Curriculum factors influencing knowledge of communication skills among medical students

Background  

Communication training builds on the assumption that understanding of the concepts related to professional communication facilitates the training. We know little about whether students' knowledge of clinical communication skills is affected by their attendance of communication training courses, or to what degree other elements of the clinical training or curriculum design also play a role. The aim of this study was to determine which elements of the curriculum influence acquisition of knowledge regarding clinical communication skills by medical students.     

Inhibitory versus facilitory interference for finger-tapping to verbal and nonverbal, motor, and sensory tasks

The purpose of the present experiment was to investigate lateralized effects of concurrent verbal and nonverbal tasks on right- and left-hand finger-tapping. In addition to the verbal vs. nonverbal dichotomy, both motor and sensory tasks were used. It was predicted that a verbal motor task (reading aloud) would lead to more inhibitory interference for right-hand tappings than would a sensory verbal task (watching and remembering slides with nonsense syllables). Similarly, it was predicted that a motor nonverbal task (humming a tune) would lead to more left-hand inhibitory interference than would a sensory nonverbal task (watching pairs of spatial patterns). Results showed a predicted lateralized right-hand decrement in finger-tapping during the motor verbal task. However, an increase in left-hand tapping frequency above baseline was observed during both sensory tasks, while no significant difference was observed between the hands for the motor nonverbal task.     

Are planning,working memory,and inhibition associated with individual differences in preschool ADHD symptoms?

The association between executive function (EF; planning, working memory, and inhibition) and individual differences in symptoms of attention deficit hyperactivity disorder (ADHD) was explored in a sample of preschool children. One hundred sixty children (between the ages of 3 years, 0 months and 5 years, 6 months), selected so as to oversample high ADHD scorers, performed 3 tasks previously shown to measure planning (Tower of London), working memory (Noisy Book) and inhibition ("Puppet Says..."). EF measures were reliable (kappa > .77) and were correlated with IQ (rs > .38) and age (rs > .59). Once IQ and age were controlled, planning and working memory (r = .41) were correlated. Planning and working memory were not correlated with inhibition (rs < .20). There was no association between ADHD and working memory or planning (rs < .12). There was a significant negative association between ADHD and conduct problems and inhibition (r = -.30 and r = -.25, respectively). Only the link with ADHD persisted after the effects of other factors were controlled for in a multiple regression. Specific deficits in inhibitory control rather than general EF deficits are associated with ADHD in the preschool period. This association is linear in nature, supporting the idea that ADHD is better seen as a continuum rather than a discrete category. This association provides evidence for Barkley's (1997) view that ADHD is underpinned by inhibitory deficits in the preschool period.     

The Psychological Significance of Task-Induced Tonic Changes in Somatic and Autonomic Activity

Two experiments tested the view that task-induced autonomic-somatic gradient parallelism does exist and that the steeper the physiological gradients, over the course of a task, the more involved the subject and the greater the effort. Thirty-three male subjects performed easy and difficult versions of a continuous reaction time task. In both experiments the difficult task prompted steeper electromyographic (EMG) activity gradients than did the easy version. Scores on heart rate (HR) and skin conductance did not show clear gradients. However, task-dependent effort was positively related to the magnitude of the initial HR acceleration and to the steepness of the EMG gradient. The autonomic-somatic coupling hypothesis of Obrist did not explain the results. Instead, evidence for ventilatory-somatic parallelism was found.     

Optic nerve atrophy and CT scanning: the target sign

Three patients are described who demonstrate the "target-sign" of optic nerve atrophy on CT scanning. This sign is produced by the centrally located atrophic optic nerve surrounded by a patulous perioptic subarachnoid space. An explanation for this phenomenon is proposed.     

Lay people's evaluations of health: are there variations between different subgroups?

STUDY OBJECTIVE--To elicit lay concepts of health and to see whether these are related to various sociodemographic factors, as has been suggested by previous smaller studies. DESIGN AND SETTING--A total of 196 people aged 18 and over were selected, as a representative sample of the general population, from the electoral registers of Walsall and Dudley in the West Midlands. Respondents were interviewed in their own homes in the autumn of 1989. MEASUREMENTS--Open ended and structured questions were used to elicit concepts of health. The three main stages consisted of an unprompted section in which respondents were asked to describe the features of good or poor health in themselves or others; a prompted section in which they were asked to rate 37 health statements using a series of categories from "very important" to "not at all important"; and a section in which they were asked to indicate which of six groups of statements, each representing a particular concept of health, best represented their own notions of health. RESULTS--Health was seen as multidimensional. Irrespective of whether respondents addressed health in self or health in others, or good or poor health, the biomedical dimension remained an important one. The manner by which concepts of health are elicited may provide some explanation as to why so many and varied concepts are alleged to be held by different subgroups of the population (notably different social classes). CONCLUSIONS--The differences found in this study between models of health employed by different subgroups of the general population have not been as great as has previously been suggested in the published reports. This is encouraging for those using existing health status measurements.     

Health care inequalities: hospitalization and socioeconomic position in Rome

Although the interest for equity is growing, scanty attention has been reserved so far in Italy to health care inequalities. The relation between hospitalization and socioeconomic position in Rome has been studied by evaluating overall heterogeneity and differences in access to effective non-discretionary treatments or at high degree of generic or specific inappropriateness. An area-based socioeconomic index was assigned to 86.4% out of 554.168 discharges of Rome residents identified during 1997 through the hospital information system. The analysis was performed by comparing standardized hospitalization rates across socioeconomic groups through linear trends and risk ratios. A significant inverse relation of overall hospitalization with socioeconomic position was observed for both acute admissions (+44% for most deprived males) and day hospital (+25%). No difference was found in use of effective treatments such as admissions in coronary care units for acute myocardical infarction or surgery for hip fractures. The inverse relation between socioeconomic position and acute hospitalization blunted in day hospital for inguinal hernia repair and actually reversed for cataract removal among females. The hospitalization risk for minor skin diseases, an ambulatory care sensitive condition, resulted inversely associated to socioeconomic position. An excess of hospitalization was also observed for poorest females undergoing appendectomy. Results indicate that observed heterogeneity between socioeconomic groups does not depend only on different health needs but also on an unequal utilization of services: although disadvantaged groups have equal access to treatments of non-discretionary effectiveness, they hardly use innovative services and are more vulnerable in receiving unnecessary treatments.     

The European Donor Hospital Education Programme (EDHEP): enhancing communication skills with bereaved relatives

Intensive care medical and nursing staff self-rate their communication skills as improved following attendance at the European Donor Hospital Education Programme (EDHEP) workshop. A prospective study was conducted to determine what impact EDHEP has on communication skills. Doctor-nurse pairs from 10 experimental and 10 control Intensive Care Units undertook two standardized simulated relative encounters (Breaking Bad News and Donation Request) at three measurement points (pre, post and follow-up). Nurses showed no change in communication skills. Experimental group doctors showed significant improvement in breaking bad news and requesting donation; most of these improvements were not maintained. Control group doctors showed some improvement in breaking bad news, indicating that participating in measurement by itself initiates some transient change in communication skills. Attendance at EDHEP does lead to significant improvement in some, but not all, communication skills essential in breaking bad news and requesting donation. Further research is necessary to determine what factors additional to EDHEP will contribute to enduring change in these particular skills.