Motivation in medical education and patient communication. The EGPRN meeting in Zurich,Switzerland, October 2010

Abstract

The European General Practice Research Network held an international research meeting on ‘Motivation in medical education and patient communication’ in Zürich, Switzerland, in October 2010. The two authors were keynote speakers, who introduced the theme from different angles and summarized and reflected on individual papers presented at the conference. The theme of the conference underlined the importance of communication in general practice and of motivation in medical education in particular. There were a variety of papers each addressing in its own way the topic of this meeting. We conclude that it is still uncommon to use psychological theories on motivation in research on motivation and patient communication in general practice/family medicine. Motivation and readiness to change are essential concepts in experimental health services research. Research designs increasingly follow the Framework for the Evaluation of Complex Interventions in Health Care as suggested by the British Medical Research Council. However, there are also difficulties related to classical experimental designs that have to be critically discussed.     

Children in general practice: an exciting area for research. Reflections on the EGPRN meeting in Plovdiv, Bulgaria, May 2010

The European General Practice Research Network organized an international research conference on 'Children in General Practice' in Plovdiv, Bulgaria, in May 2010. Two of the authors were keynote speakers at the workshop, tasked with summarizing the theme research presentations on each of the two days of the meeting. The theme of the meeting 'Children in General Practice' refers to the primary aim for timely and high quality health care for every child and the related general practitioners' activities. The meeting was an important event, especially for young doctors and investigators from different countries, because they were informed of good practices from other European countries in preventive work with children. All participants shared and learned a lot of good ideas beyond the standards and quality management. Examples of ideas for new research questions that emerged were to study differences in routine check-ups during childhood between European countries; to study the effectiveness of advices given by GPs to (parents of) obese children; and to study adverse events of medication in general practice. CONCLUSION: At a European level, the diversity of the ways health care systems deal with health problems in children is striking. We felt great enthusiasm to further develop this research area. Interested family doctors are invited to attend future conferences to develop collaborative research projects on this topic.     

Research using electronic patient records in general practice. The EGPRN meeting in Bertinoro,Italy, May 2009

Abstract

The European General Practice Research Network organized an international workshop on research using electronic patient records in Bertinoro, Italy, in May 2009. The authors were keynote speakers at the workshop, tasked with summarizing the theme research presentations on each of the two days of the meeting. The conference discussed the utility of capturing data in a way that can be appropriately analysed. In this application, the use of ICPC was repeatedly mentioned. Such research requires disciplined data entry and retrieval, and many times consistency in coding is a challenge, which may be met by definitions for coded classes. Quality of data is a concern in such research, and there were suggestions to involve the patients in improving the quality of their record. Clinicians are qualified to code data into electronic patient records accurately, capturing the fine nuances of the consultation. Income incentives, such as the Quality Outcomes Framework, run the risk of data distortion to improve financial gain. The role of all family doctors in research was emphasized, and the full potential of collecting data from family practice is practically achievable only through large databases collecting clinical records from every practice. EGPRN has dealt with this emerging theme in primary care research over the years. Interested family doctors are invited to attend future conferences to develop collaborative research projects using electronic patient records.     

Children in general practice: An exciting area for research. Reflections on the EGPRN meeting in Plovdiv,Bulgaria, May 2010

Abstract

The European General Practice Research Network organized an international research conference on ‘Children in General Practice’ in Plovdiv, Bulgaria, in May 2010. Two of the authors were keynote speakers at the workshop, tasked with summarizing the theme research presentations on each of the two days of the meeting. The theme of the meeting ‘Children in General Practice’ refers to the primary aim for timely and high quality health care for every child and the related general practitioners’ activities. The meeting was an important event, especially for young doctors and investigators from different countries, because they were informed of good practices from other European countries in preventive work with children. All participants shared and learned a lot of good ideas beyond the standards and quality management. Examples of ideas for new research questions that emerged were to study differences in routine check-ups during childhood between European countries; to study the effectiveness of advices given by GPs to (parents of) obese children; and to study adverse events of medication in general practice.

Conclusion: At a European level, the diversity of the ways health care systems deal with health problems in children is striking. We felt great enthusiasm to further develop this research area. Interested family doctors are invited to attend future conferences to develop collaborative research projects on this topic.     

Development of a research agenda for general practice based on knowledge gaps identified in Dutch guidelines and input from 48 stakeholders

Background: Several funding organizations using different agendas support research in general practice. Topic selection and prioritization are often not coordinated, which may lead to duplication and research waste.

Objectives: To develop systematically a national research agenda for general practice involving general practitioners, researchers, patients and other relevant stakeholders in healthcare.

Methods: We reviewed knowledge gaps from 90 Dutch general practice guidelines and formulated research questions based on these gaps. In addition, we asked 96 healthcare stakeholders to add research questions relevant for general practice. All research questions were prioritized by practising general practitioners in an online survey (n?=?232) and by participants of an invitational conference including general practitioners (n?=?48) and representatives of other stakeholders in healthcare (n?=?16), e.g. patient organizations and medical specialists.

Results: We identified 787 research questions. These were categorized in two ways: according to the chapters of the International Classification for Primary Care (ICPC) and in 12 themes such as common conditions, person-centred care and patient education, collaboration and organization of care. The prioritizing procedure resulted in top 10 lists of research questions for each ICPC chapter and each theme.

Conclusion: The process resulted in a widely supported National Research Agenda for General Practice. We encourage both researchers and funding organizations to use this agenda to focus their research on the most relevant issues in general practice and to generate new evidence for the next generation of guidelines and the future of general practice.     

Teaching clinically experienced physicians communication skills. A review of evaluation studies

CONTEXT: Interest in the teaching of communication skills in medical schools has increased since the early seventies but, despite this growing interest, relatively limited curricular time is spent on the teaching of communication skills. The limited attention to the teaching of these skills applies even more to the physicians' clinical years, when attention becomes highly focused on biomedical and technical competence. Continuing training after medical school is necessary to refresh knowledge and skills, to prohibit decline of performance and to establish further improvements. OBJECTIVE: This review provides an overview of evaluation studies of communication skills training programmes for clinically experienced physicians who have finished their undergraduate medical education. The review focuses on the training objectives, the applied educational methods, the evaluation methodology and instruments, and training results. METHODS: CD-ROM searches were performed on MedLine and Psychlit, with a focus on effect-studies dating from 1985. RESULTS: Fifteen papers on 14 evaluation studies were located. There appears to be some consistency in the aims and methods of the training programmes. Course effect measurements include physician self-ratings, independent behavioural observations and patient outcomes. Most of the studies used inadequate research designs. Overall, positive training effects on the physicians' communication behaviour are found on half or less of the observed behaviours. Studies with the most adequate designs report the fewest positive training effects. CONCLUSION: Several reasons are discussed to explain the limited findings. Future research may benefit from research methods which focus on factors that inhibit and facilitate the physicians' implementation of skills into actual behaviours in daily practice.     

Qualitative outcome assessment and research on chronic disease management in general practice. Highlights from a keynote lecture,EGPRN May 2011, Nice

At its 2011 conference in Nice, France, the European General Practice Research Network (EGPRN), considered the issue of Relevant Outcome Measures in General Practice Research into Chronic Diseases. This paper, which is adapted from a keynote lecture given during that conference, considers the role of qualitative outcome assessments in research. Such assessments have a great deal in common with the patient-centred approach of general practice as they can capture the overall state of a patient rather than capturing only certain aspects. Research suggests that patients can be categorized, based on qualitative outcome assessment, and over time might change category. This approach to assessment brings to our attention alternative ways of considering the future: future as currently being made or future as predictable, at least to some extent. Although general practice needs the evidence from research that predicts the future, it also needs to engage in research that seeks to understand patients as they make their future, and to understand the impact of clinical interventions on this process.     

Qualitative outcome assessment and research on chronic disease management in general practice. Highlights from a keynote lecture, EGPRN May 2011, Nice

At its 2011 conference in Nice, France, the European General Practice Research Network (EGPRN), considered the issue of Relevant Outcome Measures in General Practice Research into Chronic Diseases. This paper, which is adapted from a keynote lecture given during that conference, considers the role of qualitative outcome assessments in research. Such assessments have a great deal in common with the patient-centred approach of general practice as they can capture the overall state of a patient rather than capturing only certain aspects. Research suggests that patients can be categorized, based on qualitative outcome assessment, and over time might change category. This approach to assessment brings to our attention alternative ways of considering the future: future as currently being made or future as predictable, at least to some extent. Although general practice needs the evidence from research that predicts the future, it also needs to engage in research that seeks to understand patients as they make their future, and to understand the impact of clinical interventions on this process.     

An outcomes research perspective on medical education: the predominance of trainee assessment and satisfaction

CONTEXT: A fundamental premise of medical education is that faculty should educate trainees, that is, students and residents, to provide high quality patient care. Yet, there is little research on the effect of medical education on patient outcomes. OBJECTIVE: A content analysis of leading medical education journals was performed to determine the primary foci of medical education research, using a three- dimensional outcomes research framework based on the paradigm of health services outcomes research. DATA SOURCES: All articles in three medical education journals (Academic Medicine, Medical Education, and Teaching and Learning in Medicine) from 1996 to 1998 were reviewed. Papers presented at the Research in Medical Education conference at the Association of American Medical Colleges annual meeting during the same period, and published as Academic Medicine supplements, were also analysed. STUDY SELECTION: Only data-driven articles were selected for analysis; thus editorials and abstracts were excluded. DATA EXTRACTION: Each article was categorized according to primary participant (i.e. trainee, faculty, provider and patient), outcome (performance, satisfaction, professionalism and cost), and level of analysis (geographic, system, institution and individual(s)). DATA SYNTHESIS: A total of 599 articles were analysed. Trainees were the most frequent participants studied (68.9%), followed by faculty (19.4%), providers (8.1%) and patients (3.5%). Performance was the most common outcome measured (49.4%), followed by satisfaction (34.1%). Cost was the focus of only 2.3% of articles and patient outcomes accounted for only 0.7% of articles. CONCLUSIONS: Medical education research is dominated by assessment of trainee performance followed by trainee satisfaction. Leading journals in medical education contain little information concerning the cost and products of medical education, that is, provider performance and patient outcomes. The study of these medical education outcomes represents an important challenge to medical education researchers.     

Australian occupational therapy research: A review of publications 1987–91

The aim of this study was to describe the characteristics of Australian occupational therapy research published during the period 1987–91. A literature review of the Australian Occupational Therapy Journal for the years 1987–91, and the Australian Association of Occupational Therapists' conference proceedings for the years 1988 and 1991 was conducted. A number of trends were identified. The proportion of research journal articles and conference papers over the 5 year period remained stable. Most journal research articles were written by academics, while clinicians were the most frequent authors of conference research papers. The majority of the research articles reviewed were the result of collaboration between authors; however, this collaboration was not usually between occupational therapy academics and clinicians. Research was predominantly on topics related to practice in clinical specialty areas; however, academics focused more on education and professional issues. The main method for data collection used in the research articles was by surveys. These findings provide valuable information about the nature of Australian occupational therapy research.     

Medical humanities: Introduction to the theme

The Twentieth European Conference on Philosophy of Medicine and Health Care was held in Helsinki, Finland, in August 2006 and highlighted the theme “Medicine, Philosophy and the Humanities.” The four papers in this thematic section are developed from presentations made at that conference.They are the work of physicians and philosophers and present fundamentally philosophical reflections on the medical humanities. The authors show that philosophy offers both a substantial way of humanizing the theory and practice of medicine and a way to orchestrate the contributions of all the medical humanities.     

Tomorrow's doctors in the making

Most medical schools still pay too little attention to primary health care, partly because of a failing in communication between governments and medical education systems. The World Federation for Medical Education has embarked on a major program aimed at helping to improve this situation. Reports, materials and surveys are being gathered by the Federation's regional associations and regional conferences have been or will be held in Africa, the Americas, Europe, the Middle East, southeast Asia and the western Pacific. A world conference in Edinburgh during August 1988 will have the theme. "Medical education for the future", and a final report and recommendations will be published. Following the conference the central office will plan the implementation phase, with the task of planning follow-up strategies to ascertain how the recommendations are being effected. Regional associations will be fully involved with this phase. 6 main themes will be investigated in the program: educational priorities for medical schools; educational strategies for medical schools; admissions--numbers and procedures; supporting resources for the education of doctors; educational linkages--continuity between basic, postgraduate and continuing medical education; and integration of medical education with the health service.     

Improving health care globally: a critical review of the necessity of family medicine research and recommendations to build research capacity

An invitational conference led by the World Organization of Family Doctors (Wonca) involving selected delegates from 34 countries was held in Kingston, Ontario, Canada, March 8 to 12, 2003. The conference theme was "Improving Health Globally: The Necessity of Family Medicine Research." Guiding conference discussions was the value that to improve health care worldwide, strong, evidence-based primary care is indispensable. Eight papers reviewed before the meeting formed the basic material from which the conference developed 9 recommendations. Wonca, as an international body of family medicine, was regarded as particularly suited to pursue these conference recommendations: 1. Research achievements in family medicine should be displayed to policy makers, health (insurance) authorities, and academic leaders in a systematic way. 2. In all countries, sentinel practice systems should be developed to provide surveillance reports on illness and diseases that have the greatest impact on the population's health and wellness in the community. 3. A clearinghouse should be organized to provide a central repository of knowledge about family medicine research expertise, training, and mentoring.4. National research institutes and university departments of family medicine with a research mission should be developed. 5. Practice-based research networks should be developed around the world.6. Family medicine research journals, conferences, and Web sites should be strengthened to disseminate research findings internationally, and their use coordinated. Improved representation of family medicine research journals in databases, such as Index Medicus, should be pursued.7. Funding of international collaborative research in family medicine should be facilitated.8. International ethical guidelines, with an international ethical review process, should be developed in particular for participatory (action) research, where researchers work in partnership with communities. 9. When implementing these recommendations, the specific needs and implications for developing countries should be addressed.The Wonca executive committee has reviewed these recommendations and the supporting rationale for each. They plan to follow the recommendations, but to do so will require the support and cooperation of many individuals, organizations, and national governments around the world.     

Popularization of oral self-examination: an example of non formal education--Part II

One of the largest challenges of the universities, especially the public ones, is to transpose the scientific knowledge produced into their walls for the general population. The non-formal education is an important tool, and yet very little used by researchers and professors to approximate the scientific knowledge. The oral cancer reaches more than 11.000 Brazilians a year. In spite of the high incidence, this pathology is still little known by the general population and part of the medical and dental class. Basing on the epidemic data in researches and scientific papers, the oral cancer was the elect theme for the action in education and communication of the first national campaign with no government character of prevention in oral cancer, being a great example of as that can be made. This paper intends to describe the methodology used in communication and the results obtained in this successful experience.     

Setting priorities and identifying barriers for general practice research in Europe. Results from an EGPRW meeting

BACKGROUND: In spring 2002, WONCA Europe, the European Society of General Practice/Family Medicine and its Network organizations reached consensus on a 'new' European definition of general practice. Subsequently, the European General Practice Research Workshop (EGPRW) started working on a European General Practice Research Agenda. This topic was addressed during the 2002 EGPRW autumn meeting. OBJECTIVE: Our aim was to explore the views of European general practice researchers on needs and priorities as well as barriers for general practice research in Europe. METHODS: In seven discussion groups, 43 general practice researchers from 18 European countries had to answer the following questions. (i) What major topics should be included in a research agenda for general practice in your country? (ii) What are the barriers to adequate implementation of general practice research in your country? Group answers were listed and subsequently categorized by two authors. RESULTS: Research on 'clinical issues' (common diseases, chronic diseases, etc.), including diagnostic strategies, was considered to be the core content of general practice research, with primary care-based morbidity registration essential for surveillance of disease, clinical research and teaching in general practice. There was also consensus on the need for research on education and teaching. 'Insufficient funding opportunities' was perceived to be the major barrier to the development of general practice research. CONCLUSIONS: These findings could be used as a basis for national checklists of 'content of' and 'conditions for' general practice research. European general practice research training programmes should be developed further.     

Statistical science at the forefront of health policy research: two ICHPS 2015 special issues

The 11th International Conference on Health Policy Statistics (ICHPS) conference was successfully held from October 7 to 9, 2015, in Providence, Rhode Island, espousing the theme “Statistical Science at the Forefront of Health Policy Research”. Authors of research presented at ICHPS 2015, in both posters and talks, were invited to submit their completed papers in two special issues of Health Services and Outcomes Research Methodology. In addition, the issues feature interviews with the winners of the American Statistical Association’s Health Policy Statistics Section of the Long-Term Excellence and Mid-career Awards.     

Engaging undergraduate medical students in health research: students' perceptions and attitudes, and evaluation of a training workshop on research methodology

Study objectives: As a preliminary step before incorporating basics of health research methodology and students' research projects, in medical curricula of Alexandria Faculty of Medicine, the present study was conducted to (1) explore students' perceptions of engaging undergraduate medical students in research, and to (2) evaluate a training workshop on Health Research Methodology. In phase 1, an anonymous questionnaire was administered to a random sample of 644 3rd, 4th, 5th and 6th years' students, Alexandria Faculty of Medicine. Students showed high levels of interest in research, and positive attitudes towards integrating research activities into undergraduate medical curricula. However, a considerable proportion of students were not fully aware of the benefits of engaging undergraduate students in research. Students believed that the main problems facing students' research are: curriculum overload, time restriction, inadequate training in research, lack of staff guidance and cooperation, lack of interest and motivation, and lack of incentives. Several solutions were suggested by students to increase their motivation and engagement in research activities. These included: decreasing the curriculum overload, more training workshops on research methodology, integration of research methodology into undergraduate curriculum, engaging students in mentored research projects, more staff guidance and cooperation, and the incorporation of research activities to be a part of students' final assessment. Students, as young promising researchers, need to be encouraged and awarded. Others suggested increasing funds to support students' research projects, training on data processing, analysis and interpretation, and applying innovative teaching methods that stimulate active learning and critical thinking. Other suggestions included: establishment of a mentored 'Student Research Committee', 'Student Research Journal' and organization of 'Student Conferences' with the subsequent publication of their research papers. In phase 2, a total of 27 students attended a one-day training workshop on research methodology. Students showed high levels of satisfaction and gain from the workshop. The great majority regarded it as valuable, enjoyable experience, providing them with both research skills and sensitization to the benefits of undergraduate medical students' engagement in research activities, as well as its crucial importance to their future medical practice. Conclusion: At our medical school, we believe that medical students are becoming more enthusiastic about getting involved in research, which is encouraging. Given the right amount of support, medical students' interest in research can be successfully nurtured.     

ISBNPA 2007: Marketing, serious games and nanny states. Observations from the sixth annual meeting of the International Society of Behavioral Nutrition and Physical Activity, Oslo 2007

This commentary paper provides a selective overview of topics addressed at the sixth annual meeting of the International Society of Behavioral Nutrition and Physical Activity (ISBNPA). With 31 symposiums, 42 free paper sessions and 236 poster presentations ISBNPA 2007 provided a comprehensive overview of the state of the art and of new avenues for behavioral nutrition and physical activity research. Research presented at the conference helps to identify and specify important nutrition and physical activity behaviors for health promotion, as well as the correlates, predictors and determinants of these behaviors, and to build and test intervention strategies that go beyond traditional health education. ISBNPA 2007 also indicates that ISBNPA should strive to become more international by inclusion of more scientists from countries outside North America, Western Europe and Australia. ISBNPA should maintain its encouragement of research that is firmly rooted in behavioral theory and research that goes beyond applying cross-sectional research designs, and that addresses the most important public health issues associated with behavioral nutrition and physical activity.     

Interactive patient education: the X-Plain model

Responding to competitive pressure to enhance services and patient satisfaction while reducing cost, many healthcare organizations are turning to interactive health communication to enhance their practices. This article reviews computer-based patient education by focusing on a product, X-Plain, and describing how it is used in medical practices. The following benefits of computer-based patient education are discussed: risk management, time saving, enhanced patient satisfactions, and meeting regulatory requirements. Two classes of computer-based patient education systems are distinguished: documentation systems used in the back office to inform patients about their diagnoses and treatments and to document patient education; and public kiosks used in the reception area to provide general information, promote the practice's services, and collect survey data. The advantages of delivering patient education through the Web such as global networking and presentation of customized health information are discussed.