Three-year predictive validity of DSM-IV attention deficit hyperactivity disorder in children diagnosed at 4-6 years of age

OBJECTIVE

Predictive validity is a fundamental consideration in evaluating the DSM-IV diagnostic criteria for attention deficit hyperactivity disorder (ADHD), particularly for younger children.

METHOD

The authors conducted four annual assessments of ADHD and functional impairment using multiple informants in 255 probands and matched comparison children who were 4-6 years old in wave 1.

RESULTS

Nearly all children who met full criteria for ADHD in wave 1 met full criteria for ADHD over the next 3 years and continued to display marked functional impairment relative to comparison children, even when intelligence, co-occurring psychopathology, and demographic characteristics were controlled.

CONCLUSIONS

These findings support the validity of the DSM-IV diagnosis of ADHD in younger children by demonstrating that the symptoms and associated impairment are likely to persist well into elementary school.

Sex differences in academic advancement. Results of a national study of pediatricians

BACKGROUND

Although the numbers of women in training and in entry-level academic positions in medicine have increased substantially in recent years, the proportion of women in senior faculty positions has not changed. We conducted a study to determine the contributions of background and training, academic productivity, distribution of work time, institutional support, career attitudes, and family responsibilities to sex differences in academic rank and salary among faculty members of academic pediatric departments.

METHODS

We conducted a cross-sectional survey of all salaried physicians in 126 academic departments of pediatrics in the United States in January 1992. Of the 6441 questionnaires distributed, 4285 (67 percent) were returned. The sample was representative of U.S. pediatric faculty members. Multivariate models were used to relate academic rank and salary to 16 independent variables.

RESULTS

Significantly fewer women than men achieved the rank of associate professor or higher. For both men and women, higher salaries and ranks were related to greater academic productivity (more publications and grants), more hours worked, more institutional support of research, greater overall career satisfaction, and fewer career problems. Less time spent in teaching and patient care was related to greater academic productivity for both sexes. Women in the low ranks were less academically productive and spent significantly more time in teaching and patient care than men in those ranks. Adjustment for all independent variables eliminated sex differences in academic rank but not in salary.

CONCLUSIONS

Lower rates of academic productivity, more time spent in teaching and patient care and less time spent in research, less institutional support for research, and lower rates of specialization in highly paid subspecialties contributed to the lower ranks and salaries of female faculty members.

Obtaining systematic teacher reports of disruptive behavior disorders utilizing DSM-IV

This study examines the psychometric properties of the Vanderbilt AD/HD Diagnostic Teacher Rating Scale (VADTRS) and provides preliminary normative data from a large, geographically defined population. The VADTRS consists of the complete list of DSM-IV AD/HD symptoms, a screen for other disruptive behavior disorders, anxiety and depression, and ratings of academic and classroom behavior performance. Teachers in one suburban county completed the scale for their students during 2 consecutive years. Statistical methods included (a) exploratory and confirmatory latent variable analyses of item data, (b) evaluation of the internal consistency of the latent dimensions, (c) evaluation of latent structure concordance between school year samples, and (d) preliminary evaluation of criterion-related validity. The instrument comprises four behavioral dimensions and two performance dimensions. The behavioral dimensions were concordant between school years and were consistent with a priori DSM-IV diagnostic criteria. Correlations between latent dimensions and relevant, known disorders or problems varied from .25 to .66.

National growth in simulation training within emergency medicine residency programs, 2003-2008

OBJECTIVES

The use of medical simulation has grown dramatically over the past decade, yet national data on the prevalence and growth of use among individual specialty training programs are lacking. The objectives of this study were to describe the current role of simulation training in emergency medicine (EM) residency programs and to quantify growth in use of the technology over the past 5 years.

METHODS

In follow-up of a 2006 study (2003 data), the authors distributed an updated survey to program directors (PDs) of all 179 EM residency programs operating in early 2008 (140 Accreditation Council on Graduate Medical Education [ACGME]-approved allopathic programs and 39 American Osteopathic Association [AOA]-accredited osteopathic programs). The brief survey borrowed from the prior instrument, was edited and revised, and then distributed at a national PDs meeting. Subsequent follow-up was conducted by e-mail and telephone. The survey concentrated on technology-enhanced simulation modalities beyond routine static trainers or standardized patient-actors (high-fidelity mannequin simulation, part-task/procedural simulation, and dynamic screen-based simulation).

RESULTS

A total of 134 EM residency programs completed the updated survey, yielding an overall response rate of 75%. A total of 122 (91%) use some form of simulation in their residency training. One-hundred fourteen (85%) specifically use mannequin-simulators, compared to 33 (29%) in 2003 (p < 0.001). Mannequin-simulators are now owned by 58 (43%) of the programs, whereas only 9 (8%) had primary responsibility for such equipment in 2003 (p < 0.001). Fifty-eight (43%) of the programs reported that annual resident simulation use now averages more than 10 hours per year.

CONCLUSIONS

Use of medical simulation has grown significantly in EM residency programs in the past 5 years and is now widespread among training programs across the country.

Impact of pediatric epilepsy on the family: a new scale for clinical and research use

PURPOSE

There is no brief, global instrument available that specifically measures the psychosocial impact of pediatric epilepsy on the family. An 11-item scale was created for parents' use to evaluate the influence of epilepsy on the major aspects of their family and child's life. This will be a helpful tool both in the clinical setting and as an outcome measure for research studies.

METHODS

Mothers rated their child's quality of life on a visual analogue scale (1-6) and completed the Impact of Pediatric Epilepsy Scale (IPES), which assesses the impact on academic achievement, participation in activities, health, relationships with family and with peers and siblings, social activities, self-esteem, and the caregiver's hopes for their child's future adapted from the scale developed by Jacoby. External validation was determined by comparison of the IPES with physicians' reports of the characteristics of the child's epilepsy and neurological limitations and parents' ratings on the Family Environment Scale or Parenting Stress Index. In addition, each school-aged child completed the Piers-Harris Children's Self-Concept Scale, Brother-Sister Questionnaire, and Loneliness Scale. Teachers of children completed the Academic Performance Rating Scale. Seven days later, retest reliability of the IPES was evaluated.

RESULTS

Ninety-seven mothers of children aged 2-16 years completed the IPES and the appropriate family and age-related questionnaires. Internal validation on the IPES yielded a Cronbach's a for the scale of 0.92. A significant Pearson's correlation indicated that total scores were consistent over time (r = 0.81). Spearman's correlations for the individual items were also significant, ranging from 0.48 to 0.78. Significant Spearman's correlations also indicated that quality of life was negatively related to impact on each of the 11 items of psychosocial function. Children with IPES scores above the median differed in some psychosocial aspects from those who scored below. Their parents were more stressed, their siblings were more respectful, they had lower self-esteem, and they experienced more emotional problems. Total impact was also significantly related to seizure frequency, total number of medications taken, number of visits to a physician in the previous year, and number of nights spent in hospital for neurological reasons.

CONCLUSIONS

The IPES is an accurate, acceptable, and quick measurement tool that reflects the way in which childhood epilepsy has an impact on the child and on family life. It may be helpful in routine clinical care and may be useful in the research setting to find ways to improve the lives of children with epilepsy.

Snoring in Portuguese primary school children

OBJECTIVE

To determine the prevalence of snoring and its potential associations with sleep problems, such as daytime symptoms, medical conditions, school performance, and behavioral disturbances in Portuguese children attending primary school.

METHODS

A previously validated questionnaire was sent to the parents of 1381 children attending primary schools in a parish of Coimbra, Portugal. To assess behavioral disturbances, the Portuguese version of Rutter's Children's Behavior Questionnaire for completion by teachers was used.

RESULTS

Of the 988 questionnaires returned (71.5%), complete information concerning snoring was obtained for 976 children (496 girls and 480 boys; mean age: 8.1 +/- 1.5 years). Loud snoring during sleep was reported as frequent or constantly present (LSn) in 84 children (8.6%), as occasionally present in 299 children (30.6%), and as never present (NSn) by 593 children (60.8%). The LSn and NSn groups did not differ with respect to age, gender, sleep duration, time to fall asleep, frequency of night wakings, bedwetting, daytime tiredness, and school achievement. However, LSn was significantly associated with increased bedtime problems (fears and struggles), increased need for comforting activities to fall asleep, behaviors suggestive of parasomnias (sleep talking, teeth grinding, and night terrors), increased daytime sleepiness and irritability, and behavioral disturbances. Children in the LSn group were also more likely to report recurrent medical problems particularly those involving infections of the respiratory tract.

CONCLUSIONS

Snoring is a common symptom in Portuguese children that is associated with behavioral daytime and sleep time disturbances. Children with loud snoring may benefit from early evaluation and intervention.

Risk factors of psychosis: identifying vulnerable populations premorbidly

This article reviews premorbid indicators of psychosis that may be relevant to primary intervention. These risk markers are divided into two categories: (1) precursors related to early etiological factors (family psychiatric history, perinatal and obstetric complications, neurobehavior deficits, early parental separation, institutionalization, and poor family function) and (2) precursors signaling latent mental illness (personality measurements indicating proneness to psychosis, and teacher ratings indicating emotional lability, social anxiety, social withdrawal, passivity, poor peer relations, and disruptive and aggressive behavior). Because teacher ratings have been shown to be powerful predictors of adult mental breakdown, part of this article focuses on a specific study that assesses such ratings as predictors of psychosis in a high-risk population. Risk indicators may also provide clues about protective factors relevant for primary prevention.

Initial Experience of a Digital Training Resource for Modified Rankin Scale Assessment in Clinical Trials

BACKGROUND AND PURPOSE

The modified Rankin Scale (mRS) is the preferred measure of disability in cerebrovascular clinical trials, but its value is restricted by interobserver variability. Poor reliability reduces the statistical power of clinical trials and leads to underestimation of effect size. Strategies to improve mRS grading are required. Video training has previously improved application of the National Institutes of Health Stroke Scale in clinical research. We developed an mRS training resource in an attempt to minimize interobserver variability.

METHODS

We produced a complete training resource comprising an instructional DVD with accompanying written materials and assessment recordings of patient interviews. Formal assessment of training involved grading of real-life cases. Results of initial training and recertification were collected centrally and scored.

RESULTS

Data from 1564 assessments are presented. The majority of assessors were participating in 2 large prospective clinical stroke trials. Assessors represented a mixed group of disciplines and nationalities. After training, most trainees (90%) achieved certification in mRS assessment. The majority (85%) of investigators who did not reach an acceptable score on initial testing achieved certification after further exposure to the package.

CONCLUSIONS

Mass training in mRS assessment for clinical trials is possible. We outline the development of a video-based training package, including technical issues, patient selection procedures, and methods of scoring and assessment. Certification results suggest that use of the resource can improve mRS grading. Acceptability of the training has been demonstrated by its successful use in 2 international acute stroke trials, SAINT 1 and CHANT.

Evaluation of Traditional Classroom Teaching Methods Versus Course Delivery Via the World Wide Web

Higher education is moving with deliberate speed to an electronic classroom. Much has been published on faculty experiences with World Wide Web (WWW) course delivery. However, little research exists on the evaluation of these methods. The purpose of this study was to evaluate students' perceptions of two approaches to teaching: classroom and WWW modules. Classroom methods were rated significantly higher in relation to content, interaction, participation, faculty preparation, and communication. Technical skills were rated higher for WWW modules. Critical thinking and time allotted for assignments were not significantly different between classroom and WWW instruction. Open-ended comments were rich and supported both positive and negative aspects of classroom and WWW-based modules. Implications call for creativity in course development, course redesign and orientation, active communication with students, support for technical problems, faculty development, and university-wide planning through partnerships.

Administration of corticosterone after memory reactivation disrupts subsequent retrieval of a contextual conditioned fear memory: dependence upon training intensity

Reactivation of stabilized memories returns them to a labile state and causes them to undergo extinction or reconsolidation processes. Although it is well established that administration of glucocorticoids after training enhance consolidation of contextual fear memories, but their effects on post-retrieval processes are not known. In this study, we first asked whether administration of corticosterone after memory reactivation would modulate subsequent expression of memory in rats. Additionally, we examined whether this modulatory action would depend upon the strength of the memory. We also tested the effect of propranolol after memory reactivation. Adult male Wistar rats were trained in a fear conditioning system using moderate (0.4 mA) or high shock (1.5 mA) intensities. For reactivation, rats were returned to the chamber for 90 s 24h later. Immediately after reactivation, rats were injected with corticosterone (1, 3 or 10mg/kg) or vehicle. One, 7 and 14 days after memory reactivation, rats were returned to the context for 5 min, and freezing behavior was scored. The findings indicated that corticosterone when injected after memory reactivation had no significant effect on recall of a moderate memory, but it impaired recall of a strong memory at a dose of 3mg/kg. Propranolol (5mg/kg) given after the reactivation treatment produced a modest impairment that persisted over three test sessions. Further, the results showed that corticosterone, but not propranolol deficit was reversed by a reminder shock. These findings provide evidence that administration of glucocorticoids following memory reactivation reduces subsequent retrieval of strong, but not moderate, contextual conditioned fear memory likely via acceleration of memory extinction. On the other hand, propranolol-induced amnesia may result from blockade of reconsolidation process. Further studies are needed to determine the underlying mechanisms.

Developing the role of big data and analytics in health professional education

As we capture more and more data about learners, their learning, and the organization of their learning, our ability to identify emerging patterns and to extract meaning grows exponentially. The insights gained from the analyses of these large amounts of data are only helpful to the extent that they can be the basis for positive action such as knowledge discovery, improved capacity for prediction, and anomaly detection. Big Data involves the aggregation and melding of large and heterogeneous datasets while education analytics involves looking for patterns in educational practice or performance in single or aggregate datasets. Although it seems likely that the use of education analytics and Big Data techniques will have a transformative impact on health professional education, there is much yet to be done before they can become part of mainstream health professional education practice. If health professional education is to be accountable for its programs run and are developed, then health professional educators will need to be ready to deal with the complex and compelling dynamics of analytics and Big Data. This article provides an overview of these emerging techniques in the context of health professional education.

Forty-year psychiatric outcomes following assessment for internalizing disorder in adolescence

OBJECTIVE

The aim of this study was to define the long-term psychiatric outcomes of adolescent internalizing disorder in the general population, using data collected over 40 years from a national birth cohort.

METHOD

A total of 3,279 members of the Medical Research Council National Survey of Health and Development (the 1946 British birth cohort) underwent assessments of psychiatric symptoms, primarily anxiety and depression, at ages 13 and 15. Adolescents who had internalizing disorder at both ages 13 and 15 and those who had internalizing disorder at one of the two ages were compared with mentally healthy adolescents on various psychiatric outcomes in adulthood (ages 26-53), including the prevalence of mental disorders, self-reported trouble with "nerves," suicidal ideation, and treatment for psychiatric disorders.

RESULTS

About 70% of adolescents who had internalizing disorder at both ages 13 and 15 had mental disorder at age 36, 43, or 53, compared with about 25% of the mentally healthy adolescents. They were also more likely than healthy adolescents to have self-reported "nervous trouble" and to have been treated for psychiatric disorder during adulthood. None of these effects was apparent among subjects who had internalizing disorder at only one of the two adolescent assessments.

CONCLUSIONS

The long-term psychiatric outcome for adolescents with persistent or recurrent internalizing disorder was poor, whereas the outcome for those who had a single episode was better than expected. The association between adolescent internalizing disorder and poor psychiatric outcomes in adulthood may be mediated by persistence or severity of symptoms in adolescence.

Building an Evidence Base for Effective Supervision Practices: An Analogue Experiment of Supervision to Increase EBT Fidelity

Treatments that are efficacious in research trials perform less well under routine conditions; differences in supervision may be one contributing factor. This study compared the effect of supervision using active learning techniques (e.g. role play, corrective feedback) versus "supervision as usual" on therapist cognitive restructuring fidelity, overall CBT competence, and CBT expertise. Forty therapist trainees attended a training workshop and were randomized to supervision condition. Outcomes were assessed using behavioral rehearsals pre- and immediately post-training, and after three supervision meetings. EBT knowledge, attitudes, and fidelity improved for all participants post-training, but only the SUP+ group demonstrated improvement following supervision.

Epidemiological study of voice disorders among teaching professionals of La Rioja, Spain

The purpose of the present study was to calculate the prevalence and incidence of voice disorders among teaching staff and find out the associated occupational risk factors. A case-control study was performed with 905 teachers, 579 cases and 326 controls; 492 were randomly selected and 413 volunteered. All teachers were asked to fill out a standard questionnaire. Next, a complete laryngeal exam was performed including a general ear, nose, and throat evaluation and videolaryngostroboscopy. The prevalence of voice disorders among teaching staff was 57%. The most prevalent lesions were vocal overstrain (18%), nodular lesions (14%), and hyperfunctional dysphonia (8%). The incidence rate was 3.87 new cases per year per 1000 teachers. Women had organic lesions three times more than men (odds ratio [OR]: 3.52, confidence interval [CI]: 2.04-6.09). However, men had chronic laryngitis three times more than women (OR: 2.93, CI: 1.50-5.71) and functional dysphonia nearly twice more than women (OR: 1.81, CI: 1.21-2.69). We find a significant risk of suffering voice disorders in teachers who smoke daily (OR: 2.31, CI: 1.58-3.37) and who drink several cups of coffee or tea (OR: 1.87, CI: 1.36-2.56). It is advisable to carry out an annual evaluation of all teaching staff on account of the high prevalence of voice disorders among them.

Insomnia in school-age children with Asperger syndrome or high-functioning autism

BACKGROUND

Asperger syndrome (AS) and high-functioning autism (HFA) are pervasive developmental disorders (PDD) in individuals of normal intelligence. Childhood AS/HFA is considered to be often associated with disturbed sleep, in particular with difficulties initiating and/or maintaining sleep (insomnia). However, studies about the topic are still scarce. The present study investigated childhood AS/HFA regarding a wide range of parent reported sleep-wake behaviour, with a particular focus on insomnia.

METHODS

Thirty-two 8-12 yr old children with AS/HFA were compared with 32 age and gender matched typically developing children regarding sleep and associated behavioural characteristics. Several aspects of sleep-wake behaviour including insomnia were surveyed using a structured paediatric sleep questionnaire in which parents reported their children's sleep patterns for the previous six months. Recent sleep patterns were monitored by use of a one-week sleep diary and actigraphy. Behavioural characteristics were surveyed by use of information gleaned from parent and teacher-ratings in the High-Functioning Autism Spectrum Screening Questionnaire, and in the Strengths and Difficulties Questionnaire.

RESULTS

Parent-reported difficulties initiating sleep and daytime sleepiness were more common in children with AS/HFA than in controls, and 10/32 children with AS/HFA (31.2%) but none of the controls fulfilled our definition of paediatric insomnia. The parent-reported insomnia corresponded to the findings obtained by actigraphy. Children with insomnia had also more parent-reported autistic and emotional symptoms, and more teacher-reported emotional and hyperactivity symptoms than those children without insomnia.

CONCLUSION

Parental reports indicate that in childhood AS/HFA insomnia is a common and distressing symptom which is frequently associated with coexistent behaviour problems. Identification and treatment of sleep problems need to be a routine part of the treatment plan for children with AS/HFA.

The teaching of complementary and alternative medicine in U.S. medical schools: a survey of course directors

PURPOSE

The number of U.S. medical schools offering courses in complementary and alternative medicine (CAM) has risen sharply in recent years. This study gauged the current state of CAM instruction by gathering details about the specific topics being taught and the objectives behind the instruction.

METHOD

Data were collected from questionnaires mailed to 123 CAM course directors at 74 U.S. medical schools.

RESULTS

Questionnaires were returned by 73 course directors at 53 schools. The topics most often being taught were acupuncture (76.7%), herbs and botanicals (69.9%), meditation and relaxation (65.8%), spirituality/faith/prayer (64.4%), chiropractic (60.3%), homeopathy (57.5%), and nutrition and diets (50.7%). The amounts of instructional time devoted to individual CAM topics varied widely, but most received about two contact hours. The "typical" CAM course was sponsored by a clinical department as an elective, was most likely to be taught in the first or fourth year of medical school, and had fewer than 20 contact hours of instruction. Most of the courses (78.1%) were taught by individuals identified as being CAM practitioners or prescribes of CAM therapies. Few of the courses (17.8%) emphasized a scientific approach to the evaluation of CAM effectiveness.

CONCLUSION

A wide variety of topics are being taught in U.S. medical schools under the umbrella of CAM. For the most part, the instruction appears to be founded on the assumption that unconventional therapies are effective, but little scientific evidence is offered. This approach is questionable, especially since mainstream medicine owes much of its success to a foundation of established scientific principles.

Compensation to a department of medicine and its faculty members for the teaching of medical students and house staff

BACKGROUND

Changes in the organization and financing of health care threaten to alter the prevailing system of financing the teaching of medical students and residents. Little information is available from private medical schools and teaching hospitals about the extent of teaching by faculty members or the mechanisms and levels of reimbursement for teaching.

METHODS

We surveyed faculty members in the Department of Medicine at Columbia-Presbyterian Medical Center to ascertain the extent of their teaching activities. A standard number of hours was assigned to each activity, and the total number of teaching hours was calculated for each faculty member. Teaching of fellows and in continuing medical education programs was excluded. We also determined how much money the Department of Medicine received in payment for faculty members' teaching activities, and the sources of this compensation.

RESULTS

In the 1992-1993 academic year, the 188 full-time faculty members spent a total of 46,086 hours teaching (mean [+/- SD], 245 +/- 178 hours per faculty member); 10,780 hours (23.4 percent) were spent teaching medical students, and 35,306 hours (76.6 percent) teaching house staff. Eighty percent of faculty members taught for 137 or more hours each. In a multivariate analysis including faculty rank, subspecialty division, years since graduation from medical school, sex, and tenure or clinical track, senior faculty members (P = 0.02), members of certain subspecialty divisions (P < 0.001), and women (P = 0.05) contributed more than the average number of teaching hours. An additional 56 non-full-time faculty members contributed a total of 5684 hours. The net reimbursement to the department for teaching totaled $965,808, or about $16 per hour of teaching by full-time faculty members, after the cost of fringe benefits was excluded.

CONCLUSIONS

Faculty members of the department of medicine at a major medical center contribute a large number of hours teaching medical students and house staff. This effort is poorly compensated. Cost-containment efforts have the potential to jeopardize fragile social contracts at academic health centers whereby the faculty participates in teaching by contributing unreimbursed or underreimbursed time.

Raters who pursue different goals give different ratings

J. N. Cleveland and K. R. Murphy (1992) suggested that phenomena such as rater errors and interrater disagreements could be understood in terms of differences in the goals pursued by various raters. We measured 19 rating goals of students at the beginning of a semester, grouped them into scales, and correlated these with teacher evaluations collected at the end of the semester. We found significant multiple correlations, both within classes and in an analysis of the pooled sample (adjusting for instructor mean differences, incremental R2 =.08). Measures of rating goals obtained after raters had observed a significant proportion of ratee performance accounted for variance (incremental R2 =.07) not accounted for by measures of goals obtained at the beginning of the semester.

The role of simple emotion recognition skills among school aged boys at risk of ADHD

Poor social skills and behavioral problems are a major component of ADHD. The different explanations offered so far, such as cognitive deficits and deficient self regulation, have not been able fully to account for the various aspects of the social dysfunction, suggesting that other mechanisms might underlay this impairment. Our study sought to assess the emotion recognition of Israeli boys at risk of ADHD, and to evaluate its associations with their social skills. A group of 111 boys (grades 4 and 5) were assigned to an At-risk (n=50) and a control (n=61) group based on their scores in an ADHD symptoms questionnaire. The two groups were matched on age, socio-economic status and class and school environment. Group comparisons revealed that compared to their non-At-risk counterparts, At-risk boys have impaired emotion recognition. Finally, multiple groups Structural Equation Modeling analyses (SEM) demonstrated that emotion misrecognition plays a significant role in the At-risk children's social functioning and behavioral problems compared to its role in the social competence and behavioral problems among the comparison group. Implications for the understanding and treatment of social skills problems among children at risk of ADHD are proposed.

Randomised, controlled study investigating the optimal instructor: student ratios for teaching suturing skills

INTRODUCTION

Recently, there has been a shift away from practising procedures on patients for the first time and towards bench model teaching of clinical skills to undergraduate medical students. However, guidelines for the most effective instructor : student ratio for technical skills training are unclear. This has important implications for staffing laboratory based teaching sessions. The purpose of this study was to assess the optimal ratio of teachers to learners during the teaching of a simulated wound closure.

METHODS

A total of 108 undergraduate medical students participated in a 1-hour course on wound closure. They were randomised to 3 groups, each with a different instructor:student ratio (Group A: 6-12; Group B: 3-12; Group C: 1-12). Students were evaluated on a pre-test, an immediate post-test and a delayed retention test using an objective, computer-based technical skills assessment method. Collectively termed the "economy of movements", the total time taken to complete the task and the number of movements executed were the primary outcome measures.

RESULTS

Improvements in the economy of movements were the same for Groups A and B and were better than in Group C (P < 0.005).

DISCUSSION

The optimal instructor:student ratio was 1 instructor for 4 students. Higher ratios of instructors to students resulted in no improvements in learning, and lower ratios of instructors to students resulted in significantly less learning. These findings are in keeping with current motor learning theories.

The teaching of Class I and Class II direct composite restorations in European dental schools

OBJECTIVES

The purpose of this descriptive study was to provide updated data on the teaching of Class I and Class II direct composite restorations in Europe as part of a survey of this aspect of the primary dental curriculum in Europe and North America.

METHODS

Data on the teaching of posterior composite restorations and related matters were collected by means of a postal questionnaire sent to 185 dental schools known to exist in Europe. Non-respondents were sent a second questionnaire after two months. Further information pertaining to student requirements was sought after six months from all respondents.

RESULTS

The response ranged from 92% for dental schools in Scandinavia to 40% from dental schools in Southern Europe with an overall response of 56%. All but four of the 104 participating schools were found to teach the use of composites in Class I and Class II, two-surface situations in at least premolar teeth. Contraindications and techniques taught for posterior composites varied within and between the country groupings of Northern and Central Europe. Scandinavia, Southern Europe and Eastern Europe. However, certain consensus views were identified. The experience of adverse biological reactions to the use of resin-based restoratives in European dental schools was found to be limited.

CONCLUSIONS

Notwithstanding the variation in the response from the four geographic regions investigated and the relatively low overall response to the questionnaire, it is concluded that the data reported indicates that most dental schools in Europe teach the use of composites in selected Class I and Class II situations. However, considerable variation exists both within and between the regions investigated in relation to this teaching. Further research and consensus conferences should be planned to reduce variability across Europe in relation to the contraindications and techniques taught for posterior composites.

New tools for systematic evaluation of teaching qualities of medical faculty: results of an ongoing multi-center survey

Background

Tools for the evaluation, improvement and promotion of the teaching excellence of faculty remain elusive in residency settings. This study investigates (i) the reliability and validity of the data yielded by using two new instruments for evaluating the teaching qualities of medical faculty, (ii) the instruments' potential for differentiating between faculty, and (iii) the number of residents' evaluations needed per faculty to reliably use the instruments.

Methods and Materials

Multicenter cross-sectional survey among 546 residents and 629 medical faculty representing 29 medical (non-surgical) specialty training programs in the Netherlands. Two instruments—one completed by residents and one by faculty—for measuring teaching qualities of faculty were developed. Statistical analyses included factor analysis, reliability and validity exploration using standard psychometric methods, calculation of the numbers of residents' evaluations needed per faculty to achieve reliable assessments and variance components and threshold analyses.

Results

A total of 403 (73.8%) residents completed 3575 evaluations of 570 medical faculty while 494 (78.5%) faculty self-evaluated. In both instruments five composite-scales of faculty teaching qualities were detected with high internal consistency and reliability: learning climate (Cronbach's alpha of 0.85 for residents' instrument, 0.71 for self-evaluation instrument, professional attitude and behavior (0.84/0.75), communication of goals (0.90/0.84), evaluation of residents (0.91/0.81), and feedback (0.91/0.85). Faculty tended to evaluate themselves higher than did the residents. Up to a third of the total variance in various teaching qualities can be attributed to between-faculty differences. Some seven residents' evaluations per faculty are needed for assessments to attain a reliability level of 0.90.

Conclusions

The instruments for evaluating teaching qualities of medical faculty appear to yield reliable and valid data. They are feasible for use in medical residencies, can detect between-faculty differences and supply potentially useful information for improving graduate medical education.

The clinical role of nurse teachers within a Project 2000 course framework

This paper reports on part of a national study that was conducted over a 3-year period (1991-1994). The overall aim of the study was to explore the changing role of the nurse teacher. Multiple methods of data collection were used, including a modified Delphi survey, a case study and telephone interviews. The sample included a wide variety of respondents (nurse teachers, midwife teachers, clinical nurses, health service managers and higher education lecturers). Findings in relation to the clinical role of the nurse teacher within a Project 2000 course framework are presented. This includes the nature of the clinical role, views on linking theory and practice, and potential barriers to the nurse teacher's clinical role. The future role of nurse teachers within the clinical area is discussed and this includes suggestions for the ways in which a nurse teacher's clinical commitment could be facilitated. Issues relating to the role of lecturer/practitioner are also highlighted.

The feminization of the medical work force, implications for Scottish primary care: a survey of Scottish general practitioners

BACKGROUND

The number of women working in general practice internationally has been steadily rising. In Scotland there have been concerns that such a change may lead to increased part-time working and subsequently to a fall in available general practice manpower despite an apparently rising overall number of general practitioners. However, there is very little information on the actual hours worked by men and women general practitioners or on the types of work they are undertaking.

METHODS

Anonymous workload questionnaires of all Scottish general practitioner principals and non-principals

RESULTS

Response rates for general practice principals and non-principals were 67.2% and 65.2% respectively. Male principals spent on average 18% more time on general medical services (GMS) and 50% more time on non-GMS activities (such as teaching, specialist sessions, administration and research) than women (both p <0.01). This difference was similar for non-principals. In no age group did the hours worked by women doctors approach that of male doctors.

CONCLUSION

Women doctors in primary care in Scotland work fewer hours in all age groups than their male counterparts. The rapidly increasing proportion of women in general practice may lead to an increasing shortfall of medical availability in the future if current work patterns are maintained. Further longitudinal research is required to establish this and man-power planning is required now to address this. More worryingly auxiliary activities such as teaching and administrative duties are not being taken up by women. This may have serious implications for the future development of the specialty in Scotland.

Psychometric properties of the School Anxiety Scale-Teacher Report (SAS-TR)

This paper describes the development and psychometric evaluation of a teacher report scale of anxiety in children. After initial pilot, the School Anxiety Scale-Teacher Report (SAS-TR) was reduced to 16 items which were answered on a 4-point scale. Psychometric evaluation was conducted on 240 community and 140 anxiety disordered children aged 5-12 years. Factor analysis identified two subscales reflecting social and generalized anxiety. The SAS-TR was found to have acceptable internal consistency, appropriate relationships with other teacher report scales, and was positively correlated with parent report of child anxiety. Gender and age effects on total and subscale scores were not evident. Clinical utility was evident with the scale discriminating between the community and clinical groups, correctly classifying a large proportion of anxiety disordered children and showing sensitivity to changes in anxiety with treatment. The SAS-TR complements existing measures and can be used within a multi-informant approach to the assessment of child anxiety.