MENUCLOSE

 

Connect with us

Author: Brian S McGowan, PhD

RESOURCE: Note-Taking Seminars at Radcliffe Institute for Advanced Study – NYTimes.com

…the conference was more than a celebration of quirky marginalia and academic navel-gazing. The study of notes — whether pasted into commonplace books, inscribed on index cards or scribbled in textbooks — is part of a broader scholarly investigation into the history of reading, a field that has gained ground as the rise of digital technology has made the encounter between book and reader seem more fragile and ghostly than ever.

“The note is the record a historian has of past reading,” said Ann Blair, a professor of history at Harvard and one of the conference organizers. “What is reading, after all? Even if you look introspectively, it’s hard to really know what you’re taking away at any given time. But notes give us hope of getting close to an intellectual process.”

Not that note-taking was presumed to be an entirely wholesome activity. During the first panel, when asked if enthusiastic note-takers weren’t more like “compulsive hoarders,” Peter Burke, an emeritus professor of history at the University of Cambridge in England, recalled one of his own teachers warning that any student caught taking notes would be sent out of the classroom for inattention.

via Note-Taking Seminars at Radcliffe Institute for Advanced Study – NYTimes.com.

RESOURCE: Online class providers will grant credentials, for a fee

Providers of free online classes are experimenting with academic security measures that will enable students who successfully complete the college courses to obtain credentials, for a small fee, that convey some of the cachet of a premier university.The credentials, or certificates, won’t translate into course credit toward a degree — at least not at big-name schools — because questions persist about how much those schools are willing to grant students who don’t pay tuition, as well as about the potential for cheating online.

via Online class providers will grant credentials, for a fee.

ABSTRACT: Temporal reasoning over clinical text: the state of the art

Objectives To provide an overview of the problem of temporal reasoning over clinical text and to summarize the state of the art in clinical natural language processing for this task.

Target audience This overview targets medical informatics researchers who are unfamiliar with the problems and applications of temporal reasoning over clinical text.

Scope We review the major applications of text-based temporal reasoning, describe the challenges for software systems handling temporal information in clinical text, and give an overview of the state of the art. Finally, we present some perspectives on future research directions that emerged during the recent community-wide challenge on text-based temporal reasoning in the clinical domain.

via Temporal reasoning over clinical text: the state of the art — Sun et al. — Journal of the American Medical Informatics Association.

ABSTRACT: Patient–provider communication and trust in relation to use of an online patient portal among diabetes patients: The Diabetes and Aging Study — Lyles et al. — Journal of the American Medical Informatics Association

Patient–provider relationships influence diabetes care; less is known about their impact on online patient portal use. Diabetes patients rated provider communication and trust. In this study, we linked responses to electronic medical record data on being a registered portal user and using secure messaging (SM). We specified regression models to evaluate main effects on portal use, and subgroup analyses by race/ethnicity and age. 52% of subjects were registered users; among those, 36% used SM. Those reporting greater trust were more likely to be registered users (relative  risk (RR)=1.14) or SM users (RR=1.29). In subgroup analyses, increased trust was associated with being a registered user among white, Latino, and older patients, as well as SM use among white patients. Better communication ratings were also related to being a registered user among older patients. Since increased trust and communication were associated with portal use within subgroups, this suggests that patient-provider relationships encourage portal engagement.

via Patient–provider communication and trust in relation to use of an online patient portal among diabetes patients: The Diabetes and Aging Study — Lyles et al. — Journal of the American Medical Informatics Association.

ABSTRACT: Communication Challenges for Chronic Metastatic Cancer in an Era of Novel Therapeutics

Advances in the production of novel therapies for cancer management are creating new challenges for the support of increasing numbers of persons surviving for extended periods with advanced disease. Despite incurable and life-limiting metastatic conditions, these patients are living longer with serious disease, pushing the boundaries of what science explains and clinicians can confidently interpret using available evidence. Here we report findings from an early subset of such individuals within a longitudinal qualitative cancer cohort study on clinician–patient communication across the cancer trajectory. In these findings, we contextualize experiential accounts of communication in a changing environment of the costs and uncertainties of personalized medicine, and examine the complex psychosocial circumstances of this rapidly growing patient population. Interpretation of these findings illustrates how emerging issues in cancer treatment influence the experience of these patients, their social and support networks, their cancer care specialists, and the multidisciplinary teams charged with coordinating their care.

via Communication Challenges for Chronic Metastatic Cancer in an Era of Novel Therapeutics.

ABSTRACT: UUnderstanding the Etiology of Prescription Opioid Abuse Implications for Prevention and Treatment

Although studies on the initiation of substance abuse abound, the body of literature on prescription opioid abuse (POA) etiology is small. Little is known about why and how the onset of POA occurs, especially among high-risk populations. In this study we aimed to fill this important knowledge gap by exploring the POA initiation experiences of 90 prescription opioid abusers currently in treatment and their narrative accounts of the circumstances surrounding their POA onset. This research was conducted within a storyline framework, which operates on the premise that the path to drug abuse represents a biography or a process rather than a static condition. Audiotapes of in-depth interviews were transcribed, coded, and thematically analyzed. Analyses revealed the presence of four trajectories leading to POA. This study adds to the limited research on POA etiology by not only illuminating the psychosocial factors that contribute to POA onset, but also by situating initiation experiences within broader life processes. The study findings provide crucial insights to policymakers and interventionists in identifying who is at risk for POA, and more important, when and how to intervene most efficaciously.

via Understanding the Etiology of Prescription Opioid Abuse.

ABSTRACT: Medical student perspectives of what makes a high-quality teaching practice

Abstract
Primary care has seen increasing involvement in undergraduate medical education following recommendation from the GMC in Tomorrow’s Doctors. This is also influenced by an increasing number of medical students and changing patterns of health care. The variety of practices involved in delivering undergraduate primary care placements poses a challenge for the quality of these placements. The variety of learners in primary care may also affect this. To reflect this, Cotton et al in 2009 produced a national consensus list of quality criteria for community-based education using a variety of medical education stakeholders. This paper seeks to explore the medical student perspective of what makes a high-quality teaching practice. This study uses focus group interviewing to explore student perspectives of the range of factors that can contribute towards the quality of a primary care placement. Previous research into student perspectives of teaching in primary care has revealed a strong focus on tutor quality. Students in this study again highlighted the important of good GP tutors and organisation of placements. However, one novel finding was the emphasis that students placed on involving patients in teaching and the vital role that they play in this.

via Medical student perspectives of what makes a … [Educ Prim Care. 2013] – PubMed – NCBI.

ABSTRACT: Do residents need end-of-life care training?

Abstract
Objective: As medical education evolves, emphasis on chronic care management within the medical curriculum becomes essential. Because of the consistent lack of appropriate end-of-life care training, far too many patients die without the benefits of hospice care. This study explores the association between physician knowledge, training status, and level of comfort with hospice care referral of terminally ill patients. Method: In 2011, anonymous surveys were distributed to physicians in postgraduate years 1, 2, and 3; fellows; hospital attending physicians; specialists; and other healthcare professionals in five hospitals of a large health system in New York. Demographic comparisons were performed using χ2 and Fisher’s exact tests. Spearman correlations were calculated to determine if professional status and experience were associated with comfort and knowledge discussing end-of-life topics with terminal patients. Results: The sample consisted of 280 participants (46.7% response rate). Almost a quarter (22%) did not know key hospice referral criteria. Although 88% of respondents felt that knowledge of hospice care is an important competence, 53.2% still relinquished advance directives discussion to emergency room (ER) physicians. Fear of patient/family anger was the most frequently reported hospice referral barrier, although 96% of physicians rarely experienced reprisals. Physician comfort level discussing end-of-life issues and hospice referral was significantly associated with the number of years practicing medicine and professional status. Significance of results: Physicians continue to relinquish end-of-life care to ER staff and palliative care consultants. Exploring unfounded and preconceived fears associated with hospice referral needs to be integrated into the curriculum, to prepare future generations of physicians. Medical education should focus on delivering the right amount of end-of-life care training, at the right time, within the medical school and residency curriculum.

via Do residents need end-of-life care trai… [Palliat Support Care. 2013] – PubMed – NCBI.

ABSTRACT: Virtual patient design: exploring what works and why. A grounded theory study.

Abstract
OBJECTIVES:
Virtual patients (VPs) are online representations of clinical cases used in medical education. Widely adopted, they are well placed to teach clinical reasoning skills. International technology standards mean VPs can be created, shared and repurposed between institutions. A systematic review has highlighted the lack of evidence to support which of the numerous VP designs may be effective, and why. We set out to research the influence of VP design on medical undergraduates.
METHODS:
This is a grounded theory study into the influence of VP design on undergraduate medical students. Following a review of the literature and publicly available VP cases, we identified important design properties. We integrated them into two substantial VPs produced for this research. Using purposeful iterative sampling, 46 medical undergraduates were recruited to participate in six focus groups. Participants completed both VPs, an evaluation and a 1-hour focus group discussion. These were digitally recorded, transcribed and analysed using grounded theory, supported by computer-assisted analysis. Following open, axial and selective coding, we produced a theoretical model describing how students learn from VPs.
RESULTS:
We identified a central core phenomenon designated ‘learning from the VP’. This had four categories: VP Construction; External Preconditions; Student-VP Interaction, and Consequences. From these, we constructed a three-layer model describing the interactions of students with VPs. The inner layer consists of the student’s cognitive and behavioural preconditions prior to sitting a case. The middle layer considers the VP as an ‘encoded object’, an e-learning artefact and as a ‘constructed activity’, with associated pedagogic and organisational elements. The outer layer describes cognitive and behavioural change.
CONCLUSIONS:
This is the first grounded theory study to explore VP design. This original research has produced a model which enhances understanding of how and why the delivery and design of VPs influence learning. The model may be of practical use to authors, institutions and researchers.

via Virtual patient design: exploring what works and wh… [Med Educ. 2013] – PubMed – NCBI.

ABSTRACT: Beyond individualism: professional culture and its influence on feedback.

Abstract
CONTEXT:
Although feedback is widely considered essential to learning, its actual influence on learners is variable. Research on responsivity to feedback has tended to focus on individual rather than social or cultural influences on learning. In this study, we explored how feedback is handled within different professional cultures, and how the characteristics and values of a profession shape learners’ responses to feedback.
METHODS:
Using a constructivist grounded theory approach, we conducted 12 focus groups and nine individual interviews (with a total of 50 participants) across three cultures of professional training in, respectively, music, teacher training and medicine. Constant comparative analysis for recurring themes was conducted iteratively.
RESULTS:
Each of the three professional cultures created a distinct context for learning that influenced how feedback was handled. Despite these contextual differences, credibility and constructiveness emerged as critical constants, identified by learners across cultures as essential for feedback to be perceived as meaningful. However, the definitions of credibility and constructiveness were distinct to each professional culture and the cultures varied considerably in how effectively they supported the occurrence of feedback with these critical characteristics.
CONCLUSIONS:
Professions define credibility and constructiveness in culturally specific ways and create contexts for learning that may either facilitate or constrain the provision of meaningful feedback. Comparison with other professional cultures may offer strategies for creating a productive feedback culture within medical education.

via Beyond individualism: professional culture and its … [Med Educ. 2013] – PubMed – NCBI.