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1.
Julia H. Vermylen Gordon J. Wood Elaine R. Cohen Jeffrey H. Barsuk William C. McGaghie Diane B. Wayne 《Journal of pain and symptom management》2019,57(3):682-687
Introduction
Physician communication impacts patient outcomes. However, communication skills, especially around difficult conversations, remain suboptimal, and there is no clear way to determine the validity of entrustment decisions. The aims of this study were to 1) describe the development of a simulation-based mastery learning (SBML) curriculum for breaking bad news (BBN) conversation skills and 2) set a defensible minimum passing standard (MPS) to ensure uniform skill acquisition among learners.Innovation
An SBML BBN curriculum was developed for fourth-year medical students. An assessment tool was created to evaluate the acquisition of skills involved in a BBN conversation. Pilot testing was completed to confirm improvement in skill acquisition and set the MPS.Outcomes
A BBN assessment tool containing a 15-item checklist and six scaled items was developed. Students' checklist performance improved significantly at post-test compared to baseline (mean 65.33%, SD = 12.09% vs mean 88.67%, SD = 9.45%, P < 0.001). Students were also significantly more likely to have at least a score of 4 (on a five-point scale) for the six scaled questions at post-test. The MPS was set at 80%, requiring a score of 12 items on the checklist and at least 4 of 5 for each scaled item. Using the MPS, 30% of students would require additional training after post-testing.Comments
We developed a SBML curriculum with a comprehensive assessment of BBN skills and a defensible competency standard. Future efforts will expand the mastery model to larger cohorts and assess the impact of rigorous education on patient care outcomes. 相似文献2.
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6.
Jennifer Tuboku-Metzger Blakely Ronda L Sinkowitz-Cochran William R Jarvis 《Infection control and hospital epidemiology》2006,27(8):873-875
A 19-item survey instrument was designed and mailed by the Infectious Diseases Society of America to its membership to determine the media preferred by infectious diseases physicians for continuing medical education on general topics and on antimicrobial resistance. The objective of the survey was to offer the developers of educational programs knowledge on which to base more-effective ways to deliver educational materials to physicians in this specialty. 相似文献
7.
Monolayer cultures of normal human bone cells contain multiple subpopulations of alkaline phosphatase positive cells 总被引:5,自引:0,他引:5
Toshikatsu Matsuyama K. -H. William Lau Jon E. Wergedal 《Calcified tissue international》1990,47(5):276-283
Summary Cytochemical staining of normal human bone cells in monolayer cultures for alkaline phosphatase (ALP) indicated that the cultures
contained mixed-cell populations. Time course evaluations of the cytochemical staining revealed, in addition to the ALP-negative
cell population, at least two subpopulations of ALP-positive human bone cells with different levels of ALP. A cytochemical
method has been developed which separates the ALP-positive cells into high and intermediate ALP subpopulations. In this method,
human bone cells were stained for ALP using an azo-dye method and incubating at 4°C for 10 and 30 minutes, respectively. We
defined the cell population that stained positively for ALP at 10 minutes as strong ALP-positive cells, and both strong and
intermediate cells were stained at 30 minutes. The intermediate cells were determined from the difference between the values
at the two time points. The intra- and interassay variations of the assay, with the same investigator in blinded investigations,
were both less than 10% and the interobserver variation was approximately 25%. Analysis of the distribution of ALP levels
in cells with a laser densitometer confirmed the presence of at least three cell subpopulations. 1,25(OH)2D3 treatment increased the proportions of both ALP-positive cell populations, whereas TGF-beta treatment increased only the
intermediate ALP-positive cell population. On the contrary, fluoride increased the proportion of the strong ALP cells, and
IGF-1 had no effect on the proportions of either ALP-positive subpopulation. When the ALP-specific activity was compared with
the percentage of each ALP-positive subpopulations for the cells treated with effectors, the ALP-specific activity correlated
with the total ALP-positive and with the strong ALP-positive populations but not with the intermediate ALP-positive subpopulation.
In summary, this study represents the first evidence that normal human bone cells in monolayer cultures contained at least
two subpopulations of ALP-positive cells, and that bone cell effectors could have differential effects on each cell population. 相似文献
8.
Aaron H. Burstein Pharm.D. William G. Reiss Pharm.D. Eric Kantor B.A. Gail D. Anderson Ph.D. 《Pharmacotherapy》1998,18(6):1271-1276
Study Objective . To characterize cytochrome P450 (CYP) 3A4 activity in premenopausal and postmenopausal women by evaluating the urinary 6-β-hydroxycortisokcortisol ratio. Design . Prospective study. Subjects . Thirteen premenopausal and 13 postmenopausal women who were healthy and not receiving drugs known to affect CYP3A4 activity. Interventions . Beginning on day 2 of menses, premenopausal women collected first morning urine samples every other day for a complete menstrual cycle. Postmenopausal women collected first morning urine every other day for 28 days. Measurements and Main Results . Mean weekly 6-β-hydroxycortisol:cortisol ratios did not differ during the phase (week) of the menstrual cycle. Daily ratios did not differ in postmenopausal women. No difference between premenopausal and postmenopausal women was found on comparing overall median ratios. Conclusion . Cytochrome P450 3A4 activity as measured by 6-β-hydroxy cortisol:cortisol ratio did not differ by week of menstrual cycle, suggesting no menstrual cycle-related changes. Menopause does not appear to be associated with differences in CYP3A4 activity, compared with premenopause. 相似文献
9.
William Plummer 《The British journal of general practice》2002,52(482):766-767
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