PRESS-NEWS.org - Press Release Distribution
PRESS RELEASES DISTRIBUTION

Educational intervention may help medical students adapt care for patients needing nonstandard care

2010-09-15
(Press-News.org) Fourth-year medical students who participated in an educational intervention were more likely to seek, identify and incorporate into care patient circumstances that may require variation from standard care, compared to students in a control group, according to a study in the September 15 issue of JAMA, a theme issue on medical education.

"Clinical decision making requires 2 distinct skills: classifying patients' conditions into diagnostic and management categories that permit the application of best-evidence guidelines, and individualizing or contextualizing care for patients when their circumstances and needs require variations from the standard approach to care. Contextualization is the process of identifying individual patient circumstances (their context) and, if necessary, modifying the plan of care to accommodate those circumstances," the authors write. A contextual error occurs when a physician does not identify contextual factors, such as access to care, that may demand an alternative approach.

Alan Schwartz, Ph.D., of the University of Illinois at Chicago, and colleagues evaluated an educational intervention designed to increase physicians' skills in identifying patient context and to decrease the rate of contextual errors. The study included fourth-year medical students (n = 124) in internal medicine subinternships at the University of Illinois at Chicago or Jesse Brown Veterans Administration Medical Center between July 2008 and April 2009 and between August 2009 and April 2010. The intervention consisted of 4 weekly case-based 1-hour sessions designed to help the students develop knowledge and skills in contextualizing patient care. There were 65 students who participated in the intervention, and 59 students in the control group. Outcomes were assessed using four previously validated standardized patient encounters performed by each participant.

The researchers found that students who participated in the contextualization workshops were significantly more likely to probe for contextual issues in the standardized patient encounters than students who did not (90 percent vs. 62 percent) and significantly more likely to develop appropriate treatment plans for standardized patients with contextual issues (69 percent vs. 22 percent). "There was no difference between the groups in the rate of probing for medical issues (80 percent vs. 81 percent) or developing appropriate treatment plans for standardized patients with medical issues (54 percent vs. 66 percent)," the authors write.

Also, students who participated in the intervention group were much more likely to write an appropriate treatment plan in the contextual variant than students in the control group (67 percent of encounters vs. 24 percent).

"Medical students are typically trained to identify biomedical red flags that may alter their diagnosis and management of patients but are rarely trained to identify contextual red flags that may be equally vital in providing appropriate care. Similarly, practicing physicians are tracked for adherence to quality measures, such as the Healthcare Effectiveness Data and Information Set, that do not incorporate contextual issues; hence, deficits are unlikely to be addressed," the researchers write.

"Yet contextualization of care is an important skill for physicians. Not considering patient context in management plans may result in harms of a magnitude equal to not appreciating a biomedical finding. Moreover, several contextual factors such as access to care, religion, and socioeconomic status, are associated with health disparities, and not identifying and integrating patient context in clinical decision making may worsen these disparities. The skills required for contextual probing and contextualization in treatment planning are teachable, but students may not acquire them through current medical school curricula. Curricula and activities that emphasize contextualization may be warranted."

(JAMA. 2010;304[11]:1191-1197. Available pre-embargo to the media at www.jamamedia.org)

Editor's Note: Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.

Editorial: How (Should) Physicians Think?

In an accompanying editorial, Stephen G. Pauker, M.D., and John B. Wong, M.D., of Tufts Medical Center, Boston, comment on the findings of this study.

"Previous work has emphasized the importance of considering a particular patient's biomedical context (e.g., comorbid conditions or risk factors) in generating diagnostic hypotheses … Using simulated patients, these investigators showed that relatively brief training (or priming) of students improves their awareness and exploration of contextual issues."

INFORMATION: (JAMA. 2010;304[11]:1233-1235. Available pre-embargo to the media at www.jamamedia.org)

Editor's Note: Please see the article for additional information, including financial disclosures, funding and support, etc.


ELSE PRESS RELEASES FROM THIS DATE:

Personal sacrifices, rationalization may play role for physicians who accept gifts from industry

2010-09-15
Sunita Sah, M.B.Ch.B., B.Sc., M.B.A., M.S., and George Loewenstein, Ph.D., of Carnegie Mellon University, Pittsburgh, conducted a study to determine whether reminding resident physicians of the sacrifices made to obtain training, as well as suggesting this as a potential rationalization, increases self-stated willingness to accept gifts from industry. In a study that included a survey of 301 U.S. resident physicians, the researchers found that "reminding physicians of sacrifices made in obtaining their education resulted in gifts being evaluated as more acceptable: 21.7 ...

Structured re-analysis of case findings may help improve diagnostic accuracy

2010-09-15
Silvia Mamede, M.D., Ph.D., of Erasmus University Rotterdam, the Netherlands and colleagues investigated whether recent experience with clinical problems provokes availability bias (overestimation of the likelihood of a diagnosis based on the ease with which it comes to mind) resulting in diagnostic errors and whether reflection (structured reanalysis of the case findings) counteracts this bias. The researchers conducted a study in 2009 with 18 first-year and 18 second-year internal medicine residents and found that "the availability bias may occur in medical diagnosis ...

Lower admission scores, non-white race/ethnicity may increase chance of withdrawal from medical school

2010-09-15
Dorothy A. Andriole, M.D., and Donna B. Jeffe, Ph.D., of Washington University, St. Louis, conducted a study to identify demographic variables prior to medical school acceptance associated with outcomes for medical school students. The study used data from a 1994-1999 national cohort of 97,445 students accepted to medical school who were followed up through March 2009 and had graduated, withdrawn, or were dismissed. The authors found that "lower scores on the Medical College Admission Test, nonwhite race/ethnicity, and premedical debt of at least $50,000 were independently ...

Clerkship order linked with outcomes on clerkship subject exams, grades, not clinical performance

2010-09-15
Susan M. Kies, Ed.D., of the University of Illinois College of Medicine, Urbana, and colleagues conducted a study to assess whether the order in which third-year core clerkships are completed affects student performance. Anecdotal experience has suggested that third-year medical students whose first clerkship is internal medicine may have superior performance throughout the academic year. The researchers reviewed the clerkship performance records of medical students at all four campuses of the University of Illinois College of Medicine who completed their third-year core ...

Type D personality associated with higher future heart risk

2010-09-15
Heart patients with the "distressed" (Type D) personality profile may face a higher risk of future cardiovascular problems, according to a summary article published in the American Heart Association journal Circulation: Cardiovascular Quality and Outcomes. An analysis of previous reports involving more than 6,000 patients found an association between the Type D personality and future cardiovascular issues among heart patients. The personality classification system that identified "Type A" decades ago more recently defined Type D as a personality marked by chronic negative ...

Mayo Clinic study: Med school burnout linked to unprofessional behavior

2010-09-15
ROCHESTER, Minn. -- A Mayo Clinic study involving seven major medical schools shows a majority of medical students surveyed suffer from burnout and that those students were more likely to cheat or be dishonest in relation to patient care. The findings appear in this week's issue of JAMA. The study was based on anonymous responses from 4,400 students. Just over half (53 percent) the students responding were found to have burnout. Academic cheating was relatively rare, but roughly 40 percent of third- and fourth-year students admitted to some form of unprofessional conduct ...

Teaching doctors to treat the individual

2010-09-15
Doctors can be taught to listen better to individual circumstances that may affect patient care, according to researchers at the University of Illinois at Chicago College of Medicine. The findings are reported in the Sept. 15 issue of JAMA. In a previous study the investigators had shown that doctors are not good at picking up clues to details in their patients' personal lives that may affect their treatment -- what the researchers call "context." The current study was designed to see if doctors could be taught to think about context when examining patients. Fourth-year ...

Mount Sinai researchers find mechanism behind cleft palate development

2010-09-15
Researchers from Mount Sinai School of Medicine have found a new mechanism that explains why a certain gene mutation causes craniofrontonasal syndrome (CFNS), a disorder that causes cleft palate and other malformations in the face, brain, and skeleton. Cleft palate affects one of every 1,000 newborns. The research is published in the September 15 issue of Genes & Development. Previous research has shown that a mutation in a gene called ephrin-B1 caused abnormalities in facial development, but researchers were uncertain of how. Philipe M. Soriano, PhD, Professor, Developmental ...

Making bees less busy: Social environment changes internal clocks

Making bees less busy: Social environment changes internal clocks
2010-09-15
Washington, DC — Honey bees removed from their usual roles in the hive quickly and drastically changed their biological rhythms, according to a study in the Sept. 15 issue of The Journal of Neuroscience. The changes were evident in both the bees' behavior and in their internal clocks. These findings indicate that social environment has a significant effect on the physiology and behavior of animals. In people, disturbances to the biological clock are known to cause problems for shift workers and new parents and for contributing to mood disorders. Circadian rhythm, the ...

Carnegie Mellon research: How doctors rationalize acceptance of industry gifts

2010-09-15
PITTSBURGH— Despite heightened awareness about the undue influence that gifts from pharmaceutical companies can have on doctors' prescribing practices, and despite expanding institutional conflict-of-interest policies and state laws targeted at preventing such practices, companies continue to reward doctors for prescribing their drugs with gifts ranging from pens and paper, to free dinners and trips. A new study by two researchers at Carnegie Mellon University, published in the Journal of the American Medical Association, helps to explain how doctors rationalize acceptance ...

LAST 30 PRESS RELEASES:

Sensitive ceramics for soft robotics

Trends in hospitalizations and liver transplants associated with alcohol-induced liver disease

Spinal cord stimulation vs medical management for chronic back and leg pain

Engineered receptors help the immune system home in on cancer

How conflicting memories of sex and starvation compete to drive behavior

Scientists discover ‘entirely unanticipated’ role of protein netrin1 in spinal cord development

Novel SOURCE study examining development of early COPD in ages 30 to 55

NRL completes development of robotics capable of servicing satellites, enabling resilience for the U.S. space infrastructure

Clinical trial shows positive results for potential treatment to combat a challenging rare disease

New research shows relationship between heart shape and risk of cardiovascular disease

Increase in crisis coverage, but not the number of crisis news events

New study provides first evidence of African children with severe malaria experiencing partial resistance to world’s most powerful malaria drug

Texting abbreviations makes senders seem insincere, study finds

Living microbes discovered in Earth’s driest desert

Artemisinin partial resistance in Ugandan children with complicated malaria

When is a hole not a hole? Researchers investigate the mystery of 'latent pores'

ETRI, demonstration of 8-photon qubit chip for quantum computation

Remote telemedicine tool found highly accurate in diagnosing melanoma

New roles in infectious process for molecule that inhibits flu

Transforming anion exchange membranes in water electrolysis for green hydrogen production

AI method can spot potential disease faster, better than humans

A development by Graz University of Technology makes concreting more reliable, safer and more economical

Pinpointing hydrogen isotopes in titanium hydride nanofilms

Political abuse on X is a global, widespread, and cross-partisan phenomenon, suggests new study

Reintroduction of resistant frogs facilitates landscape-scale recovery in the presence of a lethal fungal disease

Scientists compile library for evaluating exoplanet water

Updated first aid guidelines enhance care for opioid overdose, bleeding, other emergencies

Revolutionizing biology education: Scientists film ‘giant’ mimivirus in action

Genetic variation enhances cancer drug sensitivity

Protective genetic mutation offers new hope for understanding autism and brain development

[Press-News.org] Educational intervention may help medical students adapt care for patients needing nonstandard care