The healthcare marketplace is rapidly changing how we finance medical education, how we train physicians, and the interrelationships within an academic institution. This case study examined the historical development of the Department of Family and Community Medicine and the impact of growing financial constraints on the training of medical students and residents, the clinical practice, faculty workload, and departmental organization. The theoretical frameworks of resource dependence, culture, and professionalization theory were employed to understand how different groups within the context of an academic health center co-exist to meet the core missions of teaching, research, and service. Data collection was conducted over a two-year period and utilized the triangulation of interviews, document analysis, and participant observation methods. The study's findings indicated that the Department of Family and Community Medicine continually faced the challenge of being a primary care department in an academic medical culture that placed more emphasis on specialized care and specialty departments. Over a period of time, the Department went from a profit-center to a cost-center where faculty's ability to teach and conduct research revolved around the success or failure of the clinical care enterprise. Faculty productivity was increasingly emphasized and its definition was dependent on the healthcare marketplace and the availability of resources. The competitive health care market encroached on faculty workload and manifested itself in part through the loss of a major patient care contract, the receivership of the Department, and the splitting of the Department and its resources. During the period of time analyzed, the department was in a no-win situation because the success of the department was determined by more powerful coalitions that had decision making ability and controlled the necessary resources. The department's power lay in the provision of teaching resources and its alignment with the state's goal of training primary care physicians to work in rural and underserved communities. Conflict arose as departments tried to defend and protect their declining resources and jurisdictions. The study findings emphasized the importance of understanding departmental jurisdictions and how resource allocation decisions are made in the context of the academic setting and culture.

Research on belief perseverance--the finding that people cling to initial beliefs to an unwarranted extent--has demonstrated that a belief persists to the extent that there are more explanations available to the believer to support the original belief than to support alternative beliefs. Thus, explanatory evidence that supports an alternative target belief may be more effective in changing prior beliefs than statistical evidence. In an experiment testing this hypothesis, subjects read explanatory (biological) information and/or statistical (epidemiological) information supporting the belief that Acquired Immune Deficiency Syndrome (AIDS) cannot be spread by casual contact. Subjects' beliefs on this issue were assessed before and after reading this information. Subjects also evaluated the evidence they read. Finally, the availability of explanations supporting the target belief was assessed. Results indicated that: (1) explanatory evidence produced significant belief change, whereas statistical evidence did not; (2) evaluations of evidence were biased in accord with subjects' initial beliefs; (3) information polarized attitudes, although attitudes changed in the appropriate direction; (4) final beliefs were more congruent with the target alternative belief after subjects read explanatory information than after they read statistical information. Evidence was mixed regarding whether explanatory evidence was less subject to evaluation bias and subsequent attitude polarization than statistical information. In addition, explanation availability mediated the effectiveness of information in determining final beliefs, and evaluations of the evidence mediated the effect of initial beliefs on attitude polarization. A motivational construct, attitudes toward gay men, was related to initial beliefs and belief change--those with negative attitudes had more inappropriate beliefs and displayed less change in beliefs than those with moderate attitudes. However, evaluations of evidence were better predicted by initial beliefs than by attitudes toward gay men. This study has clear implications for those attempting to change beliefs, including those responsible for AIDS education: explanatory evidence is more effective than statistical evidence in changing beliefs.

Thesis (Ph.D.)--Pacific Graduate School of Psychology, 1994. / Source: Dissertation Abstracts International, Volume: 56-04, Section: B, page: 1921. Chair: Bruce Bongar.

Master of Public Health / Human Nutrition / Richard R. Rosenkranz / Background: Children who obtain insufficient physical activity (PA) have increased risk for chronic diseases. From childhood to adolescence, there is typically a decline in overall PA, with a more rapid decline in girls, at a younger age. The objective of this study was to determine the impact of two types of organized PA instructional conditions (structured no-choice, structured choice) on girls’ PA levels, as compared to free-play at a summer camp in Russia. We hypothesized that free-play would elicit the highest levels of PA. Methods: This study used a within-subjects cross-over trial design. Thirty-two girls (aged 10.7± 0.6yr; BMI percentile 47± 31%) at a Russian summer camp, attended daily 35-minute PA sessions for three weeks. Using the evidence-based Coordinated Approach to Child Health physical activity box, three PA instructional conditions (structured choice, structured no-choice, free-play) were implemented each day. Actical PA monitors collected step count and PA intensity data. Mixed model ANOVAs were used to assess differences in step counts and percentage of time in Moderate to Vigorous Physical Activity (MVPA) by instructional condition. Results: Twenty-five of the 32 participants attended all sessions, and 31 attended at least two of three sessions for each condition. Both structured conditions, no-choice steps/min (mean= 42.7 steps/min; 95%CI= 39.6–45.7; p= 0.0003) and choice condition steps/min (mean= 41.0 steps/min; 95%CI= 37.9–44.1; p= 0.004) were significantly higher than free-play steps/min (mean= 33.4 steps/min; 95%CI= 30.2–36.5). Percent time in MVPA was higher in the no-choice condition (mean= 30.9%; 95%CI= 28.1–33.8; p<0.0001) and choice condition (mean= 30.8%; 95%CI= 27.9–33.7; p< 0.0001) when compared to free-play (mean= 21.2 steps/min; 95%CI=18.2–24.1). There was no difference in steps/min or percentage time in MVPA between both structured conditions. Conclusion: Both types of instruction were superior to free-play with regard to PA level. Although contrary to our hypothesis, our results fit with previous literature that suggests evidence-based instructional interventions can promote higher PA levels in physical education sessions. Our results suggest that well-planned, stimulating PA sessions can increase short-term PA levels in girls compared to free-play opportunities in a Russian summer camp setting.

Master of Science / Department of Journalism and Mass Communications / Soontae An / African American women account for almost two thirds of all women living with HIV/AIDS in the United States. These epidemiological data highlight a critical need to develop intervention campaigns that communicate risk reduction strategies to this population. Using the framework of the Information-Motivation-Behavioral skills (IMB) model, the current study recruited African American women to view one of four brochures in which two experimental treatments were crossed: African American/individual prevention; Caucasian/individual prevention; African American/community prevention and Caucasian/community prevention. Attitude toward the message, risk perception, self-efficacy and community responsibility were measured through a survey questionnaire. Results showed that participants who viewed brochures featuring African American women displayed more favorable attitudes, increased self-efficacy, increased community responsibility and increased perceived risk for other African American women. The limitations of this study and implications for future research and development of HIV/AIDS prevention strategies are discussed.

An important question in teaching language is, what accounts for the emergence of either receptive or expressive labels when teaching only one of them? The teaching procedures in the present study were intended to reproduce the natural development of bidirectional naming in which caregivers comment on the items a child is interacting with and children echo those vocalizations they hear. Thus, the only vocalizations presented by the researcher during teaching occurred after the learner pointed to a specific stimulus, and were specific to the stimulus being targeted. These vocalizations are referred to in this study as stimulus-specific consequences. The purpose of this research was to investigate if the stimulus-specific consequences could become discriminative stimuli for receptive labels, and lead to the emergence of expressive labels. Three studies were conducted, each with four adults. Results demonstrated that using a stimulus-specific consequence during teaching led to receptive labels for all participants, but led to the emergence of expressive labels for only four participants. In other words, bidirectional naming did not occur for the majority of participants. Factors that may improve interrelations between receptive and expressive labels were analyzed, but further evaluations are needed to account for the inconsistent demonstrations of naming.

Graduating competent healthcare providers to meet increasing demands of the United States leads to interest in graduate health science student success. In this study, I explored the relationship between self-regulated learning strategies and licensing exam readiness among Doctor of Chiropractic students. Two research questions asked (1) how self-regulated learning strategies vary by gender and year of study, and (2) how self-regulated learning strategies relate to licensing exam readiness. One hundred thirty-three students from five chiropractic institutions were surveyed with questions from the Motivated Strategies for Learning Questionnaire (MSLQ) and exam readiness items. A series of t-tests, one-way analyses of variance, Kruskal-Wallis H tests, and ordinary least squares (OLS) regression addressed the research questions. Results indicated (1) self-regulated learning strategies do vary by gender and year of study, and (2) self-regulation is related to licensing exam readiness, particularly in Parts I and II of the exam. Chiropractic institutions and policymakers should focus efforts on introducing and reinforcing self-regulated learning strategies throughout the curriculum and explore licensing exam implications. Future research should continue expanding the literature on chiropractic education by considering actual licensing exam performance and determining appropriateness of the MSLQ for chiropractic students.

No description available.

In recent years the complexity and integrated nature of health care has increased. It has become accepted that the needs of patients are often greater than one single health profession can address and requires collaboration on the part of health care providers (Freeth, 2001). Interprofessional health education (IPHE) is the interactive educational process and cooperation among various health care professions. It is a valuable pedagogical approach for teaching health care students that they cannot work effectively without the use of a team, and is thought to be the first step in the direction of changing health care practice in the clinical setting. Using a two phase mixed methods approach, this dissertation investigated changes in student attitudes and measured interprofessional readiness as a result of a longitudinal interprofessional educational experience at Thomas Jefferson University called Health Mentors. The health care professions included in this program are: medicine, nursing, physical therapy, occupational therapy, and pharmacy. Together, these students visit an individual living in the greater Philadelphia, PA region with one or more chronic health conditions four times during the year. Of the five hundred and seventy-six students participating in the Health Mentors program, four hundred and ninety-six completed two surveys in September 2008 and again in April 2009. These were the Interprofessional Education Perception Scale (IEPS) and the Readiness for Interprofessional Learning Scale (RIPLS) which measured their attitudes and readiness toward interprofessional education. Analysis revealed slight significant differences in the means of the health programs and showed small significant decreases in attitudes and readiness over time. Two focus groups were conducted to better understand the quantitative results. Using grounded theory, the following themes emerged: preparation for future professional experience, personal enjoyment from working with their Mentor, logistical conflicts, unknown roles, and program assignments seen as an `add on' or `busy work'. The results from both the qualitative and quantitative methods indicate that students have a high opinion of the theory of IPHE but find the application difficult in practice. / Educational Psychology

Occupational therapy (OT) is a rehabilitation profession in which licensed therapists facilitate functional independence, to the greatest extent possible, of an individual with disabilities. Education for OT is at the Master’s level consisting of a two-year academic program followed by clinical Fieldwork II, a required 12-week internship under the mentorship of a licensed therapist with at least one year’s experience. In light of the fact that clinical fieldwork sites differ in size and resources, and clinical instructors may have only one year’s experience and no formal training in instruction, there is great variability in students’ clinical fieldwork experiences. The purpose of this study was to determine novice rehab OT’s perceptions of four key factors in clinical education: First, skill areas in which they felt most prepared; second, areas perceived as obstacles in adjustment to entry-level practice; third, essential elements of an ideal clinical learning environment; and fourth, the need for credentialing clinical instructors. Participants were 1-3 years post rehab fieldwork with first job in rehab. An online survey (N=45) and audiotaped interviews (N=9) were utilized to collect data on the perceptions of new OT’s on Fieldwork II experiences. Interviewees represented a convenience sample independent of survey participants. Most participants reported feeling prepared to perform basic clinical skills, communicate on interdisciplinary teams and seek mentorship in the workplace. Less proficiency was perceived in the areas of patient/family communication, and coping with reality shock (adjustment to real life practice). Over half of the participants felt that there should be some kind of mandatory credentialing for clinical instructors. There was consensus among OT’s regarding the ideal Fieldwork II setting which included well-trained instructors, availability for onsite learning and a well-equipped clinical site. / Educational Psychology