment innovation is eclipsing departmental boundaries. The case has instrumental value in illuminating how an autonomy-oriented assessment system and culture can be cultivated in residency education. The analytic frame for the case was constructed based on research literature that identified weaknesses in assessment practices in residency education more generally. The approach was theoretical, with the intent to explain how a shift in assessment culture is emerging in Pediatrics. A longitudinal approach was adopted to expose shifts in the culture. The narrative structure distills the journey into a manageable story. Three watershed events that exemplified change were systematically selected from data collected over a three-year period and constitute the findings of this research. The central contribution this research makes is that it is possible to shift the culture of assessment within a Pediatric residency program. That shift can be understood to unfold over a prolonged period through a process of mediating both social and regulatory requirements. Beginning to shift the assessment culture in Pediatrics was achieved by: recognizing the need for change in assessment practice, re-conceptualizing and realizing that change, and engaging and empowering the community to support a shift in assessment culture. Strong leadership, widening community engagement and the Rubric Descriptor Bank supported this process. Five theoretically informed principles guided the emergence of the autonomy-oriented assessment culture in Pediatrics including: (a) conceptualizing learning as a social, active process: (b) focusing attention on residents’ multidimensional growth; (c) moving away from a high-stakes orientation to assessment based on the false dichotomy between formative and summative assessment and embracing it as a tool for supporting and monitoring growth over time and across contexts; (d) actively supporting residents’ learning strategy and assessment skill development; and (e) fostering a growth orientation to learning, embracing the concept of graduated autonomy. / Thesis (Ph.D, Education) -- Queen's University, 2012-12-19 21:04:59.344

Accrediting bodies for medical schools require that medical students be provided with formative assessment in all clerkship courses. The literature describes many strategies for formative assessment in clerkship settings, but qualitative studies of clerk and supervisor experiences with formative assessment are lacking. In this thesis, I describe a study that explores clerk and supervisor experiences with formative assessment in one internal medicine clerkship course. First, the literature was reviewed to determine current conceptions of formative assessment and learning in medical education. Then, novice and experienced clerks were recruited to participate. Prior to starting their Core Internal Medicine course, each clerk participated in an interview to understand his or her concepts of learning and assessment. During the six-week course, they replied to an electronic weekly questionnaire to describe and reflect on learning experiences. Finally, they participated in a focus group at the end of the course, to explore their experiences with formative assessment. Supervisors, (residents and attending physicians), who supervised clerks were recruited to participate in one interview to explore their approach to supervision and assessment of clerks, and to understand factors that influenced their ability to do this. All relevant artifacts (forms, policies, procedures) were collected for subsequent analyses. Four experienced clerks and eleven novice clerks participated, along with eight attending physicians and five residents. Participants identified four key themes as playing a significant role in assessment and learning: (a) the developing role of doctor, (b) the role of the team, (c) working and learning environments, and (d) educational strategies. Data analysis revealed the participants had unclear formal concepts of formative assessment, even though they could all describe the key concepts about how assessment affects learning, and were quite clear about what factors supported learning, and which ones were barriers to learning. The study contributes to our understanding of clerks’ and supervisors’ experiences with assessment and learning in a workplace-based learning setting. Finally, the study led to recommendations about how to better support formative assessment in the Core Internal Medicine course, and for further research. / Thesis (Master, Education) -- Queen's University, 2012-12-24 07:06:24.439

"Widening access" (WA) policies are designed to increase the participation of underrepresented groups into Higher Education generally, and specifically into professions such as medicine. The interpretation, negotiation and enactment of WA policies is determined by key stakeholders, including medical schools, school teachers and potential applicants. In the UK, measurable progress in WA to medicine has been low. This thesis argues this may partly be due to stakeholders' conflicting values, ideologies and interests. The thesis thus aims to explore, analyse and better understand the complex motivations, perceptions and values underlying key stakeholders' behaviour in WA to medicine. Data includes medical school websites, interviews with high school teachers and focus groups with pupils. Analytical methods are qualitative (critical discourse analysis; thematic analysis) and are enriched by discursive and sociological theories (Foucault, Sen, Bernstein and Bourdieu). Analysis focuses on the pathways of mutual influence and communication between key stakeholders. Findings indicate that UK medical schools predominantly situate WA within ideas of social mobility for the individual rather than benefit to the workforce. Medical school webpages frame WA as a 'requirement', a 'value', or a 'service' and communicate distinct impressions of institutional stance to other stakeholders. High school teachers perceive medical school applications as 'risky' and this appears to limit their ability to engage as greater advocates for WA. Pupils in WA high schools perceive medicine as increasingly culturally inclusive and negotiate cultural differences through reference to role models in the profession. High academic entry requirements within a context of substantial educational inequality may now be the largest perceived 'barrier' to medicine. Overall, this thesis identifies the reasons underlying stakeholders' behaviour and evaluates whether these may be helping/hindering WA to medicine. It demonstrates the benefit of including diverse stakeholder's voices in WA research and provides practical recommendations for future research, policy and practice.

Asthma cannot be cured, but it can be managed. Asthma management is a public health issue that is complex. Medication, asthma triggers, age, and the environment are all factors that impact asthma management. There is a gap in research in terms of what lifestyle characteristics need to be in place in order for adults to manage asthma. Shaw found that posture care is a lifestyle variable that should be explored as it relates to asthma management in older adults. The Life University Clinic (Marietta, GA) sees asthmatic patients daily and teaches them about a posture care routine through a program called Straighten Up. Based on the health belief model, this study explored how the Straighten Up routine exercises impacted asthma management in adult asthmatic patients with severe asthma (n =304 ). Ordinal regression and logistic regression was used to analyze the relationships between using the Straighten Up posture exercises (independent variable) for 3 months with 3 dependent variables: patients' sleep patterns (night time awakenings due to asthma), use of quick relief medication, and hospitalizations (ER Visits) due to asthma. Straighten Up posture exercises reduced night time sleep interruptions, but not hospitalizations due to asthma or the use of quick relief medications. For persons with asthma, Straighten Up could be an additional tool to manage their asthma and reduce the known impacts of sleep deprivation including accidents, memory loss, and heart disease. For organizations who serve asthmatics, Straighten Up could be an additional resource to share with the population they serve. As a result of this study, Straighten Up exercises are recommended for adult asthmatics with severe asthma as part of their asthma management plan.

It is important for doctors to be clinically competent and this clinical competence is influenced by their clinical reasoning ability. Most research in this area has focussed on clinical reasoning ability measured in a problem - solving context. For this study, clinical reasoning is described as the process of working through a clinical problem which is distinct from a clinical problem solving approach that focuses more on the outcome of a correct diagnosis. Although the research literature into clinical problem solving and clinical reasoning is extensive, little is known about how undergraduate medical students develop their clinical reasoning ability. Evidence to support the validity of existing measures of undergraduate medical student clinical reasoning is limited. In order better to train medical students to become competent doctors, further investigation into the development of clinical reasoning and its measurement is necessary. Therefore, this study explored the development of medical students' clinical reasoning ability as they progressed through the first two years of a student - directed undergraduate problem - based learning ( PBL ) program. The relationships between clinical reasoning, knowledge base, critical thinking ability and learning approach were also explored. Instruments to measure clinical reasoning and critical thinking ability were developed, validated and used to collect data. This study used both qualitative and quantitative approaches to investigate the development of students' clinical reasoning ability over the first two years of the undergraduate medical program, and the factors that may impact upon this process. 113 students participated in this two - year study and a subset sample ( N = 5 ) was investigated intensively as part of the longtitudinal qualitative research. The clinical reasoning instrument had good internal consistency ( Cronbach alpha coefficient 0.94 for N = 145 ), inter - rater reliability ( r = 0.84, p < 0.05 ), and intrarater reliability ( r = 0.81, p < 0.01 ) when used with undergraduate medical students. When the instrument designed to measure critical thinking ability was tested with two consecutive first year medical student cohorts ( N = 129, N = 104 ) and one first year science student cohort ( N = 92 ), the Cronbach Alpha coefficient was 0.23, 0.45 and 0.67 respectively. Students ' scores for clinical reasoning ability on the instrument designed as part of this research were consistent with the qualitative data reported in the case studies. The relationships between clinical reasoning, critical thinking ability, and approach to learning as measured through the instruments were unable to be defined. However, knowledge level and the ability to apply this knowledge did correlate with clinical reasoning ability. Five student - related factors extrapolated from the case study data that influenced the development of clinical reasoning were ( 1 ) reflecting upon the modeling of clinical reasoning, ( 2 ) practising clinical reasoning, ( 3 ) critical thinking about clinical reasoning, ( 4 ) acquiring knowledge for clinical reasoning and ( 5 ) the approach to learning for clinical reasoning. This study explored students' clinical reasoning development over only the first two years of medical school. Using the clinical reasoning instrument with students in later years of the medical program could validate this instrument further. The tool used to measure students' critical thinking ability had some psychometric weaknesses and more work is needed to develop and validate a critical thinking instrument for the medical program context. This study has identified factors contributing to clinical reasoning ability development, but further investigation is necessary to explore how and to what extent factors identified in this study and other qualities impact on the development of reasoning, and the implications this has for medical training. / Thesis (Ph.D.)-- Medicine Learning and Teaching Unit, 2006.

Abstract Objectives: To 1) develop an electronic Knowledge Model (e-KM) of a surgical procedure, and 2) investigate the efficacy of the model in knowledge acquisition. The main purpose of the study was to develop a knowledge model of a surgical procedure (cyst removal) in an electronic medium such that it would enhance knowledge acquisition of surgical skills and to then determine the efficacy of the model. This is based on the Fits-Posner stage theory of learning motor skills that has been adopted in many surgical teaching models. Methods: Two randomized experimental studies were conducted in three phases; the total student sample size was 118 (Study 1=56, Study 2=62). In both studies, one group received face-to-face instruction from a professor while the second group employed the e-KM. Both groups were administered a multiple choice test. Analysis of variance (ANOVA), regression analysis and Pearson’s correlation methods were employed to analyze data. Descriptive statistics were used to analyze the frequency of access and its impact on test scores. Reliability was determined with Cronbach’s alpha. Results: The results showed no significant difference (p> .05) between e-KM the computer model and the surgeon instructor. There was a significant correlation between access time to video and knowledge (significant r ranged from .68 to .86, p < .01); however, increased time on task increase test scores, thus having a positive impact on knowledge acquisition. Discussion: Research findings indicate that e-KM performs as well as the human instructor and provides the additional advantage of unlimited online access through the Web while addressing many of the pressures currently plaguing medical schools such as limited resources (staff and facilities), cost of administration, access to knowledge, academic regulations, policies and competing curricula. Furthermore, e-KM provides a standardized teaching model, eliminating instructor variability and functioning as a dependable learning tool. Conclusion: In this thesis, I addressed the efficacy of e-KM on knowledge acquisition. While there was no significant difference between e-KM and the surgeon instructor on knowledge acquisition overall, students who accessed the e- KM multiple times achieved higher scores. / Experimental Medicine

The complex nature of health care and medical educational organizations, their different primary goals (clinical service versus education), different organizational structures and the necessity for ensuring efficient and harmonious relationships between these two types of organizations create a challenging environment in which to provide effective medical education leadership. The calls for reform in both medical education and health care have added to these challenges.<p> The purpose of the study was to develop a framework of leadership for medical education and contribute to the literature on leadership in medical education, based on an analysis of the perceptions of key health education leaders in Saskatchewan medical education organizations at the national level in Canada.<p> The main objectives were the identification of core competencies, challenges and strategies for effectiveness in medical education with a focus on unique aspects of about leadership in the medical education setting. Multiple methods of data collection (individual interviews and an event study with components of focus groups interviews and short surveys) with subjects of varied backgrounds and at different levels of leadership in medical education were entailed in this study.<p> The data were collected over a period of 13 months (January, 2009 - February, 2010). The perceptions of 32 medical education leaders, stratified into first- (11), middle- (6) and senior-level (15) leadership positions, based upon the hierarchical position and the scope of the job, were obtained and analyzed. Quantitative data were analyzed through descriptive statistics. Qualitative data were analyzed for themes through content analysis.<p> The findings provide useful information on leadership competencies, challenges and effectiveness strategies in medical education. Leadership competencies included five domains including personal and interpersonal characteristics, skills for effective leadership, skills as an efficient manager, skills in medical education delivery, skills as a teacher and skills as a researcher. All leaders considered personal and interpersonal characteristics to be at the core of leadership; while skills in medical education delivery, and skills as a medical education teacher and researcher were considered least important. The senior-level leaders spent most of their time in activities requiring leadership functions (e.g., strategic planning and creating alignment) followed by activities requiring managerial skills (e.g., operational management). This distinction in the rank ordering of leadership and managerial skills was not obvious for the first- and middle-level leaders; however, most did indicate that they spent more of their time in roles requiring more managerial skills than leadership skills. Among the key competencies, essential at all levels, were effective communication and building and managing relationships. For the most part, the leadership skills were acquired informally with only a few leaders having undergone formal leadership training.<p> The leaders faced three types of challenges: personal and interpersonal challenges including effective time management and personal limitations; organizational challenges including those around structures and processes, organizational communication, personal and organizational relationships, creating engagement and alignment, managing culture and resistance and limited resources; and inter-organizational challenges including competing agendas and interests of stakeholders.<p> The context (societal needs, multiple stakeholders and health care reform), content (medical education delivery and calls for reform) and culture (e.g. professionalism, apprenticeship model of medical education, and the hidden curriculum) of medical education and inherent dualities and conflict require situated leadership skills and strategies. The main leadership theories and approaches helpful in practicing contextual leadership included transactional, transformational, and servant leadership. However, other theoretical approaches, such as moral leadership and learner-centered leadership were also useful. Effective leadership was considered to include personal and interpersonal strategies, strategies for becoming an efficient manager and strategies for practicing inspiring and effective leadership. Personal and interpersonal strategies included looking after self, seeking advice, consciously developing fortitude, allotting time for priorities and thinking and personal development. Becoming an efficient manager involved diligent delegation, appropriate organizational communication and managing priorities. Practicing inspiring leadership involved developing the structure and processes to achieve vision, providing hope, developing mutually valued relationships which were considered key to engagement, alignment, leading change and managing resistance, moving from power to process, using appropriate leadership styles, developing the art of leading change and managing resistance, proactively influencing culture and accomplishing the vision.<p> In conclusion, medical education leadership was perceived as requiring both effective leadership and efficient management. The practice of inspiring and effective leadership, however, appeared to be more an art requiring an alchemy of strategies than a simple matter of application.

Ideas of what constitutes a good doctor underlie decisions about medical student selection, as well as curriculum design and the structure of medical education at both undergraduate and postgraduate levels of training. Factors at play include knowledge paradigms (what does a good doctor need to know), identity paradigms (who can become a good doctor) and notions about the relationship of doctors to society (the social responsibility or social accountability of the good doctor). As with any social phenomenon, constructs of the good doctor are historically derived and socially negotiated. Ideas about the good doctor tend to be considered as ‘truths’ in any era, with little attention to or understanding of the assumptions that underpin any particular formulation. In this thesis, I explore and dissect the dominant constructs of the good doctor in North American medical education between 1910 and 2010. Drawing upon Foucauldian critical discourse analysis, I focus particular attention on discursive shifts in the conception of the good doctor over the past century. This analysis reveals a series of discursive shifts in the framing of the good doctor in medical education between 1910-2010. Abraham Flexner promoted the construct of the good doctor as a scientist physician who was also a man of character. In the post-Flexnerian transformation of medical education, science became curricular content while the discourse of character remained. In the late 1950s a sudden discursive shift occurred, from the character of the good doctor to characteristics. With this shift, the student was dissected as an object of study. Further discursive shifts incorporated discourses of performance and production into constructs of the good doctor as roles-competent. This research explores the implications and consequences of these various discursive framings of the good doctor.

Ideas of what constitutes a good doctor underlie decisions about medical student selection, as well as curriculum design and the structure of medical education at both undergraduate and postgraduate levels of training. Factors at play include knowledge paradigms (what does a good doctor need to know), identity paradigms (who can become a good doctor) and notions about the relationship of doctors to society (the social responsibility or social accountability of the good doctor). As with any social phenomenon, constructs of the good doctor are historically derived and socially negotiated. Ideas about the good doctor tend to be considered as ‘truths’ in any era, with little attention to or understanding of the assumptions that underpin any particular formulation. In this thesis, I explore and dissect the dominant constructs of the good doctor in North American medical education between 1910 and 2010. Drawing upon Foucauldian critical discourse analysis, I focus particular attention on discursive shifts in the conception of the good doctor over the past century. This analysis reveals a series of discursive shifts in the framing of the good doctor in medical education between 1910-2010. Abraham Flexner promoted the construct of the good doctor as a scientist physician who was also a man of character. In the post-Flexnerian transformation of medical education, science became curricular content while the discourse of character remained. In the late 1950s a sudden discursive shift occurred, from the character of the good doctor to characteristics. With this shift, the student was dissected as an object of study. Further discursive shifts incorporated discourses of performance and production into constructs of the good doctor as roles-competent. This research explores the implications and consequences of these various discursive framings of the good doctor.