A randomized controlled trial of an online immunization curriculum

IntroductionImmunization education for physicians-in-training is crucial to address vaccine concerns in clinical practice. Vaccine education is not standardized across residency programs. The Collaboration for Vaccination Education and Research (CoVER) team developed an online curriculum for pediatric (Peds) and family medicine (FM) residents.MethodsA cluster randomized controlled trial (RCT) was performed during the 2017–2018 academic year to evaluate the CoVER curriculum. A convenience sample of residency institutions were randomly allocated to the intervention or control group, with stratification by residency type. The intervention, the CoVER curriculum, consisted of four online modules and an in-person training guide. Control sites continued with their standard vaccine education. Pre-intervention and post-intervention surveys were emailed to residents in both groups. The primary outcomes compared between groups were changes in “vaccine knowledge,” “vaccine attitudes/hesitancy,” and “self-confidence” in immunization communication. The team assessing outcomes was unblinded to assignments. Hierarchical general linear model was used to adjust for residency type and residency year; residency site was modeled as a random effect.ResultsOverall, 1444 residents from 31 residency programs were eligible to participate (734 intervention, 710 control). The pre-intervention response rate was 730 (51%) and post-intervention was 526 (36%). Average knowledge scores increased from pre-intervention (control 53%; CoVER 53%) to post-intervention (control 58%; CoVER 60%). Increases in vaccine knowledge among FM residents were greater for CoVER compared to controls (p = 0.041). Vaccine hesitancy was more common among FM (23%) than Peds (10%) residents. In all three residency years, residents in the CoVER group showed greater increases in self-confidence in ability to discuss vaccines with parents/patients (p < 0.03) compared to control group.ConclusionThe CoVER curriculum is an effective model to standardize immunization education of physicians-in-training. This RCT demonstrated the effectiveness of the CoVER curriculum to improve resident confidence in their ability to discuss vaccines with parents and patients.     

Effect of stepwise perinatal immunization education: A cluster-randomized controlled trial

BackgroundPerinatal immunization education is important for improving the immunization outcomes of infants; however, the content of educational materials used at each perinatal period has not been carefully evaluated. We hypothesized that stepwise education offered at different perinatal periods would improve infant immunization status and enhance maternal immunization knowledge.MethodsIn this cluster-randomized controlled trial, pregnant women were recruited from nine obstetric sites in Niigata, Japan. The intervention group received a stepwise, interactive education intervention (prenatally, postnatally, and 1 month after birth). The control group received a leaflet containing general information on immunization. Infant immunization status was evaluated at 6 months of age, and maternal immunization knowledge was evaluated by a written survey after each intervention.ResultsAmong 188 study participants, 151 (80.3%) replied to the final post-intervention survey. At 6 months of age, the percentage of children who completed three doses of inactivated polio, diphtheria, tetanus toxoid, and acellular pertussis (DTaP-IPV) vaccine was higher in the intervention group than in the control (p = 0.04); however, no differences between groups were observed for the Haemophilus influenzae type b (Hib) (p = 0.67) or 13-valent pneumococcal conjugate (PCV13) vaccines (p = 0.20). The duration to the completion of the third dose of the DTaP-IPV, Hib, and PCV13 vaccines was shorter in the intervention group than in the control (p = 0.03, p < 0.01, and p < 0.01, respectively). Furthermore, maternal knowledge scores exhibited significantly greater improvement in the intervention group over time compared with those of the control group (p = 0.02).ConclusionsStepwise perinatal immunization education improved immunization schedule adherence for required vaccines and improved maternal immunization knowledge.     

医学科教新任务——促进转化医学

近年来基础医学研究发展迅速,耗费不断增高,但是基础医学研究成果能够形成转化的却很少,对临床研究起到推动作用的就更少,因此,在基础研究与临床研究之间形成了一条严重制约医学科技进步和阻碍人民大众健康水平提高的“鸿沟”。为了消除基础研究与临床研究之间的“鸿沟”,转化医学应运而生,它作为新生的学科,正在被各国学者认识和应用。本文在总结和归纳了现有有关转化医学研究的一些特点和新进展的基础上,结合我国医疗改革的现状和医院科教工作的特点,提出了加强我国转化医学研究的新思路,以缓解政府、社会、民众对医学科学发展“错配”局面的不满,开创和谐医学科技发展的新局面。     

A survey of internal and family medicine residents: Assessment of disability-specific education and knowledge

BackgroundThe literature suggests that primary care physicians are inadequately educated in the care of people with disabilities. No study to date has evaluated whether internal medicine (IM) and family medicine (FM) residents have received disability-specific education or their level of comfort in caring for people with physical disabilities.ObjectivesTo assess IM and FM residents’ receipt of disability-specific education during medical school and residency; to evaluate their self-reported comfort in managing secondary conditions associated with physical disabilities and in coordinating therapies and services for individuals with disabilities; to gauge their interest in receiving disability-specific education.MethodsAn on-line survey distributed to residents at a convenience sample of ten academic IM and FM residency programs in the northeastern United States. Participants (n = 176) were asked about their socio-demographic and training-specific characteristics and their self-assessed ability to manage secondary conditions associated with physical disabilities and coordinate care and services for individuals with disabilities. Chi Square tests were used to compare participant characteristics and outcomes.ResultsFew participants had received disability-specific education during medical school or residency (34.6% and 11.2%, respectively), and nearly all (96.0%) expressed interest in receiving more. Small minorities reported feeling comfortable managing common secondary conditions or in coordinating therapies and services for individuals with disabilities.ConclusionAlthough one-fifth of adult Americans have a disability, few of our participating IM and FM residents had received disability-specific education or felt comfortable managing the care of people living with disabilities. Our results indicate a need to develop and disseminate disability-specific curricula.     

One-day seminar for residents for implementing abdominal pocket-sized ultrasound

Despite its proven high utility, integration of pocked-sized portable ultrasound (US) into internal medicine residency training remains inconsistent. For 10 years, we have held a 1-d seminar biannually, consisting of lecture (half-day) and hands-on training (half-day) on pocket-sized US of the abdomen and lungs. The lecture consists of training on US physics and clinical applications of pocket-sized US, followed by a lecture covering the basic anatomy of the abdomen and lungs and introducing the systemic scanning method. Given the simple structure of pocket-sized US devices, understanding the basic physics is sufficient yet necessary to operate the pocket-sized US device. It is important to understand the selection of probes, adjustment of B mode gain, adjustment of color gain, and acoustic impedance. Basic comprehension may have a significant positive impact on the overall utilization of pocket-sized US devices. The easiest and most reliable way to observe the whole abdomen and lungs is a combination of transverse, sagittal, and oblique scanning, pursuing the main vascular system from the center to the periphery of the organ in the abdomen and systemic scanning of the pleura. There is usually a marked change in knowledge and attitudes among the program participants, although skill gaps remain among them. We discuss the limitations and problems to this education system as well.     

Core competencies for preventive medicine residents: Version 2.0

During the early 1990s, the American College of Preventive Medicine (ACPM), with support from the Health Resources and Services Administration (HRSA), identified core competencies and performance indicators (measures to assess their achievement) for all preventive medicine residents. After the competencies were approved, distributed by the ACPM and HRSA, and published in the American Journal of Preventive Medicine, they were integrated in various ways into the operation of individual residency programs. Changes in the health care system during the decade, however, necessitated an update of the original competencies to better equip preventive medicine educators to prepare residents for new roles those in preventive medicine can play in a restructured health care system. HRSA funded an effort to produce Version 2.0 of the preventive medicine competencies based on review and refinement of the original competencies through a consensus process. This article includes these revised core competencies and performance indicators.     

Improving capacity to care for patients with intellectual and developmental disabilities: The value of an experiential learning model for family medicine residents

BackgroundPatients with intellectual and developmental disabilities (IDD) are more likely to experience poor health outcomes and family physicians receive inadequate training to provide appropriate care to this patient group. Little prior research has studied how to effectively train family physicians to care for patients with IDD.ObjectiveThe aim of this pilot study was to assess the value of adding an experiential component to didactic education strategies to improve family medicine resident perceived comfort, skills and knowledge related to caring for patients with IDD.MethodsStructured education programs for residents were implemented at three primary care practices in Ontario, Canada. Two practices received didactic information only (didactic-only group); one received didactic information and an experiential training model including clinical interactions and a written reflection on that experience (didactic plus experiential group). In this separate-sample pre-post design, residents were invited to complete a brief anonymous survey prior to and following the training assessing their perceived comfort, skills and knowledge related to patients with IDD.ResultsAt baseline, there were no significant differences between the two groups of residents. At follow up, the experiential group reported significantly higher levels of comfort, skills, and knowledge compared to baseline for most items assessed, while in the didactic-only group most items showed little or no improvement.ConclusionThis pilot study suggests that providing residents the opportunity to participate in clinical encounters with patients with IDD, as well as a structured process to reflect on such encounters, results in greater benefit than didactic training alone.     

Complementary medicine and childhood immunisation: A critical review

BackgroundVaccination is one of the most significant and successful public health measures of recent times. Whilst the use of complementary medicine (CM) continues to grow, it has been suggested that CM practitioners hold anti-vaccination views. The objective of this critical review is to examine the evidence base in relation to CM practitioner attitudes to childhood vaccination alongside attitudes to vaccination among parents who visit CM practitioners and/or use CM products.MethodsA database search was conducted in MEDLINE, PubMed, CINAHL, EMBASE and AMED for research articles published between January 2000 and September 2015 that evaluated either CM practitioner or CM user attitudes and intention towards childhood vaccination.ResultsA total of 23 articles were found that detailed the attitudes of CM practitioners to vaccination. A further 16 papers examined the association between the use of CM products and visits to CM practitioners, and immunisation. The interface between CM and vaccination is complex, multi-factorial and often highly individualised. The articles suggest that there is no default position on immunisation by CM practitioners or parents who use CM themselves, or for their children. Although CM use does seem positively associated with lower vaccination uptake, this may be confounded by other factors associated with CM use (such as higher income, higher education or distrust of the medical system), and may not necessarily indicate independent or predictive relationships.ConclusionsAlthough anti-vaccination sentiment is significant amongst some CM practitioners, this review uncovers a more nuanced picture, and one that may be more agreeable to public health values than formerly assumed.     

社区居民健康教育干预试验

1997- 2 0 0 2年对邹城市 4个社区居民开展了健康教育干预 ,实验组受试对象卫生知识水平自干预前的6 2 .84分提高到 89.2 8分 ,卫生观念发生了明显的改变 ,8项卫生行为形成率显著提高 ,肠道寄生虫感染率较对照组低16 .0 1% ,所观察的 8种老年人常见慢性病发病率除恶性肿瘤发病率与对照组相近外 ,其余 7种均低于对照组     

Students who wish to specialize in forensic medicine vs. their fellow students: motivations,attitudes and reactions during autopsy practice

Purpose To investigate the particular features of students who express the desire to follow a forensic career. Methods and materials Three hundred and four 6th-year students attending the compulsory practice in forensic medicine in the academic year 2005–2006 were asked to fill in a self-administered questionnaire at the end of the course. Results The predominant motivation for following forensics was the scientific interest (39.7%). Gender, marital status, religion, place of residence, number of siblings, father/mother being a health professional, being a religious individual were not associated with forensics. Higher grades were a negative predictor for the forensic specialty. A trend linking rejection of an afterlife and orientation towards forensic medicine was found. The fear of death was more intense in students rejecting forensics. Feelings of fear, aversion and grief during the last day of autopsy seemed to be important negative predictors. Stereotypes about forensic doctors (such as “forensic doctors have a peculiar character”) significantly modified the decision of students, but the beliefs about the role of the autopsy practice (cause of anxiety for death, stimulus to live every moment in life) did not. Conclusion Medical students who want to follow forensics present only small differences concerning their inherent features, beliefs, reactions, emotions and attitudes, compared with the rest of their fellow students.     

Feasibility of a randomized controlled trial to evaluate Text Reminders for Immunization Compliance in Kids (TRICKs)

Objective

To pilot test the Text Reminders for Immunization Compliance in Kids (TRICKs) program to evaluate its feasibility and potential to increase immunization coverage.

Design

Randomized controlled trial (RCT).

Setting

Pediatric clinic.

Participants

Parents of newborns being discharged from a local hospital who intended to seek child health care at the University-sponsored pediatric resident and faculty clinic.

Intervention

Text message immunization reminders prior to immunization due dates.

Main Outcome Measures

Receipt and timeliness of immunizations at 2, 4 and 6 months of age.

Results

Participants (N = 90) were English (83%) or Spanish (17%) speaking. The majority were female (83%), on public insurance (59%), and had adequate health literacy (96%). Parents were married or a member of an unmarried couple (62%). Over 66% had a high school diploma or less. Greater numbers of intervention children received immunizations and were “on time” using per protocol analysis; though not statistically significance. Limitations include sample size, problematic text messaging software, and loss of phone service at 7 months for 40% of intervention parents. However, post-intervention interviews (N = 18) indicated strong support for TRICKs; 83% found the text message reminders very helpful and 17% somewhat helpful.

Discussion

Pilot testing allowed us to assess processes, including recruitment, retention, and software, which will increase the success of an RCT. Software with built-in backup systems is needed for follow-up when mobile service is interrupted. However, in spite of limitations, immunization rates were higher in the text message reminder group, though not statistically significant. Parent support and interest was high. A fully powered RCT is needed with follow-up over the full 4-3-1-3-3-1 series. Based on our results, for 80% power where we expected 90% compliance in the intervention group and 80% in the control group we need 219 per group, plus increases to address drop out and loss of follow-up.     

Comparison of directed and self-directed learning in evidence-based medicine: a randomised controlled trial

OBJECTIVES: To compare 2 educational programmes for teaching evidence-based medicine (EBM). DESIGN: Prospective randomised controlled trial accompanied by a qualitative evaluation. SETTING: University of Oslo, Norway, 2002-03. PARTICIPANTS: A total of 175 students entered the study. All tenth semester medical students from 3 semesters were eligible for inclusion if they completed baseline assessment and consent forms and either attended teaching on the first day of the semester or gave reasons for their absence on the first day in advance. Interventions One intervention was based on computer-assisted, self-directed learning (self-directed intervention), whilst the other was organised as workshops based on social learning theory (directed intervention). Both educational interventions consisted of 5 half-day sessions. MAIN OUTCOME MEASURES: The primary outcomes were knowledge about EBM and skills in critical appraisal. A secondary outcome measured attitudes to EBM. Outcomes were compared on an intention-to-treat basis using a stratified Wilcoxon rank-sum test. RESULTS: There were no differences in outcomes for the 2 study groups in terms of EBM knowledge (mean deviation 0.0 [95% confidence interval - 1.0, 1.0], P = 0.8), critical appraisal skills (MD 0.1 [95% CI - 0.9, 1.1], P = 0.5), or attitudes to EBM (MD - 0.3 [95% CI - 1.4, 0.8], P = 0.5). Follow-up rates were 96%, 97% and 63%, respectively. CONCLUSIONS: This trial and its accompanying qualitative evaluation suggest that self-directed, computer-assisted learning may be an alternative format for teaching EBM. However, further research is needed to confirm this and investigate alternative educational models.     

临床医学院开展医学伦理学教育的探讨

本文在对医学伦理学概念及其内涵界定的基础上，立足于国内外医学伦理学教育的现状，分析了临床医学院开展医学伦理学教学的必要性，并进一步探讨了如何在临床医学院开展医学伦理学教育，认为临床医学院医学伦理学教育应结合医德教育有重点、分层次推进的模式进行。     

Fetal alcohol syndrome: knowledge and attitudes of family medicine clerkship and residency directors

Fetal alcohol spectrum disorders (FASD) are the leading preventable causes of developmental disabilities with serious permanent consequences. Regardless of the increased awareness of fetal alcohol syndrome (FAS), 13% of women in the United States drink alcohol during pregnancy. Health care professionals do not routinely assess the frequency and quantity of alcohol use by their patients. This study examined the knowledge, skills, and practices of family medicine residency and clerkship directors and assessed the time devoted and format of FAS curricula in the programs. A self-administered anonymous survey was sent to the residency and clerkship directors (N = 571). Response rate of clerkship directors was 52% and residency directors 46%. Both groups showed high level of knowledge of FASD and of alcohol counseling practices for pregnant women. Although almost two thirds of the residency programs had FASD integrated in the curriculum, an equivalent fraction of predoctoral programs did not. More than half of the clerkship directors without FASD in their curriculum agreed that a need exists for its inclusion. These findings raise important medical education and policy issues and provide insight into the disparity in FASD content of curricula between predoctoral and family medicine residency programs in the United States. The role of physician counseling in primary prevention of FAS should continue to be stressed in predoctoral and residency education.     

临床医学专业学生对循证医学双语教学的认知与需求调查分析

目的了解安徽省某医科大学临床医学专业学生对循证医学双语教学的认知与需求状况,探讨双语教学方法在高等医学院校应用的前景。方法采取方便抽样的方法,选取临床医学专业的本科生为研究对象,采用自制调查问卷,调查学生对循证医学双语教学的认知和需求。结果共调查323名临床医学专业学生,仅有1.9%的学生深入了解双语教学模式,一般或不了解双语教学的学生占64.1%;54.8%的学生认为循证医学课程很有必要或有必要开展双语教学;40.6%的学生希望双语教学的学时数占该课程总学时的60%～80%;16.4%的学生希望双语教学的重点在系统评价和meta分析;不同年级的学生和既往参与双语教学的经历是循证医学双语教学的认知程度和需求情况的影响因素。结论临床医学专业大学生对循证医学双语教学的认知程度相对较低,但具有较高的需求。采取灵活多变的教学方式、提高教师双语教学的水平、选编难度适宜的教材对双语教学的推广至关重要。     

A cluster-randomized controlled trial evaluating the effect of culturally-appropriate hypertension education among Afro-Surinamese and Ghanaian patients in Dutch general practice: study protocol

Background  

Individuals of African descent living in western countries have increased rates of hypertension and hypertension-related complications. Poor adherence to hypertension treatment (medication and lifestyle changes) has been identified as one of the most important modifiable causes for the observed disparities in hypertension related complications, with patient education being recommended to improve adherence. Despite evidence that culturally-appropriate patient education may improve the overall quality of care for ethnic minority patients, few studies have focused on how hypertensive individuals of African descent respond to this approach. This paper describes the design of a study that compares the effectiveness of culturally-appropriate hypertension education with that of the standard approach among Surinamese and Ghanaian hypertensive patients with an elevated blood pressure in Dutch primary care practices.     

面向未来的检验医学教育教学改革与发展之探讨

从现代科学技术对检验医学的影响、实验室质量保证和认可制度、独立实验室、检验与临床的联系等4个方面分析了我国检验医学的现状与未来发展,对我国检验医学教育教学改革进行了有益的探索与思考,提出了探索多样性的培养体系、完善人才培养目标、创新课程体系、革新教学理念和教学方法、编写具有规划和特色的教材的改革思路.