Doris Duke Clinical Research Fellowship: report of the second annual meeting.

The second annual national meeting of the Doris Duke Charitable Foundation Clinical Research Fellowship for Medical Students program was held June 24 to 26, 2003, at Cold Spring Harbor Laboratory near Long Island Sound. This 3-day meeting offered an opportunity for 63 of the 2002 Doris Duke clinical research fellows, program directors, administrators, and invited physician-scientists to present and share their research with one another in an informal, inspiring setting at an institution with a history that mirrors the development of modern American medical research. Following a keynote lecture by Dr. Kenneth Davis, dean of the Mount Sinai School of Medicine, six physician-scientists representing different areas of clinical research presented their work. Oral and poster presentations by the Doris Duke fellows of their research were interspersed throughout the meeting and comprised its central focus. The fellows' research spanned a broad spectrum of clinical research from studies translating basic research findings to those addressing clinical questions to epidemiologic and health outcomes studies. The meeting culminated in a forum entitled "'Where Do We Go from Here?' Residency Selection and Further Research Training in Pursuit of a Career as a Clinician-Scientist," which was moderated by this year's clinical research fellow national program leader, Dr. Allyn L. Mark. The meeting celebrated the accomplishments of these talented medical students during their fellowship year and, it is hoped, instilled in them awareness that their continued efforts are important to the future progress of medicine.     

Interview with Elaine Gallin, program director for medical research at the Doris Duke Charitable Foundation.

The Doris Duke Charitable Foundation (DDCF) is an independent private foundation devoted to improving the quality of people's lives through grants supporting four specific areas: the performing arts, wildlife conservation, medical research, and the prevention of child abuse. The foundation was established in 1996 and began awarding grants in 1997. By the end of 2004, more than 500 grants had been awarded to support work in the focus areas. In the area of medical research, the Doris Duke Charitable Foundation has established and developed a number of programs that have been designed to assist in the development of physician-scientists. We spoke with Elaine Gallin, PhD, program director for medical research since May 1999. As the Foundation's first such director, she has played an important role in the creation and management of the Doris Duke grant programs committed to support and strengthen clinical research.     

Cytapheresis: the first 25 years.

In vivo blood cell separator technology was originally developed in response to a perceived need for granulocytes for septic neutropenic patients. This impetus led to the development of a variety of cell separators which, paradoxically, ultimately have found their main applications in pheresis procedures other than granulocyte collection. In vivo blood cell separators are ideal for the removal of large numbers of normal or abnormal hemopoietic cells. Their early use in chronic myeloid leukemia demonstrated that leukapheresis could be used as definitive therapy for the disease. However, most hematological diseases in which the circulating malignant cells can be pheresed off have definitive and cost effective standard of care therapies, and cytapheresis is limited to specific circumstances. This paper reviews therapeutic cytapheresis and summarizes the current status of its limited specific indications.     

Focusing: A new challenger for improving the empathy skills of medical students

ObjectivesStudies of empathy among medical students reported an alarming significant decline during medical education. Some authors identified the third year of education as the most problematic one: empathy decreased significantly when the curriculum was shifting to patient-care activities. Scientists have tried to address the means and methods for improving empathy skills (e.g., by improving communication abilities), but investigations on this topic are missing. Based on the Damasio’s hypothesis and scientific studies, we assume that Focusing (i.e., an embodied practice where one attends to a bodily felt sense and uses it to understand the self and situations) would be significantly and positively linked to empathy.MethodAfter their clinical internships, we selected third-year medical students (N = 121) and asked them to complete three questionnaires assessing empathy, Focusing, and social desirability.ResultsBy controlling social desirability, findings confirmed that Focusing (especially the “having access to the felt body” component) was significantly and positively linked with empathy (i.e., Fantasy & Perspective-Taking), and positively predicted Fantasy, Perspective-Taking, and Empathic Concern.ConclusionsThese preliminary results suggest that the felt body plays a role in increasing empathy (mainly on cognitive empathy). Few scientific studies have described constructs that significantly promote cognitive empathy and empathic concern (a deeply anchored trait of empathy), which suggests new avenues of investigation.     

Type 2 diabetes: incremental medical care costs during the first 8 years after diagnosis.

OBJECTIVE: To describe and analyze the time course of medical care costs caused by type 2 diabetes, from the time of diagnosis through the first 8 postdiagnostic years. RESEARCH DESIGN AND METHODS: From electronic health maintenance organization (HMO) records, we ascertained the ongoing medical care costs for all members with type 2 diabetes who were newly diagnosed between 1988 and 1995. To isolate incremental costs (costs caused by the diagnosis of diabetes), we subtracted the costs of individually matched HMO members without diabetes from costs of members with diabetes. RESULTS: The economic burden of diabetes is immediately apparent from the time of diagnosis. In year 1, total medical costs were 2.1 times higher for patients with diabetes compared with those without diabetes. Diabetes-associated incremental costs (type 2 diabetic costs minus matched costs for people without diabetes) averaged $2,257 per type 2 diabetic patient per year during the first 8 postdiagnostic years. Annual incremental costs varied relatively little over the period but were higher during years 1, 7, and 8 because of higher-cost hospitalizations for causes other than diabetes or its complications. CONCLUSIONS: For the first 8 years after diabetes diagnosis, patients with type 2 diabetes incurred substantially higher costs than matched nondiabetic patients, but those high costs remained largely flat. Once the growth in costs due to general aging is controlled for, it appears that diabetic complications do not increase incremental costs as early as is commonly believed. Additional research is needed to better understand how diabetes and its diagnosis affect medical care costs over longer periods of time.     

The grant portfolio of the National Center for Medical Rehabilitation Research: the first five years.

OBJECTIVE: To relate grant funding activities of the National Center for Medical Rehabilitation Research (NCMRR) with the Center's mission, priorities, and terminology for disability classification. STUDY DESIGN: Retrospective review by the National Advisory Board on Medical Rehabilitation Research (NABMRR). DATA: Abstracts of 153 research proposals and one contract funded by the NCMRR from 1992 through 1996. METHOD: A six-member research group participated in the development of a rating form and related instructions used to evaluate each abstract. The form was piloted and revised, and interrater agreement was monitored. RESULTS: Funded proposals reflected each of the NCMRR priorities evaluated, with the highest proportion in the areas of assistive technology and whole body system, and the lowest in the area of behavioral adaptation. Although some proposals were funded in each of the domains of the disability classification system, proportionately fewer addressed the domains of disability and societal limitations. Findings also indicated that few funded proposals addressed more than one domain in the disability classification system and that most abstracts did not address consumers' perspectives on quality of life. RECOMMENDATIONS: The NABMRR recommended that the NCMRR (1) encourage more research in the areas of disability and societal limitations and in behavioral adaptation, (2) examine funded proposals in light of a recent Institute of Medicine report, and (3) explore quality-of-life measurements. Further, members of the rehabilitation community are encouraged to e-mail their responses to this review to NCMRR staff at (1q2n@nih.govA) and to suggest areas of research emphasis.     

Student-centered outcomes evaluation of the Clinical Immersion Program: five years later

Curricular innovation is an ever-present element of nursing education. It is incumbent for nurse educators to evaluate their curricula and its outcomes to ensure quality nursing education. This article describes a comprehensive student-centered outcome evaluation of the Clinical Immersion Model. This model and the foundational components unique to the curricular design and the senior clinical immersion are described. Several methods of evaluation, including National Council Licensure Examination for Registered Nurses pass rates, exit surveys, alumni surveys, and a senior nursing student focus group, are presented. Implications of this evaluation and future directions are explored to inform potential implementation and adaptation of this effective curriculum by other schools of nursing.     

Assessment of toxicology knowledge in the fourth-year medical students: Three years of data

BACKGROUND: Pharmacology and toxicology are core content knowledge for physicians. Medical students should demonstrate understanding of general pharmacology and basic treatment of poisoning. The objective of this study was to measure the knowledge of the 4th-year medical students (MS4) on these topics over 3 years.METHODS: A multiple-choice exam (15 questions) was administered to MS4 students in spring of 2010, 2011, and 2012. Questions were developed by medical toxicologists to evaluate basic knowledge in three areas: pharmacologic effects (PE), treatment of poisoning (TOP), and pharmacokinetics (PK). The students were grouped by intended specialties into pharmacologic intense (anesthesia, emergency medicine, internal medicine, pediatrics, and psychiatry), less pharmacologic intense specialties (dermatology, OB/GYN, ophthalmology, pathology, physical medicine and rehabilitation, radiology, and surgery) and by completion of a pharmacology or toxicology elective. Mean group scores were compared using ANOVA.RESULTS: Totally 332 of 401 (83%) students completed the survey. Mean scores were stable over the three years, higher for students completing a toxicology rotation and for students entering a pharmacologically intense specialty.CONCLUSION: The external validity is limited to a single medical school with incomplete participation and content was limited by the survey length. Consistent results over the three-year period and correlation of performance with completing a toxicology rotation and intent to enter a pharmacology intensive specialty suggest this survey may correlate with toxicology knowledge. Implementation of required core courses focused on toxicology may improve core content knowledge in fourth year medical students.     

www.cefalea.it: the first five years

The Italian headache disorders website (www.cefalea.it) was launched in 1999 by the CIRNA foundation in partnership with Al.Ce, which is a lay association and member of the World Headache Alliance. In 2004, the website registered almost 130 000 hits (+200% on the 1999 figure). The most visited parts were the sections devoted to topical issues relating to headache, the list of headache specialists, the headache glossary and the support group. This article summarises the website’s first five years of activity and highlights the Internet’s potential to improve headache–related decision–making, behaviour and outcomes.     

The Structure of Program Evaluation: An Approach for Evaluating a Course,Clerkship, or Components of a Residency or Fellowship Training Program

Background: Directors of courses, clerkships, residencies, and fellowships are responsible not only for determining whether individual trainees have met educational goals but also for ensuring the quality of the training program itself. The purpose of this article is to discuss a framework for program evaluation that has sufficient rigor to satisfy accreditation requirements yet is flexible and responsive to the uniqueness of individual educational programs.

Summary: We discuss key aspects of program evaluation to include cardinal definitions, measurements, needed resources, and analyses of qualitative and quantitative data. We propose a three-phase framework for data collection (Before, During, and After) that can be used across undergraduate, graduate, and continuing medical education.

Conclusions: This Before, During, and After model is a feasible and practical approach that is sufficiently rigorous to allow for conclusions that can lead to action. It can be readily implemented for new and existing medical education programs.     

Health beliefs and preferences for medical treatment: a comparison between medical and social science students.

OBJECTIVE: This study looked at the relationship between beliefs in 'scientific medicine', personal health beliefs, attitudes to complementary medical practitioners and medical treatment preferences in two different groups: medical and non-medical (mainly social science) students. It extended the previous work of looking at patient groups. DESIGN: Once the psychometric properties of the four short questionnaires (53 items in all) were established as satisfactory in terms of their factor structure, the two groups were compared. RESULTS: By means of analysis of variance it was established that there were fewer differences between medical and non-medical students than might be expected by chance. A 'higher order' factor analysis revealed three clear factors underlying attitudes to complementary medicine: pro complementary medicine; pro orthodox medicine; and satisfaction with general practitioner. All the students appeared to have a sceptical but positive attitude to complementary medicine.     

Learning strategies of first year nursing and medical students: A comparative study

Background

Interprofessional education (IPE), where two or more professions learn with, from, and about each other to improve collaboration and the quality of care, has been proposed as a curriculum strategy to promote mutual understanding between professions, thus helping to prepare health professionals to work in challenging contemporary health systems. Although there is support for IPE initiatives within health professional education, differences in student motivation and learning strategies are likely to contribute to the success of these initiatives.

Objective

To explore self-regulated learning strategies used by first year medical and nursing students, and to determine if these strategies were different among nursing students who were high achievers.

Design

A comparative survey design.

Setting

Nursing and medical nursing schools in a large university in the western region of Sydney, Australia.

Participants

Six hundred and sixty-five first year nursing (n = 565) and medical (n = 100) students in a large university in the western region of Sydney were surveyed to assess motivational and learning strategies using The Motivated Strategies for Learning Questionnaire (MSLQ). Data relating to sociodemographic characteristics and academic performance were also collected.

Results

Nursing students were significantly older than medical students (mean age: 24.4 years versus 19.4 years; p < 0.001), and there were also more females in the nursing student group (82% versus 56%; p < 0.001). Although nursing students had a higher mean score for extrinsic goal orientation compared to medical students (p < 0.001), medical students had higher mean scores for the other four learning strategies measured: peer learning (p = 0.003), help seeking (p = 0.008), critical thinking (p = 0.058), and time and study environment management (p < 0.001). Similarly, the grade point average (GPA) of medical students at the end of their first year was significantly higher (4.5, S.D. 1.4 versus 3.6, S.D. 1.3; p < 0.001) compared to that of nursing students.

Conclusion

While interprofessional education is seen to have many benefits for students, this study demonstrates differences in motivational and learning strategies between nursing and medical students that may impact on the success of interprofessional programs.     

The Edinburgh University''s Nursing Research Unit: the first four years

The Edinburgh University's Nursing Research Unit, under the direction of a nurse-researcher, was established in October 1971: the first unit of its kind in the United Kingdom. This paper describes its development, philosophy and future strategy. In the first instance attempts were made to identify nursing problems from which a common core of problems was identified. This provided specific pointers for future research activity.
The unit offers research training facilities for trained nurses and research appreciation courses have also been provided for nursing students and their teachers. A major bonus to the unit has been the opportunity and facilities for interdisciplinary and collaborative research. The unit's future activities include plans to develop new statistical, computer and data management techniques and information retrieval systems more appropriate to nursing research.