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Educational Objectives (educational + objective)
Selected AbstractsEvolution in the Assessment and Management of Trigeminal SchwannomaTHE LARYNGOSCOPE, Issue 2 2008Bharat Guthikonda MD Abstract Educational Objective: At the conclusion of this presentation, the participants should be able to understand the contemporary assessment and management algorithm used in the evaluation and care of patients with trigeminal schwannomas. Objectives: 1) Describe the contemporary neuroradiographic studies for the assessment of trigeminal schwannoma; 2) review the complex skull base osteology involved with these lesions; and 3) describe a contemporary management algorithm. Study Design: Retrospective review of 23 cases. Methods: Chart review. Results: From 1984 to 2006, of 23 patients with trigeminal schwannoma (10 males and 13 females, ages 14,77 years), 15 patients underwent combined transpetrosal extirpation, 5 patients underwent stereotactic radiation, and 3 were followed without intervention. Of the 15 who underwent surgery, total tumor removal was achieved in 9 patients. Cytoreductive surgery was performed in six patients; of these, four received postoperative radiation. One patient who underwent primary radiation therapy required subsequent surgery. There were no deaths in this series. Cranial neuropathies were present in 14 patients pretreatment and observed in 17 patients posttreatment. Major complications included meningitis (1), cerebrospinal fluid leakage (2), major venous occlusion (1), and temporal lobe infarction (1). Conclusions: Trigeminal schwannomas are uncommon lesions of the skull base that may occur in the middle fossa, posterior fossa, or both. Moreover, caudal extension results in their presentation in the infratemporal fossa. Contemporary diagnostic imaging, coupled with selective use of both surgery and radiation will limit mor-bidity and allow for the safe and prudent management of this uncommon lesion. [source] Retropharyngeal Pseudomeningocele Presenting as Dysphagia After Atlantooccipital Dislocation,THE LARYNGOSCOPE, Issue 9 2006Dr. David M. Cognetti MD Abstract Educational Objective: At the conclusion of this paper, the readers should be able to recognize a retropharyngeal pseudomeningocele as a potential complication of atlanto occipital dislocation. Objectives: To demonstrate how a retropharyngeal pseudomeningocele may present as dysphagia in a patient who is recovering from atlanto occipital dislocation as well as to discuss the treatment options in this situation. Study Design: Case report and literature review. Methods: Analysis of a case through medical record and literature review. Results: A retropharyngeal pseudomeningocele is a very rare complication of atlanto occipital dislocation. It may develop weeks after the initial injury and can present with respiratory or swallowing difficulties. Decompression via a ventriculoperitoneal or lumboperitoneal shunt facilitates resolution of the cerebral spinal fluid collection. Conclusions: A retropharyngeal pseudomeningocele should be considered in all patients status post-atlanto occipital dislocation who are experiencing respiratory distress or dysphagia. [source] Laryngeal Findings in Users of Combination Corticosteroid and Bronchodilator Therapy,THE LARYNGOSCOPE, Issue 9 2004Natasha Mirza MD Educational Objective: At the conclusion of this article, the readers should be able to 1) describe the laryngeal findings in patients who use combination therapy for asthma, 2) discuss the mechanism of laryngeal irritation from the use of inhalers, and 3) describe possible mechanisms for reducing laryngeal irritation and secondary dysphonia from the use of inhalers. Objectives: To describe voice changes and laryngeal findings in patients who are started on combination corticosteroid and bronchodilator therapy in the form of a dry powder inhaler (DPI). Study Design: Retrospective, single-subject design. Methods: Retrospective review of 10 consecutive patients meeting inclusion criteria, who presented at the voice center with more than 4 weeks of dysphonia after being started on a combination form of asthma medication for control and maintenance therapy. All patients were nonsmokers and without history of previous identification or excision of vocal pathology. All patients were treated previously with a proton pump inhibitor for gastroesophageal reflux. Laryngeal videostroboscopic evaluations were performed on all patients. Patients were asked to complete a questionnaire regarding their perceived voice change and history of medical maintenance therapy for asthma. Results: Dysphonia was present in the patients selected for greater than 4 weeks. Patients had been switched to combination therapy after previously using traditional two-drug asthma regimens. In eight of nine patients, the vocal folds demonstrated areas of hyperemia, with plaque-like changes on the surface mucosa. Reduced amplitude of vibration and a reduction in mucosal wave propagation were present on videostroboscopy. Questionnaires revealed that all patients were initiated on combination DPI treatment within the last 6 months. Conclusions: Dysphonia caused by a change in the surface mucosa is a side effect from the use of DPI therapy for asthma. The high-impact force during inhalation of the medication and carrier leads to deposition of particles in the upper airway. We believe the extent of mucosal irritation can be minimized by patient education in the proper delivery of DPI. In some cases, however, return of the two medications delivered separately was necessary. The irritation of the laryngeal mucosa and return of normal vibratory parameters occurred in all patients. [source] The Use of Acellular Dermis in the Prevention of Frey's SyndromeTHE LARYNGOSCOPE, Issue 11 2001Satish Govindaraj MD Abstract Educational Objective At the conclusion of this presentation, the participant should be able to discuss the indications and advantages of using acellular dermis in the prevention of post-parotidectomy gustatory sweating (Frey's Syndrome). Introduction Gustatory sweating is a common postoperative problem and a challenge to treat. The purpose of this study was to evaluate the role of acellular dermis in preventing post-parotidectomy gustatory sweating. Methods Sixty-four patients were randomly assigned to two groups. Group I consisted of 32 patients who underwent a superficial lobe parotidectomy. Group II consisted of 32 patients who underwent a superficial lobe parotidectomy and underwent intraoperative placement of acellular dermis within the parotid bed, between the skin flap and the remaining parotid tissue. The implanted volume of acellular dermis was determined by the amount required to aesthetically restore lateral facial contour. All 64 patients were evaluated for gustatory sweating by identical phone and mail questionnaires. Thirty randomly chosen patients (group I = 15, group II = 15) were evaluated using a modified Minor's Starch-Iodine Test (MSIT). In all 30 patients, the MSIT was administered to both sides of the face. Results The responses to questionnaires (N = 64) demonstrated the subjective presence of gustatory sweating in 3 of 32 patients (9.3%) in group I, whereas group II demonstrated a subjective incidence in 1 of 32 patients (3.1%). The objective incidence determined by those who underwent the MSIT (n = 30) revealed a 40% (6) and 0% incidence of Frey's Syndrome in groups I and II, respectively. The complication rate in group I was 9% (3 seromas) and in group II it was 25% (7 seromas and 1 wound infection). Conclusions Acellular dermis appears to be an effective method for preventing post-parotidectomy gustatory sweating, despite its higher complication rate. [source] Early patient contact in primary care: a new challengeMEDICAL EDUCATION, Issue 9 2001Ann-Christin Haffling Background The Medical School of Lund University, Sweden, has introduced an early patient contact course, including training in communication and examination skills. The course runs parallel with theoretical subjects during the students' first two-and-a-half years. General practitioner (GP) participation is gradually increasing, and in the last half-year of the course GPs in all health centres in the area are involved. Little is known about the GPs' interest, competence and time for this new task. Aim To describe the GPs' attitudes towards teaching and the rewards and problems they experience. Subjects 30 GPs teaching third-year medical students. Method Semistructured interview study. Data analysis by a method described by Malterud. Results The attitude towards teaching was mostly positive and the teachers were confident about teaching examination procedure. Among rewards of teaching, improved quality of clinical practice was the main theme, but imparting knowledge to others, contact with enthusiastic students, and gains in self-esteem were also mentioned. Problems with teaching were mostly due to external factors such as lack of time and space, but concern about a negative effect on patient care was also recognized. Educational objectives of the course were not completely accepted. GPs were not fully aware about what to expect from the students, with subsequent problems concerning how to assess students' performance and how to give effective feedback. Conclusions The teaching of junior medical students is maintained by the GPs' enthusiasm for teaching. However, teacher training is required and the crucial issues of time and space have to be considered. [source] The link between board composition and board objectives: an empirical analysis on Flemish non-profit schoolsMANAGERIAL AND DECISION ECONOMICS, Issue 3 2009Cind Du Bois Flemish non-profit schools have no legally imposed composition rules with respect to their board of directors. Hence, large variation exists in their size and composition. We argue that these differences in board composition can result in different policies followed by the board. To empirically test this hypothesis we question the board's chairpersons of Flemish non-profit schools about the objectives set forward by the board. Ordered probit regressions on the importance attached to different educational objectives provide support for our hypothesis and thus alert policy makers to account for the linkages between objectives and board characteristics when formulating legislation with respect to school board composition. Copyright © 2008 John Wiley & Sons, Ltd. [source] International health electives: thematic results of student and professional interviewsMEDICAL EDUCATION, Issue 7 2010Andrew Petrosoniak Medical Education 2010: 44: 683,689 Objectives, The purpose of this study was to explore the complexities (including harms and benefits) of international health electives (IHEs) involving medical trainees. This exploration contributes to the ongoing debate about the goals and implications of IHEs for medical trainees. Methods, This qualitative study used anonymous, one-to-one, semi-structured interviews. All participants had previous international health experiences. Between September 2007 and March 2008, we interviewed a convenience sample of health care professionals (n = 10) and medical trainees (n = 10). Using a modified grounded theory methodology, we carried out cycles of data analysis in conjunction with data collection in an iterative and constant comparison process. The study's thematic structure was finalised when theme saturation was achieved. Results, Participants described IHEs in both negative and positive terms. IHEs were described as unsustained short-term contributions that lacked clear educational objectives and failed to address local community needs. Ethical dilemmas were described as IHE challenges. Participants reflected that many IHEs included aspects of medical tourism and the majority of participants described the IHE in negative terms. However, a few participants acknowledged the benefits of the IHE. Specifically, it was seen as an introduction to a career in global health and as a potential foundation for more sustainable projects with positive host community impacts. Finally, despite similar understandings among participants, self-awareness of medical tourism was low. Conclusions, International health electives may include potential harms and benefits for both the trainee and the host community. Educational institutions should encourage and support structured IHEs for trainee participation. We recommend that faculties of medicine and global health educators establish pre-departure training courses for trainees and that IHE opportunities have sufficient structures in place to mitigate the negative effects of medical tourism. We also recommend that trainees be provided with opportunities to conduct self-reflection and critically assess their IHE experiences. [source] Cultural competence: a conceptual framework for teaching and learningMEDICAL EDUCATION, Issue 3 2009Conny Seeleman Objectives, The need to address cultural and ethnic diversity issues in medical education as a means to improve the quality of care for all has been widely emphasised. Cultural competence has been suggested as an instrument with which to deal with diversity issues. However, the implementation of culturally competent curricula appears to be difficult. We believe the development of curricula would profit from a framework that provides a practical translation of abstract educational objectives and that is related to competencies underlying the medical curriculum in general. This paper proposes such a framework. Methods, The framework illustrates the following cultural competencies: knowledge of epidemiology and the differential effects of treatment in various ethnic groups; awareness of how culture shapes individual behaviour and thinking; awareness of the social context in which specific ethnic groups live; awareness of one's own prejudices and tendency to stereotype; ability to transfer information in a way the patient can understand and to use external help (e.g. interpreters) when needed, and ability to adapt to new situations flexibly and creatively. Discussion, The framework indicates important aspects in taking care of an ethnically diverse patient population. It shows that there are more dimensions to delivering high-quality care than merely the cultural. Most cultural competencies emphasise a specific aspect of a generic competency that is of extra importance when dealing with patients from different ethnic groups. We hope our framework contributes to the further development of cultural competency in medical curricula. [source] The ,Collaborative Care' curriculum: an educational model addressing key ACGME core competencies in primary care residency trainingMEDICAL EDUCATION, Issue 9 2003Keith Frey Aim, The ,Collaborative Care' curriculum is a 12-month senior resident class project in which one evidence-based clinical guideline is designed, implemented and evaluated in our residency practice. This curriculum specifically addresses three of the six Accreditation Council for Graduate Medical Education (ACGME) core competencies: Practice-Based Learning and Improvement, Interpersonal and Communication Skills and System-Based Practices. Additionally, the project enhances the quality of patient care within the model family practice centre in a family practice residency. Methods, During the project, the third-year residency class selects the disease, develops the clinical guideline, leads its implementation and guides the evaluation process. Select faculty members serve as mentors and coach the resident class through each phase of the project. Specific educational objectives are developed for each content area: evidence-based medicine, clinical guideline development, continuous quality improvement and team leadership. A series of seminars are presented during the project year to provide ,just-in-time' learning for the key content and skills required for each step in the project. By working together to develop the practice guideline, then working with nurses and allied health staff to implement the guideline and review its effectiveness, the resident team gains competence in the areas of practice-based learning and improvement, interpersonal and communication skills and system-based practices. Results, The self-reported level of resident confidence in skill acquisition for each content area was measured for each resident at the time of graduation from the residency programme. Results from the first 2 years of this curriculum are reported (resident n = 12), and demonstrate a high level of physician confidence in the skills addressed and their utility for future practice. Conclusions, The senior resident seminar and team project model reported here creates learning experiences that appear to address at least three of the ACGME general competency expectations: practice-based learning and improvement, interpersonal communication skills, and systems-based practice. From the initial resident feedback, this educational model seems to establish a high level of physician confidence in the skills addressed and their utility for future practice. [source] Premature Ejaculation: On Defining and Quantifying a Common Male Sexual DysfunctionTHE JOURNAL OF SEXUAL MEDICINE, Issue 2006Gregory A. Broderick MD ABSTRACT Introduction., Premature ejaculation (PE) and its individual and relationship consequences have been recognized in the literature for centuries. PE is one of the most common male sexual dysfunctions, affecting nearly one in three men worldwide between the ages of 18 and 59 years. Until recently, PE was believed to be a learned behavior predominantly managed with psychosexual therapy; however, the past few decades have seen significant advances in understanding its etiology, diagnosis, and management. There is, as yet, no one universally agreed upon definition of PE. Aim., To review five currently published definitions of PE. Methods., The Sexual Medicine Society of North America hosted a State of the Art Conference on Premature Ejaculation on June 24,26, 2005 in collaboration with the University of South Florida. The purpose was to have an open exchange of contemporary research and clinical information on PE. There were 16 invited presenters and discussants; the group focused on several educational objectives. Main Outcome Measure., Data were utilized from the World Health Organization, the American Psychiatric Association, the European Association of Urology, the Second International Consultation on Sexual Dysfunctions, and the American Urological Association. Results., The current published definitions of PE have many similarities; however, none of these provide a specific "time to ejaculation," in part because of the absence of normative data on this subject. While investigators agree that men with PE have a shortened intravaginal ejaculatory latency time (IELT; i.e., time from vaginal penetration to ejaculation), there is now a greater appreciation of PE as a multidimensional dysfunction encompassing several components, including time and subjective parameters such as "control,""satisfaction," and "distress." Conclusion., There is a recent paradigm shift away from PE as a unidimensional disorder of IELT toward a multidimensional description of PE as a biologic dysfunction with psychosocial components. Broderick GA. Premature ejaculation: On defining and quantifying a common male sexual dysfunction. J Sex Med 2006;3(suppl 4):295,302. [source] The development of undergraduate curricula in surgery: III.ANZ JOURNAL OF SURGERY, Issue 3 2001Assessment The present review is aimed at providing an overview of the assessment process. The mode of assessment has a powerful influence on the learning behaviour of students. It is therefore important to ensure that there is congruity between the objective, the task and the test. In other words: define it, teach it, examine it. It is difficult to evaluate many of the attributes that we desire in a doctor; and examples of this include empathy, ethical behaviour, problem-solving skills, ability to self-educate and teamwork. Nevertheless, it is generally agreed that it is better to measure uncertainly the significant than to measure reliably and validly the trivial. Furthermore different methods of assessment suit different educational objectives (fitness for purpose) and this supports the use of multiple assessment techniques. [source] Multiple Encounter Simulation for High-acuity Multipatient Environment TrainingACADEMIC EMERGENCY MEDICINE, Issue 12 2007Leo Kobayashi MD Patient safety interventions for multitasking, multipatient, error-prone work settings such as the emergency department (ED) must improve assorted clinical abilities, specific cognitive strategies, and teamwork functions of the staff to be effective. Multiple encounter simulation scenarios explore and convey this specialized mental work-set through use of multiple high-fidelity medical simulation (SIM) manikins in realistic surroundings. Multipatient scenarios reflect the work situations being targeted yet have the benefit of scripted control and instructor guidance to advance specific educational objectives. The use of two or more SIM patients promotes the exploration not only of multiple distinct clinical issues but also of interdependent processes pervasive in EDs. Cascading shortages of time, personnel, equipment, and supplies are re-created, thereby replicating process limitations at various levels, in a safe environment in which compensatory actions and adaptive behaviors can be learned. Distinguishing features of multipatient exercises include 1) broadened educational scope and expanded indications for SIM application, 2) enhanced scenario complexity, 3) controlled exposure to high workload environments, 4) expanded communication requirements, and 5) increased potential for reflective learning. Widespread and effective training in well-replicated, carefully coordinated representations of complex multipatient work environments may strengthen educational interventions for personnel working in high acuity and work-overloaded settings such as the ED. The use of concurrent patient encounter SIM exercises to elicit calculated stressors and to foster compensatory staff behaviors is an educational advance toward this objective. The authors present SIM methodology using concurrent patient encounters to replicate these environments. [source] | ||||||||||