Meaningful Patient Care Experiences for Minority Graduate School Students

BackgroundIncreasing numbers of underrepresented in medicine minority (URMM) physicians has garnered increased attention. Pipeline programs aid this effort and are designed to expose learners to the healthcare experience and strengthen academic preparedness. This paper describes the clinical experiences of students who participated in a bridge to medical school Master's Degree pipeline program at a community based medical school.MethodsUsing qualitative methodology, the authors sought to explore the clinical experiences of three cohorts of graduate school pipeline students on a path to medical school. Thirty six master's level students responded to an evaluation of opened-ended questions at the conclusion of their clinical preceptorship. The responses to three open-ended questions were analyzed via the constant comparison analysis method.ResultsThe total number of clinical encounters during the clinical preceptorship over the three-year period was 633, a total of 144 h. The most common diagnoses seen were related to cardiovascular disease and diabetes. Three primary themes were identified regarding students’ experiences in the pipeline program: connecting academic and clinical skills, learning the needs of and how to advocate for underserved patients and the need to increase exposure to underserved patient populations across specialties in medicine.ConclusionsThe clinical preceptorship linked academic knowledge with clinical skills and provided an avenue for learning about health disparities and patient advocacy for underserved patients. It also identified a need for increased exposure to underserved patient populations across medical specialties.     

Increasing students' perceived sociopolitical empowerment through online and face‐to‐face community psychology seminars

Community psychology theorists underline the importance of promoting sociopolitical empowerment, but few studies have been conducted on the evaluation of the efficacy of empowering programs among university students. The authors report two studies: the first, with 216 psychology majors, compared the efficacy of face‐to‐face and online community psychology seminars in promoting perceived sociopolitical empowerment and self efficacy. The second, with 170 psychology majors, explored if differences in teachers experiences affected students sociopolitical empowerment. Results of ANOVA, on measures of empowerment and self‐efficacy, indicate that learning community psychology principles and a community analysis skill did increase sociopolitical empowerment and efficacies in all studies, both in online and face‐to‐face settings, regardless of teachers' experience. Implications for promoting active citizenship and attracting more students to community psychology programs are discussed. © 2009 Wiley Periodicals, Inc.     

Training graduate-level pediatric psychology researchers at Case Western Reserve University: meeting the challenges of the new millennium

OBJECTIVE: To describe the challenges in training graduate-level pediatric psychology researchers for successful careers and to discuss solutions. METHODS: We reviewed experiences in training graduate students at Case Western Reserve University to identify key challenges in research training and potential strategies to meet them. RESULTS: We identified the following key challenges: stimulating graduate students' career interest in pediatric psychology research; teaching students about the pragmatic challenges of conducting research in pediatric settings, specialized research design, and data analytic issues; helping students to develop essential research skills; developing opportunities for student research-related collaborations; helping students develop professional identities as researchers; and developing and supporting their research careers beyond graduate school. CONCLUSIONS: Useful strategies for meeting these challenges include involving an interdisciplinary faculty in research training; developing specialized training methods that focus on critical research skills such as writing and data analysis; peer support; and involvement with multiple mentors who are successful researchers. Pediatric psychologists should also develop opportunities for the next generation of researchers by facilitating research job options and leadership opportunities.     

Evaluation of different delivery modes of an interactive e-learning programme for teaching cultural diversity

Objective

UK medical schools find it challenging to provide standardised teaching to expanding year intakes. In addition, developing and implementing diversity training can cause difficulties. This paper describes the evaluation of an interactive e-learning programme to raise awareness and understanding of communication difficulties in diversity consultations.

Methods

The programme was part of an undergraduate portfolio-based community module. Three hundred and two students were assigned to one of three delivery methods—a large group setting, small groups with a facilitator, and as part of distance learning while on community placement. The evaluation included analysis of their coursework marks, a self-completed evaluation questionnaire, and small group discussions.

Results

Two hundred and twenty-three students took part in the evaluation. They were able to apply the concepts they learnt to clinical examples from their own experiences. Type of delivery did not affect coursework marks, but students tended to prefer the e-learning as part of a distance learning package. They offered helpful suggestions to improve its complexity and range.

Conclusion

The acceptability and utility of this e-learning module both in face to face teaching and remote placement has been demonstrated, and evaluation by the students has provided valuable information for its further development.

Practice implications

All medical schools should include some diversity training, and further research should concentrate on the effects of this type of learning on longer term outcomes such as attitude and performance tests. Such tools could reduce demands on staff time in facilitation of small groupwork, and their cost effectiveness could be increased by making them available to other medical schools.     

IDENTIFICATION AMONG FIRST‐GENERATION CITIZEN STUDENTS AND FIRST‐GENERATION COLLEGE STUDENTS: AN EXPLORATION OF SCHOOL SENSE OF COMMUNITY

The current study explored the relationships within a higher education institution between school sense of community among first‐generation U.S. citizen students and first‐generation college students compared to students of non‐first generation studentship and citizenship (N = 3,025; M age = 27.21), and of varied racial backgrounds. Students at a large, urban, and faith‐based university completed a measure of belongingness on campus. In terms of generational status, results found a significant interaction such that students who were both first‐generation U.S. citizen students and first‐generation college students reported the highest school sense of community. However, the combined first‐generation U.S. citizen students and non‐first‐generation college student group reported the lowest scores. Despite these significant findings, sense of community scores were very similar with few differences between groups, which is further discussed in the discussion and limitation sections. Significant racial differences were not found. Implications for community psychology and higher education policy are discussed.     

Clinical psychology at the end of the century

In this article the status quo of clinical psychology at the end of the 20th century is discussed, based on the series of Comprehensive Clinical Psychology (Bellack and Hersen, 1998). In this series an attempt is made to integrate the research findings in specialized areas of clinical psychology. As shown in this series, the scientific achievements of clinical psychology are great. There is no other area in psychology that has had such a great impact upon our society. Compared to other fields of psychology and psychiatry, clinical psychology has developed a high standard of empirical research using a wide variety of sophisticated research methodologies. This has produced psychometrically sound instruments of clinical and personality assessment, which in turn has allowed the accumulation of a wealth of reliable evidence regarding the major disorders. Major achievements have also been made in the area of health psychology and neuropsychology, and especially in these areas there are still many promises. One of the main challenges for the next century seems to be to reduce the scientist–practitioner gap and to investigate effective means of implementation of evidence‐based methods in clinical practice. Copyright © 1999 John Wiley & Sons, Ltd.     

Ethics, professionalism, and humanities at Michigan State University College of Human Medicine.

This article describes the variety of approaches used at Michigan State University's College of Human Medicine for teaching ethics, professionalism, and humanities to undergraduate medical students: courses in ethics and health policy; mentoring programs; selectives in history, literature, and spirituality; structured patient care experiences; and discussions with students in their clinical years on the ethical and professional challenges confronting them in their clinical experiences. Some of these approaches, such as the structured patient-care experience, may be unique to Michigan State. The authors place special emphasis on discussing the challenges that confront this curriculum, including struggles to keep up with the pace of change in the health care system, preserving and highlighting the linkages between the "ethics" and the "professionalism" strands of the curriculum, making optimal use of Web technologies, successfully communicating to students the ultimately practical importance of the medical humanities other than ethics, and solving the problems of geography created by a widely dispersed community campus system.     

Student's perspective of success in a postbaccalaureate program

ObjectiveTo identify contributors to the success of students in medical school that graduate from a 1-year postbaccalaureate bridge program.MethodIn 2010, using rigorous qualitative methodology, the principal investigator interviewed a random sample of 15 (23%) of current and past graduates of The Florida State University College of Medicine Bridge program. The investigators recorded and transcribed the interviews, utilized consensual qualitative research methodology to analyze the data, and identified an overarching theoretical construct.ResultsContent analysis of all 15 interviews yielded 73 themes, which were grouped into 6 broad categories/domains: The Florida State University College of Medicine Bridge Program attributes, personal attributes, proof of competence, support systems, exposure to medical programs, and faith/religion.ConclusionPostbaccalaureate programs prepare students for success in medical school. The Florida State University College of Medicine Bridge Program has been particularly successful in identifying and educating students who demonstrated promise upon application, despite noncompetitive grades and Medical College Admission Test scores. The authors identify the characteristics and individual experiences of the students and program that relate to success.     

Mapping hospice patients' perception and verbal communication of end-of-life needs: an exploratory mixed methods inquiry

Background  

Comprehensive "Total Pain" assessments of patients' end-of-life needs are critical for providing improved patient-clinician communication, assessing needs, and offering high quality palliative care. However, patients' needs-based research methodologies and findings remain highly diverse with their lack of consensus preventing optimum needs assessments and care planning. Mixed-methods is an underused yet robust "patient-based" approach for reported lived experiences to map both the incidence and prevalence of what patients perceive as important end of life needs.     

Using participatory methods and geographic information systems (GIS) to prepare for an hiv community‐based trial in Vulindlela,South Africa (Project Accept–HPTN 043)

Recent attempts to integrate geographic information systems (GIS) and participatory techniques, have given rise to terminologies such as participatory GIS and community‐integrated GIS. Although GIS was initially developed for physical geographic application, it can be used for the management and analysis of health and health care data. Geographic information systems, combined with participatory methodology, have facilitated the analysis of access to health facilities and disease risk in different populations. Little has been published about the usefulness of combining participatory methodologies and GIS technology in an effort to understand and inform community‐based intervention studies, especially in the context of HIV. This article attempts to address this perceived gap in the literature. The authors describe the application of participatory research methods with GIS in the formative phase of a multisite community‐based social mobilization trial, using voluntary counseling and testing and post‐test support as the intervention. © 2008 Wiley Periodicals, Inc.     

RACE AND COMMUNITY PRACTICE: REFLECTIONS FROM THE SUPERVISION OF PROFESSIONAL TRAINING

Given South Africa's unique history of colonization and racial segregation, understanding and working with issues of race and racialization have been of paramount importance in South African critical community psychology. This article considers how race has emerged in the supervision of community work with master's students in a community psychology practicum. Using an autoethnographic approach, we document our reflections as two community psychology supervisors to discuss the dilemmas experienced in dealing with race in community psychology supervision. We engage with notions of Whiteness and Blackness, intersections of race and language, and race and crime, and document specific issues that emerge in the supervision for Black and White supervisors. In conclusion, we highlight the importance for supervisors to adopt a critical stance that utilizes reflexivity as a tool for the supervision of community work to help students to reflect on issues of race and racism as part of their community engagement.     

COMMUNITY PSYCHOLOGY ENACTMENTS IN PALESTINE: ROOTS AND CURRENT MANIFESTATIONS

This article describes enactments of community‐centered work and a master's program at Birzeit University as manifestations of community psychology in Palestine. The early roots of community psychology may be traced back to the community organizing and grassroots activism evident during the first Intifada in 1987. These early enactments affirmed community voice and supported national liberation receded in the post‐1993 Oslo Agreement era when international donor funding and institutional arrangements privileged the establishment of nongovernment organizations (NGOs) and research on posttraumatic stress disorder (PTSD), focusing on Palestinian victims of military violence. These enactments tended towards unreflexive individualized modalities of community psychology. In contrast, the Birzeit program is positioned as an attempt to continue and develop the spirit and substance of the critical enactments contained in the first Intifada. This article embodies a case for the development of critical community psychology in Palestine given its history of prolonged colonial occupation and disenfranchisement.     

A South African perspective on community psychology practice competencies

The appropriateness of the paradigm underlying competency frameworks and their specific application in the list of definitions developed by a Task Group of Society for Community Research and Action (SCRA) for US community psychologists need further consideration. This paper considers the technicist and behavioural roots of some of these concepts, illustrating tensions when applying them to community psychology. It then proposes a competency perspective from the global South. Drawing from focus group discussions with, and written reflections from, postgraduate Master's students in training as clinical and counselling psychologists, this paper builds inductively from the recorded data. Following a template analysis of the material, four integrating themes were evident. The distinctive nature of community psychology is highlighted through the themes: relational foundations, activity evolution, self-management and the awareness and influences of processes. Proposals for an alternative framework (“RASP”) are based on its emergence from the applications of learning to practice, emphasising community-based principles. The importance of reflection as the basis for the learning is highlighted. The imperatives to foreground social justice and to enable reflexive thinking on action are discussed, along with concepts based on Humanist and Social Constructivist paradigms, to lead to more interactive and inclusive processes in work on competencies.     

Ranking institutional settings based on publications in community psychology journals

Two primary outlets for community psychology research, the American Journal of Community Psychology and the Journal of Community Psychology, were assessed to rank institutions based on publication frequency and scientific influence of publications over a 32‐year period. Three specific periods were assessed (1973–1983, 1984–1994, 1995–2004). Findings indicate that there were a large group of institutions that published articles during these periods. Those academic institutions that had the most published articles as well as the largest influence, based on citations by other authors, were identified. Using archival data from the community psychology literature represents one approach for identifying those settings that made substantial contributions to the development and growth of the field. © 2007 Wiley Periodicals, Inc. J Comm Psychol 35: 967–979, 2007.     

Methodologies for assessing telemedicine: a systematic review of reviews

Background and objectives

Previous reviews have expressed concerns about the quality of telemedicine studies. There is debate about shortcomings and appropriate methodologies. The aim of this review of systematic reviews of telemedicine is to summarize methodologies used in telemedicine research, discuss knowledge gaps and recommendations and suggest methodological approaches for further research.

Methods

We conducted a review of systematic reviews of telemedicine according to a protocol listing explicit methods, selection criteria, data collection and quality assessment procedures. We included reviews where authors explicitly addressed and made recommendations for assessment methodologies. We did a qualitative analysis of the reviews included, sensitized by two broad methodological positions; positivist and naturalistic approaches. The analysis focused on methodologies used in the primary studies included in the reviews as reported by the review authors, and methodological recommendations made by the review authors.

Results

We identified 1593 titles/abstracts. We included 50 reviews that explicitly addressed assessment methodologies. One group of reviews recommended larger and more rigorously designed controlled studies to assess the impacts of telemedicine; a second group proposed standardisation of populations, and/or interventions and outcome measures to reduce heterogeneity and facilitate meta-analysis; a third group recommended combining quantitative and qualitative research methods; and others applying different naturalistic approaches including methodologies addressing mutual adaptations of services and users; politically driven action research and formative research aimed at collaboration to ensure capacity for improvement of services in natural settings.

Conclusions

Larger and more rigorous studies are crucial for the production of evidence of effectiveness of unambiguous telemedicine services for pre defined outcome measures. Summative methodologies acknowledging telemedicine as complex innovations and outcomes as partly contingent on values, meanings and contexts are also important. So are formative, naturalistic methodologies that acknowledge telemedicine as ongoing collaborative achievements and engage with stakeholders, including patients to produce and conceptualise new and effective telemedicine innovations.     

Learning to mark: a qualitative study of the experiences and concerns of medical markers

Background  

Although there is published research on the methods markers use in marking various types of assessment, there is relatively little information on the processes markers use in approaching a marking exercise. This qualitative paper describes the preparation and experiences of general practice (GP) teachers who undertake marking a written assessment in an undergraduate medical course.     

质的研究方法在临床心理学中的应用

在心理学研究方法中素来都有"质"与"量"的分歧。伴随着对定量的研究方法的反思,近年来,质的研究方法在临床心理学研究中呈上升趋势。本文在论证质的研究方法非常适合于临床心理学研究的同时介绍了四种经常被应用于临床心理学研究的具体方法,并且指出临床心理学工作者在进行质的研究的时候需要更多的反思,下结论的时候也需要更加慎重。     

An innovative program to augment community preceptors' practice and teaching skills.

Medical students currently interface more and more with community-based physicians, many of whom have little training or experience as educators. They also start their ambulatory experiences from the beginning of their medical school training, not just at the clerkship year. This has prompted substantial literature on the need for improved faculty development for community preceptors, which is widely believed to be inadequate at present. The authors describe a novel program, designed to augment community preceptor teaching skills and practice behaviors, focusing on topics relating to humanism, communication, and psychosocial issues common in primary care. The program was conducted for four years beginning in 1999 and organized around acknowledged attributes of successful adult learning, and used case-based, small-group sessions, where individual community preceptors were each asked to "teach" a series of standardized students, in front of the group, regarding issues raised by a number of hypothetical patient cases. The standardized students had in turn been trained by the authors to interact with the participating faculty in a defined manner. The small-group sessions were led by community "opinion leaders" who had been chosen for this role by the participants, and who themselves first underwent training by the authors to familiarize them with core concepts felt to be essential to the program. At the conclusion of the entire process, surveys of the opinion leaders, the other community preceptor participants, and the standardized students suggested that the program did stimulate significant changes in attitude and behavior, although further research is needed to confirm this.