University of Cincinnati Study Shows Residents May Benefit Most From Time in the Clinic

A new approach to internal medicine residency training could improve patient care and physician-patient relationships, according to a University of Cincinnati study.

Eric Warm, MD, associate professor of medicine and lead investigator of the study, says research showed residents who spent increased time in outpatient settings as opposed to the hospital delivered a higher quality of care and had more satisfaction in their duties.

Results of this study are published in the July edition of the Journal of General Internal Medicine.

“We essentially redesigned how the internal medicine residency runs,” says Warm. “With this new system, residents complete one year in an outpatient clinic actually doing the things patients expect from their primary care doctors. In the past, residents were based mainly in the hospital, and their delivery of care to outpatients suffered.”

Warm says in restructuring the program, he and colleagues hoped to reduce conflict between inpatient and outpatient care, provide enough time for hands-on learning and enhance the feeling of reward for residents, in addition to raising patient satisfaction and improving physician continuity.

He says there are two overall problems with current residency programs that are primarily focused on inpatient care: not enough time spent in the clinics and no tool to assess the quality of work in the clinic or ways to make it better.

“By placing our residents in the clinic, it allows them to focus on patient care,” he says. “Within the first year, both the patients’ and the residents’ satisfaction had increased.

“We utilized the chronic care model—a tool that helps improve patient care—as our central operating force.”

Instead of allowing residents to engage in “sporadic” interactions with patients for three years, this new model placed them face-to-face with the same patients for one year. During this time, they developed more intimate relationships with patients and learned how to assess and improve the quality of care they delivered.

Overall, residents reported an improvement in their ability to focus in the clinic without being distracted, an increase in personal reward and a greater sense of relationship with their patients.

Patients were also more satisfied with their care, according to Press-Ganey survey data.

Warm says there are several other legs of this study to be completed in the future, including research on the long-term impact on chronic disease.

“We hope research such as this will lead to the most optimal training for our doctors, which will benefit patients in the future,” he says.

The study is part of the Educational Innovations Project (EIP), sponsored through the Accreditation Council for Graduate Medical Education, to facilitate competency-based education and outcomes assessment in programs needing innovation.

BioMed Central Study find The kids most likely to go armed

A new analysis of a 2005 survey of American schoolchildren has identified factors that may be used to help improve school safety. The research, published in BioMed Central's open access journal Annals of General Psychiatry, gives detailed information about the carrying of guns, blades and clubs.

13,707 students participated in the study, 6,664 (50.5%) were male and 7,193 (49.5%) were females. Overall, 10.2% of males and 2.6% of females reported carrying a weapon on school property. An estimated 29.8% of males and 19.3% of females had carried weapons elsewhere.

The analysis was carried out by Emmanuel Rudatsikira, from the Loma Linda University, California, and his colleagues. They showed that the variables most associated with the carrying of weapons were being male and being a member of certain self-selected racial groups. Pupils who identified themselves as white were more likely to carry weapons than those who identified themselves as black.

The authors point out that, "We do not believe that there are any inherent genetic differences that determine race and that affect the way that adolescents behave. We take the view that racial categorization has facilitated the distribution of social and economic resources (housing, school districts, wealth, social networks) that may consequently influence adolescent behaviors and perceptions toward violent behavior".

The results were surprising. The authors state that as the poor are likely to live in violent neighbourhoods, they would be more likely to feel unsafe and therefore carry weapons to school, "We would have expected that minorities such as African Americans, being largely disadvantaged in the United States, would be more likely to bear weapons." Rudatsikira suggests some explanations for this apparent discrepancy "If black students felt less threatened at school, it's less likely they'll carry weapons. Alternatively, the schools they attend may be more vigilant in policing weapon carrying as a possible result of high violence and weapon bearing in black neighbourhoods."

Other factors associated with weapon carrying were substance use, depression, having been a victim of theft or property damage at school, having been raped, having been threatened with a weapon or having been involved in a physical fight.

###

Notes to Editors

1. Correlates of weapon carrying among high school students in the United States
Adamson S Muula, Emmanuel Rudatsikira and Seter Siziya
Annals of General Psychiatry 2008, 7:8 doi:10.1186/1744-859X-7-8

Article available at the journal website: http://www.annals-general-psychiatry.com/content/7/1/8

Please name the journal in any story you write. If you are writing for the web, please link to the article. All articles are available free of charge, according to BioMed Central's open access policy.

Article citation and URL available on request at press@biomedcentral.com

2. Annals of General Psychiatry is an Open Access, peer-reviewed, online journal covering the wider field of Psychiatry, Neurosciences and Psychological Medicine.

Annals of General Psychiatry is aimed at publishing articles on all aspects of psychiatry. Primary research articles are our priority. Both basic and clinical neuroscience contributions are encouraged. The journal strongly supports and follows the principles of evidence-based medicine.

3. BioMed Central (http://www.biomedcentral.com/) is an independent online publishing house committed to providing immediate access without charge to the peer-reviewed biological and medical research it publishes. This commitment is based on the view that open access to research is essential to the rapid and efficient communication of science.

North Carolina State University Study Shows Increased Education on Nanotech, Human Enhancement Increases Public Concerns

Educating the public about nanotechnology and other complex but emerging technologies causes people to become more "worried and cautious" about the new technologies' prospective benefits, according to a recent study by researchers at North Carolina State University.
A new study by researchers at North Carolina State University on public attitudes towards nanotechnology, artificial intelligence and other emerging technologies shows that educating people about the new technologies results in those people becoming more concerned about the potential impact of the technologies.
The researchers, Dr. Michael D. Cobb, assistant professor of political science, and Dr. Patrick Hamlett, associate professor of science, technology and society and political science, gave questionnaires to study participants around the country to determine their position on emerging technologies with "human enhancement" applications – such as using nanotechnology to improve therapies for injuries and degenerative diseases. Nanotechnology is generally defined as technology that uses substances having a size of 100 nanometers or less (thousands of times thinner than a human hair), and is expected to have widespread uses in medicine, consumer products and industrial processes.
Cobb and Hamlett then put the participants through a deliberative forum in March 2008 that provided structured discussions and educational background on the technologies. The participants were then asked to fill out the same questionnaire they had been given before the deliberative forum and asked to provide policy recommendations on how to handle the emerging science.
In a recent presentation to the 10th Conference on Public Communication of Science, in Malmo, Sweden, Cobb noted that, compared to their pre-deliberation opinions, panelists "became more worried and cautious about the prospective benefits" of the human enhancement technologies. Prior to the deliberation, 82 percent of the participants were at least somewhat certain that the benefits of the technologies outweighed the risks – but that number dropped to 66 percent after the deliberation.
Cobb and Hamlett conducted the study, called the 2008 National Citizens' Forum on Human Enhancement, under a subcontract from the Center for Nanotechnology in Society at Arizona State University. The study was conducted at sites in Arizona, California, Colorado, Georgia, New Hampshire and Wisconsin.
Cobb says the study is also important because it shows that deliberative forums are a viable tool for encouraging informed public engagement in the development of governmental policies. This is significant because there have been questions in the past about whether "ordinary citizens" are able to engage in useful deliberation - or whether collective opinions developed during group deliberation are worse than if the deliberation had never taken place.
The driver for the study was to develop a format for informed interaction about the trajectories of science and technology policies as those policies are being developed, Cobb says, so that the public's concerns are incorporated into the policy development process.
- shipman -
Note to editors: The presentation abstract follows.
"The First National Citizens' Technology Forum on Converging Technologies and Human Enhancement: Adapting the Danish Consensus Conference in the USA"
Authors: Dr. Michael D. Cobb and Dr. Patrick Hamlett, North Carolina State University
Presented: June 27, 2008, at the 10th Conference on Public Communication of Science and Technology, Malmo, Sweden
Abstract: Many people believe that informed citizen input should influence public policies about modern science and technology, but several prominent academics warn against relying on citizen deliberations to promote public engagement in policy-making. These scholars contend that citizens do not enjoy the process of deliberating and individual and collective opinions developed during group deliberation are often worse than if deliberation had never taken place. Following the Danish practice known as "Consensus Conferences," we tested this skeptical perspective about citizen capacities by holding Citizen Technology Forums (CTF) in six cities in the United States throughout March 2008. Volunteer participants became informed about human enhancement technologies and they generated written reports about their concerns and recommendations regarding the development trajectory of these technologies. We find that participants dramatically increased their factual understanding about human enhancement technologies and they reported feeling more internally efficacious and trusting of others after deliberating; however, they also became more wary of the potential risks and benefits of these technologies and more concerned about potential inequities in the distribution of these benefits.

Dartmouth College research reveals passive learning imprints on the brain just like active learning

Study uses dance video game to measure motor skills

It's conventional wisdom that practice makes perfect. But if practicing only consists of watching, rather than doing, does that advance proficiency? Yes, according to a study by Dartmouth researchers.

In a study titled "Sensitivity of the Action Observation Network to Physical and Observational Learning" published in the journal Cerebral Cortex in May 2008, Dartmouth researchers determined that people can acquire motor skills through the "seeing" as well as the "doing" form of learning.

A view of the left hemisphere of the brain (with the left part of the image being the forward part of the brain) illustrating the Action Observance Network regions. (image courtesy Emily Cross) Video: Studying the similarites between active and passive learning

"It's been established in previous research that there are correlations in behavioral performance between active and passive learning, but in this study we were surprised by the remarkable similarity in brain activation when our research participants observed dance sequences that were actively or passively experienced," says Emily Cross, the principal investigator and PhD student at Dartmouth. Cross, who earned her degree in June, is currently a post-doctoral fellow at the Max Planck Institute for Cognitive and Brain Sciences in Leipzig, Germany.

Cross and her collaborators used a video game where players have to move in a particular sequence to match the position of arrows on the screen, similar to the popular Dance Dance Revolution game. The researchers measured the skill level of participants for sequences that were actively rehearsed daily, and a different set of sequences that were passively observed for an equivalent amount of time. Brain activity when watching both kinds of sequences (as well as a third set of sequences that were entirely unfamiliar) was captured using fMRI, functional magnetic resonance imaging. The study focused on the Action Observance Network (AON) in the brain, a group of neural regions found mostly in the inferior parietal and premotor cortices of the brain (near the top of the head) responsible for motor skills and some memory functions.

"We collected fMRI data before and after five days of both visual and physical training," says Cross, "and there was common AON activity when watching the practiced and observed dance sequences."

This research contributes to a growing body of study about how people learn and how best to help people with brain injuries. Cross explains that future studies might consider how such overlap between physical and observational learning at the brain level can improve upon rehabilitation therapies for individuals affected by physical or neurological injury.

Cross's co-authors on the paper were David J. M. Kraemer, Antonia F. de C. Hamilton, William M. Kelley, and Scott T. Grafton, all currently or formerly associated with Dartmouth's Department of Psychological and Brain Sciences. Kraemer is currently a postdoctoral fellow at the University of Pennsylvania, Hamilton is now on the faculty of the University of Nottingham's School of Psychology, Kelley is associate professor of psychological and brain sciences at Dartmouth, and Grafton is a professor of psychology at the University of California, Santa Barbara.