Thesis (Ed. D.)--West Virginia University, 2006. / Title from document title page. Document formatted into pages; contains vii, 244 p. : ill. Includes abstract. Includes bibliographical references (p. 212-227).

Thesis (Ph. D.)--University of Washington, 2006. / Vita. Includes bibliographical references (leaves 134-140).

The 1858 Medical Act removed geographical boundary restrictions on medical qualifications conferred in the United Kingdom, yet historians have hitherto overlooked this aspect of the legislation. This thesis uses practitioners working in London who held a Scottish qualification between 1861 and 1921 as a case study to consider the implications of this feature of the Act. It uses a database constructed using the Medical Directory and follows a prosopographical approach to examine the careers of these practitioners and identifies several defining characteristics that were a consequence of their training and qualifications. The central argument is that Scottish degrees and licences conferred certain opportunities and restrictions on their holders, which could assist practitioners in their careers or limit the work they undertook in the capital. However, these characteristics were not uniform across the entire group. There were differences between those who held a corporation's licence and a university degree, and the increasing number of women in the medical profession revealed a gender divide that diminished the relevance of holding specific qualifications for women. Furthermore, the introduction of panel practice under the 1911 National Health Insurance Act added an extra dimension to these distinctions. Panel doctors could acquire a practice from the government regardless of their qualifications, meaning they were less reliant on their own connections and networks. Additionally, the ongoing tensions between panel and non-panel doctors introduced new divisions into the profession that, in some respects, overshadowed previous boundaries.

Abre-se este trabalho com uma poesia homenageando o Dr. Joaquim Eduardo de Alencar, como lutador pioneiro e resistente em defesa da liberdade e da saÃde pÃblica. Na introduÃÃo, faz-se breve relato sobre a vida do autor, continua-se falando sobre a motivaÃÃo da pesquisa, o seu contexto, a importÃncia de se resgatar a memÃria do IMEP, citam-se os procedimentos de pesquisas. No capÃtulo 1, trata, genÃrica, resumidamente e num esboÃo cronolÃgico, das aÃÃes de saÃde desenvolvidas no Brasil e no CearÃ. Procura-se conceituar e situar os movimentos da Reforma SanitÃria, Medicina Social, Integral, Preventiva e ComunitÃria, dentro da realidade do ensino mÃdico e no final tenta-se mostrar, a partir de um estudo feito pelo PESES (Programa de Estudos SÃcio- EconÃmicos em SaÃde), ÃrgÃo criado por convÃnio entre a FundaÃÃo Oswaldo Cruz (FIOCRUZ) e a Financiadora de Estudos e Projetos (FINEP), como se deu a evoluÃÃo da chamada "ideologia preventivista" e a criaÃÃo dos Departamentos de Medicina Preventiva nas Universidades, para poder se comparar com o IMEP e com o "novo modelo de atenÃÃo a saÃde da famÃlia", proposto para o Cearà (ANDRADE, et al.,1995) e para todo o paÃs (BRASIL, 1997a). No capÃtulo 2, chega-se finalmente a experiÃncia do IMEP, objetivo principal da tese, em que se trabalha na sua histÃria e nas suas realizaÃÃes e propostas. Propostas, hoje reproduzidas evolutivamente, com outros nomes mas com o mesmo espÃrito, com a mesma formulaÃÃo. Algumas deveriam ser repensadas e inclusive, retornarem a idÃia original, por mais correta e abrangente. No capÃtulo final, se faz uma anÃlise da atual polÃtica de saÃde do paÃs e seus reflexos no Estado do CearÃ, e, pretensiosamente, quer se propor o renascimento de trabalhos semelhantes à experiÃncia do IMEP, fazendo-se a sua comparaÃÃo no contexto atual.

Background Active Learning using smartphone technology can be implemented as a tool for teaching medical students (MS) and residents (Rs). The use of technology would increase participation and enhance student learning by engaging them in solving ID clinical case scenarios. Our objective was to describe the methods used and to share the opinions of the users of such active learning methods. Methods The smartphone applications used were Socrative and WhatsApp. We used Socrative during the Universidad Peruana de Ciencias Aplicadas (UPC) ID course for MS in two different ways. In selected lectures (4 of 32), teacher paced questions were asked based on clinical scenarios related to the topic reviewed, and by voluntary homework questionnaires (student paced). At the British American Hospital (BAH) Medicine Department (MS and Rs) Socrative was used similarly: during some noon lectures (teacher paced questions) and during the baseline MS exam and Rs mid-year exam and voluntary homework questions (student paced). WhatsApp is currently used at the BAH with questions send from Monday to Friday. MS /Rs answer individually via WhatsApp to the mentor in charge. The right answer is given the next day. Questions using WhatsApp deal with recent cases seen at the Wards or in the outpatient clinic, and are designed so that the MS/Rs must do quick literature searches in order to provide the right answer. Results Forty-one MS/Rs answered the survey on Socrative use, 25 of 48 (52%) of UPC MS and 16 (89%) MS/Rs from the BAH. Forty (97%) believed using Socrative had influenced their learning and all but 2 believed it promoted participation from the class. 36 (87.8%) would like to have Socrative used in other lectures and 35 (85%) in other courses. Only one person voted against Socrative use in courses or lectures. With regards to WhatsApp use 16 MS/Rs from BAH answered the survey. Six had used before WhatsApp as a teaching tool. All felt the methodology was useful for learning and promoting reading and would recommend this methodology to promote learning on a student paced way. Conclusion Socrative and WhatsApp can be used for teaching ID through MS/Rs smartphones. Most MS/Rs who were surveyed recommended the use of such methods in their education.

Background. Access to health care in northern and rural communities has been an ongoing challenge. Training undergraduate medical students in regional sites is one strategy to enhance physician recruitment and retention in rural regions. With this goal in mind, in 2004, the Northern Medical Program was created to bring undergraduate medical education to Prince George. The NMP is also hypothesized to have wider impacts on the community. This study aimed to describe perceptions of the broader impacts of the NMP. Methods. In this qualitative study, semi-structured interviews were conducted with community leaders in various sectors of Prince George. The interviewer probed about perceived current and anticipated future impacts of the program, both positive and negative. A descriptive content analysis was performed. A conceptual framework of hypothesized impacts was created based on the literature and a model of neighbourhood social capital by Carpiano (2006). Findings. Comments were overwhelmingly positive. Impacts were described on education, health services, economy, politics, and media. Some reported negative impacts included tension between the NMP and other departments at UNBC, and a strain on health system resource capacity. Participants also reported that the NMP has impacted social capital in the region. Social capital, defined as the resources belonging to a network of individuals, was a pervasive theme. Impacts on social cohesion, various forms of social capital, access to social capital and outcomes of social capital are described. Conclusions. The full impact of the NMP will likely not be felt for at least a decade, as the program is still relatively new to Prince George. Findings suggest that an undergraduate medical education program can have pervasive impacts in an underserved community. Evaluation of the impact of such programs should be broad in scope. Findings also suggest that impacts of the program on other community sectors and on social capital may in fact lead to greater human capital gains than originally anticipated. A comprehensive communication strategy should be developed and maintained to ensure continued stakeholder support for the program. Next steps include identifying key quantifiable indicators of community impact to track changes in the community over time. / Medicine, Faculty of / Population and Public Health (SPPH), School of / Graduate

Purpose: To explore how non-physician team members of a health care team perceive their contributions to educating residents about interprofessional collaboration in an intensive care rotation and to compare this to residents’ perceptions. Method: Participants in this exploratory case study were selected using maximal variation, purposive and convenience sampling strategies. Data were collected through semi-structured individual and focus group interviews, and analyzed using inductive thematic analysis. Findings: Contributions occurred implicitly and explicitly during patient care activities and focused on role clarification, sharing of expertise, and help navigating the workflow. Contributions were influenced by a) Intensive Care Unit context, b) tension between working and teaching, c) expectations, d) resident engagement, e) power/hierarchy. Conclusion: Team members contribute to residents’ education about collaboration through participation in the everyday business of caring for critically ill patients. Recognition of this contribution may improve resident training. However, some residents may not be learning basic skills, what they learn about interprofessional collaboration may have limited transferability, and team interactions may influence the validity of judgements made about entrustability and performance.

Objectives: Obesity-related illnesses are a major public health concern. Although doctors are expected to discuss obesity and health-related behaviour change with patients, they report being unprepared by medical education to do this effectively. Healthcare settings provide an opportunity to help patients tackle unhealthy behaviours and make the necessary changes to improve their health and longevity. This programme of research aims to investigate and improve current obesity management education for medical students. It also aims to identify whether the existing evidence-base on behaviour change techniques has been used to inform educational interventions in this area. Five separate studies were conducted in order to investigate obesity management education for medical students, identify challenges and solutions to its integration within medical schools, and then design and test a novel educational intervention in this area. Methods: Two systematic reviews were conducted to investigate relevant educational interventions about obesity management in terms of a) their efficacy and b) their educational content. A qualitative study using semi-structured interviews with medical educators (n = 27) was conducted to explore key challenges to integrating this education into medical schools in Ireland and the UK. The final two studies involved designing and validating a communication tool based upon behaviour change techniques, and subsequently evaluating this within an educational intervention in a before-and-after feasibility study (n = 34 medical students). Results: Findings from the systematic reviews illustrated that educational interventions addressing obesity management for medical students are rare. Robust empirical evaluations are scarce, and on the whole authors report using little behaviour change theory or evidence to inform their interventions. Barriers to integrating obesity management education into medical schools may relate to the diverse and opportunistic manner in which it is currently delivered within medical schools; varied support for its inclusion, and varied medical student engagement in the topic. Taking into account these issues, findings of the feasibility study suggest that it is possible to deliver theory- and evidence-based obesity management education to medical students. This educational intervention was delivered consistently by clinical tutors, it was acceptable and valued by students, and results suggest that participants would go on to discuss obesity management with patients and use desired communication skills within such interactions.Conclusions: The available evidence-base on obesity management educational interventions for medical students is poor. However, it is possible to design and deliver this education within an existing undergraduate medical programme. Further research is required to investigate the efficacy and effectiveness of such an intervention in practice.

At least 11 million Americans are diagnosed with chronic obstructive pulmonary disease (COPD), and there is a high likelihood millions more suffer from the disease but are undiagnosed. Spirometry is a medical test to determine how well a patient’s lungs work, and is used to diagnosis COPD. Despite this test’s utility, resident providers may be uneducated about or uncomfortable with administering spirometry. Past research has demonstrated that brief educational interventions can lead to clinically significant improvements in knowledge of spirometry. The purpose of this study is to compare family medicine residents’ responses regarding the use of spirometry in a rural Family Medicine Residency clinic before and after an educational program on the topic. Researchers will administer a survey to resident physicians at the Family Physicians of Bristol clinic about their knowledge regarding spirometry; residents will then be resurveyed after an educational program. It is expected that resident providers will show significant gains in their knowledge of spirometry after the completion of the educational program. Results of this project will be useful in identifying methods to increase medical providers’ awareness and comfort with spirometry, which will hopefully lead to increased accurate diagnosis of airway diseases.

Topic: This article describes a curricular transformation initiative, the Recovery Education in the Academy Program (REAP), spearheaded by the University of Illinois at Chicago's National Research and Training Center on Psychiatric Disability. Purpose: REAP is designed to integrate principles of recovery, self-determination, and other evidence-based practices for people with psychiatric disabilities into medical, social, and behavioral sciences curricula. The principles on which the curricula transformation efforts are based, the instructional activities employed, early outcomes of the endeavor, and future plans for replication are delineated. Sources used: As described in this paper, REAP builds on a theoretical framework derived from the evidence-based literature, multiple technical reports, and curricular initiatives, including the Institute of Medicine, the Annapolis Coalition for Behavioral Workforce Development, and the Final Report of President's New Freedom Commission on Mental Health. Conclusions: REAP has delivered state-of-the-science education to over 1,000 trainees, including medical students, psychiatry residents, psychology and social work interns, and rehabilitation counselors, pre/post-doctoral students and professionals within a variety of academic settings. REAP serves as a replicable structure to successfully integrate recovery education into existing, accredited academic programs and curricula using the parameters outlined by multiple experts and stakeholders. Barriers to curricular transformation and strategies to overcome these barriers are highlighted.