The Brief Attitudes Survey for Interprofessional Collaborative Learning: The Design, Reliability, and Validation of a New Instrument

This paper describes the development and validation of a new questionnaire designed to measure and investigate attitudes towards interprofessional education (IPE) among health professions students. After a thorough literature review and survey of prior instruments, we created an instrument built around a single construct domain: attitudes toward interprofessional collaborative learning. Through a rigorous design methodology rooted in behavior change theory and an iterative question development process, we launched the 11-item "Brief Attitudes Survey for Interprofessional Collaborative Learning" (BASIC-L). Implemented as part of a "toolbox" for assessing the progress of learners in IPE, the questionnaire was then administered to a large cohort of medical and nursing students. Its reliability, validity, and fit with our one-domain model were evaluated via thorough psychometric analysis, including computation of reliability coefficients and a Rasch analysis. These analyses indicate strong reliability, validity, and fit of the questions with our one-domain model. The analyses also included assessment for any sources of measurement error, which were not significant. The BASIC-L appears to be a useful, valid, and reliable instrument for the assessment of attitudes toward interprofessional collaborative learning among students in the health professions, especially as part of a larger multidimensional assessment process.

Improving Nutrition Education with Second-Year Medical Students: From Take-Home Assignment to Large-Group Application Exercise

Augmenting its nutrition education, the Herbert Wertheim College of Medicine Endocrinology course initially used a case-based, take-home assignment on type II diabetes dietary guidelines, with literature search requirement and a module on relevant social determinants of health (SDOH). Course evaluations indicated this assignment did not adequately improve student perceptions of learning. For the subsequent cohort, we changed to a large-group active learning session, requiring one faculty facilitator, where student teams created problem lists including SDOH and reviewed research articles to support evidence-based nutrition recommendations. Survey results indicate that the new session resulted in significantly improved student perceptions of learning.

SUPPLEMENTARY INFORMATION

The online version contains supplementary material available at 10.1007/s40670-021-01342-7.

Caring for Vulnerable Communities in Miami Dade County during the COVID-19 Pandemic

In response to the COVID-19 pandemic, the Herbert Wertheim College of Medicine's Neighborhood Health Education Learning Program (NeighborhoodHELP) initiated a longitudinal assessment and mitigation of social and health care challenges for a population of approximately 850 underserved households. Here, we describe the needs assessment, ensuing interventions, and lessons learned during this pandemic.

Prompting a Fresh Start for Adults With Food Insecurity and Increased BMI: A Case Series of Four Patients in a Food Prescription Program

Estimates place low intake of fruits and vegetables, physical inactivity, and high BMI (overweight-obesity) as all in the top 12 causes of death. Food and dietary education are becoming a focus in how we approach disease prevention and management, and food prescription programs in particular are showing promise, especially in under-resourced, food-insecure communities. This paper describes a pilot food prescription program in a handful of uninsured patients enrolled in an interprofessional clinical and educational program of a medical school in South Florida. This case series of four patients struggling with food insecurity profiles the demographic and clinical characteristics of the participants and provides the results of standardized assessments of their dietary behaviors, physical activity levels, and attitudes toward food before and after the intervention. This four-month pilot food prescription program, Fresh Start Food Rx, involved a prospective case report of four patients seen on a mobile health center (MHC) for uninsured patients in South Miami, Florida. The MHC is part of an interprofessional health professions education, health care, and social service program of the Herbert Wertheim College of Medicine at Florida International University called the Neighborhood Health Education Learning Program (NeighborhoodHELP). A systematic review of South Miami MHC patient electronic medical records identified eligible participants for the program: patients with food insecurity and a BMI >30, with comorbid health conditions. Patients with greater BMI and more comorbidities were prioritized. Once enrolled, we provided biweekly packages of fresh fruits and vegetables along with monthly dietary education to the participants. Key measures included self-reported fruit and vegetable consumption, attitude toward healthy eating, and level of activity. Pre- and post-intervention focus groups assessed barriers the participants faced to eating healthy and pursuing physical activity, satisfaction with the program, feedback on strengths and weaknesses, and anticipated behavioral changes after completion of the program. Prior to the intervention, participants reported eating fruits on an average of 4.5 days out of the week. Post-survey answers increased to 5.0 days per week. Though the average amount of days per week that participants reported eating vegetables decreased slightly, the average number of vegetable servings that participants reported eating in a week increased. At termination of the program, most participants agreed that a diet rich in fruits and vegetables is good for you, that it is important to eat fruits and vegetables every day, and that a diet rich in fruits and vegetables can protect against cancer. This case study demonstrates that easier access to healthy foods, such as fresh produce delivery, and regular health education have the potential to promote healthier attitudes toward foods like fruits and vegetables. This change in attitude can then influence behavior, such as choosing to try new produce or increasing the amount and frequency of produce consumption. With the lessons learned from this small pilot program, the authors helped facilitate the expansion of a larger food prescription program in conjunction with a community partner hospital in the area. Findings from this experience might prove useful for others attempting to develop or expand a food prescription and health education program of their own.

Parts and wholes: the human microbiome, ecological ontology, and the challenges of community

The early results of the Human Microbiome Project, released in June 2012, add to the overwhelming data that show that there are literally trillions of microbes that live in and on each human individual. This research raises profound questions about what it means to be an individual organism, human or otherwise. In this paper, we ask two broad questions: (1) how might we conceive of an individual organism, given these results? and (2) in light of this emerging conception of the individual organism, what are the implications for how humans conceive of their own self-sufficiency and interact with other members of the living world? We highlight the ontological and political presuppositions animating this research and return to Aristotle for insights into how to conceive of and how to behave towards and within a diverse community of interdependent living parts that function together as one.

Use of computers and the Internet by residents in US family medicine programmes

Computers, personal digital assistants (PDA), and the Internet are widely used as resources in medical education and clinical care. Educators who intend to incorporate these resources effectively into residency education programmes can benefit from understanding how residents currently use these tools, their skills, and their preferences. The researchers sent questionnaires to 306 US family medicine residency programmes for all of their residents to complete. Respondents were 1177 residents from 125 (41%) programmes. Access to a computer was reported by 95% of respondents. Of these, 97% of desktop and 89% of laptop computers could access the Internet. Residents accessed various educational and clinical resources. Half felt they had 'intermediate' skills at Web searches, 23% had 'some skills,' and 27% were 'quite skilled.' Those under 30 years of age reported higher skill levels. Those who experienced a Web-based curriculum in medical school reported higher search skills and greater success in finding clinical information. Respondents preferred to use technology to supplement the didactic sessions offered in resident teaching conferences. Favourable conditions exist in family medicine residency programmes to implement a blend of traditional and technology-based learning experiences. These conditions include residents' experience, skills, and preferences.

Effectiveness of a graduate medical education program for improving medical event reporting attitude and behavior

OBJECTIVES

To evaluate the effectiveness of an educational program for improving medical event reporting attitude and behavior in the ambulatory care setting among graduate medical trainees.

DESIGN

One group pre- and post-test study.

SETTING

The University of Texas Southwestern Medical Center at Dallas Family Medicine Residency Program.

PARTICIPANTS

All family practice residents (n = 30).

INTERVENTION

Patient safety educational program implemented through an introductory lecture and 6 monthly conferences, June to December 2002, involving medical events that occurred in the ambulatory care setting.

OUTCOME MEASURES

Medical event reporting attitude and behavior at baseline and at 6 month follow up, and barriers to medical event reporting at the 6 month follow up.

RESULTS

Program attendance was significantly correlated with medical event reporting attitude and behavior change (rho = 0.525, p = 0.003). The median change in medical event reporting attitude and behavior was zero and not statistically significant (p = 0.566). Major barriers to medical event reporting were lack of time, extra paper work, and concern about career and personal reputation.

CONCLUSIONS

Attending the patient safety educational program was key for promoting a positive medical event reporting attitude and behavior change among graduate trainees. Major barriers to medical event reporting were lack of time, extra paper work, and concern about career and personal reputation. Future research will need to focus on reducing these barriers and to evaluate the effectiveness of such a program over longer periods of time, since making a positive change in medical event reporting attitude and behavior must be made at the individual and organizational levels.

Enrolling research subjects from clinical practice: ethical and procedural issues in the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) trial

The Sequenced Treatment Alternatives to Relieve Depression (STAR*D) trial is a multi-site effectiveness study funded by the National Institute of Mental Health (NIMH) with the aim of identifying successful, acceptable and cost-effective treatment strategies for outpatients with unremitted depression. With enrollment of 4,041 adults with major depressive disorder (MDD), it is the largest controlled psychiatric treatment study ever undertaken. In the course of developing procedures to ensure that ambitious enrollment goals were met, a number of ethical and practical issues became apparent that underscore the conflicts between effectiveness research and human subject protections. These are delineated as they relate to study design; eligibility criteria; incentives to subjects; investigators and clinical sites; the complementary roles of clinical research coordinators (CRCs) and study clinicians; and recruitment and consent procedures. The STAR*D trial exemplifies the interplay and tension between those strategies that integrate research and clinical aims and roles in the service of enhancing external validity, site participation, and recruitment and retention versus those strategies that differentiate research and clinical treatment in the service of research integrity and human subject protections. We hope that a discussion of these key challenges and dilemmas and how they have been addressed will help inform future discussions concerning design and conduct of ethical effectiveness trials designed to optimize care in real world clinical settings.

Fostering a culture of prevention in a residency program through a continuous quality improvement project

This project explored the effect of a multifaceted quality improvement (QI) intervention at a university-based residency program clinic on the documented provision of preventive services. The intervention, based on the Put Prevention Into Practice program and standard QI techniques, consisted of patient self-administered Health Risk Profiles (HRPs) and a monthly educational curriculum for patients, staff, and providers. Documentation of preventive services in patient charts was measured using a repeated cross-sectional sampling design before and after the 1-year intervention period. Documentation of 8 of 19 preventive services under examination increased significantly (P < .05). Measurements of the intervention, including use of the HRPs and the educational curriculum, revealed little association with the observed improvements. Although the intervention was associated with improved documentation of clinical preventive services, specific elements of the intervention were underused. The authors postulate that the QI process fostered a culture change in the clinic that affected prevention activities. Whether the increased documentation of services reflected an increase in the actual provision of services and whether this increase is clinically significant require further study.

Revisiting the Navajo way: lessons for contemporary healing

Given the paradox of the success of modern medical technology and the growing patient dissatisfaction with present-day medicine, critics have called for a reevaluation of contemporary medical practice. This paper offers a phenomenological analysis of traditional Navajo healers and their ceremonies to highlight key aspects of healing. A phenomenological view of medical practice takes into account three key features: the lifeworld, the lived body, and understanding. Because of their closeness to a phenomenological view, traditional Navajo mythology and healing practices offer insight into the healing process. Contemporary physicians can appreciate the phenomenological elements of Navajo healing ceremonies, including the Mountain Chant. Navajo healers help patients make sense of their illnesses and direct their lives accordingly, an outcome available to contemporary practitioners, who are also gifted with the benefits of new technologies. By examining scientific medicine, Navajo healing practices, and phenomenology as complementary disciplines, the authors provide the groundwork for reestablishing a more therapeutic view of health.

Providing primary care for long-term survivors of childhood acute lymphoblastic leukemia

Primary care physicians will be providing longitudinal health care for long-term survivors of childhood acute lymphoblastic leukemia (ALL) with increasing frequency. Late effects (sequelae) secondary to treatment with radiation or chemotherapeutic agents are frequent and may be serious. Depending on treatment exposures, this at-risk population may experience life-threatening late effects, such as cirrhosis secondary to hepatitis C or late-onset anthracycline-induced cardiomyopathy, or life-changing late effects, such as cognitive dysfunction. Many survivors of childhood ALL will develop problems such as obesity and osteopenia at a young age, which will significantly affect their risk for serious health outcomes as they grow older. The goal of our review is to assist primary care physicians in providing longitudinal health care for long-term survivors of childhood ALL. We also highlight areas needing further investigation, including the prevalence of different late effects, determination of risk factors associated with a late effect, a better understanding of the potential impact of late effects on the premature development of common adult health problems, and the value and timing of different tests for screening asymptomatic survivors.

C.A.R.E.: an approach for teaching ethics in medicine

Various societal factors have contributed to an increase in the ethical dilemmas faced by physicians, yet limited formal training in ethical decision-making is provided for those practitioners during their medical education. The pluralistic nature of contemporary medicine seems amenable to the development of common clinical and educational approaches to ethical dilemmas. The authors propose one such framework--a four question approach called C.A.R.E.--that encourages physicians at all levels of training to acknowledge individual and collective factors that enter into ethical decision-making. These questions are clearly described, and examples for use of the model in teaching settings are also provided. The authors believe that this approach can have significant utility in medical education and clinical settings, and advocate for its use and evaluation.

Interface dynamics in a centrifugal cell separator

Experiments were performed with bovine blood to study the response of the plasma/cell interface position to pumping rate adjustments in two single-stage (SS I and SS II) cell separation chambers. Standard clinical instrumentation and equipment and on-line computer interfacing were used to monitor and control the interface position. The data provided a quantitative description of its dynamics in the SS I and the SS II chambers. In the SS I chamber, adjustments in the flow rate caused the interface to move very slowly and in a complex manner from one steady-state operation position to another. Such behavior made both manual and computer-controlled operation very difficult. By contrast, the SS II chamber was inherently unstable for most operating conditions. We demonstrated, however, that a feedback controller could be used easily to adjust or maintain the interface position, and this system moved from one steady-state operating condition to another 10 times as fast as the system using the SS I chamber. Also, the manner in which the controller allowed the system to respond to operator requests was much simplier than that for the SS I system.

The effects of RPM and recycle on separation efficiency in a clinical blood cell centrifuge

A COBE blood cell centrifuge, model 2997 with a single stage channel, was modified to allow computer controlled sampling, and to allow recycle of red blood cells (RBCs) and plasma streams using bovine whole blood. The effects of recycle of the packed RBC and plasma product streams, and of the centrifuge RPM on platelet and white blood cell (WBC) separation efficiencies were quantified using a central composite factorial experimental design. These data were then fit using second order models. Both the model for the WBC separation efficiency and the model for the platelet separation efficiency predict that RPM has the greatest effect on separation efficiency and that RBC and plasma recycle have detrimental effects at moderate to low RPM, but have negligible impact on separation efficiency at high RPM.