In search of criteria for the assessment of medical education

This paper describes results of a study to asses whether an undergraduate educational curriculum is 'relevant'. The people surveyed comprised 290 individuals involved in medical education or health service administration. They were asked to suggest five major criteria for judging whether a medical undergraduate programme is relevant or not and to say whether they felt current curricula meet these criteria. Of those sampled, 40 % replied.
An analysis of the data from respondents showed that medical school professors and senior administrators of health services in Australia have roughly similar expectations of the outcome of medical education. Both groups were concerned that graduates be conscious of health care requirements and costs, that they have adequate clinical skills, knowledge in medical school subjects and skill in interacting with patients and managing their continuing education. On the various dimensions examined there were frequently strong expressions of dissatisfaction with current achievements.     

A critical historical analysis of the medical construction of lesbianism

Lesbians are frequently treated with insensitivity, antagonism, and discrimination in health care encounters. The authors argue that contemporary health care experiences of lesbian clients cannot be understood apart from a critical examination of the historical construction of medical ideologies that pathologized lesbianism. An excavation of historical data about medical conceptualizations of lesbian women is undertaken to demonstrate how cultural and medical ideologies throughout the century have reinforced each other to shape lesbians' health care experiences and influence public policies. By illuminating both the prejudical content of medical theories as well as the emancipatory actions of lesbian and gay communities to change stigmatizing diagnostic and treatment situations, the authors attempt to demystify ideologies about lesbians that motivate clinicians, administrators, educators, researchers, and theorists in the delivery of health services.     

成都市儿保人员婴儿喂养知识、指导现状及需求评估

目的：评估成都市儿童保健人员的婴儿喂养知识水平、指导现状及需求.方法：整群抽取成都市妇幼保健系统儿童保健人员共157名进行问卷调查.结果：大专/大学文化以上的调查对象知识评分集中在“优”,高/初中文化的调查对象知识评分以“差”为主;家庭访视人员的知识水平明显低于门诊儿保人员;基层门诊儿保人员的知识水平明显低于市、区级.调查对象回答辅食添加原则单一法引入辅食的原因等知识点的正确率低.调查对象在母乳喂养、辅食添加时间和原则等方面给予看护人的指导最多.而对婴儿异常情况时的饮食、辅食的量和婴儿进食行为培养等方面,部分调查对象存在指导困难.调查对象更新知识主要依靠业务培训和专题讲座.结论：基层儿保人员的婴儿喂养知识和指导能力亟需提高.     

Users' understanding of medical knowledge in general practice

Much emphasis is now being placed on the quality of medical care, and various ways are being developed to assess the medical knowledge of general practitioners. It is increasingly recognised that the users perspective on health care is important, and that the views of health care professionals do not and cannot represent patients' views. In order to explore whether or not a large-scale survey, which asked people to rate their doctors' medical knowledge, yielded meaningful results, this paper draws on findings from a study involving in-depth interviews with 26 lay people who had already completed the General Practice Assessment Survey questionnaire. When completing the questionnaires, patients had been asked to consider the 'technical care' provided by their general practitioners and to make a judgement about their doctors' medical knowledge. When interviewed at a later date, some people explained that they defined medical knowledge as knowledge of 'disease and treatments', while others defined it as knowledge of the 'whole person', and some defined a knowledgeable doctor as one who would acknowledge uncertainty. Patients appeared to have made judgements about their general practitioners' medical knowledge based on many factors, such as their experience of illness, perceptions of professional training, contact with other health care professionals in both primary and secondary care, and exposure to the media. The paper discusses the nature of medical knowledge, and concludes that although patient surveys are useful for the evaluation of interpersonal care and access to care, asking patients about their general practitioners' medical knowledge may yield invalid results. This is partly because patients defined medical knowledge in different ways, and partly because it appears that relatively few patients had enough knowledge about their own particular illnesses, or about possible alternative treatments, to make informed judgements about their general practitioners' medical knowledge.     

Undergraduate medical education in underdeveloped countries: the case of Pakistan

The type of medical education of a country is closely linked with its system of health care. Any health care system, with its own peculiarities, requires a certain type of doctor who can function effectively in the given environment. The same is the case with underdeveloped capitalist countries, such as Pakistan, where a skewed, elitist, curative model of health care exists. In Pakistan, where the literacy levels in the native tongue are very low, medicine is taught in English, and nearly all prescribed textbooks are written in and for the West. Conditions specific to Pakistan, such as the degree of cheating in exams, the time lost due to closure, and the level of debate concerning the medical system may find their parallels in other UDCs. Since it is the social and economic forces, which, in the final analysis, determine the system of health care and medical education, one cannot expect any significant improvement within the existing class structure. Only in a country where the masses have control over the production and distribution of resources, can the systems of health care and medical education be brought in line with the real needs of the community and of the country.     

Management training in long-term care

The education of health care administrators faces its most dramatic change since the inception of the field. Recent discussions at the national level call for major overhaul of curricula and teaching modalities, including moving education to position students for evidence-based practice. This paper presents recommendations for incorporating training about chronic and long-term care into health care management curricula. It asserts that all health care management students should have a basic knowledge of the fundamental policy, operating, and financing principles of long-term care. The majority of people using the health care delivery system today, and increasingly in the future, suffer from chronic conditions. Long-term care services, although less expansive in structure, far outnumber acute care services and health plans. They will grow in the future to meet the portending demand. To maximize job opportunities and to optimize performance in any job, health care administrators need to know about the long-term care delivery system. This paper delineates critical topics pertaining to long-term care, organized according to 11 fundamental management areas in which the field is developing core competencies. The contents were derived from a year-long process of asking stakeholders in the various facets of long-term care what topics they thought were essential for administrators to know. The topics delineated in this document represent the consensus about essential knowledge that all health care administrators should have about long-term care, whether specializing in long-term care or following a more general management career. The education of health care administrators faces its most dramatic change since the inception ofthe field. Recent discussions at the national level call for major overhaul of curricula and teaching modalities, including moving education to position students to perform according to evidence-based practice. It is thus timely to consider content, as well as educational format. This paper presents recommendations for incorporating training about chronic and long-term care into health care administration curricula. It asserts that all health care administration students should have a basic knowledge of the fundamental policy, operating, and financing principles of long-term care.     

Experiences and perceptions of residential and home care services among older lesbian women and gay men in Australia

The needs of older lesbian and gay people regarding access and use of aged‐care services remain underresearched. This paper reports the findings of 33 qualitative interviews with older lesbian women and gay men about their perceptions and experiences of residential aged‐care and home‐based aged‐care services in Australia. The focus of this paper is their preparedness for using aged‐care services. The results highlight that participants had a number of concerns related to accessing residential‐care services in particular, including perceptions of a lack of inclusivity and concerns of potential for discrimination and hostility, loss of access to community and partners, decreased autonomy and concerns relating to quality of care and the potential for elder abuse. Participants noted a number of strategies they employed in avoiding residential‐care services, including the use of home‐care services, renovating the home for increased mobility, moving to locations with greater access to outside home‐care services, a preference for lesbian/gay‐specific housing and residential‐care options if available, and the option of voluntary euthanasia to ensure dignity and autonomy. Participants, on the whole, were hopeful that they would never require the use of residential‐care services, with some believing that having current good health or the support of friends could prevent this from happening. The findings suggest that older lesbian and gay people have a variety of concerns with aged‐care and may need additional support and education to improve their perceptions and experiences of services, whether these are needed presently or in the future.     

Exploring the perceived effect of an undergraduate multiprofessional educational intervention

CONTEXT: Improved teamwork and greater collaboration between professions are important factors in effective health care. These goals may be achieved by including interprofessional learning in the undergraduate medical curriculum. The Faculty of Medicine at the University of Liverpool organized a pilot two-day multiprofessional course involving all the health care related disciplines. OBJECTIVE: The present study examined the perceived effect of the multiprofessional course on the work practice of these newly qualified health care professionals. METHOD: The views of former students who took part in the pilot course were collected using a semi-structured interview schedule and analysed using a qualitative data analysis software package QSR NU*DIST. RESULTS: Two main themes emerged. These centred around role knowledge and interprofessional attitudes. Data indicated that participants perceived the course to have increased their knowledge of the other professions and that this effect had persisted. Reported benefits to their working practice included facilitating appropriate referrals, increasing professional empathy and awareness of other professionals' skills, raising confidence and heightening awareness of the holistic nature of patient treatment. Participants reported forming negative attitudes towards other professions during their undergraduate education. They believed these had been partly encouraged by course tutors. The pilot course was perceived to have had had little effect on these attitudes. Changes occurred once the newly qualified professionals started work. CONCLUSIONS: The results support the idea that interprofessional educational interventions must be tailored to specific learning goals to be implemented successfully, and that interprofessional education should be prolonged and widespread to have a real impact.     

Heteronormativity and practitioner–patient interaction

Heteronormativity is the presumption of heterosexuality as the default sexual orientation and can result in discrimination against the lesbian, gay, and bisexual (LGB) population. This study serves as one of the first experimental studies to examine heteronormative perceptions in communication and their effects on practitioner–patient relationships. LGB participants were randomly assigned to read either heteronormative or non-heteronormative vignettes of a doctor–patient interaction. They then indicated how much health-relevant information they would disclose to the doctor in the vignette and their level of trust in the doctor. In the heteronormative condition, participants were less likely to disclose health-relevant information to the doctor in the vignette and were less trustful of the doctor as compared to those in the non-heteronormative condition. These results have important health implications, as lack of disclosure and trust may prevent people from getting needed care and prevent doctors from giving the best health advice possible. The results of this study provide further evidence that there is a need for more education for all health care professionals to feel comfortable while respectfully communicating with and treating patients who do not identify as heterosexual in order to ensure the best health care experience.     

The Finnish family competence study: characteristics of pregnant women with low childbirth knowledge

The present paper characterizes the socio-demographic background, health behaviour and attitudes of 1443 nulliparous women in relation to their level of childbirth knowledge. The response rate was 92%. Those women who refused to participate were not significantly occupationally different from the study subjects. Practically all pregnant women in Finland use maternity health care services. However, those with a low childbirth knowledge needed more health counselling and were largely characterized by the same factors that identify mothers in other countries who do not use such services. This finding emphasizes the importance of a wide coverage of antenatal care. Mothers with low childbirth knowledge were more often than those with high knowledge, unemployed, somewhat younger, living near or with their parents, and less well educated. They felt that they had had no education in child rearing, but they also felt no need for such guidance. They smoked more than mothers with high knowledge both before and during pregnancy. They had less physical exercise, ate more fatty foods and less vegetables. They also used more drugs during the first trimester of pregnancy and had fewer leisure time activities, read fewer books and used fewer cultural services. They assessed themselves as emotionally closer to their own mothers than did those with high childbirth knowledge. A low level of childbirth knowledge seems to be associated with risks in health-connected behaviour, which has important implications for prenatal health education.     

Health,well‐being,and social support in older Australian lesbian and gay care‐givers

Informal care‐givers play an important role in society, and many of the people who provide this care are lesbian women and gay men. Being a care‐giver is known to be associated with poorer health and well‐being, and lesbian and gay care‐givers report experiences of stigma and discrimination in the care‐giving context. This study involved a survey of 230 lesbian women and 503 gay men aged 60 years and over living in Australia, of which 218 were care‐givers. We compared care‐givers to non‐caregivers on a range of health and well‐being measures, including psychological distress, positive mental health, physical health and social support. While we found no significant differences between these two groups, we further compared care‐givers who were caring for an LGBTI person to those who were caring for a non‐LGBTI person. Among the lesbian women, care‐givers of an LGBTI person reported feeling less supported in their carer role and reported lower levels of social support more generally. They were also lower on positive mental health and physical health indicators. Among the gay men, care‐givers of an LGBTI person also reported feeling less supported in their carer role, but there were no differences in reported levels of social support more generally or health and well‐being compared to those caring for a non‐LGBTI person. Overall, results from this study suggest that older lesbian and gay care‐givers may be facing some challenges related to their well‐being and feeling supported, especially if they are caring for another LGBTI person.     

Sexual Identity,Identity Disclosure,and Health Care Experiences: Is There Evidence for Differential Homophobia in Primary Care Practice?

BackgroundGiven extant health disparities among women who belong to the sexual minority, we must understand the ways in which access to and satisfaction with health care contribute to such disparities. The purpose of this study was to explore how sexual minority women's (SMW) health care experiences compared with those of their heterosexually identified counterparts. We also sought to investigate whether there were differences within SMW in this regard. Finally, we explored whether participant satisfaction and comfort with health care providers (HCPs) differed depending upon HCP knowledge of participants' sexual orientation.MethodsWe administered surveys to 420 women including lesbian, gay, bisexual, or other “queer” identified women (n = 354) and heterosexually identified women (n = 66).FindingsContrary to our expectations, we found that SMW were as likely to have had a recent health care appointment, to have been recommended and to have received similar diagnostic and preventive care, and to feel comfortable discussing their sexual health with their HCPs. They were, however, less likely to report being satisfied with their HCPs. We found no differences between lesbian SMW and non-lesbian SMW with respect to these indicators. We found important differences with respect to sexual orientation disclosure and health care satisfaction, however. Those participants whose HCPs purportedly knew of their minority sexual orientation reported greater satisfaction with their HCPs and greater comfort discussing their sexual health than those whose providers were presumably unaware.ConclusionWe discuss important clinical and research implications of these findings.     

Exploiting subjective information to understand impoverished children's use of health care

Understanding what drives households to seek medical services is challenging because the factors affecting the perceived benefits and costs of professional health care can be the same. In this paper, we disentangle the channels through which different factors affect the use of medical services, whether through perceived benefits and/or costs. We do this by exploiting data on why individuals have not visited a health care professional. Amongst a sample of impoverished Colombian households, we find that health knowledge reduces the use of medical services through decreasing mothers’ perceived benefits of seeking professional care for ill children; birth parity, distance to health facilities and violent shocks all decrease medical care use due to increasing the perceived costs; and education decreases both the perceived benefits and costs, with no overall effect on use. We propose two specification tests, both of which our model passes, as well as a series of robustness checks.     

End-of-life care for gay,lesbian, bisexual and transgender people

There is little understanding in Australia of the special issues faced by gay, lesbian, bisexual and transgender people in end-of-life care and advance care planning. This exploratory study aimed to achieve an initial understanding of these issues to inform the development of a larger study involving gay, lesbian, bisexual and transgender service users. Consultations were carried out with 19 service providers and 6 gay, lesbian, bisexual and transgender community members in the Northern Rivers and metropolitan Sydney areas of New South Wales, Australia. Participants reported barriers to health care service access due to discrimination, inappropriate care and lack of knowledge among both consumers and health care workers of legal rights at the end of life. While advance care planning can assist with improving end-of-life care, respondents reported a number of obstacles. These included a lack of knowledge and absence of perceived need and the additional obstacle of social isolation, leading to difficulties identifying alternative decision-makers. The study highlighted the need for education for gay, lesbian, bisexual and transgender people and health and aged care providers on existing legal provisions to prevent discrimination in end-of-life care.     

北京地区医务人员对应对突发公共卫生事件薄弱环节认知情况的调查分析

目的了解各级医院医务人员对目前应对突发公共卫生事件的管理现状,尤其是薄弱环节所获数据为全国各医院健全突发公共卫生事件的应急机制,完善应急处置预案提供有益的借鉴和参考,为政府相关部门制定突发公共卫生事件应急体系提供可靠依据.方法采用抽样问卷调查方法,对北京地区15家医院和2家医疗卫生单位的1223名医务人员进行有关突发公共卫生事件及救治知识的认知情况、管理现状、救治能力等方面的调查.结果应对突发公共卫生事件的管理水平和救治能力亟待提高.结论政府和各级卫生行政部门要重视救治常识的宣传教育、公共卫生体系的建设、医院应急预案的完善,提高医院的危机管理水平和医务人员的救治能力.     

Evaluation of health care needs and patient satisfaction among hepatitis C patients treated at a hospital-based, viral hepatitis clinic

OBJECTIVE: To define self-reported hepatitis C knowledge, health care needs, and patient satisfaction in a representative cohort of hepatitis C virus (HCV)-infected adults treated at a university hospital-based viral hepatitis clinic in Canada. METHODS: A questionnaire package evaluating HCV knowledge, health care needs, and patient satisfaction was administered to 111 consecutive consenting HCV patients during their first and 10-month follow-up HCV clinic visits. RESULTS: At their first HCV clinic visit, 52% of patients rated their current HCV knowledge as "fair" or "poor". Patients identified HCV education, quality medical care, medication coverage, and psychological counselling as important HCV health care needs. Health care satisfaction outcome data at 10-month follow-up indicated that patients felt significantly better informed, more satisfied, and more actively involved in their HCV health care. CONCLUSION: A bio-psychosocial framework in which medical, psychological, educational, and social issues are addressed is desirable for optimal HCV health care.     

Peer-to-Peer JXTA Architecture for Continuing Mobile Medical Education Incorporated in Rural Public Health Centers

ObjectivesMobile technology helps to improve continuing medical education; this includes all aspects of public health care as well as keeping one's knowledge up-to-date. The program of continuing medical and health education is intertwined with mobile health technology, which forms an imperative component of national strategies in health. Continuing mobile medical education (CMME) programs are designed to ensure that all medical and health-care professionals stay up-to-date with the knowledge required through mobile JXTA to appraise modernized strategies so as to achieve national goals of health-care information distribution.MethodsIn this study, a 20-item questionnaire was distributed to 280 health professionals practicing traditional training learning methodologies (180 nurses, 60 doctors, and 40 health inspectors) in 25 rural hospitals. Among the 83% respondents, 56% are eager to take new learning methodologies as part of their evaluation, which is considered for promotion to higher grades, increments, or as part of their work-related activities.ResultsThe proposed model was executed in five public health centers in which nurses and health inspectors registered in the JXTA network were referred to the record peer group by administrators. A mobile training program on immunization was conducted through the ADVT, with the lectures delivered on their mobiles. Credits are given after taking the course and completing an evaluation test. The system is faster compared with traditional learning.ConclusionMedical knowledge management and mobile-streaming application support the CMME system through JXTA. The mobile system includes online lectures and practice quizzes, as well as assignments and interactions with health professionals. Evaluation and assessments are done online and credits certificates are provided based on the score the student obtains. The acceptance of mobile JXTA peer-to-peer learning has created a drastic change in learning methods among rural health professionals. The professionals undergo training and should pass an exam in order to obtain the credits. The system is controlled and monitored by the administrator peer group, which makes it more flexible and structured. Compared with traditional learning system, enhanced study improves cloud-based mobile medical education technology.     

End-of-life care for gay, lesbian, bisexual and transgender people

There is little understanding in Australia of the special issues faced by gay, lesbian, bisexual and transgender people in end-of-life care and advance care planning. This exploratory study aimed to achieve an initial understanding of these issues to inform the development of a larger study involving gay, lesbian, bisexual and transgender service users. Consultations were carried out with 19 service providers and 6 gay, lesbian, bisexual and transgender community members in the Northern Rivers and metropolitan Sydney areas of New South Wales, Australia. Participants reported barriers to health care service access due to discrimination, inappropriate care and lack of knowledge among both consumers and health care workers of legal rights at the end of life. While advance care planning can assist with improving end-of-life care, respondents reported a number of obstacles. These included a lack of knowledge and absence of perceived need and the additional obstacle of social isolation, leading to difficulties identifying alternative decision-makers. The study highlighted the need for education for gay, lesbian, bisexual and transgender people and health and aged care providers on existing legal provisions to prevent discrimination in end-of-life care.     

Lesbians with disabilities

There is a severe lack of information on sexuality for any woman with a disability. Often, what is available is limited to material on birth control and child delivery. For women who are disabled and lesbian, virtually no written information exist and health care workers seldom feel comfortable discussing the topic. Lesbians with disabilities have the responsibility to discuss sexual preference with their health care workers. Yet, there is much to lose. This paper discusses the issues of being lesbian and disabled as well as the unique problems faced by their partners. Finally, the article discusses negative attitudes of health care workers toward both disability and homosexuality.     

Auswirkungen des Menschenhandels auf die Gesundheit von betroffenen Frauen und m?gliche Handlungsoptionen

Human trafficking is the modern form of slavery. Annually, thousands of women, children and men of all ages are affected. Trafficking in persons has a severe impact on the health of those affected. In particular, young women are very vulnerable and easily accessible for perpetrators. They are forced into prostitution in their own country or abroad. The soundest knowledge is available in the field of exploitation of women with the purpose of prostitution which is why this article will focus on this phenomenon. The causes are reflected in a complex system of push and pull factors. The health implications are enormous. Not only do the women suffer from sexually and non-sexually transmitted infections but also from the physical abuse caused by the perpetrators. The injuries and trauma often lead to post-traumatic stress disorder (PTSD). Doctors are often the only ones who have contact with those concerned which is the reason why they are responsible for identifying and treating the victims as well as helping them to escape their miserable situation. In the area of trafficking in women and minors for sexual exploitation much research is needed. Furthermore, an extensive education campaign is necessary to sensitize medical health care professionals to this situation. Thus, doctors can handle and use the given diagnostic questions and symptom complexes to identify victims and although medical health care professionals are capable of using and handling diagnostic measures to identify the victims, they are not able to prevent human trafficking. However, they can contribute by identifying victims and supply them with medical services and provide educational work.