Evaluation activities to strengthen an injury prevention resource center for urban families

The Johns Hopkins Children's Safety Center (CSC) is a unique health care provider and patient education resource that elevates the attention injury prevention receives in a medical setting and reduces barriers to injury prevention experienced by low-income, urban families, the Center's priority population. This article describes the CSC's development, implementation, and selected elements of its evaluation. Because evaluation has played an important role in the CSC from its inception through its implementation and sustainability, three evaluation activities are described: process evaluation to monitor activity, impact evaluation to understand its effects on parents' safety behaviors, and qualitative interviews with CSC visitors and non-visitors to enhance services. Implications of each evaluation activity are described and recommendations are made for strengthening the CSC.     

Simulated patients as a learning resource in the study of reproductive medicine

Simulated patients have been used to foster active learning and problem solving skills in an undergraduate programme of reproductive medicine. These simulators were trained to present a series of clinical problems and were used in a variety of approaches. They served to highlight communication skills and to force attention on the recognition, assessment and management of patient problems.     

eSTEP: a Web-based learning resource for basic surgical trainees

A website has been set up by the Royal College of Surgeons of England for trainees registered on the Surgeons in Training Education Programme (STEP). eSTEP has been designed to provide an interactive component to the course and looks to have added a new dimension to basic surgical training.     

View from a cancer center

As part of Healthplan's genomics series, we have sought opinion and perspective from various sectors of health care. Articles in past issues have reflected both the enthusiasm and optimism of the genomics industry as well as the caution and concerns of health plan medical directors confronted with the question of who will pay for the new genetic services and treatments and--more importantly--how they will truly benefit patients. In this issue, we publish the perspective and goals of doctors and researchers at a renowned cancer center. As our series unfolds, it is becoming increasingly clear that a national dialogue is needed on the important questions raised by the authors in our genomic series. Readers are encouraged to send their views on this topic to Healthplan.     

Evaluation of a surgical simulator for learning clinical anatomy

BACKGROUND: New techniques in imaging and surgery have made 3-dimensional anatomical knowledge an increasingly important goal of medical education. This study compared the efficacy of 2 supplemental, self-study methods for learning shoulder joint anatomy to determine which method provides for greater transfer of learning to the clinical setting. METHODS: Two groups of medical students studied shoulder joint anatomy using either a second-generation virtual reality surgical simulator or images from a textbook. They were then asked to identify anatomical structures of the shoulder joint as they appeared in a videotape of a live arthroscopic procedure. RESULTS: The mean identification scores, out of a possible score of 7, were 3.1 +/- 1.3 for the simulator group and 2.9 +/- 1.5 for the textbook group (P = 0.70). Student ratings of the 2 methods on a 5-point Likert scale were significantly different. The simulator group rated the simulator more highly as an effective learning tool than the textbook group rated the textbook (means of 3.2 +/- 0.7 and 2.6 +/- 0.5, respectively, P = 0.02). Furthermore, the simulator group indicated that they were more likely to use the simulator as a learning tool if it were available to them than the textbook group was willing to use the textbook (means of 4.0 +/- 1.2 and 3.0 +/- 0.9, respectively, P = 0.02). CONCLUSION: Our results show that this surgical simulator is at least as effective as textbook images for learning anatomy and could enhance student learning through increased motivation. These findings provide insight into simulator development and strategies for learning anatomy. Possible explanations and future research directions are discussed.     

Occupational histories of cancer patients in a Canadian cancer treatment center and the generated hypothesis regarding breast cancer and farming

Occupational exposures increase cancer risks. The Windsor Regional Cancer Centre in Windsor, Ontario, was the first Canadian cancer treatment center to collect the work histories of its patients, which were recorded using a computer-based questionnaire. Breast cancer cases represented the largest respondent group. The lifetime occupational histories of 299 women with newly diagnosed breast cancers were compared with those of 237 women with other cancers. Odds ratios (ORs) were calculated using logistic regression, adjusting for age, social class, and education. The OR for women < or = 55 years of age with breast cancer who had ever farmed, compared with women of the same age with other cancers, was 9.05 (95% CI 1.06, 77.43). Patients' occupational histories can help to inform understanding of cancer etiology and prevention. This effort points to a need for investigation of the possible association between breast cancer and agricultural hazards such as pesticides.     

Evaluation of 'Sun-safe': a health education resource for primary schools.

The aim of the study was to assess the effectiveness of 'Sun-safe', a computer-based resource designed to promote skin cancer awareness and educate children, aged 10-11 years, about the effects of excessive exposure to the sun and associated skin cancer preventive behaviours. Effectiveness was measured by changes in knowledge, attitudes and behavioural intentions using a self-completed questionnaire. A cluster, controlled evaluation design was used. Twelve schools were randomly allocated to the intervention arms of the study (workbook or computer), with a further four schools acting as controls (no intervention). One school allocated to the computer group had serious technical problems with their computers on the day of the intervention and had to be excluded from the study, leaving six schools in the workbook group and five in the computer group. One class in each of the 15 schools participated. The questionnaire was administered before the intervention, the day after and 6 weeks thereafter. The primary outcome measures were changes in mean scores at 6 weeks. In all, 376 children, 83% of the roll, completed both pre- and 6-week tests. Mixed-model analysis, allowing for pre-intervention score and the cluster effect, showed significant increases in knowledge scores in all three groups [workbook 2.36, 95% confidence interval (CI): 1.66 to 3.05; computer 1.73, 95% CI: 1.00 to 2.46; control 0.93, 95% CI: 0.11 to 1.74], but only the workbook group was significantly better than the control group (1.43, 95% CI: 0.36 to 2.50) and there was no significant difference between the intervention groups (0.63, 95% CI: -0.38 to 1.63). With regard to attitudes, both interventions showed significantly greater increases in scores than the control group, but there was no significant difference between them (workbook 2.37, 95% CI: 1.27 to 3.47; computer 1.92, 95% CI: 0.76 to 3.09; control -0.01, 95% CI: -1.28 to 1.27). Although the mean increases for behavioural intentions scores were small (workbook 0.66, 95% CI: 0.26 to 1.05; computer 1.11, 95% CI: 0.70 to 1.51; control 0.08, 95% CI: -0.37 to 0.52), those for the intervention groups were significantly better than the control group, but were not significantly different from each other. The evaluation showed significant improvements in knowledge, attitudes and behavioural intentions, which were still present 6 weeks after the intervention. This suggests that interventions employing the Sun-safe workbook and computer-based resources could be most usefully put into effect in the week before the start of the summer holidays.     

Portfolio learning: a proposal for undergraduate cancer teaching

Summary. This paper describes a randomized study to evaluate a longitudinal approach to undergraduate education using cancer patients and cancer medicine as a model.
Medical students were randomized to the study or control group. Those in the study were allocated to tutors (general practitioners or consultants) in groups of three. Each student was allocated three consenting patients with cancer to follow longitudinally. They compiled a portfolio to record events, interactions, relevant articles, etc. based around the patients' case histories. The students received tutorials to provide direction, discussion and support bimonthly during the course. Evaluation was by central review of the portfolios, appraisal in the clinical competence examination and hidden questions in the standard MCQ examinations. The aim was to provide the learner with a personal experience of cancer patients at all stages of the disease, an understanding of the natural history of cancer and an insight into the impact of the disease and its treatment on the patient and family. The study evaluates whether these aims were achieved to a greater extent in those students receiving the portfolio teaching compared with a control group receiving the standard curriculum teaching only.