Thesis (Ph. D.)--University of Texas at Austin, 2007. / Vita. Includes bibliographical references.

Thesis (M.S.)--University of Michigan, 1977.

Thesis (Ph.D.) - University of Queensland, 2003. / Includes bibliography.

Thesis (MEdPsych)--University of Stellenbosch, 2006. / Bibliography. Also available via the Internet.

This research study explores in general the nature of a private general medical practice [PGMP] and whether analysis of the PGMP as a social system can lead the Group Dynamics Practitioner towards developing interventions that will enhance group effectiveness in the PGMP support staff group. The main assumption is that, through the application of a framework of analysis based on that of G. C. Homans and the AGIL functional prerequisites developed by T. Parsons, a structured analysis of the external and internal variables that impact on the PGMP as a social system can be undertaken. The findings of the analysis would lead to the formulation of interventions that would improve the performance effectiveness of the PGMP as a social system. Following a two-questionnaire survey of 17 practices that provided demographic information as well as soft skills training needs, a single PGMP was identified for the case study. Data pertaining to the group as a social system were collected, and by using direct observation, content analysis and a sociometric test, the practice support staff sub-system, being the main focus of this research, could be analysed. By linking the findings to the elements of the framework of analysis, areas of ineffective group functioning could be identified and interventions suggested. This research indicates that the choice of soft skills is associated with the nature and size of the practice, as well as the dynamics of the sociometric patterns characteristic of the relations within the practice support staff subsystem; that while some practice support staff have preferences for sociometric task and socio-emotional relations outside their work clusters, these seem to serve as a buffer against clique forming, thus enhancing the function of integration within the social system as a whole; and that the physical practice layout, and the interaction dynamics that it creates, tend to hinder integration between the members of the practice support staff group, as a social subsystem.

The practice of midwifery by those other than physicians is illegal in Canada and despite recommendations of nursing, medical and consumer groups, no trials evaluating the effectiveness of the nurse-midwife as a member of the modern obstetrical team have occurred here. To demonstrate a nurse-midwifery model, four nurse-midwives provided primary care to forty-seven childbearing women and their families over a twenty-two month period in a maternity teaching hospital. This clinic presented a unique opportunity for comparing the prenatal care provided by nurse-midwives with that of general practitioners who attended deliveries in the same setting. Utilizing a retrospective chart audit, case control study design, the nurse-midwife cases (NM cases) were each matched to two general practitioner controls (GP controls) through the use of the hospital's prenatal data base. The matching characteristics included low risk status, date of delivery, age, parity, gravidity, previous pregnancy losses and census tract income. Prenatal criteria that had been developed and tested in "The Burlington Randomized Clinical Trial of the Nurse Practitioner" for assessing the quality of care were reviewed and updated for this study. With these criteria two blinded abstractors audited the prenatal record forms of all the subjects and scored them as either "superior", "adequate" or "inadequate". Seventy-seven percent of the records of the NM cases received a "superior" score, where as 60% of the GP controls' records received an "inadequate" score [mathematical formula omitted] Overall, the general practitioners' records indicated more erratic care than those of the nurse-midwives. Although the physicians met most of the initial assessment criteria, they failed to meet the criteria that evaluated the ongoing routine assessment process by recording an inadequate number of prenatal visits (36%), or by omitting urine test results (38$) and blood pressure readings (21%). No differences were found in variables relating to labour and delivery with the exception of the incidence of episiotomies. The results indicate that nurse-midwives as part of an obstetrical team are able to provide safe prenatal care to a low risk population in a Canadian urban context, and that their records are thorough and more consistent than those of general practitioners. / Medicine, Faculty of / Population and Public Health (SPPH), School of / Graduate

The sequence of events leading to the implementation of a change in emergency physicians' practice and the learning activities and processes undertaken are examined and described in this study. A qualitative case study design was utilized and semi-structured interviews were employed as the primary means of data collection. Thirty emergency physicians were interviewed in face-to-face or telephone interviews. One change that required learning was selected per physician for an in-depth interview. The following factors were examined: motivation to change a practice behavior, time to implementation of changes, source of awareness, barriers to change, use of learning resources, stages in the change process, and method of learning.

Thesis (M.D.)--Guatemala, 1902. / Includes index.

In American medicine, research has consistently shown disparities between the health experiences of non-Hispanic whites and minority groups (Shervington, 2000); but the practice of racial discrimination within the medical profession is less well acknowledged. Unlike other professions, medicine is a person-oriented field, where Indian physicians are susceptible to facing discrimination on a daily basis. My in-depth interviews with 108 Indian physicians show that individual physicians may achieve social mobility and gain economic parity in the United States, but only as exceptions to the rule, as evident by racial discrimination in promotions, referral patterns, and the 'glass ceiling' faced by them 'when it comes to really rising to the top'. Moreover, the social incorporation of Indian physicians is itself tied to paradoxes and discontents, when minority group members are not fully accepted either by the dominant group or by their own ethnic community. It is in this context that I seek to analyze the influence of social interactions at work on the social incorporation of first and second-generation Indian physicians and in determining their workplace experiences and migratory outcomes. Likewise, with the effects of discrimination being greater for men than for women, the existing gender inequalities in American medicine have differential impacts on the workplace experiences of Indian men vis-à-vis women. However, much of the production of gender and racial inequalities in organizations at large (Acker, 2006) and particularly in medicine, have focused on one or another of these categories, seldom attempting to study them as complex, mutually reinforcing or contradicting processes. My dissertation research strives to make this dimension a crucial part of the analysis. This study should contribute to our understanding of the interaction of recent migration of skilled personnel with developing racial/ethnic and gender relations in US workplaces. The healthcare workforce in the developed world has become increasingly dependent on immigrants from the developing world. I see addressing issues of racial and gender bias in American medicine as a priority in the social sciences and a necessity for a holistic healthcare system in the 21st century. My research is an effort in this direction. / text

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