Thesis (M.A.)-- University of Texas Southwestern Medical Center at Dallas, 2006. / Vita. Bibliography: p. 158-163

Thesis (M.S.)--University of Michigan, 1983.

Thesis (M.S.)--University of Michigan, 1983.

Diss. (sammanfattning) Stockholm : Karolinska institutet, 2010.

Thesis (Ph.D.)--Aberdeen University, 1998. / Title from web page (viewed on Mar. 4, 2010). Includes bibliographical references.

Thesis (Ph. D.)--University of North Texas, May, 2007. / Title from title page display. Includes bibliographical references.

Introducción: Un tercio de la población mundial presenta una infección tuberculosa latente, con 9,4 millones de casos nuevos reportados en el 2009; los estudiantes de medicina tienen de 2 a 50 veces más probabilidad de adquirir la infección. Objetivos: Establecer la prevalencia de PPD positivo basal al inicio de la carrera médica y determinar la incidencia y los factores asociados a la conversión de PPD en alumnos de medicina. Materiales y Métodos: Análisis secundario de datos de una cohorte histórica (2007-2010) involucrando alumnos de medicina de una universidad privada en Perú. Se evaluó la conversión de PPD. Se aplicó un análisis de regresión binomial para cada variable de interés. Resultados: 707 estudiantes fueron seguidos, de ellos 219 (31%) fueron hombres. La prevalencia basal de PPD positivo fue 14,4%. Se encontró asociación significativa con el año de ingreso 2007-08 (p = 0,007) y antecedente de tuberculosis anterior (p = 0,02). Con un total de 822 personas-año, la incidencia de conversión fue de 2,92 por 100 personas-año (IC95%: 1,96-4,36). En el modelo bivariado, el año de ingreso a la carrera y el IMC > 25 kg/m2 estuvieron asociados con conversión de PPD. Sin embargo, en el modelo multivariado, sólo el año de ingreso mostró asociación estadísticamente significativa (RR = 2,53; IC95%: 1,11-5,76). Conclusiones: Existe una prevalencia basal elevada de infección latente en alumnos de medicina. La tasa de incidencia está dentro de los valores esperados y previamente reportados. Se recomienda prestar más atención a las medidas de bioseguridad y prevención en estudiantes de medicina. / Revisión por pares

Orientadores: Eliana Martorano Amaral, Angelica Maria Bicudo Zeferino / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas / Made available in DSpace on 2018-08-12T11:06:13Z (GMT). No. of bitstreams: 1 Domingues_RosangelaCurvoLeite_D.pdf: 2568394 bytes, checksum: ef02de041cdb4116f477edbaf37a5267 (MD5) Previous issue date: 2008 / Resumo: Objetivo: Relacionar o Conceito Global Itemizado com o Conceito Geral dos alunos do 4º ano de Medicina, atribuídos por três tipos de avaliadores (docentes, colegas e próprio aluno) e compará-lo com os outros métodos de avaliação das competências esperadas no atendimento em unidade de atenção primária. Sujeitos e métodos: Foram estudadas as notas atribuídas a estudantes do 4º ano (n=106), por docentes (n=19), pelos próprios alunos e por colegas, ao final de um módulo de ensino que se desenvolve em 6 unidades básicas de saúde, sob supervisão de docentes e tutores de Ginecologia e Obstetrícia (GO), Clínica Médica (CM) e Pediatria (Ped). Os docentes forneceram uma nota (0 a 10) que resumia as competências do aluno no semestre, cuja média foi definida como Conceito Geral (CG). Depois de duas semanas, os mesmos docentes preencheram o formulário pré-testado do Conceito Global Itemizado (CGI) para os mesmos alunos, que continha 6 domínios de competências técnicas (CGIt) e 7 de competências humanísticas (CGIh). Os alunos preencheram formulários iguais (de CG e de CGI) para realizar sua auto-avaliação e apenas a parte das competências humanísticas (CGIh) para anonimamente avaliar 3-4 colegas que compunham o seu grupo. Por meio de um instrumento auto-respondido, também expressaram sua opinião sobre o exercício de se auto-avaliar e de avaliar seus colegas. As notas de CGI foram comparadas com notas provindas de outros métodos de avaliação: Provas Teóricas (Pt), Portfólio (Pf) e Avaliação Estruturada (AE). A análise estatística incluiu estatísticas descritivas, análise fatorial, coeficientes de Cronbach, testes de Friedman e de Wilcoxon para dados emparelhados, coeficientes de correlação de Pearson e de Spearman, modelos de análise de variância (ANOVA) e distâncias Euclidianas. Assumiu-se o nível de significância de 5%. Foi utilizado o programa SPSS Versão 10.0. O projeto foi aprovado pelo Comitê de Ética e Pesquisa da instituição. Resultados: Houve predominância de notas elevadas e discriminação reduzida entre os alunos. A consistência interna do questionário de CGI foi elevada para todos os avaliadores (alfa de Cronbach > 0,881). As notas de CG dos alunos foram significativamente inferiores às dos docentes (diferença de medianas = 0,41). As notas de CG foram significativamente inferiores às notas do CGI na avaliação docente (diferença de medianas = 0,13), mas não na auto avaliação e tiveram maior concordância e correlação com as notas de CGIt (r= 0,873 docente, r= 0,715 auto-avaliação) do que com as de CGIh (r= 0,614 docente, r= 0,481 auto-avaliação). As notas de CGIh foram significativamente mais elevadas do que as de CGIt, tanto na auto-avaliação (diferença de medianas = 0,17) quanto na avaliação docente (diferença de medianas = 0,19), com modestas correlações entre elas (r= 0,62 docentes, r= 0,61 auto-avaliação). Os alunos atribuíram notas significativamente mais baixas para os colegas do que para si mesmos (CGIh, diferença de medianas = 0,36). As correlações entre as notas dos três tipos de avaliadores para todos os domínios do CGI foram muito pobres e, em geral, não significativas. As notas dos docentes de Ped foram significativamente inferiores às dos docentes de GO e CM (diferenças de medianas entre 0,50 e 0,67), com correlações baixas entre elas (-0,02<r<0,48). A maior discordância ocorreu entre as notas de GO e Ped, em todos os métodos. Os domínios que tiveram maior impacto na confiabilidade do CGI foram: Exame físico, Solução de problemas, Capacidade de auto-reflexão e Julgamento clínico. Hábitos de trabalho poderia ser excluído do instrumento itemizado. 90,6% dos alunos/avaliadores avaliaram todos os seus colegas de grupo. Houve indicações de reciprocidade e constância no padrão das notas entre pares e situações sugestivas de conflitos interpessoais. Os alunos se sentiram mais confortáveis e preparados para a auto-avaliação do que para a avaliação dos colegas (diferença de 34,4% e 17,7%, respectivamente) e julgaram a auto-avaliação mais justa e valiosa do que a avaliação dos colegas (diferença de 4,2% e 34,7%, espectivamente). Houve diferenças significativas entre as distribuições das notas de todos os métodos, com notas mais elevadas na AE (mediana = 9,27). Houve correlação forte e significativa (r= 0,719) e maior concordância entre as notas da AE e as do CGI. Conclusão: Os alunos foram mais rigorosos consigo mesmo do que os docentes no CG e nos atributos técnicos do CGI e com seus pares nos atributos humanísticos do CGI. As notas do CG foram inferiores às do CGI para os docentes, mas não para os próprios alunos e enfocaram principalmente as competências técnicas dos estudantes. O CGI mostrou-se uma estratégia válida e confiável para compor o conjunto de métodos de avaliação dos estudantes do 4º ano de medicina, em estágio clínico. / Abstract: Purpose: To correlate the Global Itemized Rating with the Global Overall Rating attributed to Y4 medical students by three types of assessors (faculty, peers and self), and to compare it with other assessment methods used to evaluate learners in clinical clerkship, at the primary level of care. Subjects and Methods: The focus of the present study were ratings attributed to Y4 medical students (n= 106) by faculty members (n= 19), by own students and peers, at the end of a teaching module conducted at 6 primary care centers, and supervised by faculties and tutors from Obstetric and Gynecology (O&G), Internal Medicine (IM) and Pediatrics (Ped). Faculties provided a summative global numeric rating, ranging from 0 to 10, which summarized student's competencies during the clerkship. Faculty global scores across disciplines were averaged and defined as a Global Overall Rating (GOR). Two weeks after securing GOR ratings for all students, the same faculty members assessed the same students using in a pre-tested Global Itemized Rating, named GIR, which encompassed thirteen domains: six referred to technical skills (GIRt), and seven to humanistic skills (GIRh). Students completed similar GOR and GIR forms for self-assessment, and the humanistic scoring components of the GIR form to anonymously assess three to five working-group peers. Students answered a questionnaire on their perceptions to the experience as self and peer raters. GIR ratings were compared with ratings from other assessment methods: Multiple-choice questions (MCQs), Portfolio (Pf) and Real-case structured clinical assessment (RC-SCA). Statistical analyses included descriptive statistics, factor analysis, Cronbach's alpha, Friedman test, Wilcoxon signed rank test, Pearson and Spearman correlation coeffients, ANOVA models and Euclidean distances. Statistical significance was set at P<0.05. Statistical analyses were performed using SPSS program, version 10.0. Ethical approval was obtained. Results: Distributions were negatively skewed and reduced discrimination among students was observed. GIR internal consistency was high, across all types of raters (Cronbach's alpha > 0.881). Students' GOR ratings were significantly lower than faculties' (median difference = 0.41). GOR ratings were significantly lower than GIR ratings for faculty (median difference = 0.13), but not for self, and showed stronger agreement and correlation with GIRt (r= 0.873 for faculty and r= 0.715 for self) than with GIRh (r= 0.614 for faculty and r= 0.481 for self). GIRh ratings were significantly higher than GIRt (median difference = 0.17 for self and 0.19 for faculty), with modest correlations between them (r= 0.62 for faculty and r= 0.61 for self). Learners attributed lower mean ratings to their fellow students than to themselves (CGIh median difference = 0.36). Correlations between faculty, self and peer scores were very poor in all domains, and generally non significant. Ped scores were significantly lower than O&G and IM (median differences between 0.50 and 0.67), with low correlations between them (-0.02<r<0.48). O&G and Ped scores showed greater disagreement, in all methods. The domains that had greater impact on the reliability of the scale were: Physical examination, Problem-solving, Self- reflective skills and Clinical Judgment. Work habits could be excluded from the itemized form. 90.6% of the learners/raters assessed all their group-peers. Patterns of reciprocity and constancy in ratings, and some situations suggesting conflicts were noticed in working groups. Learners expressed to be more comfortable and prepared for self than for peer assessment (difference = 34.4% and 17.7%, respectively), and considered self-assessment more fair and valuable than peer assessment (difference = 4.2% and 34,7%, respectively). There were significant differences between score distributions in all assessment methods, with higher ratings in RC-SCA (median = 9.27). RC-SCA and GIR showed strong and significant correlations (r= 0.719) and greater agreement. Conclusion: Learners were sctricter with themselves than faculty in GOR and in GIR technical domains, and with their colleagues in GIR humanistic domains. GOR ratings were lower than GIR ratings for faculty, but not for self, and focused mainly on students' technical skills. GIR has shown to be a valid and reliable strategy, which can make up the set of assessment methods used to evaluate fouth-year students in clinical clerkship. / Doutorado / Ciencias Biomedicas / Doutor em Tocoginecologia

Background: In Germany, the process of moving pre-registration nursing education into higher education within a faculty of medicine has differed from developments at universities of applied sciences. This is because such a process implies radical change for the status of and relationship between nurses and physicians. Literature review: The body of knowledge on interprofessional undergraduate education of nursing and medical students, including work on the nurse-physician relationship and collaborative practices of nurses and physicians, provides the foundation of this research. Aim: The primary aim has been to involve the active participation of educational practitioners of the nursing and medical professions concerned in working towards a collaborative culture, including interprofessional undergraduate education for nursing and medical students. Methodology and methods: A participatory paradigm position guided this research, using cooperative inquiry as one approach in action research. The inquiry group decided on the methods to be used for the inquiry and planned, acted out, and reflected on eight interprofessional educational sessions in three cycles over a process of two years. Data from inquiry group members' experiences were audiotaped during this process and analysed with a focus on experiential and propositional knowledge development. Inquiry group members gained feedback from nursing and medical students after their interprofessional sessions in eight group discussions. Framework analysis of qualitative data was used to guide data analysis. In addition, students had the option to provide feedback by completing a questionnaire to evaluate the sessions. For the analysis of the questionnaire data descriptive statistics was used. Findings: The 3P model (presage, process, product) was used as a meta-structure for the IPE_NUMESO model to guide further classroom teaching of nursing and medical students. It was found that undergraduate education of nursing and medical students is a complex social process accompanied by mixed emotions and a strong desire to overcome the separation of both professions. Discussion: The research adds new insight into IPE for undergraduate nursing and medical students: emotions, values, and a problematic reality in which both groups of professionals work together (presage), role change in simulation, the asset of a safe learning environment, peer learning, and strategies to overcome the separation (process). Certain experiences are proposed to be worthwhile (product), such as being able to understand the essence of clinical situations and deal with issues like emotions, values, knowledge and its communication, clinical experience, and power. Social learning theory provided a suitable explanatory approach for the findings. Conclusion and recommendations: This research adds to the knowledge on interprofessional education for undergraduate education for nursing and medical students. Considering IPE as a complex social process offers promising potential to transform future collaborative practices by preparing students for a complex and dynamic collaboration of both professions at the patient's bedside. Recommendations for clinical practice, interprofessional education, and policy are presented.

This study investigated the perceptions of college student health center administrators concerning the availability of contraceptive services to college students. The major purposes of the study were (1) to determine the extent to which specific contraceptive services were available to college students from various sources, (2) to determine the extent and effectiveness of any opposition or support from various pressure groups concerning the provision of contraceptive services by student health centers, and (3) to describe the trend, as .perceived by student health center directors, of student access to contraceptive services from 1970 to 1975 and to project the trend to 1980. The findings indicated that pressure activity supporting the provision of contraceptive services by student health centers arose mostly from institutionally related student groups and was considered to be "effective" (i.e., influenced administrative decision making). Pressure which arose from other groups was found to be slight and of little effectiveness.