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Yamamoto LM, Pavin ML, de Souza GBD, de Oliveira JLHB, Costa RRDO, Fernandes AY, Mazzo A. Cognitive abilities and medical students' practice of physical exams: A quasi-experimental study. SAO PAULO MED J 2023; 141:e2022564. [PMID: 37991092 PMCID: PMC10665003 DOI: 10.1590/1516-3180.2022.0564.r1.10042023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 01/29/2023] [Accepted: 04/10/2023] [Indexed: 11/23/2023] Open
Abstract
BACKGROUND To highlight the importance of clinical simulations and simulated laboratories for student training, especially in physical examination teaching. OBJECTIVE To evaluate the gains obtained by medical students in their cognitive and practical performance of physical examinations (abdominal, cardiological, and pulmonary), as well as satisfaction and self-confidence in what they have learned, after concentrated practice developed in a skills and simulation laboratory. DESIGN AND SETTING A quantitative and quasi-experimental study in which 48 students were evaluated at the Faculdade de Odontologia de Bauru, São Paulo, Brazil. METHODS A quantitative and descriptive study was conducted with regularly enrolled 2nd year medical students over 18 years of age who had content prior to data collection regarding anamnesis and physical examination remotely taught in a Moodle virtual learning environment. For data collection, the participants were subjected to a concentrated period of skill training (abdominal, cardiological, and pulmonary). Every day after the skill training session, they were subjected to a practical evaluation and completed a theoretical test before and after the practical activities. At the end of all activities, they answered the instrument to assess the simulated practices (self-confidence and satisfaction). RESULTS Among the 49 students evaluated, positive and significant theoretical and practical gains were identified in all three components (abdominal, cardiological, and pulmonary) (P = 0.000), as well as in the general evaluation (Theoretical 1 and Theoretical 2) (P = 0.000), satisfaction, and self-confidence (P = 0.000). CONCLUSION Concentrated laboratory practice resulted in positive improvements in students' physical examination skills.
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Affiliation(s)
- Lucas Moura Yamamoto
- Undergraduate Medical Student, Faculdade de Odontologia de Bauru (FOB), Universidade de São Paulo (USP), Bauru (SP), Brazil
| | - Matheus Landi Pavin
- Undergraduate Medical Student, Faculdade de Odontologia de Bauru (FOB), Universidade de São Paulo (USP), Bauru (SP), Brazil
| | - Giordano Bruno Duarte de Souza
- Undergraduate Medical Student, Faculdade de Odontologia de Bauru (FOB), Universidade de São Paulo (USP), Bauru (SP), Brazil
| | | | - Raphael Raniere de Oliveira Costa
- MD, MSc, PhD. Adjunct Professor, Medicine Course, Escola Multicampi de Ciências Médicas (EMCM), Universidade Federal do Rio Grande do Norte (UFRN), Caicó (RN), Brazil
| | - Adriano Yacubian Fernandes
- MD, PhD. Associated Professor, Faculdade de Odontologia de Bauru (FOB), Universidade de São Paulo (USP), Bauru (SP), Brazil. Associated Professor, Faculdade de Medicina de Botucatu, Universidade Estadual Paulista (UNESP), Bauru (SP), Brazil
| | - Alessandra Mazzo
- PhD. Associate Professor, Medicine Course, Faculdade de Odontologia de Bauru (FOB), Universidade de São Paulo (USP), Bauru (SP), Brazil
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Kors J, de la Croix A, Martin L, Verhoeven CJM, Bakker P, Peerdeman SM, Kusurkar RA. Autonomy-supportive decision-making in maternity care during prenatal consultations: a qualitative interaction analysis. BMJ Open 2022; 12:e063463. [PMID: 36385034 PMCID: PMC9670942 DOI: 10.1136/bmjopen-2022-063463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES The aim of this study was to identify mechanisms of autonomy-supportive consultation (ASC) that maternity care professionals use during decision-making in prenatal consultations. DESIGN This study was a descriptive, qualitative analysis of professional-patient interactions in maternity care, using concepts and analytic procedures of conversation analysis. SETTING The prenatal consultations took place in hospitals and midwifery practices in the Netherlands. This study was part of a larger project. For the current study, we selected prenatal consultations concerning three topics in which patients make their own choices. PARTICIPANTS The first author invited the patient who was waiting in the waiting room. Participants were not selected a priori. MAIN OUTCOME MEASURES The main outcome measures were mechanisms of ASC. RESULTS We selected 20 consultations which were conducted by 20 different professionals. We found eight mechanisms in the professional-patient interaction which were categorised into three overarching themes. The first theme, 'Lightheartedness', comprises the interactional mechanisms 'minimising language' and 'humour'. The theme 'Orientation to agreement' describes how professionals and patients seem to be oriented towards demonstrating agreement and mutual understanding. The last theme, 'Offering information and options', describes the professional formally giving factual information almost completely without verbal interaction between the professional and the patient. CONCLUSION The results of this study show that the model of ASC can be enriched by adding minimising language and humour to the mechanisms that can be used to fulfil the psychological need 'relatedness'. Second, our results show that professionals use only few mechanisms to meet the patients' psychological needs 'competence' and 'autonomy'. They mainly use information giving to meet patients' need competence. To meet patients' need for autonomy, the professionals keep all options open. This suggests that professionals could pay more attention to other mechanisms to meet patients' needs for 'competence' and 'autonomy'.
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Affiliation(s)
- Joyce Kors
- Faculty of Medicine, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, Netherlands
- Midwifery Science, AVAG, Amsterdam Public Health Research Institute, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, Netherlands
- LEARN! Research Institute for Learning and Education, Faculty of Psychology and Education, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Anne de la Croix
- Faculty of Medicine, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, Netherlands
- LEARN! Research Institute for Learning and Education, Faculty of Psychology and Education, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Linda Martin
- Midwifery Science, AVAG, Amsterdam Public Health Research Institute, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Corine J M Verhoeven
- Midwifery Science, AVAG, Amsterdam Public Health Research Institute, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, Netherlands
- Midwifery, School of Health Sciences, University of Nottingham, Nottingham, Nottinghamshire, UK
- Department of Obstetrics and Gynaecology, Maxima Medical Centre, Veldhoven, Netherlands
| | - Petra Bakker
- Department of Obstetrics and Gynaecology, Amsterdam UMC Locatie Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Saskia M Peerdeman
- Faculty of Medicine, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, Netherlands
- Department of Neurosurgery, Amsterdam UMC Location University of Amsterdam, Amsterdam, Netherlands
- Center for Evidence Based Education, Amsterdam UMC location University of Amsterdam, Amsterdam, Netherlands
| | - Rashmi A Kusurkar
- Faculty of Medicine, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, Netherlands
- LEARN! Research Institute for Learning and Education, Faculty of Psychology and Education, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
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Qin M, Zhu W, You C, Li S, Qiu S. Patient's behavior of selection physician in online health communities: Based on an Elaboration likelihood model. Front Public Health 2022; 10:986933. [PMID: 36262241 PMCID: PMC9574016 DOI: 10.3389/fpubh.2022.986933] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 09/12/2022] [Indexed: 01/26/2023] Open
Abstract
Background With the rapid development of "Internet + medicine" and the impact of the COVID-19 epidemic, online health communities have become an important way for patients to seek medical treatment. However, the mistrust between physicians and patients in online health communities has long existed and continues to impact the decision-making behavior of patients. The purpose of this article is to explore the influencing factors of patient decision-making in online health communities by identifying the relationship between physicians' online information and patients' selection behavior. Methods In this study, we selected China's Good Doctor (www.haodf.com) as the source of data, scrapped 10,446 physician data from December 2020 to June 2021 to construct a logit model of online patients' selection behavior, and used regression analysis to test the hypotheses. Results The number of types of services, number of scientific articles, and avatar in physicians' personal information all has a positive effect on patients' selection behavior, while the title and personal introduction hurt patients' selection behavior. Online word-of-mouth positively affected patients' selection behavior and disease risk had a moderating effect. Conclusion Focusing on physician-presented information, this article organically combines the Elaboration likelihood model with trust source theory and online word-of-mouth from the perspective of the trusted party-physician, providing new ideas for the study of factors influencing patients' selection behavior in online health communities. The findings provide useful insights for patients, physicians, and community managers about the relationship between physician information and patients' selection behavior.
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Affiliation(s)
- Min Qin
- Research Center of Management Science and Engineering, Jiangxi Normal University, Nanchang, China,School of Software, Jiangxi Normal University, Nanchang, China,*Correspondence: Min Qin
| | - Wei Zhu
- Research Center of Management Science and Engineering, Jiangxi Normal University, Nanchang, China,School of Software, Jiangxi Normal University, Nanchang, China,Wei Zhu
| | - Changmeng You
- School of Software, Jiangxi Normal University, Nanchang, China
| | - Shuqin Li
- Research Center of Management Science and Engineering, Jiangxi Normal University, Nanchang, China,School of Software, Jiangxi Normal University, Nanchang, China
| | - Shanshan Qiu
- Research Center of Management Science and Engineering, Jiangxi Normal University, Nanchang, China,School of Software, Jiangxi Normal University, Nanchang, China
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Use of Tactile Contact Accompanying Health Prmotion Messages During Routine Health & Physical Examinations: A Technique for Improving Compliance. JOURNAL OF PUBLIC HEALTH INTERNATIONAL 2022; 4:18-27. [PMID: 35291713 PMCID: PMC8920405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
A daunting challenge for health providers and medical practitioners is communicating the vital importance of health promotion and medical treatment adherence and compliance. This article is an evidence-based, best-practices commentary advocating the use of touch-accompanied verbal suggestions during the touching portions of routine, near-universal Health & Physical examinations. Notional case examples are presented; based on the professional literature, underlying Behavioral Mechanics are discussed. Touch-accompanied verbal health promotion messages skillfully deployed in routine Health & Physical examinations offer a non-harmful and efficient technique to synergistically and substantially enhance the probability of patient compliance with health improvement and medical treatment regimens. Though it is not a magic panacea, the public health applications, extensions and benefits are incalculable in terms of healthy behavior adoption. Additionally, if deftly conducted in accordance with best practices, it has the potential to greatly improve practitioner-patient relations and increase patient satisfaction. Further avenues of research inquiry are considered.
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Forsey J, Ng S, Rowland P, Freeman R, Li C, Woods NN. The Basic Science of Patient-Physician Communication: A Critical Scoping Review. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2021; 96:S109-S118. [PMID: 34348382 DOI: 10.1097/acm.0000000000004323] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
PURPOSE Strong verbal communication skills are essential for physicians. Despite a wealth of medical education research exploring communication skills training, learners struggle to become strong communicators. Integrating basic science into the curriculum provides students with conceptual knowledge that improves learning outcomes and facilitates the development of adaptive expertise, but the conceptual knowledge, or "basic science," of patient-provider communication is currently unknown. This review sought to address that gap and identify conceptual knowledge that would support improved communication skills training for medical trainees. METHOD Combining the search methodology of Arksey and O'Malley with a critical analytical lens, the authors conducted a critical scoping review of literature in linguistics, cognitive psychology, and communications to determine: what is known about verbal communication at the level of word choice in physician-patient interactions? Studies were independently screened by 3 researchers during 2 rounds of review. Data extraction focused on theoretical contributions associated with language use and variation. Analysis linked patterns of language use to broader theoretical constructs across disciplines. RESULTS The initial search returned 15,851 unique studies, and 271 studies were included in the review. The dominant conceptual groupings reflected in the results were: (1) clear and explicit language, (2) patient participation and activation, (3) negotiating epistemic knowledge, (4) affiliative language and emotional bonds, (5) role and identity, and (6) managing transactional and relational goals. CONCLUSIONS This in-depth exploration supports and contextualizes theory-driven research of physician-patient communication. The findings may be used to support future communications research in this field and educational innovations based on a solid theoretical foundation.
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Affiliation(s)
- Jacquelin Forsey
- J. Forsey is a PhD candidate, Rehabilitation Sciences Institute, University of Toronto, and a fellow, Wilson Centre, Toronto, Ontario, Canada
| | - Stella Ng
- S. Ng is associate professor, Faculty of Medicine, University of Toronto, and director of research, Centre for Faculty Development, St. Michael's Hospital, Toronto, Ontario, Canada; ORCID: https://orcid.org/0000-0003-1433-6851
| | - Paula Rowland
- P. Rowland is assistant professor, Department of Occupational Therapy, University of Toronto, and scientist, Wilson Centre, Toronto, Ontario, Canada; ORCID: https://orcid.org/0000-0001-8054-7142
| | - Risa Freeman
- R. Freeman is vice chair of education and scholarship, Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Connie Li
- C. Li is a medical student, McMaster University, Hamilton, Ontario, Canada
| | - Nicole N Woods
- N.N. Woods is associate professor, Department of Family and Community Medicine, University of Toronto, and director, Institute for Education Research, UHN, Toronto, Ontario, Canada; ORCID: https://orcid.org/0000-0002-2976-1108
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Chang YW, Hsu PY, Wang Y, Chang PY. Integration of online and offline health services: The role of doctor-patient online interaction. PATIENT EDUCATION AND COUNSELING 2019; 102:1905-1910. [PMID: 31279612 DOI: 10.1016/j.pec.2019.04.018] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Revised: 04/12/2019] [Accepted: 04/17/2019] [Indexed: 06/09/2023]
Abstract
OBJECTIVE This study aims to investigate how doctor-patient online interaction affects the integration of online and offline health services. Drawing on justice theory and the stimulus-organism-response (S-O-R) framework, justice perceptions are conceptualized as online health communication in influencing patient experiences and subsequent responses. METHODS Data were collected from 241 online consultation patients. Partial least squares structural equation modeling (PLS-SEM) approach was used to test the research model and 12 hypothesized relationships. RESULTS Distributive justice, procedural justice, and interpersonal justice significantly affect trust, which in turn affects satisfaction and the continued intention to consult. Distributive justice and informational justice significantly affect satisfaction, which in turn affects the continued intention to consult. Finally, the continued intention to consult significantly affects the behavioral intention to visit. CONCLUSION Doctors can attract patients to visit them in physical hospitals by providing good online health services. Before physically visiting doctors, patients can also search for a suitable doctor that meets their needs through online consultations. To the best of our knowledge, this study is the first to integrate online and offline health services. PRACTICE IMPLICATIONS From the perspective of health communication, the understanding of doctor-patient online interaction offers doctors and hospitals guidance to improve doctor-patient relationships.
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Affiliation(s)
- Yu-Wei Chang
- Department of Business Management, National Taichung University of Science and Technology
| | - Ping-Yu Hsu
- Department of Business Administration, National Central University.
| | - Ying Wang
- Department of Gastroenterology, Wenzhou People's Hospital
| | - Po-Ya Chang
- Department of Leisure Industry and Health Promotion, National Taipei University of Nursing and Health Sciences
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Coffey F, Tsuchiya K, Timmons S, Baxendale B, Adolphs S, Atkins S. Simulated patients versus manikins in acute-care scenarios. CLINICAL TEACHER 2015; 13:257-61. [PMID: 26597094 DOI: 10.1111/tct.12425] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Manikins and simulated patients (SPs) are commonly used in health care education and assessment. SPs appear to offer a more realistic experience for learners than 'plastic' manikins, and might be expected to engender interactions that approximate real clinical practice more closely. The analyses of linguistic patterns and touch are methodologies that could be used to explore this hypothesis. Our research aims were: (1) to compare verbal interactions and the use of procedural touch by health care workers (HCWs) in scenarios with SPs and with manikins; and (2) to evaluate the methodologies used to inform a large-scale study. METHODS We conducted a pilot preliminary comparative study on conversations and touch in two scenarios in emergency care training, each performed using an SP and a high-fidelity manikin. The setting was a simulation centre. Two scripted acute-care scenarios (chest pain and acute breathlessness) were performed using both an SP and a high-fidelity manikin. Audiovisual recordings were subsequently analysed. Two teams comprising a clinician (medical student), a senior nurse and a clinical support worker took part in the study. The linguistics research methodology integrated a multimodal corpus-based approach and discourse analysis. Simulated patients appear to offer a more realistic experience for learners than 'plastic' manikins RESULTS Overall, HCWs had far more interactions with the SPs than with the manikins, and the utterances and behaviours were more akin to what one would expect in real clinical practice. HCWs used procedural touch without the patient's permission much more frequently with the manikin. DISCUSSION These methodologies offer opportunities for further research projects studying interactions with SPs, manikins and real clinical practice.
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Affiliation(s)
- Frank Coffey
- Department of Research and Education in Emergency Medicine, Acute Medicine and Major Trauma, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Keiko Tsuchiya
- Foreign Language Centre, Tokai University, Hiratsuka, Kanagawa, Japan
| | - Stephen Timmons
- Centre for Health Innovation, Leadership and Learning, University of Nottingham, Nottingham University Business School, Nottingham, UK
| | - Bryn Baxendale
- The Trent Simulation and Clinical Skills Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Svenja Adolphs
- School of English, University of Nottingham, Nottingham, UK
| | - Sarah Atkins
- School of English, University of Nottingham, Nottingham, UK
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Li Y, Li N, Han Q, He S, Bae RS, Liu Z, Lv Y, Shi B. Performance of physical examination skills in medical students during diagnostic medicine course in a University Hospital of Northwest China. PLoS One 2014; 9:e109294. [PMID: 25329685 PMCID: PMC4198092 DOI: 10.1371/journal.pone.0109294] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2014] [Accepted: 09/10/2014] [Indexed: 11/18/2022] Open
Abstract
This study was conducted to evaluate the performance of physical examination (PE) skills during our diagnostic medicine course and analyze the characteristics of the data collected to provide information for practical guidance to improve the quality of teaching. Seventy-two fourth-year medical students were enrolled in the study. All received an assessment of PE skills after receiving a 17-week formal training course and systematic teaching. Their performance was evaluated and recorded in detail using a checklist, which included 5 aspects of PE skills: examination techniques, communication and care skills, content items, appropriateness of examination sequence, and time taken. Error frequency and type were designated as the assessment parameters in the survey. The results showed that the distribution and the percentage in examination errors between male and female students and among the different body parts examined were significantly different (p<0.001). The average error frequency per student in females (0.875) was lower than in males (1.375) although the difference was not statistically significant (p = 0.167). The average error frequency per student in cardiac (1.267) and pulmonary (1.389) examinations was higher than in abdominal (0.867) and head, neck and nervous system examinations (0.917). Female students had a lower average error frequency than males in cardiac examinations (p = 0.041). Additionally, error in examination techniques was the highest type of error among the 5 aspects of PE skills irrespective of participant gender and assessment content (p<0.001). These data suggest that PE skills in cardiac and pulmonary examinations and examination techniques may be included in the main focus of improving the teaching of diagnostics in these medical students.
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Affiliation(s)
- Yan Li
- First Affiliated Hospital, School of Medicine, Xi'an Jiaotong University, Shaanxi, Xi'an, China
| | - Na Li
- First Affiliated Hospital, School of Medicine, Xi'an Jiaotong University, Shaanxi, Xi'an, China
| | - Qunying Han
- First Affiliated Hospital, School of Medicine, Xi'an Jiaotong University, Shaanxi, Xi'an, China
| | - Shuixiang He
- First Affiliated Hospital, School of Medicine, Xi'an Jiaotong University, Shaanxi, Xi'an, China
| | - Ricard S. Bae
- First Affiliated Hospital, School of Medicine, Xi'an Jiaotong University, Shaanxi, Xi'an, China
| | - Zhengwen Liu
- First Affiliated Hospital, School of Medicine, Xi'an Jiaotong University, Shaanxi, Xi'an, China
- * E-mail:
| | - Yi Lv
- First Affiliated Hospital, School of Medicine, Xi'an Jiaotong University, Shaanxi, Xi'an, China
| | - Bingyin Shi
- First Affiliated Hospital, School of Medicine, Xi'an Jiaotong University, Shaanxi, Xi'an, China
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