UA Open Access Publishing Fund / Study objectives: Multiple curricula have been designed to teach medical students the basics of ultrasound; however, few focus on critical problem-solving. The objective of this study is to determine whether a theme-based ultrasound teaching session, dedicated to the use of ultrasound in the management of the hypotensive patient, can impact medical students’ ultrasound education and provide critical problem-solving exercises. Methods: This was a cross-sectional study using an innovative approach to train 3rd year medical students during a 1-day ultrasound training session. The students received a 1-hour didactic session on basic ultrasound physics and knobology and were also provided with YouTube hyperlinks, and links to smart phone educational applications, which demonstrated a variety of bedside ultrasound techniques. In small group sessions, students learned how to evaluate patients for pathology associated with hypotension. A knowledge assessment questionnaire was administered at the end of the session and again 3 months later. Student knowledge was also assessed using different clinical scenarios with multiple-choice questions. Results: One hundred and three 3rd year medical students participated in this study. Appropriate type of ultrasound was selected and accurate diagnosis was made in different hypotension clinical scenarios: pulmonary embolism, 81% (95% CI, 73%–89%); abdominal aortic aneurysm, 100%; and pneumothorax, 89% (95% CI, 82%–95%). The average confidence level in performing ultrasound-guided central line placement was 7/10, focused assessment with sonography for trauma was 8/10, inferior vena cava assessment was 8/10, evaluation for abdominal aortic aneurysm was 8/10, assessment for deep vein thrombus was 8/10, and cardiac ultrasound for contractility and overall function was 7/10. Student performance in the knowledge assessment portion of the questionnaire was an average of 74% (SD =11%) at the end of workshop and 74% (SD =12%) 3 months later (P=0.00). Conclusion: At our institution, we successfully integrated ultrasound and critical problemsolving instruction, as part of a 1-day workshop for undergraduate medical education

Thesis (DPhil)--University of Stellenbosch, 2004. / ENGLISH ABSTRACT: In this thesis, an ‘alignment approach’ to the quality assurance of medical curricula is developed and practically illustrated in the evaluation of a section of a new curriculum in undergraduate medical education and training instituted at the Faculty of Health Sciences of the University of Stellenbosch in 1999. The background of curriculum innovation at this institution during the 1990s is described, and the literature on the concepts of quality assurance is explored in higher education in general and in medical education and training in particular. The current focus on socially responsive curriculum renewal and accountability illustrates the need for this study. The empirical part of the study was conducted in two phases. The first phase consisted of a ‘clarification evaluation’. The planning of the new curriculum introduced in 1999 was analysed retrospectively through a study of the planning documents and interviews with leaders of the planning process. The results of this clarification evaluation are presented in the form of a ‘Logic Model’. The implicit theory of the curriculum, as represented by the Logic Model, was then evaluated regarding its consistency with trends in medical education. These trends were determined through a study of the literature on the subject published during the time of the planning of the curriculum. It was found that the planning of the curriculum was in line with most of the identified trends, but that it lacked detailed information on how the basic sciences and clinical skills training were to be addressed. This compromised the evaluability of phase I of the curriculum and of the clinical rotations1 by the method use in this study. Because of this, and also considering the time frame of this evaluation, phase I of the curriculum and the late clinical rotations were excluded from the second phase of the study. The aims identified for the curriculum during the process of clarification evaluation were also aligned with the document, The Profile of the Stellenbosch Doctor 2 . This indicates that the planning process of the curriculum was in line with its intended outcome.The second phase of the study consisted of an ‘implementation evaluation’ of phases II and III of the theoretical components and of the early and middle clinical rotations of the curriculum. Data for this implementation evaluation were collected from April 2002 to June 2003. Module chairpersons3, lecturers and students were used as sources of data for the evaluation of the theoretical phases. The perceptions of these groups regarding the implementation of phases II and III of the theoretical part of the curriculum were collected by means of questionnaires designed specifically for this study. For the evaluation of the clinical rotations, the results of the standard student feedback obtained by the Faculty of Health Sciences were used as a source of data for a secondary analysis. The study guides provided for each of the theoretical modules and the clinical rotations were also used as a secondary source for the analysis of data. The data obtained were then analysed by using the framework provided by the Logic Model. Following this, a judgment of the quality of the implementation of the curriculum was made. The planned curriculum was aligned with the practised curriculum by drawing up a ‘curriculum scoreboard’. It was found that alignment was adequately achieved for six of the identified aims, while the implementation of four of the aims was not aligned to the planning according to the criteria used in this study. The study illustrates that the methods of programme evaluation can be validly applied in the evaluation of a curriculum in medical education and training. The Logic Model enables an alignment between the planned and the practised curriculum, which can be used as a measure of the quality of a curriculum in terms of ‘fitness of purpose’. 1 See Addendum A for a diagrammatic overview of the curriculum. The curriculum was structured into three theoretical phases (phases I, II and III) and three clinical rotations (early, middle and late). 2 This document was drawn up during the initial phases of the planning process of the curriculum and regarded by the Faculty as a blueprint for the intended outcomes of the curriculum. 3 A module chairperson in the context of the Faculty of Health Sciences of the University of Stellenbosch is a senior faculty member responsible for the organisation and management of the modules presented as part of the curriculum in medical education and training. / AFRIKAANSE OPSOMMING: In hierdie tesis word ʼn ‘belyningsbenadering’ tot die gehalteversekering van mediese kurrikula ontwikkel en prakties op die proef gestel deur ʼn gedeelte van die nuwe kurrikulum vir voorgraadse mediese onderrig, wat in 1999 aan die Fakulteit Gesondheidswetenskappe van die Universiteit van Stellenbosch ingestel is, te evalueer. Die agtergrond van kurrikulumverandering in hierdie instansie gedurende die 1990’s word ondersoek, en daar word ’n oorsig gegee van die literatuur oor die konsepte van gehalteversekering wat op daardie stadium in die hoër onderwys in die algemeen en in mediese onderrig in besonder in gebruik was. Die huidige fokus op sosiaal responsiewe kurrikula en verantwoordbaarheid illustreer die noodsaaklikheid van ʼn studie van hierdie aard. Die empiriese gedeelte van die studie is in twee fases uitgevoer. Die eerste fase het bestaan uit ‘n ‘verklarende evaluasie’. Die beplanning van die 1999-kurrikulum is retrospektief geanaliseer deur die bestudering van die relevante beplanningsdokumente en deur onderhoude met leiers van die beplanningsproses te voer. Die resultate van die verklarende evaluasie is in die vorm van ʼn ‘Logika Model’ voorgestel. Die implisiete teorie van die kurrikulum, soos voorgestel in die Logika Model, is daarna geëvalueer ten opsigte van die ooreenstemming van die model met die tendense in mediese onderrig wat op daardie stadium geldig was. Hierdie tendense is nagespeur in die belangrikste literatuur oor die onderwerp wat in dieselfde tydperk as die beplanning van die 1999-kurrikulum gepubliseer is. Die bevinding was dat die beplanning van die kurrikulum in lyn is met die meerderheid geïdentifiseerde tendense, maar dat die basiese wetenskappe en opleiding in kliniese vaardighede nie in detail aangespreek is nie. Dit het die evalueerbaarheid van fase I van die kurrikulum en die kliniese rotasies4 deur die metode wat in hierdie studie gebruik is, gekompromitteer. Om hierdie rede, en met inagneming van die tydsraamwerk van hierdie evaluasie, is fase I en die laat kliniese rotasies nie in die tweede gedeelte van hierdie studie ingesluit nie. Die doelwitte van die kurrikulum wat gedurende die verklarende evaluasie geformuleer is, is ook met die dokument, Die Profiel van die Stellenbosch dokter 5, belyn. Dít het aangedui dat die beplanningsproses van die kurrikulum in lyn met die beoogde uitkoms daarvan is.Die tweede deel van die studie het bestaan uit ʼn ‘implementerings-evaluasie’ van fases II en III van die teoretiese komponente en van die vroeë en middel kliniese rotasies van die kurrikulum. Data vir die implementerings-evaluasie is vanaf April 2002 tot Junie 2003 ingesamel. Modulevoorsitters6, dosente en studente is as bronne van data vir die evaluering van die teoretiese fases gebruik. Die indrukke van hierdie groepe persone betreffende die implementering van die teoretiese fases is deur middel van vraelyste ingesamel wat spesiaal vir hierdie studie ontwerp is. Vir die evaluering van die kliniese rotasies is die resultate van die standaard studenteterugvoer wat deur die Fakulteit ingewin word, gebruik as bron vir sekondêre analise. Die studiegidse wat vir elke teoretiese module en die kliniese rotasies verskaf word, het ook as ʼn bron vir sekondêre data-analise gedien. Die data wat vir hierdie studie ingewin is, is deur middel van die raamwerk wat deur die Logika Model verskaf is, geanaliseer. Daarna is ʼn oordeel gevel oor die kwaliteit van die implementering van die kurrikulum. Die kurrikulum-soos-beplan is belyn met die uitgevoerde kurrikulum deur ’n ‘kurrikulumtelbord’ op te stel. Die bevinding was dat hierdie belyning voldoende bereik is vir ses van die geïdentifiseerde doelstellings van die kurrikulum, terwyl die uitvoering van vier van die doelstellings nie goed met die beplanning daarvan belyn was volgens die kriteria wat vir hierdie studie gebruik is nie. Hierdie studie illustreer dat die metodes van programevaluasie geldig toegepas kan word in die evaluering van ’n kurrikulum in mediese onderrig en opvoeding. Die Logika Model maak dit moontlik om die beplande kurrikulum met die uitgevoerde kurrikulum te belyn. Dit kan dan gebruik word as ’n maatstaf van die kwaliteit van ’n kurrikulum in terme van ‘geskiktheid vir doel’.4 Sien Addendum A vir ʼn diagrammatiese oorsig van die kurrikulum. Die kurrikulum is gestruktureer volgens drie teoretiese fases (fases I, II en III) en drie kliniese rotasies (vroeg, middel en laat). 5 Hierdie dokument is gedurende die vroeë fases van die beplanningsproses van die kurrikulum saamgestel en word deur die Fakulteit as ʼn bloudruk vir die beoogde uitkomste van die kurrikulum beskou.6 ’n Module-voorsitter in die konteks van die Fakulteit Gesondheidswetenskappe van die Universiteit van Stellenbosch is ʼn senior lid van die fakulteit wat verantwoordelik is vir die organisasie en bestuur van die modules wat as deel van die kurrikulum in mediese onderrig en opleiding aangebied word.

Thesis (MPhil)--Stellenbosch University, 2014. / ENGLISH ABSTRACT: Background - The College of Phycians and Surgeons Pakistan (CPSP) was established in 1962 and its role is to oversee the postgraduate medical education within Pakistan. At present, various specialties belonging to the CPSP carry out quality assurance visits including evaluation of the learning environment of the teaching hospitals by asking the supervisors and doctors in training about the qualification and experience of supervisors, equipment, library, infrastructure and type of work load. The CPSP do not make use of a valid and reliable method when performing these assessments and therefore there is a need for the CPSP to develop a standardized method of assessing the learning environments of the teaching hospitals in Pakistan. This method needs not only to be valid and reliable but also reproducible and transferable so that it can be used to measure the learning environments in various departments and teaching hospitals .It can further be used to compare the learning environments across different teaching hospitals and specialties with in Pakistan. The learning environment of teaching hospitals of Pakistan have not been studied before therefore the purpose of this study was to measure the postgraduate learning environment of private and public sector teaching hospitals of twin cities in Pakistan Islamabad and Rawalpindi .Public sector hospitals are fully funded by the government of Pakistan and patients receive free treatment, while private hospitals are commercial hospitals where everything is paid by patients. Following the postgraduate educational environment measurement results between house officers and residents working in the above mentioned environments was then compared. These results can inform supervisors and institutions about short comings as well as strong points with regards to the learning environment. Materials and Methods After approval from the Shifa International Hospital`s Ethical committee and Health Research Ethical committee of the University of Stellenbosch, and informed consent were obtained from research participants. The Postgraduate Hospital Educational Environment Measurement questionnaire (PHEEM) was administered to the house officers and residents of six public and one private sector teaching hospital of twin cities (Islamabad and Rawalpindi) in Pakistan with the help of the supervisors of CPSP based at these hospitals. The PHEEM was completed during their respective teaching sessions at the various hospitals .The supervisors was asked to encourage students to complete the PHEEM questionnaire .Supervisors were instructed to collect the completed questionnaires the from doctors in training at their individual hospitals and then send it back using the enclosed envelope The PHEEM contains of 40 items covering a range of issues directly related to the clinical learning environment of house officers and residents1. These statements make up 3 subscales of the clinical learning environment namely autonomy, social support and teaching. Autonomy (such as the quality of supervision) is represented by 14 statements teaching (the qualities of teachers by 15 statements and social support (such as facilities and atmosphere) by 11statements. Each of the 40 statements can be rated from 0-4 .The respondents are asked to indicate their agreement using a 5 point Likert scale .These range from strongly agree(4) ,agree(3), unsure(2), disagree(1) to strongly disagree (0). Agreement with the items indicates a positive learning environment and will result in high scores. The maximum possible scores are 56 for autonomy, 60 for teaching, 44 for social support and an overall score of 160.It is essential that each junior doctor applies the items to their own current learning place1. - Statistical analysis - The statistical analysis was conducted by using SPSS 16.0 and the four negative items were scored in reverse (question 7, 8, 11, 13). The scores for the total as well as the sub-scales were described by using means and standard deviations (SD). Comparisons of the perception of the educational environments between house officers and residents were expressed as a mean and ± SD and its statistical significance was determined by student t- tests. A p value ≤ 0.05 was considered statistically significant. The results from the three construct of the PHEEM survey were compared among the house officers and residents from surgery, medicine, pediatrics and Obstetrics’ and Gynecology by ANNOVA and post hoc sidak test. A p value ≤ 0.05 was considered statistically significant. - Results - The internal reliability of the questionnaire was good with a total Cronbach`s Alpha value of 0.92 (a Cronbach`s alpha of more than 0.7 or 0.8 is accepted as being good). The questionnaire further revealed Crobach`s alpha value of 0.78, 0.89 and 0.70 for the various subscales of autonomy, teaching and social supports .When this was analyzed to exclude each question in turn, using the alpha if deleted there was no significant improvement in the score, thus confirming all questions were relevant and should be included. A total of 286 out of 300 (95.33% response rates) house officers and residents belonging to the seven different teaching hospitals of twin cities of Islamabad and Rawalpindi, Pakistan participated in the study. The PHEEM questionnaire was completed by all the participating doctors composing of 51% house officers and 49 % residents .Both genders were almost equally represented in the two groups comprising of 52% male and 48% female doctors. The distribution of male and female gender is different among respondents from various specialties. There was 23.60% male and 15.03% females in surgery, 22.20% males and 18.30% females in medicines, 6.20% males and 4.32% females in Pediatrics and 10.33% females in obstetrics. House officers and residents belonging to all major specialties took part in the study with the distribution looking as follows, Medicine 44.8%, Surgery 33.6% Obstetrics and Gynecology11.2% and Pedriatics10.50%. The mean score (M) and the standard deviation (SD) for each of the subscale namely the perceptions of autonomy, teaching and social support of house officers and residents are shown Table number 1 (Autonomy), Table number 2 (Teaching) and Table number 3 (Social support) respectively. These tables also show the mean of the total scores of each subscale. The lowest recorded score was 1.37 for question number 4.Question number 1, 4,5,9,11,17 and 32 with in the autonomy section were found to have a relatively low rating as shown in table number 1. Teaching quality questions 3, 21 and 33 showed a low rating as demonstrated in table number 2. Social support showed a low rating for question number 19, 20, 25, 26, 36 and 38 again shown in table number 3. The results from the three subscales of the PHEEM survey were compared between residents and house officers from the teaching hospitals of the twin cities are shown in Table number 1, 2, and 3 respectively. The perception of autonomy was higher amongst residents with a mean of 28.74 compared to house officers 28.27. The difference, however, was not statistically significant between the two groups but there was a statistically significant difference between the two groups in question number 32, where the residents perceived that work load for them was better than house officers. It seems as the residents have better opportunities to access and participate in educational events and programs compared to the house officers seeing that there was a statistically significant difference in question numbers 12 and 21 respectively as shown in table number 1. The perceived level of quality of teaching was higher for residents with mean of 32.02 as compared to the house officers with a mean of 31.12. However this difference was not statistically significant as shown in table 2. The perception of social support was high amongst house officers with a mean of 19.66 compared to residents with a mean of 19.06. There was statistically no difference between the two groups regarding the social support provided at these teaching hospitals; however the house officers felt physically more save compared to residents as shown in table 3 Regarding the difference between private and public sector hospitals, the mean score of the three subscales of the PHEEM, namely the mean score for the perception of autonomy (28.71 vs. 27.14, p=0.24) teaching (33.08 vs. 32.37, p=0.25) and social support (21.94 vs. 21.22, p=0.24) were not statistically significant. The results from the three subscales of the PHEEM survey were compared amongst the junior doctors from Surgery, Medicine, Pediatrics and Obstetrics’ and Gynecology by ANNOVA and post hoc sidak test. There was no statistically significant difference among these junior doctors in the majority of the PHEEM questions. For question number 4, I had an informative induction programme, there was statistically significant difference between the junior doctors of medicine and obstetrics & gynecology .Regarding the question number 5, I had appropriate level of responsibility in this post, and there was statistically significant difference between junior doctors of surgery & pediatrics and surgery and obstetrics & gynecology. There was significant difference between the junior doctors of medicine and Obstetrics and gynecology for question number 29, I feel part of the team working here. Regarding perception of question number 30, I have opportunity to acquire the appropriate practical procedures for my grade; there was significant difference between the junior doctors of obstetrics & gynecology and surgery. For perception of teaching, there was a significant difference between the junior doctors of medicine and obstetrics & gynecology in the following questions. Question number 10: my clinical teachers have good communication skills; Question number 23: my clinical teachers are well organized; and question number 27: I have enough clinical learning opportunity of my needs. In the subscale of social support there was a significant difference for item number 13 which states that there is sex discrimination in this post between the junior doctors of surgery and pediatrics .The junior doctors from medicine perceive that there was more calibration among the doctors of medicine as compared to pediatrics. - Discussion and conclusion - This study shows that the PHEEM questionnaire consists of a practical, reliable and simple set of questions to measure the learning environment of doctors in training at teaching hospitals of Pakistan; a country which is socially, culturally and economically different from the country where this questionnaire was originally constructed. This could imply that the perceptions of doctors in training are similar regardless of geographical boundaries and economic conditions of the country where they live. . Other studies that employed PHEEM in different parts of the world show similar scores. This study does not show a statistically significant difference between house officers and residents in terms of teaching, role of autonomy and social support. The reasons for this may be that house officers and residents share the same infrastructure for accommodation, catering and social support. Furthermore, there is no practically organized structured training programme with a specified job description for doctors at different levels of training. This study therefore does not confirm results of the studies performed in United Kingdom and Australia, where house officers experienced a better learning environment than residents in many respects. This study was completed by house officers and residents from private as well as public sector teaching hospitals. We did not find a statistical difference in the level of perceptions between doctors in training working in these two different set up of hospitals. This goes against the common notion present amongst junior doctors that training at public sector hospitals have a higher level of satisfaction due to better and more learning opportunities than at private sector hospitals because in these hospitals independent work is not allowed. The result off this study indicates that the perception level of house officers and residents in training in various specialties was different regarding the learning environment. This difference was even more marked for the specialty of Gynecology and obstetrics where the PHEEM items were scored lessened compared to the other specialties. The reason for this could be due to better training opportunities, more structured and availability of mentors in Surgery, Medicine and Pediatrics compared to the female dominated specialty of Gynecology and obstetrics. The female work and learn in different way because they score three items directly related to perception of teaching lower compare to male dominated specialities. The PHEEM questionnaire results have been taken from seven teaching hospitals of the twin cities, and therefore provide a good overall picture of the learning environments of teaching hospitals in Pakistan seeing that the teaching hospitals of Pakistan almost have similar infrastructure and faculties with few individual variations. This sample represents all major specialties thus provide a good picture of the learning environment for all doctors in training. It is clear that in order to ensure high standards in education and training of junior doctors, the importance of the learning environment cannot be ignored. The following are recommendations for the CPSP so that they take steps in collaboration with administrative and medical staff to improve the learning environments where needed. 1. A meeting between the CPSP and administrative staff should held every year to overcome the weakness pointed out in this study 2. Teaching hospitals should publish an informative junior doctors hand book , with a job description, responsibilities, expectation and information about working hours 3. The junior doctors should have protected time for educational activities 4. The attendance at educational sessions must be supported by the Supervisors of CPSP 5. Career advice and counseling opportunities should be avaible at each regional center of CPSP 6. Accommodation should meet the appropriate standards 7. Good quality hygienic catering facilities should be present around the clock for junior doctors. 8. Each teaching hospital should administer the PHEEM ever year to measure their quality and potentially improve their standards. In conclusion this study shows a great need for the creation of a supportive environment as well as designing and implementing interventions to remedy unsatisfactory elements of the educational environment if effective and successful learning is to be realized by the CPSP.

Thesis (MSc)--Stellenbosch University, 2012. / ENGLISH ABSTRACT: The Centre for Rehabilitation Studies, Faculty Health Sciences, University of ENGLISH ABSTRACT: Stellenbosch, South Africa, delivers a rehabilitation training programme to its MBChB students. The aim of this programme is to equip graduates with the knowledge, skills and attitudes to manage persons with disabilities in the community which aligns with both the faculty mission and the National Department of Health’s 2010 Plan. In line with rehabilitation philosophies a generic approach using the International Classification of Function, Disability and Health is used in this programme. Feedback has been received from the students at the end of each of the rehabilitation modules and the programme has been reviewed annually by the Module Chair Persons and Rehabilitation Programme Co-ordinator. It had however never been formally evaluated and hence the need for this study. In this study a cross-sectional description of the programme was made using the framework of the World Health Organisation approved World Federation for Medical Education’s Global Standards for basic medical education. Sixty five themes were arranged according to the original nine areas of the standards. Interviews and questionnaires were designed and documentation was reviewed to obtain quantitative and qualitative data from direct and indirect stakeholders from nine population samples. Participants included faculty staff, students as well as rehabilitation experts and persons with disabilities. The analysis of the results of the data collected between March and September 2011 showed that the programme was compliant against 40 of the 65 indicators. The programme was compliant regarding the area pertaining to the mission and objectives and largely compliant regarding the content and delivery of the programme. Where there was non compliance or room for improvement regarding the content, delivery and assessment of the students, recommendations were made, reviewed by the programme committee in November 2011 and implementation was planned for January 2012. Shortcomings identified in the training and support of teaching staff, availability of training resources and in the administrative support of the programme were referred to the Head of the Centre for Rehabilitation Studies. Non-compliance regarding electives and enrolment of medical students with disabilities was considered beyond the immediate control of the programme and were to be referred to the Faculty Health Sciences management. The results showed non-compliance of monitoring and evaluation of the programme, supporting the original need for this study. The indicators were deemed comprehensive and relevant for this evaluation of the rehabilitation programme. It was recommended that four indicators be refined according to the results of this study and that the lists of heath conditions and bio psychosocial problems that persons with disability experience be further validated. Three changes to the tools were recommended should they be used for repeat evaluations of the programme. It was recommended that the methods used to monitor the programme be reviewed allowing for more specific feedback against selected indicators, with wider stakeholder input including lecturers. A final recommendation was that the post of the Rehabilitation Programme Co-ordinator be evaluated in order to effect these recommendations. / AFRIKAANSE OPSOMMING: Die Sentrum vir Rehabilitasie Studies, Fakulteit Gesondheidswetenskappe, Universiteit van Stellenbosch, Suid-Afrika, lewer 'n rehabilitasie-opleidingsprogram aan sy MBChB-studente. Die doel van hierdie program is om gegradueerdes met die nodige kennis, vaardighede en gesindhede toe te rus om persone met gestremdhede in die gemeenskap te kan behandel wat in lyn is met die fakulteit se missie en die Nasionale Departement van Gesondheid se 2010 Plan. In ooreenstemming met rehabilitasie filosofieë word 'n generiese benadering volgens die Internasionale Klassifikasie van Funksie, Gestremdheid en Gesondheid in hierdie program gebruik. Terugvoer is van die studente aan die einde van elk van die rehabilitasie modules ontvang en die program is jaarliks deur die Module voorsitter en Rehabilitasie Program-koördineerder hersien. Dit was egter nooit formeel geëvalueer nie en daarom die behoefte vir hierdie studie. In hierdie studie is 'n deursnee beskrywing van die program gemaak deur gebruik te maak van die raamwerk van die Wêreld-Gesondheidsorganisasie goedgekeurde Wêreld Federasie van Mediese Onderwys se globale standaarde vir basiese mediese opleiding. Vyf-en-sestig temas is volgens die oorspronklike nege gebiede van die standaarde gerangskik. Onderhoude en vraelyste is ontwerp en dokumentasie is hersien om kwantitatiewe en kwalitatiewe data te verkry van direkte en indirekte belanghebbendes uit nege bevolking monsters. Deelnemers het fakulteit personeel, studente, sowel as rehabilitasie kundiges en persone met gestremdhede ingesluit. Die ontleding van die resultate van die data wat ingesamel is tussen Maart en September 2011 het getoon dat die program aan 40 van die 65 aanwysers voldoen. Die program voldoen met betrekking tot die gebied van die missie en doelwitte en is grootliks in ooreenstemming met betrekking tot die inhoud en aflewering van die program. Waar daar nie-nakoming was of ruimte vir verbetering ten opsigte van die inhoud, lewering en beoordeling van die student was, is aanbevelings gemaak in November 2011, deur die program komitee hersien en implementering was vir Januarie 2012 beplan. Leemtes geïdentifiseer in die opleiding en ondersteuning van die doserende personeel, die beskikbaarheid van opleiding hulpbronne en in die administratiewe ondersteuning van die program is verwys na die Hoof van die Sentrum vir Rehabilitasiestudies. Nie-nakoming ten opsigte van elektiwe en die inskrywing van mediese studente met gestremdhede was buite die onmiddellike beheer van die program oorweeg en sou na die Fakulteit Gesondheidswetenskappe verwys word. Die resultate het nie-nakoming van monitering en evaluering van die program getoon, wat die oorspronklike behoefte vir hierdie studie ondersteun het. Die aanwysers was omvattend geag en relevant vir die evaluering van die rehabilitasieprogram. Dit was aanbeveel dat vier van die aanwysers volgens die resultate van hierdie studie verfyn moet word en dat die lyste van die Gesondheids kondisies en bio-psigososiale probleme wat persone met gestremdhede ervaar verder valideer moet word. Drie veranderinge is aan die instrumente aanbeveel sou hulle vir herevaluering van die program gebruik word. Dit is aanbeveel dat die metodes wat gebruik word om die program te monitor, hersien moet word, met voorsiening vir meer spesifieke terugvoer teen gekose aanwysers, met wyer belanghebbendes se insette insluitend dosente. 'n Finale aanbeveling was dat die pos van die rehabilitasie-program-koördineerder geëvalueer moet word ten einde hierdie aanbevelings aan te bring.

The medical profession in recent decades has made culture and cross-cultural competence an issue for patient – physician relationships. Many in the profession attribute the necessity of cross-cultural competence to increased diversity, globalization, and health disparities; however, a historical analysis of medicine indicates that culture’s relevancy for health care and outcome is not new. The rise of clinics, which can be traced to 17th century France, the professionalization of physicians in 18th century U.S., and the civil rights movement of the 20th century illustrate that medicine, throughout its history, has grappled with culture and health. While medicine has a history of discussing cultural issues, the profession has not defined culture cogently. Medicine’s ambivalence in defining culture raises questions about how effectively medical educators prepare residents to be cross-culturally competent. Some medical educators have expressed that many didactic and experiential efforts result in stereotyping patients. Definitions of culture and their impact on stereotyping patients are the central problems of this study. Specifically, this study hypothesized that cultural beliefs impact ones willingness to accept stereotypes. Thus, this study sought to learn how faculty members and residents define culture. Faculty members also were compared to residents to glean the impact of cross-cultural education. This study used an explanatory mixed method design where quantitative and qualitative methods work complementarily to examine a complex construct like culture. A valid and reliable survey provided quantitative data to compare the two groups, while open-ended questions and interviews with faculty members provided context. The statistical results reveal that faculty members and residents share a philosophy of culture; however, when the two groups’ definitions are contextualized, they have many different beliefs. Differences also emerged with respect to predictability; cultural beliefs predict stereotyping among residents, but not faculty members. Faculty members attribute these differences to experiences, while residents believe that they do not learn about culture during their professional education.

Patient and caregiver education is recognized as a critical component of stroke rehabilitation and physical therapy practice yet the informational needs of stroke survivors and caregivers are largely unmet and optimal educational interventions need to be established. The objective of this dissertation was to develop a theory and model of “Rehabilitation Education for Caregivers and Patients” (RECAP) in the context of physical therapy and stroke rehabilitation, grounded in the experiences and perceptions of stroke survivors, their caregivers, and physical therapists. Qualitative research methods with a novel grounded theory approach were used. Potential constructs of RECAP were identified from existing research. Next, semi-structured interviews were conducted with 13 stroke survivors and 12 caregivers from rural Appalachian Kentucky, a region with high incidence of stroke and lower levels of educational attainment. Lastly, 13 physical therapists, representing inpatient rehabilitation, outpatient, and home health, were recruited and participated in pre-interview reflection activities and interviews. Data analysis involved predetermined and emerging coding and a constant comparative method was employed. Verification strategies included self-reflective memos, analytic memos, peer debriefing, and triangulation. The theory generated from this dissertation is: physical therapists continually assess the educational needs of stroke survivors and caregivers, to participate in dynamic educational interactions that involve the provision of comprehensive content, at a point in time, delivered through diverse teaching methods and skilled communication. This phenomenon is influenced by characteristics of the physical therapist and receiver (stroke survivor/caregiver) and occurs within the context of the physical therapist’s professional responsibility, the multidisciplinary team, a complex healthcare system, and the environmental/socio-cultural context. The RECAP theoretical model depicts the relationships between the core and encompassing constructs of the theory. The RECAP theory and model presents a significant advancement in the study of patient and caregiver education in physical therapy in stroke rehabilitation. This research provides a springboard to inform future research, guide RECAP in stroke physical therapy practice, design optimal educational interventions, develop training tools for entry-level curriculum and practicing clinicians, and to potentially translate to the practice of patient and caregiver education for other rehabilitation professionals and patient populations.

The primary purpose of this study was to examine the relationship between educational and curricular factors and physician location decisions. As a background to the study, a literature search traced the history of medical education in the U.S., focusing on various influences on physician distribution. In the research on physician location decision, this study is unique in its use of the constant comparative method. This method is an inductive approach developed and refined by Glaser and Strauss, used in this study to generate theory regarding the role of educational factors in physician location decisions. In this research, two groups of physicians who completed training after 1965 were selected for study, based on their locations in distinctly different practice settings in Arizona: urban and rural. An open-ended interview format was developed, and each physician was interviewed, with data analysis beginning during the first interview and continuing through the entire period of data collection. Using the constant comparative method, similar groups (rural physicians) were compared to bring out basic properties of categories, and different groups (urban physicians) were then compared to establish boundaries of applicability of the theory. As the interviews proceeded a basic theoretical framework emerged, enabling development of a grounded theory of physician location decisions. The study presents strong empirical evidence in support of the proposition that educational factors are influential in the decision of a physician to enter practice in a rural area. Four primary influences were identified: faculty role modeling, participation in rural clerkships, preceptorships, or required family practice rotations, service activities related to health care for medically underserved populations, and education in a non-traditional setting, or residency training in a rural area. Curriculum content and requirements take on major significance when these influences are subsumed under the major influence of socialization. The extent to which these educational factors play a role in the practice locations of physicians varies according to educational opportunities available during the training period.

Ultrasound imaging is a rapid and noninvasive tool ideal for the imaging of soft tissue infections and is associated with a change of clinician management plans in 50% of cases. We developed a realistic skin abscess diagnostic and therapeutic training model using fresh frozen cadavers and common, affordable materials. Details for construction of the model and suggested variations are presented. This cadaver-based abscess model produces high-quality sonographic images with internal echogenicity similar to a true clinical abscess, and is ideal for teaching sonographic diagnostic skills in addition to the technical skills of incision and drainage or needle aspiration.

Team-based learning (TBL) is one strategy for improving team-work and critical thinking skills. It has proven to be an engaging teaching pedagogy in face-to-face classes, however, to our knowledge, has never been implemented online in a 3-D virtual world. We implemented virtual TBLs in an online undergraduate anatomy course using Second LifeTM, and evaluated whether it engaged students. This study was conducted over 2 semesters with 39 total students. Surveys and content analysis of transcripts were used to evaluate student engagement. Our results indicate virtual TBLs were engaging for most students. The average engagement score was 7.8 out of 10 with 89.2% of students reporting a score of 6 or above. Students exhibited high levels of cognitive engagement during the clinical application portion of the TBL process. Males felt more emotionally engaged than females, however, most measures of engagement indicated no differences between groups of students (mode of communication, previous technology experience, gender, and performance); therefore, virtual TBLs may be engaging for a broad range of students. 95% of students agreed that this was a worthwhile experience. In light of this evidence, we feel that virtual TBL sessions are valuable, and could be implemented in other online courses.

After emergency department (ED) discharge, Spanish-speaking patients with limited English proficiency are less likely than English-proficient patients to be adherent to medical recommendations and are more likely to be dissatisfied with their visit.