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Vanasse AM, Weiler T, Roth EA, Upadhya S, Toriello HV, VanLeuven AJ, Norris JR, Carey JC, Sobering AK. Teaching perspectives on the communication of difficult news of genetic conditions to medical students. Am J Med Genet A 2023; 191:299-305. [PMID: 36286987 PMCID: PMC10092636 DOI: 10.1002/ajmg.a.63003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 06/23/2022] [Accepted: 09/28/2022] [Indexed: 12/14/2022]
Abstract
Informing parents that their child has a diagnosis of Down syndrome (DS) is a common example of the delivery of unexpected or difficult news. Expectations and life planning will change, and if detected prenatally, discussions might include the option of pregnancy termination. Medical school curricula currently include training in breaking unexpected news; however, it is difficult to teach and assess. We use the perspectives of clinicians, educators, and a medical student who is the parent of a child with DS to frame a discussion on teaching, practicing, and assessing communication of difficult news in human genetics during medical school.
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Affiliation(s)
- Ashley M Vanasse
- Department of Biochemistry, St. George's University, St. George's, Grenada.,Department of Pediatrics, University of Oklahoma School of Community Medicine, Tulsa, Oklahoma, USA
| | - Tracey Weiler
- Department of Human and Molecular Genetics, Herbert Wertheim College of Medicine, Florida International University, Miami, Florida, USA
| | - Elizabeth A Roth
- AU/UGA Medical Partnership Campus of the Medical College of Georgia, Athens, Georgia, USA
| | - Sharmila Upadhya
- Department of Biochemistry, St. George's University, St. George's, Grenada
| | - Helga V Toriello
- Department of Pediatrics and Human Development, Michigan State University - College of Human Medicine, East Lansing, Michigan, USA
| | - Ariel J VanLeuven
- AU/UGA Medical Partnership Campus of the Medical College of Georgia, Athens, Georgia, USA.,Department of Cellular Biology and Anatomy, Medical College of Georgia, Augusta University, Augusta, Georgia, USA
| | - John R Norris
- AU/UGA Medical Partnership Campus of the Medical College of Georgia, Athens, Georgia, USA
| | - John C Carey
- Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Andrew K Sobering
- Department of Biochemistry, St. George's University, St. George's, Grenada.,AU/UGA Medical Partnership Campus of the Medical College of Georgia, Athens, Georgia, USA.,Windward Islands Research and Education Foundation, True Blue, St. George's, Grenada
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Ceglio K, Rispoli MJ, Flake EM. Training Medical Professionals to Work with Patients with Neurodevelopmental Disorders: A Systematic Review. Dev Neurorehabil 2020; 23:463-473. [PMID: 32543301 DOI: 10.1080/17518423.2020.1777217] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Background: Patients with neurodevelopmental disorders are not always provided the quality of medical care they deserve. Medical personnel report limited preparation and education in caring for patients with neurodevelopmental disorders. Aim: The purpose of this systematic review is to summarize the research on medical personnel training programs, identify effective training methods, and provide directions for future application and research. Methods: Thirty-four studies met inclusion criteria. The studies were summarized in terms of training components, the medical personnel trained, and the effectiveness of the training in achieving target outcomes. Results: Seventy-nine percent of studies demonstrated improvement in target outcomes. A variety of training components were used in combination throughout the studies, demonstrating a possibility of significant change to medical personnel's abilities for and attitudes about working with patients with neurodevelopmental disorders. Conclusion: Further research is needed to determine specifically which types of training can affect which target outcomes.
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Affiliation(s)
- Katherine Ceglio
- Indiana University School of Medicine - Lafayette , West Lafayette, IN, USA
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Howell EP, Fischer J, Valea FA, Davidson BA. Communication Matters: a Survey Study of Communication Didactics in Obstetrics/Gynecology Residency. MEDICAL SCIENCE EDUCATOR 2020; 30:1069-1076. [PMID: 34457769 PMCID: PMC8368866 DOI: 10.1007/s40670-020-01017-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
BACKGROUND Delivery of excellent patient care hinges on effective communication. Improved communication between physicians, patients, and colleagues can facilitate shared decision-making and foster successful interprofessional teams. Despite the importance of this skill, little is understood about the status or acceptability of dedicated communication training during obstetrics and gynecology (OB/GYN) residency. OBJECTIVE To explore the national landscape of dedicated communication didactics during OB/GYN training. METHODS Residents and program directors (PDs) at ACGME-accredited programs were emailed anonymized surveys. Survey responses pertaining to communication didactics and trainee experiences were evaluated using descriptive statistics and chi-squared tests. RESULTS Of 143 PDs, 45 responded (31.5%). Although the total number of residents receiving our survey is unattainable, our 215 resident respondents can be estimated to represent at least 4.4% of trainees. 98.1% of residents reported challenging clinical communication at least monthly, with many reporting this weekly (47.9%) and daily (30.0%). A majority of PDs (77.8%) and residents (67.0%) endorsed interest in communication training. 62.2% of programs reported formally teaching communication skills. Certain topics were infrequently taught yet cited by residents as particularly challenging-such as "diffusing conflict" and "angry patient or family members." PDs tended to significantly overestimate trainee competence in conducting difficult conversations with both patients (p = 0.0003) and interdisciplinary colleagues (p < 0.0001), as compared with resident self-assessments. CONCLUSIONS Residents encounter frequent challenging communications interactions, and often feel inadequately equipped to navigate them. Dedicated didactics may provide a critical component to optimally educating of the next generation of trainees within OB/GYN and more broadly.
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Affiliation(s)
- Elizabeth P. Howell
- Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, NC USA
| | - Jonathan Fischer
- Department of Family Medicine and Community Health, Duke University, Durham, NC USA
| | - Fidel A. Valea
- Department of Obstetrics and Gynecology, Carilion Clinic and Virginia Tech Carilion School of Medicine, Roanoke, VA USA
| | - Brittany A. Davidson
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Duke University Medical Center, DUMC Box 3079, Durham, NC 27710 USA
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Jackson L, Cichon M, Kleinert H, Trepanier A. Teaching medical students how to deliver diagnoses of Down syndrome: Utility of an educational tool. PATIENT EDUCATION AND COUNSELING 2020; 103:617-625. [PMID: 31669046 DOI: 10.1016/j.pec.2019.10.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2019] [Revised: 10/07/2019] [Accepted: 10/15/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE This study assessed whether using an educational tool increased the knowledge and perceived comfort level of first-year medical students in giving a diagnosis of Down syndrome. METHOD A total of 295 students taking a genetics course completed a knowledge questionnaire and Situations Inventory (aimed at assessing comfort with sharing certain information), prior to and following use of Brighter Tomorrows, a web-based educational module on giving parents a diagnosis of Down syndrome. RESULTS The pre-intervention mean on the knowledge survey was 3.67, which significantly increased to 5.47 following the intervention. Mean Situational Inventory scores were significantly higher pre-intervention (M = 45.5), which indicates greater discomfort, compared to post-intervention (M = 36.7). Qualitative analysis of responses regarding lessons learned fell into 5 major themes. The most common theme (48% of responses) was related to communication skills. The most frequently cited lesson learned was the importance of demonstrating empathy. CONCLUSIONS This study found that knowledge and perceived comfort levels of first-year medical students in giving a postnatal diagnosis of Down syndrome were significantly increased following use of an educational tool. PRACTICE IMPLICATIONS Educational modules can provide medical students with foundational knowledge on providing distressing information to help prepare for future clinical encounters.
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Affiliation(s)
- Lauren Jackson
- Cytogenetics, Beaumont Hospital, Dearborn, Dearborn, MI, United States.
| | - Michelle Cichon
- Center for Molecular Medicine and Genetics, Wayne State University, Detroit, MI, United States
| | - Harold Kleinert
- The Human Development Institute, University of Kentucky, Lexington, KY, United States
| | - Angela Trepanier
- Center for Molecular Medicine and Genetics, Wayne State University, Detroit, MI, United States
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Gregg AR, Skotko BG, Benkendorf JL, Monaghan KG, Bajaj K, Best RG, Klugman S, Watson MS. Noninvasive prenatal screening for fetal aneuploidy, 2016 update: a position statement of the American College of Medical Genetics and Genomics. Genet Med 2016; 18:1056-65. [PMID: 27467454 DOI: 10.1038/gim.2016.97] [Citation(s) in RCA: 439] [Impact Index Per Article: 54.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Accepted: 06/07/2016] [Indexed: 12/17/2022] Open
Abstract
DISCLAIMER This statement is designed primarily as an educational resource for clinicians to help them provide quality medical services. Adherence to this statement is completely voluntary and does not necessarily assure a successful medical outcome. This statement should not be considered inclusive of all proper procedures and tests or exclusive of other procedures and tests that are reasonably directed toward obtaining the same results. In determining the propriety of any specific procedure or test, the clinician should apply his or her own professional judgment to the specific clinical circumstances presented by the individual patient or specimen. Clinicians are encouraged to document the reasons for the use of a particular procedure or test, whether or not it is in conformance with this statement. Clinicians also are advised to take notice of the date this statement was adopted and to consider other medical and scientific information that becomes available after that date. It also would be prudent to consider whether intellectual property interests may restrict the performance of certain tests and other procedures.Noninvasive prenatal screening using cell-free DNA (NIPS) has been rapidly integrated into prenatal care since the initial American College of Medical Genetics and Genomics (ACMG) statement in 2013. New evidence strongly suggests that NIPS can replace conventional screening for Patau, Edwards, and Down syndromes across the maternal age spectrum, for a continuum of gestational age beginning at 9-10 weeks, and for patients who are not significantly obese. This statement sets forth a new framework for NIPS that is supported by information from validation and clinical utility studies. Pretest counseling for NIPS remains crucial; however, it needs to go beyond discussions of Patau, Edwards, and Down syndromes. The use of NIPS to include sex chromosome aneuploidy screening and screening for selected copy-number variants (CNVs) is becoming commonplace because there are no other screening options to identify these conditions. Providers should have a more thorough understanding of patient preferences and be able to educate about the current drawbacks of NIPS across the prenatal screening spectrum. Laboratories are encouraged to meet the needs of providers and their patients by delivering meaningful screening reports and to engage in education. With health-care-provider guidance, the patient should be able to make an educated decision about the current use of NIPS and the ramifications of a positive, negative, or no-call result.Genet Med 18 10, 1056-1065.
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Affiliation(s)
- Anthony R Gregg
- Department of Obstetrics and Gynecology, University of Florida, Gainesville, Florida, USA
| | - Brian G Skotko
- Department of Pediatrics, Harvard Medical School and Division of Medical Genetics, Department of Pediatrics, Massachusetts General Hospital, Boston, Massachusetts, USA
| | | | | | - Komal Bajaj
- New York City Health + Hospitals/Albert Einstein College of Medicine, Bronx, New York, USA
| | - Robert G Best
- University of South Carolina School of Medicine, Greenville Health System, Greenville, South Carolina, USA
| | - Susan Klugman
- Montefiore Medical Center, Department of Obstetrics & Gynecology and Women's Health, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Michael S Watson
- American College of Medical Genetics and Genomics, Bethesda, Maryland, USA
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de Groot-van der Mooren MD, Gemke RJBJ, Cornel MC, Weijerman ME. Neonatal diagnosis of Down syndrome in The Netherlands: suspicion and communication with parents. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2014; 58:953-961. [PMID: 24628769 DOI: 10.1111/jir.12125] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/24/2014] [Indexed: 06/03/2023]
Abstract
OBJECTIVES To analyse which dysmorphic features are most recognised in newborns with Down syndrome (DS). Furthermore to evaluate the communication techniques used by clinicians to inform parents about the postnatal diagnosis and compare these to current best practice guidelines. STUDY DESIGN Prospective study of a birth cohort of newborns with DS born between 1 January 2003 and 31 December 2006 registered by the Dutch Paediatric Surveillance Unit (DPSU). RESULTS A total of 586 children with trisomy 21 were analysed. Most recognised dysmorphic features in DS newborns were 'upslanted palpebral fissures' (74.1%; n = 426), 'hypotonia' (73.7%; n = 424) and 'epicanthic folds' (68.5%; n = 394). The majority of parents were informed about the suspected diagnosis on the day of birth (76.5%; n = 390). Hospital deliveries had a significantly earlier suspected diagnosis (mean age 3-4 days) compared with home deliveries (mean age 7 days) (P < 0.05). In 10% (n = 44), paediatricians described dissatisfaction with the first conversation with parents. In 88.9% (n = 499) parents were both present when the diagnosis was told, however the child was not present during the conversation in 51.3% (n = 288). In 10.8% (n = 61) parents were not informed about local parent support groups or community resources. CONCLUSION DS is still often diagnosed after birth, usually on the first day of postnatal life. Most identified clinical features were upslanted palpebral fissures, epicanthic folds and hypotonia. Special attention for recognition of all present clinical features is needed for early diagnosis. Appropriate communication with the parents of the message that their child has DS can be difficult. Guidelines can help to make counselling easier and more effective, which in turn may increase parental satisfaction. Not all recommendations for the first conversation with parents were fully implemented in Dutch clinical practice.
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Ahmed KJ, Ahmed M, Jafri HS, Raashid Y, Ahmed S. Pakistani mothers' and fathers' experiences and understandings of the diagnosis of Down syndrome for their child. J Community Genet 2014; 6:47-53. [PMID: 25081228 DOI: 10.1007/s12687-014-0200-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2013] [Accepted: 07/22/2014] [Indexed: 10/25/2022] Open
Abstract
Down syndrome (DS) is a relatively common chromosomal condition, which can be diagnosed prenatally. However, little is known about the diagnosis of the condition in developing countries. This qualitative study explored parents' experiences of the diagnosis of DS in Pakistan. Fifteen mothers and fifteen fathers of children with DS had semi-structured interviews, which were analysed using thematic analysis. All the parents received their child's diagnosis after birth, ranging from the postnatal period to 7 years of age. Parents recalled receiving little or no information at the time of diagnosis, leading to misunderstandings about the cause and nature of their child's condition. Some parents referred to their child being "Mongol" and were unaware of "Down syndrome" as the more appropriate term for the condition. Use of such terms for DS restricted parents' ability to source further information about the condition. Many parents showed poor understanding of the aetiology and prognosis of the condition. Improved training for healthcare professionals in recognising key features of DS in the neonatal period or in early childhood could enable earlier diagnosis of the condition. In addition, provision of accurate information in a sensitive manner following diagnosis could enable parents to optimise their child's well-being.
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El proceso de comunicar y acompañar a los padres y al paciente frente al diagnóstico de discapacidad. REVISTA MÉDICA CLÍNICA LAS CONDES 2014. [DOI: 10.1016/s0716-8640(14)70049-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Harnett A, Bettendorf E, Tierney E, Guerin S, O'Rourke M, Hourihane JO. Evidence-based training of health professionals to inform families about disability. Arch Dis Child 2013; 98:413-8. [PMID: 23606710 DOI: 10.1136/archdischild-2012-303037] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE The development, delivery and evaluation of a training programme for medical and nursing professionals on best practice for informing families of their child's disability. DESIGN A 2 h training course on 'Best practice guidelines for informing families of their child's disability' was designed based on the findings of a nationally representative study of parents and professionals. The classroom-based course comprised a presentation of the research and recommendations of the best practice guidelines; a DVD film of parent stories and professional advice; group discussion; and a half-hour input from a parent of two children with disabilities. An anonymous, pretraining and post-training questionnaire was administered to measure knowledge and confidence levels, using scales adapted from a study by Ferguson et al (2006). PARTICIPANTS 235 participants, including medical students, nursing students, and junior hospital doctors (JHDs). OUTCOME MEASURES Knowledge of best practice and confidence in communicating diagnosis of disability. RESULTS Significant improvements in knowledge (time 1 mean (M)=14.31, SD=2.961; time 2 M=18.17, SD=3.068) and confidence (time 1 M=20.87, SD=5.333; time 2 M=12.43, SD=3.803) following training were found. In addition, a significant interaction between time and cohort (medical students, nurses and JHDs) was found for knowledge. Further examination suggested medical students' knowledge was developing to the extent that post-training, their scores were higher than nurses, but not significantly different to JHDs. CONCLUSIONS The increase in reported levels of knowledge and confidence following training in best practice for informing families of their child's disability indicates the potential for providing communication skills training in this area.
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Affiliation(s)
- Alison Harnett
- Department of Research, National Federation of Voluntary Bodies Providing Services to People with Intellectual Disability, Oranmore Business Park, Oranmore, Galway, Ireland.
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Acharya K. Prenatal testing for intellectual disability: misperceptions and reality with lessons from Down syndrome. ACTA ACUST UNITED AC 2013; 17:27-31. [PMID: 22447752 DOI: 10.1002/ddrr.135] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Down syndrome is the most common cause of intellectual disability. In the United States, it is recommended that prenatal testing for Down syndrome be offered to all women. Because of this policy and consequent public perception, having Down syndrome has become a disadvantage in the prenatal period. However, in the postnatal period, there may be some advantage in having Down syndrome. To help parents make informed decisions about screening and testing, it is crucial to reconcile divergent prenatal and postnatal perspectives. Advancements in genetic technologies will also impact the informed consent process and need to be considered.
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Affiliation(s)
- Kruti Acharya
- Departments of Medicine and Pediatrics, MacLean Center for Clinical Medical Ethics, University of Chicago, Chicago, Illinois, USA.
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Lunney CA, Kleinert HL, Ferguson JE, Campbell L. Effectively training pediatric residents to deliver diagnoses of Down syndrome. Am J Med Genet A 2012; 158A:384-90. [PMID: 22246816 DOI: 10.1002/ajmg.a.34422] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2011] [Accepted: 11/15/2011] [Indexed: 11/10/2022]
Abstract
Physicians and parents report a need for pediatricians to have additional training in delivering a diagnosis of Down syndrome (DS). This study tested a web-based tutorial to assess its effectiveness in improving physicians' perceived comfort with both ambiguous and more medically factual situations as they deliver diagnoses of DS. Based on this web tutorial that integrated prenatal and postnatal information into virtual patient scenarios, the study assessed pediatrics residents' knowledge and comfort in delivering a diagnosis of DS pre and postnatally. A separate survey, given at the same time, asked for residents' perception of their need for this training. Ninety-one volunteer residents from 10 pediatric training programs across the country participated. The tutorial yielded significant improvement in knowledge and a significant decrease in perceived level of discomfort in both ambiguous situations and more medically certain contexts related to a DS diagnosis. In addition, across all pediatric resident groups (by year, gender, and performance on the knowledge test and the comfort scale), residents strongly agreed that this type of training was beneficial for themselves, other residents, practicing physicians, and other medical professionals. This study suggests that web-based, interactive, multi-media training may be an effective tool for improving resident physician comfort with both ambiguous and more medically certain situations in delivering a diagnosis of DS to families.
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Affiliation(s)
- Carol A Lunney
- The Human Development Institute, University of Kentucky, Lexington, Kentucky, USA.
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Skotko BG, Levine SP, Goldstein R. Having a son or daughter with Down syndrome: perspectives from mothers and fathers. Am J Med Genet A 2011; 155A:2335-47. [PMID: 21915989 DOI: 10.1002/ajmg.a.34293] [Citation(s) in RCA: 111] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2011] [Accepted: 07/29/2011] [Indexed: 11/07/2022]
Abstract
This study asks parents who have children with Down syndrome (DS) how they feel about their lives so that such information could be shared with expectant couples during prenatal counseling sessions. A valid and reliable survey instrument was mailed to 4,924 households on the mailing lists of six non-profit DS organizations. Of the 2,044 respondents, 99% reported that they love their son or daughter; 97% were proud of them; 79% felt their outlook on life was more positive because of them; 5% felt embarrassed by them; and 4% regretted having them. The parents report that 95% of their sons or daughters without DS have good relationships with their siblings with DS. The overwhelming majority of parents surveyed report that they are happy with their decision to have their child with DS and indicate that their sons and daughters are great sources of love and pride.
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Affiliation(s)
- Brian G Skotko
- Division of Genetics, Department of Medicine, Children's Hospital Boston, Massachusetts, USA.
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Cook DA, Erwin PJ, Triola MM. Computerized virtual patients in health professions education: a systematic review and meta-analysis. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2010; 85:1589-602. [PMID: 20703150 DOI: 10.1097/acm.0b013e3181edfe13] [Citation(s) in RCA: 263] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
PURPOSE Educators increasingly use virtual patients (computerized clinical case simulations) in health professions training. The authors summarize the effect of virtual patients compared with no intervention and alternate instructional methods, and elucidate features of effective virtual patient design. METHOD The authors searched MEDLINE, EMBASE, CINAHL, ERIC, PsychINFO, and Scopus through February 2009 for studies describing virtual patients for practicing and student physicians, nurses, and other health professionals. Reviewers, working in duplicate, abstracted information on instructional design and outcomes. Effect sizes were pooled using a random-effects model. RESULTS Four qualitative, 18 no-intervention controlled, 21 noncomputer instruction-comparative, and 11 computer-assisted instruction-comparative studies were found. Heterogeneity was large (I²>50%) in most analyses. Compared with no intervention, the pooled effect size (95% confidence interval; number of studies) was 0.94 (0.69 to 1.19; N=11) for knowledge outcomes, 0.80 (0.52 to 1.08; N=5) for clinical reasoning, and 0.90 (0.61 to 1.19; N=9) for other skills. Compared with noncomputer instruction, pooled effect size (positive numbers favoring virtual patients) was -0.17 (-0.57 to 0.24; N=8) for satisfaction, 0.06 (-0.14 to 0.25; N=5) for knowledge, -0.004 (-0.30 to 0.29; N=10) for reasoning, and 0.10 (-0.21 to 0.42; N=11) for other skills. Comparisons of different virtual patient designs suggest that repetition until demonstration of mastery, advance organizers, enhanced feedback, and explicitly contrasting cases can improve learning outcomes. CONCLUSIONS Virtual patients are associated with large positive effects compared with no intervention. Effects in comparison with noncomputer instruction are on average small. Further research clarifying how to effectively implement virtual patients is needed.
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Affiliation(s)
- David A Cook
- Office of Education Research, College of Medicine, Mayo Clinic, Rochester, Minnesota, USA.
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Skotko BG, Kishnani PS, Capone GT. Prenatal diagnosis of Down syndrome: how best to deliver the news. Am J Med Genet A 2010; 149A:2361-7. [PMID: 19787699 DOI: 10.1002/ajmg.a.33082] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
We sought to provide evidence-based recommendations to physicians on how to best deliver a prenatal diagnosis of DS to expectant parents. Our study design consisted of searching Medline and PsychInfo from 1960 to 2008, as well as Web sites from academic organizations and other nonprofit or private organizations, using the terms "Down syndrome," "Trisomy 21," "mongolism," "prenatal diagnosis," "postnatal care," and "delivery of health care." Our results showed that a health care professional knowledgeable about DS with specific training in the delivery of sensitive diagnoses should be part of the first conversation. A prenatal diagnosis of DS should be presented in person or at a pre-established time by phone. Physicians should provide accurate information about medical conditions associated with DS and connect parents to local DS support groups and other resources. We conclude that physicians can deliver prenatal diagnoses of DS in a sensitive manner that can be appreciated by expectant parents.
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Affiliation(s)
- Brian G Skotko
- Division of Genetics, Department of Medicine, Children's Hospital Boston, Boston, Massachusetts 02115, USA.
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Skotko BG, Capone GT, Kishnani PS. Postnatal diagnosis of Down syndrome: synthesis of the evidence on how best to deliver the news. Pediatrics 2009; 124:e751-8. [PMID: 19786436 DOI: 10.1542/peds.2009-0480] [Citation(s) in RCA: 81] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
CONTEXT Many parents of children with Down syndrome (DS) have expressed dissatisfaction with how they learned about their child's diagnosis. DS remains the most common chromosomal condition, occurring in 1 of every 733 births, with the majority of children still diagnosed postnatally. OBJECTIVE Our goal was to review systematically all available evidence regarding how physicians should approach the conversation in which they explain DS for the first time to new parents. METHODS We searched online databases from 1960 to 2008, including Medline and PsychInfo, as well as Web sites maintained by academic organizations (eg, American Academy of Pediatrics) and other nonprofit or private organizations (eg, the National Down Syndrome Society), by using the terms "Down syndrome," "trisomy 21," "mongolism," "prenatal diagnosis," "postnatal care," and "delivery of health care." Articles were selected that answered > or =1 research question, established a priori: (1) Who is the best person to communicate the news? (2) When is the best time to share the news? (3) Where is the best place or setting to deliver the news? (4) What information should be delivered? and (5) How should the news be communicated? All studies were evaluated for quality according to the method outlined by the US Preventative Services Task Force. Final recommendations were based on the strength of evidence. RESULTS Parents prefer to receive the diagnosis together in a joint meeting with their obstetrician and pediatrician. The conversation should take place in a private setting as soon as a physician suspects a diagnosis of DS. Accurate and up-to-date information should be conveyed, including information about local support groups and resources. CONCLUSION By implementing a few cost-neutral measures, physicians can deliver a postnatal diagnosis of DS in a manner that will be deemed by new parents as sensitive and appropriate.
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Affiliation(s)
- Brian G Skotko
- Division of Genetics, Department of Medicine, Children's Hospital Boston, 300 Longwood Ave, Boston, MA 02115, USA.
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Kleinert HL, Lunney CA, Campbell L, Ferguson JE. Improving residents' understanding of issues, comfort levels, and patient needs regarding screening for and diagnosing Down syndrome. Am J Obstet Gynecol 2009; 201:328.e1-6. [PMID: 19631921 DOI: 10.1016/j.ajog.2009.05.051] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2008] [Revised: 04/29/2009] [Accepted: 05/27/2009] [Indexed: 11/28/2022]
Abstract
OBJECTIVE This study assessed obstetrics and gynecology and pediatrics residents' knowledge about Down syndrome (DS) and their comfort in delivering a prenatal or postnatal diagnosis of DS before and after interaction with a web-based tutorial. STUDY DESIGN A team of physicians, parents, and educational specialists developed an interactive tutorial that asked resident physicians to provide their own responses to "virtual patient" cases related to DS diagnoses in utero and at birth. We tested resident knowledge and comfort-level changes and their satisfaction with the web-based tool. RESULTS The study yielded significant improvement in knowledge and level of comfort changes with both obstetrics and gynecology and pediatric resident physicians at 16 programs nationally. There were no significant differences between the 2 specialties. CONCLUSION This interactive tutorial is effective in improving physicians' knowledge of and comfort level with imparting accurate, balanced information about DS pre- and postnatally.
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Affiliation(s)
- Harold L Kleinert
- Human Development Institute, University of Kentucky and Chandler Medical Center, Lexington, KY, USA
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18
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Cook DA, Triola MM. Virtual patients: a critical literature review and proposed next steps. MEDICAL EDUCATION 2009; 43:303-11. [PMID: 19335571 DOI: 10.1111/j.1365-2923.2008.03286.x] [Citation(s) in RCA: 294] [Impact Index Per Article: 19.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
CONTEXT The opposing forces of increased training expectations and reduced training resources have greatly impacted health professions education. Virtual patients (VPs), which take the form of interactive computer-based clinical scenarios, may help to reconcile this paradox. METHODS We summarise research on VPs, highlight the spectrum of potential variation and identify an agenda for future research. We also critically consider the role of VPs in the educational armamentarium. RESULTS We propose that VPs' most unique and cost-effective function is to facilitate and assess the development of clinical reasoning. Clinical reasoning in experts involves a non-analytical process that matures through deliberate practice with multiple and varied clinical cases. Virtual patients are ideally suited to this task. Virtual patients can also be used in learner assessment, but scoring rubrics should emphasise non-analytical clinical reasoning rather than completeness of information or algorithmic approaches. Potential variations in VP design are practically limitless, yet few studies have rigorously explored design issues. More research is needed to inform instructional design and curricular integration. CONCLUSIONS Virtual patients should be designed and used to promote clinical reasoning skills. More research is needed to inform how to effectively use VPs.
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Affiliation(s)
- David A Cook
- Division of General Internal Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota 55905, USA.
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19
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Muggli EE, Collins VR, Marraffa C. Going down a different road: first support and information needs of families with a baby with Down syndrome. Med J Aust 2009; 190:58-61. [PMID: 19236288 DOI: 10.5694/j.1326-5377.2009.tb02275.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2008] [Accepted: 08/24/2008] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To explore the experiences of families with a baby with Down syndrome at the time of diagnosis, and their preferences for information and support in the early period after diagnosis. DESIGN, SETTING AND PARTICIPANTS A qualitative, interview-based study of 18 families living in Victoria with a child with Down syndrome born between 2002 and 2004 who had not been diagnosed with the syndrome before birth. Interviews were transcribed verbatim and interpretive content analysis was undertaken. RESULTS Parental coping with the unexpected diagnosis of Down syndrome in their infant was influenced by the time interval between birth and disclosure of clinical suspicion of Down syndrome, the level of certainty of the attending physician at the time of disclosure, and the time interval between disclosure of clinical suspicion and confirmation of karyotype. Initial uncertainty and a delay in the diagnosis were detrimental to parental coping, as was premature communication of the news. Perinatal complications increased parental anxiety regarding their child's condition and future. Individual communication style of midwives and physicians was a powerful predictor of parental adaptation. Parental needs for support and information were facilitated through normalising postnatal care, ensuring privacy, and providing early access to peer support and up-to-date written information. Many parents would have appreciated access to a liaison worker. CONCLUSION The experiences of parents in this study provide practice points for improving postnatal care with minimal changes to formal service systems.
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Affiliation(s)
- Evelyne E Muggli
- Murdoch Childrens Research Institute, Melbourne, VIC, Australia.
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20
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Rasmussen SA, Whitehead N, Collier SA, Frías JL. Setting a public health research agenda for Down syndrome: summary of a meeting sponsored by the Centers for Disease Control and Prevention and the National Down Syndrome Society. Am J Med Genet A 2008; 146A:2998-3010. [PMID: 19006076 DOI: 10.1002/ajmg.a.32581] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
On November 8-9, 2007, a meeting entitled "Setting a Public Health Research Agenda for Down Syndrome" was held to review current knowledge, identify gaps, and develop priorities for future public health research related to Down syndrome. Participants included experts in clinical and molecular genetics, pediatrics, cardiology, psychiatry, psychology, neuroscience, epidemiology, and public health. Participants were asked to identify key public health research questions and discuss potential strategies that could be used to address those questions. The following were identified as priority areas for future public health research: identification of risk and preventive factors for physical health and cognitive outcomes, focusing on understanding the reasons for previously recognized disparities; improved understanding of comorbid conditions, including their prevalence, clinical variability, natural history, and optimal methods for their evaluation and treatment; better characterization of the natural history of cognition, language, and behavior; identification of mental health comorbidities and of risk and protective factors for their development; identification of strategies to improve enrollment in research studies; development of strategies for conveying up-to-date information to parents and health professionals; identification of interventions to improve cognition, language, mental health, and behavior; understanding the impact of educational and social services and supports; identification of improved methods for diagnosis of and interventions for Alzheimer disease; and understanding the effects of different types of health care on outcomes. Participants strongly supported the development of population-based resources for research studies and resources useful for longitudinal studies. This agenda will be used to guide future public health research on Down syndrome.
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Affiliation(s)
- Sonja A Rasmussen
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA.
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21
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Head JG, Storfer-Isser A, O'Connor KG, Hoagwood KE, Kelleher KJ, Heneghan AM, Park ER, Chaudron LH, Stein REK, Horwitz SM. Does education influence pediatricians' perceptions of physician-specific barriers for maternal depression? Clin Pediatr (Phila) 2008; 47:670-8. [PMID: 18441316 DOI: 10.1177/0009922808315213] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Pediatric residency reforms have increased emphasis on psychosocial issues, but we do not know whether this has changed pediatricians' perceptions of barriers to addressing maternal depression. A survey of 1600 members of the American Academy of Pediatrics investigated whether training in adult mental health issues and perceived barriers to addressing maternal depression differed for current pediatric residents, pediatricians in practice <5 years, and those in practice >or=5 years. Training did not differ for respondents who were currently in training, in practice <5 years, or in practice >or=5 years. Those in practice >or=5 years reported more barriers to addressing maternal depression compared with current residents. Current residents with training in adult mental techniques reported fewer barriers to the care of maternal depression. However, in spite of residency reforms, 81% of current residents reported no training in adult mental health issues.
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Affiliation(s)
- Julia G Head
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio, USA
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22
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Head LS, Abbeduto L. Recognizing the role of parents in developmental outcomes: a systems approach to evaluating the child with developmental disabilities. ACTA ACUST UNITED AC 2008; 13:293-301. [PMID: 17979203 DOI: 10.1002/mrdd.20169] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
When developmental concerns arise in children, a clinical assessment focuses on the child's developmental profile to achieve three goals (1) determine diagnosis, (2) develop interventions, and (3) evaluate progress. Parents often have needs during this time that are not addressed by professionals because of the exclusive focus on the child during the evaluation. In this article, we suggest that clinicians take a "systems" approach to the assessment process by recognizing how the well being of family members can impact a child with a developmental disability. We review systems theory and its conceptualization of individual functioning and discuss how parental well-being differs according to child diagnosis. Finally we suggest a systems-based model to use during the assessment process.
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Affiliation(s)
- Lara S Head
- Waisman Center, University of Wisconsin-Madison, Madison, WI 53705, USA.
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