Bicycle helmet counseling by pediatricians: a random national survey.

A random sample of 1201 pediatricians who are members of the American Academy of Pediatrics completed questionnaires regarding bicycle injury prevention counseling. Of the 871 pediatricians in the sample who provide health supervision, 80% reported that they discuss bicycle helmet use with their patients at least once before the patient reaches the age of 12 years. Provision of bicycle helmet counseling did not vary significantly by pediatricians' age, gender, or practice location. The most important predictor of provision of bicycle helmet counseling was professional experience with injured children, including having had a patient who experienced a serious injury or death due to a bicycle accident in the last year.     

Preventive care attitudes of medical students

Presently developing attitudes of future physicians towards preventive medicine will likely provide either a major impetus for or barriers to the inclusion of preventive medicine content in medical school curricula and in other formats of physician education. In turn, attitudes about preventive care and its role in medical practice will continue to have a large influence on how much disease prevention and health promotion emphasis physicians provide in their practices. Consequently, it becomes important to study how medical students' attitudes evolve during the process of medical education. Furthermore, to the extent that we can better understand how desired attitudes can be developed and nurtured, the practice of preventive medicine may become more purposeful. Beginning and third-year medical students were surveyed with a 100-item questionnaire designed to assess their attitudes regarding: the relative importance of 20 specific preventive services to the practice of medicine and the adequacy of preclinical coursework for preparing them to offer preventive care in medical practice. The confidence of third year students' in the ability of primary care physicians to provide these specific services was also assessed. Preventive care service areas about which third-year students expressed high confidence in the ability of physicians to provide were: immunizations, health screening physicals, blood pressure control, cancer detection education, family planning, health counseling/education, and sexually transmitted disease prevention. Services that students had low confidence in the ability of physicians to provide were: smoking cessation, nutrition counseling/education and weight reduction.(ABSTRACT TRUNCATED AT 250 WORDS)     

Preventing unintentional pediatric injuries: a tailored intervention for parents and providers

The purpose of this study was to determine the efficacy of providing (i) tailored injury prevention information (T-IPI) to parents and (ii) concurrent T-IPI to parents and providers to promote parent adoption of safety practices. During well-child visits, parents of children ages 4 and younger completed a computer assessment and were randomized to receive generic injury prevention information, T-IPI or T-IPI supplemented with a tailored summary for providers. Follow-up assessments were completed by telephone 1 month later. Parents receiving T-IPI alone or with supplementary provider information were more likely to report adopting a new injury prevention behavior than those receiving generic information (49 and 45%, respectively, compared with 32%; odds ratio=2.0 and 1.9, respectively), and these effects were greatest among the least educated parents. In addition, more complicated behavior changes were reported by those receiving tailored information. Provider receipt of feedback did not result in significantly different provider-parent communication or change in parents' safety practices. Providing parents with individually tailored pediatric injury prevention information may be an effective method for delivering injury prevention anticipatory guidance. Tailoring may have particular utility for more complicated behaviors and for communication with less educated parents.     

The Ready-to-Learn Program: A School-based Model of Nurse Practitioner Participation in Evaluating School Failure

ABSTRACT: The Ready-to-Learn program, a school-based initiative begun in 1994 in three inner-city elementary schools in Hartford, Conn., provides medical input and medical-educational collaboration in the evaluation and treatment of children experiencing learning and behavior problems. The program is staffed by two specially trained nurse practitioners, with consultation provided by pediatricians and a child psychologist. During its first year of operation, pediatric assessment was performed on 57 students at all three schools. Data analysis indicates that children were referred to the program for a broad range of concerns, that assessments were completed in a timely fashion, and that a variety of diagnoses were identified. Feedback from school personnel and parents suggests that the program offers a unique and valued pediatric perspective to the evaluation of school failure. Future plans include a more formal evaluation of the program's cost and effectiveness.     

Tobacco Education and Counseling in Obstetrics and Gynecology Clerkships: A Survey of Medical School Program Directors

The 16,000 medical students completing OB/GYN clerkship programs each year provide a unique opportunity to motivate and mentor students in facilitating tobacco cessation. To determine the scope of current tobacco teaching in obstetrics/gynecology (OB/GYN) education at US medical schools and to assess opportunities for including new tobacco teaching, a 28-question survey was administered to directors and assistant directors at US medical school OB/GYN clerkship programs. Surveys were completed at 71% of schools. Only 9% reported having at least 15 min of dedicated teaching time for improving tobacco cessation skills. Nearly three-fourths of respondents reported teaching students how to intervene to reduce smoking during a work-up in the OB/GYN clinic, but only 43% reported that students would know where to refer someone wishing to quit. Only a third of respondents reported teaching students both to intervene with and refer OB/GYN patients who smoke. These findings suggest that although medical students see many OB and GYN patients who smoke, they have few opportunities to learn comprehensive cessation skills during their clerkships.     

Pediatricians' practices regarding smoking cessation among parents of their patients

OBJECTIVE: To assess pediatricians' use of the 5A's for smoking cessation among the parents of their patients. METHODS: A random sample of Ohio pediatricians (n=153) completed a mail survey on smoking cessation activities. RESULTS: Most pediatricians (80%) regularly asked their patients' parents about their smoking status. The majority "always" or "usually" implemented 2 of the 5 steps of the 5A's. Respondents perceived using the 5A's would result in fewer parents smoking but were less confident they could implement all of the 5A's. CONCLUSIONS: Pediatricians need more training to better prepare them to assist parents in quitting smoking.     

Predictors of nutrition counseling behaviors and attitudes in US medical students

BACKGROUND: Nutrition counseling by physicians can improve patients' dietary behaviors and is affected by physicians' nutrition practices and attitudes, such as the perceived relevance of nutrition counseling. OBJECTIVE: The objective was to provide data on medical students' perceived relevance of nutrition counseling, reported frequency of nutrition counseling, and frequency of fruit and vegetable intakes. DESIGN: Students (n = 2316) at 16 US medical schools were surveyed and tracked at freshmen orientation, at the time of orientation to wards, and in their senior year. RESULTS: Freshmen students were more likely (72%) to find nutrition counseling highly relevant than were students at the time of ward orientation (61%) or during their senior year (46%; P for trend = 0.0003). Those intending to subspecialize had lower and declining perceptions of counseling relevance (P for trend = 0.0009), whereas the perceived relevance of counseling by primary care specialists remained high (P for trend = 0.5). Students were significantly more likely to find nutrition counseling highly relevant if they were female, consumed more fruit and vegetables, believed in primary prevention, had personal physicians who encouraged disease prevention, or intended to specialize in primary care. Only 19% of students believed that they had been extensively trained in nutrition counseling, and 17% of seniors reported that they frequently counseled their patients about nutrition. Students who consumed more fruit and vegetables, believed that they would be more credible if they ate a healthy diet, were not Asian or white, or intended to specialize in primary care counseled patients about nutrition more frequently. Medical students consumed an average of 3.0 fruit and vegetable servings/d, which declined over time. CONCLUSIONS: The perceived relevance of nutrition counseling by US medical students declined throughout medical school, and students infrequently counseled their patients about nutrition. Interventions may be warranted to improve the professional nutritional practices of medical students.     

Evaluation of a cancer prevention and detection curriculum for medical students

BACKGROUND: Undergraduate medical education needs revision to ensure that medical students graduate with the skills necessary to assist their patients in cancer prevention and detection. We sought to implement and incorporate a cancer education curriculum into the students' core curriculum and to assess their skill levels prior to (1996), during (1997), and at the peak (1998-1999) of the incorporation of new hours. METHODS: We conducted pretest and posttest surveys of students at Boston University School of Medicine (medical student years 1-4) enrolled in each of the four study years (1996-1999). A total of 1,956 surveys (response rate, 82%) were completed. The primary outcome measure was the student's self-reported skill level (with responses ranging from 1 (very unskilled) to 5 (very skilled)) for counseling for tobacco cessation, tobacco prevention, and sun protection and for the early detection of breast, skin, and cervical cancer. Mean scores were computed for each chronological year of the study and medical school year. Differences and trends over time in mean scores of students in each medical school year were evaluated using multiple regression analysis. RESULTS: The number of hours of cancer education increased from 6 in 1996 to 15 in 1999. Strong improvements in self-rated skill levels were recorded for four of the six measures. In particular, tobacco cessation counseling skill rose from 2.16 (1996) to 3.13 (1999) for second year students (P < 0.001) and from 3.27 (1996) to 4.17 (1999) for fourth year students (P < 0.001). Among fourth year students, the percentage reporting that cancer prevention was given too little emphasis declined from 62% (1996) to 26% (1999) (P < 0.001), suggesting that the expanded curriculum reflected the students' preferences. CONCLUSIONS: Cancer education can be interwoven into the existing medical school curriculum and produce improvements in students' skill levels for counseling and examinations. Strategies to enhance prevention teaching can use this model.     

Participant- and Study-Related Characteristics Predicting Treatment Completion and Study Retention in an Adolescent Smoking Cessation Trial

Purpose

To determine which factors predict smoking cessation treatment completion and retention among adolescents.

Methods

In a multisite, randomized, controlled trial, the efficacy of motivational interviewing was compared with structured brief advice for smoking cessation and reduction in adolescents (n = 355) aged 14–18 years (55% female, 45% black, 12% Hispanic). Treatment spanned 12 weeks, with follow-up assessments at 24 weeks. Treatment completion was defined as completion of all five counseling sessions. Study retention was defined as completing the 24-week assessment. Participant and study variables served as predictors of treatment completion and retention.

Results

In all, 79% of participants completed all five counseling sessions and the same percent completed the 24-week assessment. Black race, precontemplation stage to cut back, and shorter length of time between the baseline assessment and the first counseling session were significantly associated with treatment completion. For every 7.5-day delay in starting treatment after the baseline visit, there was a 50% decrease in the odds of completing all five treatment sessions. Retention at 24 weeks was predicted by black race, younger age, greater maternal education, expectations of graduating college, and structured brief advice intervention.

Conclusions

High rates of treatment completion and study retention can be achieved in a multisession, behavioral intervention for adolescent smoking cessation. Findings suggest that treatment should begin soon after the intake session to maximize treatment completion. Enhanced efforts to retain older adolescents and youth with lower academic goals and lower family income will be important in future studies.     

The preceptorship,an integral unit of the curriculum in community and family medicine

A curriculum in community and family medicine at the University of Massachusetts Medical School, planned to include a primary care preceptorship as an integral unit, is described. The curriculum has been planned to allow for repeated and increasing exposure of medical students during their undergraduate years to a variety of health care settings within the state. An extensive program of courses is required for all students and consists of a three-week field clerkship in the first year, a field-oriented epidemiology course in the second year, and a six-week field clerkship in the third or fourth year. A preceptorship elective is available to all medical students after they have completed their first two years. Field visits by community and family medicine faculty to the preceptorship site provide overall guidance, facilitate the implementation of objectives, and provide opportunities to strengthen bonds between the practicing physicians of the Commonwealth of Massachusetts and the state medical school. The results to date are discussed.     

Lifetime parental smoking history and cessation and early adolescent smoking behavior

BACKGROUND: Associations are examined between parental smoking and smoking onset by their children. Smoking parents are more likely to have children who start smoking in their teenage years; however, less is known about whether parental quitting is related to adolescent smoking. METHODS: A cross-sectional national sample of 2,206 adolescents, ages 10-14 years, living in two-parent households were interviewed for the DEFACTO annual report on Dutch youth smoking behavior. Adolescent smokers reported that they have tried smoking, even one puff. Respondents indicated whether their parents were never, former, or current smokers, and provided, in the case a parent had quit, their age at that time. RESULTS: Logistic regression analyses revealed that likelihood increased gradually: adolescents with both parents being current smokers were four times more likely to be a smoker compared to adolescents with parents who had never smoked. Additionally, within the group of adolescents whose parents quit smoking, the findings demonstrated that the earlier the parents stopped smoking in the life of their offspring, the less likely their children were to start smoking in adolescence. CONCLUSIONS: Parental smoking history is associated with smoking initiation in early adolescence. Parental cessation at an early age of their offspring reduces the likelihood of adolescent smoking initiation. Preventive efforts, therefore, should focus on the benefits of parental cessation as early as possible.     

Effectiveness of medical school admissions criteria in predicting residency ranking four years later

BACKGROUND: Medical schools across Canada expend great effort in selecting students from a large pool of qualified applicants. Non-cognitive assessments are conducted by most schools in an effort to ensure that medical students have the personal characteristics of importance in the practice of Medicine. We reviewed the ability of University of Toronto academic and non-academic admission assessments to predict ranking by Internal Medicine and Family Medicine residency programmes. METHODS: The study sample consisted of students who had entered the University of Toronto between 1994 and 1998 inclusive, and had then applied through the Canadian resident matching programme to positions in Family or Internal Medicine at the University of Toronto in their graduating year. The value of admissions variables in predicting medical school performance and residency ranking was assessed. RESULTS: Ranking in Internal Medicine correlated significantly with undergraduate grade point average (GPA) and the admissions non-cognitive assessment. It also correlated with 2-year objective structured clinical examination (OSCE) score, clerkship grade in Internal Medicine, and final grade in medical school. Ranking in Family Medicine correlated with the admissions interview score. It also correlated with 2nd-year OSCE score, clerkship grade in Family Medicine, clerkship ward evaluation in Internal Medicine and final grade in medical school. DISCUSSION: The results of this study suggest that cognitive as well as non-cognitive factors evaluated during medical school admission are important in predicting future success in Medicine. The non-cognitive assessment provides additional value to standard academic criteria in predicting ranking by 2 residency programmes, and justifies its use as part of the admissions process.     

What do students want? The types of learning activities preferred by final year medical students

CONTEXT: A well-aligned curriculum has consistent focus on curricular goals, teaching/learning activities and assessment. Poor alignment affects the way students budget learning time and may interfere with achievement of curricular goals. We noticed students' poor attendance in clinical clerkships prior to final examinations and hypothesised that they were responding to curricular misalignment. OBJECTIVES: To quantify the extent to which students and tutors perceived a mismatch between activities pertaining to their current clerkship and those they thought necessary to prepare for final examinations and internship. SUBJECTS: Medical students in final (sixth) year clerkships in medicine, surgery and critical care and clinical tutors. METHOD: A self-report questionnaire on time spent in clerkship activities was administered 3 months before the final examinations. RESULTS: The amounts of time spent on current activities were fairly evenly spread over teaching, study and self-directed patient contacts, and observing patient care (ward rounds, operating theatre, accident and emergency, outpatient department and clinical meetings). Less time was available for recreation. Students and tutors concurred, independently, that good examination and internship preparation required a shifting of the balance. Examination preparation redistributed time from observing patient care and recreation to study and self-directed patient contacts. Internship preparation redistributed time from teaching and recreation to observing patient care. CONCLUSION: Students and tutors perceived that current activities were not well aligned with assessment requirements but were better aligned with the requirements of internship. If we want students to direct their attention towards curricular goals, we need to bring goals, teaching/learning activities and assessment into alignment.     

Statewide evaluation of a tobacco cessation curriculum for pharmacy students

BACKGROUND: Previous studies suggest that healthcare professionals are inadequately trained to treat tobacco use and dependence. Because even brief interventions from clinicians improve patient quit rates, widespread implementation of effective tobacco cessation training programs for health professional students is needed. METHODS: Pharmacy students received 7-8 h of comprehensive tobacco cessation training. Participants completed pre- and post-program surveys assessing perceived overall abilities for cessation counseling, skills for key facets of cessation counseling (Ask, Advise, Assess, Assist, Arrange), and self-efficacy for counseling. RESULTS: A total of 493 students (82.3%) completed linkable pre- and post-training evaluations. Self-reported abilities, measured on a five-point scale, increased significantly from 1.89 +/- 0.89 to 3.53 +/- 0.72 (P < 0.001). Twenty-two percent of students rated their overall counseling abilities as good, very good, or excellent before the training versus 94% of students after the training. Eighty-seven percent of students indicated the training will increase the number of patients that they counsel; 97% believed it will increase the quality of their cessation counseling. CONCLUSIONS: Comprehensive training significantly improved pharmacy students' perceived confidence and ability to provide tobacco cessation counseling. The curriculum is applicable to other health professional training programs and currently is being used to train pharmacy, medical, nursing, and dental students.     

2～3岁儿童父母儿童保健知识需求状况调查与分析

目的:探讨2～3岁儿童父母对儿童保健知识需求状况和获取途径。方法:采用自身设计的问卷调查表对在医院儿科门诊就诊的2～3岁儿童的父母278名进行调查。结果:父母对儿童保健知识的掌握程度无差异(P>0.05),随着父母文化水平的升高对儿童保健知识的掌握程度也越高(P<0.05);父母对儿童保健知识的需求包括定期体格检查占56.5%、定期智能检查占53.2%、常见疾病防治知识占55.8%、小儿营养指导占36.7%、早教指导占22.7%、心理行为咨询占21.2%以及意外伤害防治知识占2.5%。对儿童保健知识获得主要途径包括儿童保健门诊咨询占49.6%、医院发放宣传册占33.1%、广播、上网、电视等占42.4%、长辈或朋友处了解占26.3%、社区儿童健康知识讲座占29.5%和其他占20.5%。结论:目前儿童父母对儿童保健知识的掌握偏低,应开展各种形式的儿童保健知识的健康教育,以提高2～3岁儿童父母对儿童保健知识的认识。     

Smoking cessation counseling with pregnant and postpartum women: a survey of community health center providers

OBJECTIVES: This study assessed providers' performance of smoking cessation counseling steps with low-income pregnant and postpartum women receiving care at community health centers. METHODS: WIC (Special Supplemental Nutrition Program for Women, Infants, and Children) program staff, obstetric clinicians, and pediatric clinicians at 6 community health centers were asked to complete surveys. Smoking intervention practices (performance), knowledge and attitudes, and organizational facilitators were measured. Factors associated with performance were explored with analysis of variance and regression analysis. RESULTS: Performance scores differed significantly by clinic and provider type. Providers in obstetric clinics had the highest scores and those in pediatric clinics had the lowest scores. Nurse practitioners and nutritionists had higher scores than other providers. Clinic type, greater smoking-related knowledge, older age, and perception of smoking cessation as a priority were independently related to better counseling performance. CONCLUSIONS: Mean performance scores demonstrated room for improvement in all groups. Low scores for performance of steps beyond assessment and advice indicate a need for emphasis on the assistance and follow-up steps of national guidelines. Providers' own commitment to helping mothers stop smoking was important.     

Differences in Child Passenger Safety Counseling Frequency and Attitudes by Health Care Provider Specialty

Many children are not being properly restrained in motor vehicles, resulting in unnecessary injury and fatalities. Health care provider (HCP) education is effective at increasing proper child restraint within vehicles. However, differences exist by HCP specialty in regards to frequency of child passenger safety (CPS) counseling. This study of a sample of 255 HCPs examined differences in CPS counseling by HCP specialty (pediatric vs. non-pediatric). HCPs from several upper Midwest states were surveyed about how frequently they provide CPS counseling in their practice by patient age and their attitudes toward CPS-related issues. Pediatric HCPs were twice as likely as non-pediatric HCPs to always provide CPS counseling to parents/guardians of children aged 5 or older. Non-pediatric HCPs were more likely than pediatric HCPs to feel that counseling is ineffective at increasing child seat/booster (p = 0.001) or seat belt use (p = 0.006). Non-pediatric HCPs were more likely than pediatric HCPs to feel there is inadequate time to provide CPS counseling in their practice setting (p = 0.001), and were less likely to know where to refer patients if they have questions regarding CPS issues (0.0291). The differences in HCP attitudes toward CPS counseling provision and the resulting differences in counseling frequency by patient age may contribute to disparities for patients who have limited or no access to pediatric HCPs. Additional research is needed to investigate the rationale for counseling differences seen by HCP specialty and patient age, and the potential effect on child motor vehicle injuries and fatalities.     

Use of learning contracts in an office-based primary care clerkship

OBJECTIVES: This paper describes implementation of the learner-centred learning goal within the primary care clerkship at a Midwestern, United States medical school. DESIGN: The learner-centred learning goal exercise was developed to tailor students' educational activities to their personal level of development and to enhance their commitment to life-long learning in medicine. In the learner-centred learning goal exercise, each student records three specific learning goals early in the primary care clerkship. Students record the methods by which they will pursue and document achievement of each goal. Attainment of the learner-centred learning goal is evaluated based on an oral presentation at the end of the clerkship. We compiled presented learning goals along with the corresponding grade. Students' ratings of the learner-centred learning goal exercise were also compiled. Evaluations and ratings were made on a 1-5 Likert scale, where 1 is the best rating and 5 is worst. SETTING: Department of Medicine, Northwestern University Medical School, Chicago, USA. SUBJECTS: One hundred and seventy-seven third- and fourth-year medical students who presented learner-centred learning goals between 1 July 1995 and 30 June 1996. RESULTS: Students rated pursuing their individual learning goals more worthwhile than most clerkship lectures but less worthwhile than the office experience. Several learning goals were chosen by a disproportionate number of students, potentially indicative of some perceived deficiencies elsewhere in the curriculum. Third-year students ranked the learner-centred learning goal exercise more favourably than fourth-year students (2.14 vs. 2. 51, P = 0.03). CONCLUSIONS: The learner-centred learning goal exercise is a feasible and well-received method within our primary care clerkship. Further study is required to determine whether the exercise promotes independent learning after formal medical school education is completed.     

Have professional recommendations and consumer demand altered pediatric practice regarding child development?

Objective Amid growing consumer demand and professional society recommendations for more information on early childhood development, current practices of pediatricians in regard to children's development remain largely unknown. We investigate whether there are differences in provider practices and satisfaction with regard to children's development (based on length of time in practice). Design A self-reported survey was conducted of physicians at 30 pediatric practices participating in the Healthy Steps for Young Children Program. Healthy Steps is a national program to enhance the developmental potential of young children. Comparisons were made among physicians categorized as in training (n=88), recently in practice (completing residency from 1984 to 1996, n=69), or more experienced (completing residency prior to 1984, n=52). Principal Findings Relative to those recently in practice and in training, more experienced pediatricians spend less time in well-baby visits in the first 2 months of life. One-third of physicians conduct family risk assessments, half complete routine developmental screening, and over half do safety risk assessments in the first 2 months of life. There were few differences by provider experience in the topics covered under anticipatory guidance for new parents. Nearly all discussed infant car seats, sleep position, feeding practices, and temperament, but less than half routinely discussed domestic violence, and between half and three-quarters discussed infant bathing, maternal depression, and appropriate discipline practices. While all three groups of physicians were satisfied with the amount of time to discuss growth and development and parenting issues, more experienced physicians were more satisfied with their own and their staff's abilities to meet new parents' needs on these issues. Factors that over one-third of physicians reported affected their ability to deliver the best-quality care were shortage of support staff, limited referral sources, managed-care restrictions on referrals for special services, excessive paperwork, and lack of time for follow up, teaching parents, and answering questions. Physicians in recent practice were more likely than more experienced physicians to cite reimbursement concerns and limited staff to address the needs of parents regarding development. Conclusions Most pediatricians do not conduct routine developmental screening in the first 2 months of life, and most discuss safety, as opposed to developmental and mental health, concerns with parents of newborns. Pediatricians with more experience believe they are better meeting new parents' needs and are less likely to cite systems and organizational factors as limiting their ability to deliver high-quality care. This study was presented at the meeting of the Association of Health Service Research, Washington, DC, June 22, 1998.