The physicians' recognition and attitude about patient education in practice.

The purpose of this study was to investigate the current status of physicians'' recognition and their attitude towards patient education in actual clinical practice. We sent surveys containing self-questionnaires to one-hundred and fifty physicians in five university hospitals and one general hospital from the period of April to July 1995. The self-questionnaire was designed to evaluate the physicians'' recognition and attitude towards patient education at his or her clinical practice. A total of 137 answered-sheets were returned and they were subsequently analyzed. 1) The frequency of physicians'' recognition of patient education as an essential component in practice was 76.6%. There was a significant difference between family physicians and other physicians, 97.1% 69.6%, respectively (p = 0.03). 2) The frequency of physicians'' accomplishment of a satisfactory doctor-patient relationship was 51.1%; board certified physicians and residents, 79.4%, 43.3%, respectively (p = 0.001). 3) The percentage of physicians who explained details about examinations and procedures was 73.0%, who interpreted the findings of exams, tests and x-rays 72.3%, but who assessed patient readiness to modify behavior was only 29.9%. The frequency of physicians'' education to patient about the biomedical diagnosis and treatment was high, but that of physicians'' approach towards patient as a biopsychosocial model was relatively low. Therefore, it is concluded that much more time and emphasis should be placed on patient education in the undergraduate and postgraduate medical education curricula.     

The nature of patients' requests for physicians' help

This report describes patients' requests for help in two outpatient settings--one, a general medicine practice (GMP); the other, a medical walk-in unit (WIU). Interview data were collected in 1981 from 200 patients prior to their visits with the doctor. Patients were asked, "How do you hope the doctor (or clinic) can be of help to you today?" Their responses were written down verbatim. A coding system was devised that described the specificity, focus, and form of each request in order to provide the clinician with a classification for recognizing these request elements and responding to them. Specificity (precision) was identified from the response to "What do you hope the doctor will do for you?" The focus (objective) was described by four categories: problem, treatment, relationship, and administration; the form (intervention), by five categories: somatic, cognitive, affective, advice, and instrumental. Patterns of requests differed in the two settings. In the WIU, the pattern of requests had a problem focus with a form split between the cognitive (wanting an explanation) and the somatic (wanting a medical procedure); in the GMP, treatment was the focus, with a somatic form. The overall results indicate the varied requests of medical outpatients that express their perspectives about their illnesses. This classification of requests should be useful to physicians in eliciting and responding to their patients' requests.     

Evidence-based practice in psychology: implications for research and research training

In this article, the author discusses the implications of evidence-based practice (EBP) for research and research training in clinical psychology. It is argued that EBP provides a useful framework for addressing some heretofore ignored problems in clinical research. Advancing evidence-based psychological practice will require educators to inject significant new content into research, design, and methodology courses and to further integrate research and practicum training. The author believes this to be an exciting opportunity for the field, not only because it will further psychologists' integration into the interdisciplinary health care and research environment, but also because it will provide new tools to educate students for capable, not just competent professional activity.     

Evidence-guided education: patients' outcome data should influence our teaching priorities.

How should medical educators choose learning objectives and teaching content in clinical education? Given the information chain reaction, coverage of all significant topics in sufficient depth is not possible. Choosing subjects of high priority is essential if education is to have maximum impact on quality of care. These priorities should not derive from tradition and opinion, but should be informed by patient outcomes, the ultimate standard for assessing educational effectiveness. Building upon prior initiatives linking education to practice, the author uses the term "evidence-guided education" to express the process of influencing curricular choices with evidence from health outcomes. Sources of outcome evidence include incident reports, morbidity and mortality conferences, surveillance of quality of care in particular venues, case series, surveys of adverse events and "near-misses," and malpractice claims. Starting with anecdotal occurrences, additional case-finding may establish patterns of poor outcomes, some of which may be preventable. Credible research data on outcomes can inform prioritization for objectives and content at successive institutional levels, which should improve practices and outcomes, completing the loop of feedback, implementation, and improved health. The closer the educational intervention is to practice, the more accountable it becomes. Thus, EGE is more amenable to evaluation at residents' and practitioners' levels and more difficult at the undergraduate level. However, outcome evidence should still inform undergraduate teaching, since this constitutes the platform for future learning. Severe constraints on learning time mandate prioritization of content and suggest the need for the judicious application of outcome evidence in place of mere opinion.     

Unmet needs and unused skills: physicians' reflections on their liberal arts education

Physicians who graduated from 1955 to 1982 from three liberal arts colleges in southeastern Pennsylvania were asked about the ways that their undergraduate education had prepared or failed to prepare them for careers in medicine and about changes that they would, in retrospect, have made in their courses of undergraduate study. For many, college had failed to meet their perceived need, as physicians, for skill in dealing with people, but had provided skills in the form of basic science knowledge and willingness to be different that exceeded the demands of their careers. They wished that in college they had taken more courses in the humanities--especially art, history, music, and English literature--and less chemistry, mathematics, physics, and biology. Would-be physicians should be encouraged to take full advantage of the humanizing opportunities of a liberal arts education with confidence that it will contribute to their future professional and personal lives.     

Clinical implications of research on countertransference: science informing practice.

This article presents a clinically oriented synthesis of research findings pertaining to countertransference (CT). Findings are organized around five therapy-relevant questions concerning the origins, triggers, manifestations, management, and effects of CT. To date, research has focused primarily on impediments posed by therapists' CT reactions and mechanisms for managing them. It is argued that future research needs to be directed toward better understanding how therapists can use CT to enhance their work with clients.     

The physician and patient education: a review.

Education is an essential part of medical care and must be conducted properly for the patient to receive optimal benefit. Since physicians are responsible for a major portion of the health care delivered, there is a need to understand how patient education is used by these practitioners. Our current understanding of physician-patient education practices is reviewed in this paper. The frequency of patient education by physicians, the educational content and processes employed, and physician attitudes toward patient education are examined. This analysis shows that patient education is a salient issue among physicians. They report a high frequency of use of patient education with as many as 20% of visits containing a major educational intervention. The content of these interventions is weighed heavily toward instructions and information, with little assessment, monitoring or reinforcement noted. Physician attitudes toward patient education reflect an awareness of its importance and insecurity with actual educational interventions. A number of substantive issues remain to be addressed, including interventions to improve physician educational practice.     

The influence of the cultural climate of the training environment on physicians' self-perception of competence and preparedness for practice

Background  

In current supervisory practice, the learning environment in which the training of specialist registrars (SpRs) takes place is important. Examples of such learning environments are the hospital settings and/or geographical locations where training occurs. Our objective was to investigate whether the cultural climate of different learning environments influences physicians' perceived level of competence and preparedness for practice.     

Social scientific paradigms of masculinity and their implications for research and practice in men's mental health

Clinical researchers and practitioners are increasingly aware of the need for quality theory, research, and intervention in men's mental health. Successful work in this area requires an understanding of the multitude of ways that gender, and more specifically masculinities, can be conceptualized beyond a sole focus on sex differences between men and women. Drawing from a range of social sciences in addition to psychology, the authors consider several theoretical, research, and clinical directions that can follow from social learning, psychodynamic, social constructionist, and feminist paradigms. It is concluded that thinking deeply and critically within different paradigms of masculinity is critical for progress in both research and practice.     

Providing feedback to psychotherapists on their patients' progress: clinical results and practice suggestions

We describe and illustrate our system to measure, monitor, and feed back information about patient treatment. This clinical innovation relies on research-based clinical decision tools that provide psychotherapists with timely warnings when a patient's deviation from an expected treatment response foretells possible treatment failure. We summarize the results of four controlled studies using this methodology; the collective results suggest that measuring, monitoring, and predicting treatment failure (feedback) enhance treatment outcomes for patients who have a negative response. Clinicians are encouraged to employ these methods in routine practice despite their confidence in their own ability to predict patient outcome.