Validation of the 25-Item Stanford Faculty Development Program Tool on Clinical Teaching Effectiveness

Construct: The 25-item Stanford Faculty Development Program Tool on Clinical Teaching Effectiveness assesses clinical teaching effectiveness. Background: Valid and reliable rating of teaching effectiveness is helpful for providing faculty with feedback. The 25-item Stanford Faculty Development Program Tool on Clinical Teaching Effectiveness was intended to evaluate seven dimensions of clinical teaching. Confirmation of the structure of this tool has not been previously performed. Approach: This study sought to validate this tool using a confirmatory factor analysis, testing a 7-factor model and compared its goodness of fit with a modified model. Acceptability of the use of the tool was assessed using a 6-item survey, completed by final year medical students (N = 119 of 156 students; 76%). Results: The testing of the goodness of fit indicated that the 7-factor model performed poorly, χ²(254) = 457.4, p < .001 (root mean square error of approximation [RMSEA] = 0.08, comparative fit index [CFI] = 0.91, non-normed fit index [NNFI] = 0.89). Only standardized root mean square residual (SRMR) indicated acceptable fit (0.06). Further exploratory analysis identified 10 items that cross-loaded on 2 factors. The remainder of the items loaded on factors as originally intended. By removing these 10 items, repeat confirmatory factor analysis on the modified 15-item, 5-factor model demonstrated a better fit than the original model: SRMR = 0.075, NNFI = 0.91, χ²(80) = 150.1, p < .001; RMSEA = 0.09; CFI = 0.93. Although 75% of the participants stated they were willing to fill the tool on their preceptors on a biweekly basis, only 25% were willing to do so on a weekly basis. Conclusions: Our study failed to confirm factor structure of the 25-item tool. A modified tool with fewer, more conceptually distinct items was best fit by a 5-factor model. Further, the acceptability of use for the 25-item tool may be poor for rotations with a new preceptor weekly. The abbreviated tool may be preferable in that setting.     

De novo head and neck carcinoma in transplant recipients: preliminary results of management.

PURPOSE: To evaluate the stage-based definitive management approach of de novo head and neck cancer (HNC) developing in immunocompromised transplant recipients. PATIENTS AND METHODS: A retrospective analysis was performed on 5 patients with HNC who had previously received an organ or bone marrow transplant. Surgery, radiotherapy, and chemotherapy (alone or in combination) were the employed therapeutic methods for stage I to IV HNC. RESULTS: At diagnosis of HNC, the average patient age was 60 years. The average interval between transplantation and the appearance of HNC was 5 years. In addition to immunosuppressive therapy, 4 patients had another risk factor for HNC development-long history of smoking; also, another person was treated by total body irradiation. With appropriate management that included local treatment for early-stage disease and bimodal therapy in cases of locally advanced neoplasms, all patients (4 being tumor-free) were alive at 6 to 38 months' follow-up. CONCLUSION: Although longer follow-up information is needed, we contend that judicious stage-based management of HNC in transplant recipients is associated with outcomes not necessarily different from patients who are not immunosuppressed.     

Patterns of cocaine abuse in an inner city emergency psychiatric service setting

The reported study identifies the socio-demographic profile of the patient who presents himself to the emergency room of an inner city hospital with a history of recent cocaine use; and investigates the patterns of cocaine abuse.