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This study described the instructional practices of selected clinical medical school faculty. It addressed the following questions: - how do medical and surgical clinical faculty select/design and combine instructional methods and media in teaching clinical content? - what influences clinical faculty use of a particular method or medium for clinical teaching? The primary purpose of this research was to investigate how clinical medical school faculty make pedagogical decisions and carry out their instruction in clinical patient care settings. The research described the clinical faculty members' instructional practices with medical students and how the medical apprenticeship system is used for their clinical instruction. The research involved two medical schools and a sample of four clinical faculty representing surgical and medical practice. A general method of descriptive research was employed including the data-gathering techniques of participant observation, interviewing, and collection of documents. Strategies developed by Spradley (1980) and Erickson (1986) were used for data analysis. Findings indicated that the sample clinical faculty do not use an instructional planning process such as described by Gagne and Briggs (1979) or Wildman and Burton (1981). Instead, they select instructional methods and media intuitively, carefully monitoring the medical students' reactions to their instruction. The data show the instructional techniques that include the human element -- defined here as personcentered methods -- are selected most often. / Ed. D.

In the mid-1950's McKeown and Brown advanced a controversial thesis concerning the effectiveness of medical measures available in the eighteenth century. Hitherto it had been widely believed that the rise of population in England and Wales in the eighteenth century had been the result of a fall in mortality partly due to medical improvements such as the growth of hospitals and advances in medical knowledge, a view that had been put forward by Griffith in the 1920's . McKeown and Brown argued that hospitals probably did more harm than good and that contemporary medical treatment with the possible exception of inooculation and vaccination against smallpox, was of little value. They pointed out that surgery, before the introduction of anaesthesia. and antisepsis, was very unsafe and the results of surgical procedures very poor; that in the field of midwifery the introduction of institutional confinements carried greater risks than home deliveries; and that few of the drugs then available were of therapeutic value. They concluded that eighteenth century population growth was not caused by a rise in the birth rate but by a reduction in the death rate probably caused by a decline in the incidence of infectious diseases due primarily to improvements in living conditions and to a lesser extent to changes in the virulence of certain diseases. In a later paper McKeown and Record extended the analysis to 1900 and concluded that the decline in mortality in the second half of the nineteenth century was largely due to improvements in the standard of living, particularly to improvements in diet; hygienic changes introduced by the sanitary reformers accounted for the decline of typhus, typhoid and the diarrhoeal diseases, while changes in virulence of the causative organism accountfor the decline of scarlet fever. They suggested that medical treatment in the nineteenth century had an insignificant impact on mortality; the only effective prophylaxis available was for smallpox and this was responsible for only a small part of the decline in the death rate These conclusions have been questioned; Razzell has argued that the introduction of inoculation against smallpox in the eighteenth century was a major factor contributing to the decline in mortality and Sigsworth, Cherry, and Woodward have stressed from studies of individual hospitals that conditions in voluntary hospitals were better than McKeown and Brown had suggested, particularly in the late eighteenth and early nineteenth century, that surgical mortality was not as high and that a high proportion of patients were discharged "cured" or relieved". The object of this study is to test McKeown's thesis at the 16cal level by considering the relationship between mortality and hospital, medical, and public health provision in Glasgow 1855-1911. Unlike McKeown's studies, use has been made of detailed local sources relating to the hospital, public health and other medical institutions in the city. Minutes and reports of voluntary hospitals and dispensaries have been examined as well as minutes of committees of two of the Glasgow poorhouses and reports and minutes of the committee of health, the sanitary department and the infectious disease hospitals. Mortality rates in Victorian Glasgow were exceedingly high but they did fall in the period under consideration; despite the evident gross poverty and poor living conditions a considerable saving of life was achieved in the second half of the nineteenth century. This study attempts to identify the major diseases contributing to the mortality decline in Glasgow and in Scotland and to discover how the mortality experience of a large industrial city like Glasgow differed from the national pattern.

Medical practice entails lifelong learning of both the science and art of medicine. However, it is not easy to teach or observe what one has learned about the latter. Previous literature has found that learning during the clinical phase is influenced by both the macro, structural issues and micro, individual factors. This ethnographic study investigates the deliberate, systematic, and sustained effort of clinical education at a district hospital in Taiwan in order to find out how medical educators can train and retain caring and competent physicians. It focuses on the students’ experiences during their clerkship, formal and informal teachings such as ward rounds, teachings at the operating room, and fortnightly medical humanities discussions, as well as what the hospital has done to create a conducive environment for teaching and learning. Using a grounded theory approach, it uncovers the problems novices face in clinical practice and learning and effective techniques expert clinicians use in teaching. It concludes that the most effective and efficient education happens when learning is made explicit and visible, when teachers actively engage students in legitimate peripheral participation, when learners become self-directed in their endeavors, and when there is a community of reflective practitioners.

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Thesis (MPhil (Health ScEd))--University of Stellenbosch, 2010. / No abstract available

This dissertation evaluated the provision of two different one-to-one educational interventions, randomly assigned, to two separate groups of medical practitioners at a health maintenance organization (HMO), Cigna Healthplan of Tucson, Arizona. A control group received no intervention. Each group consisted of seven physicians and one nurse practitioner. The intervention was aimed at improving the prescribing of the anti-ulcer drugs, cimetidine, ranitidine, and sucralfate. The theoretical basis for the study involved the cognitive principle of vividness, which implies that more vivid information has greater effect on decisions. For this research, the vivid intervention included case scenarios, while the non-vivid intervention included statistical information of the results of a drug use review. Prescribing data, consisting of percentages and cost of inappropriate prescriptions, were collected for one month prior to and for two months after the intervention. Analysis of covariance was employed with the pre-intervention measures of prescribing as the covariate in each test and post-intervention measures as the dependent variables. No differences were found between the two interventions, but the control group was significantly different from the intervention groups. For the first post-intervention month, it was found that the interventions resulted in significantly lower percentages of prescriptions written inappropriately for indication, dose, or duration (P = 0.001). These percentages decreased by 36% for the intervention groups, while increasing by 14% for the control group. Costs of inappropriate prescribing per study prescription and per patient encounter were also significantly lower for the intervention groups than for the control group (P = 0.001 and P = 0.019, respectively). In the second post-intervention month, inappropriate prescribing increased slightly in the intervention groups and were no longer significantly different from the control group. The research demonstrated the effectiveness of a one-to-one educational intervention in improving drug prescribing at an HMO. The lack of differences between the two interventions may have been due to the overall effectiveness of the one-to-one educational discussion, the interpretation of the statistical information as prescribing feedback by the practitioners, or the inadequate presentation of vividness in the case scenarios.

Despite a shortage of Registered Dietitian Nutritionists (RDNs), only half of applicants currently match with a dietetic internship. A key reason is a shortage of preceptors. The purpose of this cross-sectional study was to better understand RDNs’ views of the preceptor role. An online survey was sent to a randomly selected sample of 10% of RDNs. A total of 1,170 RDNs completed the survey. The survey collected data on reasons dietitians precept, training received, and incentives. Five scales measured supports, benefits, satisfaction, commitment, and barriers to the preceptor role. Three groups of RDNs—current (37.1%), former (33.6%), and never preceptors (29.3%)—were compared and a regression analysis used to determine factors associated with precepting. The main reason RDNs precept was to help the field. Two-thirds of respondents would precept if it were their choice, yet only 37% were current preceptors. RDNs were somewhat dissatisfied with incentives. Continuing Professional Education Units (CPEUs) for precepting was the most common incentive (9.3%), while 35.6% received no incentives. The benefits scale mean scores were similar across the three groups, while current and former preceptors scored significantly higher (p < .001) than the never precepted group on the commitment, satisfaction, and support scales. The never group had significantly higher barriers (p < .001). The top barriers were increased stress from having interns, time-consuming/increased workload, and lack of incentives. Most (69%) RDNs received no preceptor training. Several factors were associated with being a current preceptor: fewer years as an RDN, Bachelor’s degree as the highest degree, holding a specialization credential, working full-time, working/residing in urban areas, working for a DI program, being on a DI advisory committee, and higher commitment scale scores. This study provides valuable insights for increasing RDNs who become preceptors, especially as the field transitions to the competency-based Future Education Model, which combines a graduate degree and supervised experiential learning. RDNs can be recruited as preceptors early in their career and encouraged to become members of advisory committees to connect them more to the preceptor role. Training for precepting can be widely provided, incentives improved, and barriers addressed to reduce stress for RDNs to precept.

Thesis (Master of Emergency Medical Care)--Cape Peninsula University of Technology, 2018. / For emergency medical care (EMC), clinical mentorship can be thought of as the relationship between the EMC students and qualified emergency care personnel. Through this relationship, students may be guided, supported and provided with information to develop knowledge, skills, and professional attributes needed for delivering quality clinical emergency care. However, this relationship is poorly understood and the focus of this research was to explore how this relationship enabled or constrained learning. Through having experienced mentorship, first as a student in EMC, then as an operational paramedic, mentoring students, I was privy to an insider perspective of clinical mentorship, and the experiences of fellow students‘. Through this experience the practices I observed may not have promoted learning. This is when my interest in pre-hospital clinical mentorship in relation to learning began. The aim of this research was to present a qualitative analysis of the clinical mentorship relationship in pre-hospital EMC involving the qualified pre-hospital emergency care practitioner (ECP) and the EMC student. The objectives included gaining an understanding of what enabled and/or constrained learning EMC, exploring clinical mentorship and learning in the pre-hospital EMC context, and gaining understanding of the role and scope of community members in the clinical mentorship activity system. The purpose of this study was to qualitatively document, by means of a thematic analysis, the pre-hospital clinical mentorship relationship, as well as document, by means of a Cultural Historical Activity Theory (CHAT) analysis, the clinical mentorship activity system. The focus of this qualitative documentation was the enablements and constraints to learning during clinical mentorship. This research also made possible recommendations for EMC clinical mentorship and education and may also inform (PBEC) policy, as well as work integrated learning (WIL) policy. Data collection included the use of diaries and focus group interviews. Analysis involved a two-part analysis, where data was reduced and understood with thematic analysis guided by Braun and Clarke (2006) six phase thematic analysis process (explained in Chapter three, Section 3.6). Thereafter, a CHAT analysis was conducted to uncover contradictions within the clinical mentorship activity system that made working on the object of activity difficult, thereby also uncovering constraints to learning. Inductive reasoning was applied to the thematic analysis to reduce data and identify themes and subthemes which provided insight into the enablements and constraints to learning in the pre-hospital EMC clinical mentorship relationship. The CHAT analysis of the data collected and analysed brought to surface the affordances, tensions as well as the primary-level and secondary-level contradictions of the clinical mentorship activity system. The thematic analysis of the clinical mentorship relationship provided limited understanding of the enablements and constraints to learning, and thus further motivated deeper analysis with CHAT. The results of this research included primary and secondary-level contradictions for almost all elements of the clinical mentorship activity system. Contradictions amongst the Division of Labour (DoL), the rules of the activity system, and the tools/resources of the activity system existed in that it constrained the interaction and activity of the subject and the community while working on the object of the activity system possibly achieving a lesser or undesired outcome of clinical mentorship.

Erratum pasted onto front end paper. / Bibliography: leaves 248-260. / xii, 260, 9 leaves : / Title page, contents and abstract only. The complete thesis in print form is available from the University Library. / Examines the establishment and early history of the Adelaide medical school, which was influenced by reforms of medical education in Great Britain. Finds that the content of the Adelaide medical course conformed with British standards, and gave adequate teaching by the standards of the day. Undergraduate teaching and postgraduate opportunities can be seen as Anglo-Australian synergies made possible by formal and informal linkages with the British empire in its last century. / Thesis (M.D.)--University of Adelaide, Depts. of Surgery and History, 2000