Patient Safety in Medical Education: Students’ Perceptions,Knowledge and Attitudes

Patient safety is a new and challenging discipline in the Iranian health care industry. Among the challenges for patient safety improvement, education of medical and paramedical students is intimidating. The present study was designed to assess students’ perceptions of patient safety, and their knowledge and attitudes to patient safety education. This cross-sectional analytical study was conducted in 2012 at Urmia University of Medical Sciences, West Azerbaijan province, Iran. 134 students studying medicine, nursing, and midwifery were recruited through census for the study. A questionnaire was used for collecting data, which were then analyzed through SPSS statistical software (version 16.0), using Chi-square test, Spearman correlation coefficient, F and LSD tests. A total of 121 questionnaires were completed, and 50% of the students demonstrated good knowledge about patient safety. The relationships between students’ attitudes to patient safety and years of study, sex and course were significant (0.003, 0.001 and 0.017, respectively). F and LSD tests indicated that regarding the difference between the mean scores of perceptions of patient safety and attitudes to patient safety education, there was a significant difference among medical and nursing/midwifery students. Little knowledge of students regarding patient safety indicates the inefficiency of informal education to fill the gap; therefore, it is recommended to consider patient safety in the curriculums of all medical and paramedical sciences and formulate better policies for patient safety.     

Medical Students’ Attitudes towards Overweight and Obesity

Objective

Studies from the USA have identified medical students as a major source of stigmatizing attitudes towards overweight and obese individuals. As data from Europe is scarce, medical students’ attitudes were investigated at the University of Leipzig in Leipzig, Germany.

Design

Cross-sectional survey containing an experimental manipulation consisting of a pair of vignettes depicting an obese and a normal weight 42-year-old woman, respectively. Vignettes were followed by the Fat Phobia Scale (FPS), a semantic differential assessing weight related attitudes. In case of the overweight vignette a panel of questions on causal attribution for the overweight preceded administration of the FPS.

Subjects

671 medical students were enrolled at the University of Leipzig from May to June 2011.

Results

The overweight vignette was rated significantly more negative than the normal weight vignette (mean FPS score 3.65±0.45 versus 2.54±0.38, p<0.001). A higher proportion of students had negative attitudes towards the overweight as compared to the normal weight individual (98.9% versus 53.7%, p<0.001). A “positive energy balance” was perceived as the most relevant cause for the overweight, followed by “negligent personality trait”, “societal and social environment” and “biomedical causes”. Attributing a “positive energy balance” or “negligent personality trait” as relevant cause for the overweight was positively associated with negative attitudes.

Conclusion

The results of this study confirm and complement findings from other countries, mainly the USA, and indicate that weight bias in the health care setting may be a global issue. Stigmatizing attitudes towards overweight and obesity are prevalent among a sample of medical students at the University of Leipzig. Negative attitudes arise on the basis of holding the individual accountable for the excess weight. They call for bringing the topic of overweight and obesity more into the focus of the medical curriculum and for enhancing medical students’ awareness of the complex aetiology of this health condition.     

A Comprehensive,Simulation-Based Approach to Teaching Clinical Skills: The Medical Students’ Perspective

The purpose of this study was to determine if third-year medical students participating in a mandatory 12-week simulation course perceived improvement in decision-making, communication, and teamwork skills. Students participated in or observed 24 acute emergency scenarios. At 4-week intervals, students completed 0-10 point Likert scale questionnaires evaluating the curriculum and role of team leader. Linear contrasts were used to examine changes in outcomes. P-values were Bonferroni-corrected for multiple pairwise comparisons. Student evaluations (n = 96) demonstrated increases from week 4 to 12 in educational value (p = 0.006), decision-making (p < 0.001), communication (p = 0.02), teamwork (p = 0.01), confidence in management (p < 0.001), and translation to clinical experience (p < 0.001). Regarding the team leader role, students reported a decrease in stress (p = 0.001) and increase in ability to facilitate team function (p < 0.001) and awareness of team building (p = <0.001). Ratings demonstrate a positive impact of simulation on both clinical management skills and team leadership skills. A simulation curriculum can enhance the ability to manage acute clinical problems and translates well to the clinical experience. These positive perceptions increase as the exposure to simulation increases.     

Rural and Urban Students’ Perceptions of and Attitudes toward Brown Bears in Turkey

Many studies have examined adults’ perceptions of and attitudes toward large carnivores to assess human–wildlife conflict and inform conservation strategies, but there have been few studies concerning children. I studied secondary school students’ perceptions of and attitudes toward brown bears (Ursus arctos) and other large mammals in Turkey via a questionnaire survey. The questionnaire, consisting of 18 questions, was completed by 215 rural and 98 urban secondary school students. Both sets of students liked bears; they were also afraid of them and unsure about living with them in the future. While there were no gender differences in attitudes and perceptions, there were marked differences between urban and rural students. Urban students had less contact with nature, gained more of their knowledge about bears from documentaries, and had less positive attitudes toward bears. They were also more likely to be afraid of species not present in Turkey, for example, anaconda, while rural students were most afraid of wild boars. Factor analysis identified three important themes: familiarity with bears, conservation of bears, and experiencing conflict with bears, which explained 49.8% of the variance in attitudes toward bears. The most important factor for the development of negative attitudes toward bears was personal experience of human–bear conflict, suggesting that measures to reduce human–bear conflict in rural areas may help to sustain students’ positive attitudes toward the conservation of bears.     

Medical Students’ Attitudes About Cosmetic Pesticides before and after an Ecosystem Health Seminar: A Pilot Study

The University of Western Ontario has incorporated ecosystem health as an integral component of its Community Health course for medical students. There is increasing concern regarding the negative health effects of pesticides. The issue of pesticides is, therefore, an obvious topic for the Community Health course. The goal of this pilot study was to compare the attitudes of medical students about cosmetic pesticide use before and after attending a special seminar on that topic. Sixty-three students were surveyed on their opinions before and after the pesticides seminar. After the seminar, the students’ attitudes shifted towards a more negative view of unrestrained cosmetic pesticide use. The students also felt that there were greater risks involved with the use of pesticides (P < 0.001) after attending the seminar. The results of this pilot study demonstrate the need and the effectiveness of including ecosystem health topics in medical curricula.     

Improving Upper Elementary Students’ Humane Attitudes and Prosocial Behaviors through an In-class Humane Education Program

Humane education is a long-standing field of education that endeavors to nurture kindness, compassion, and concern for nonhuman animals, people, and the environment. Despite its long history, however, few randomized control studies have evaluated its effectiveness to promote the development of relevant outcomes. The current study sought to address this dearth by investigating the effects of a humane education program on not only participating students’ attitudes, but also their behaviors. Classes of under-served, fourth-grade students in two major US cities were randomly assigned to participate in either a school-based humane education program or a chess club (the control group); all students participated in their respective activity during the same period once a week for 11 weeks. Data were collected on the attitudes (n = 236) and behaviors (n = 167) of participating students exactly one week before and exactly one week after these programs were conducted. Students self-reported their attitudes about the treatment of animals and the environment via the Intermediate Attitude Scale. Teachers rated each students’ prosocial and disruptive behaviors through sub-scales of the Teacher Observation of Classroom Adaptation– Checklist. Nested multilevel models of change found that the development of prosocial behaviors and self-reported attitudes significantly interacted with group assignment: Students who participated in the humane education program showed stronger growth in both of these outcomes compared with students in the control group. Changes in disruptive behaviors, how-ever, were not found to differ between groups. The results support the effectiveness of a humane education program to teach a relatively large and diverse group of upper elementary students to learn about animal welfare issues and to improve their prosocial behaviors. Effects appeared strongest on attitudes; behavioral effects were found to be largely limited to behaviors directly addressed by the humane education program.     

Continuing Medical Education: Planning and Goals Conference in Continuing Medical Education—Workshop Recommendations

Following are recommendations drawn up by workshops held as a part of the Planning and Goals Conference in Continuing Medical Education, sponsored by the California Medical Association and directed by its Committee on Continuing Medical Education, San Diego, 11 to 12 March 1967. The general subject was divided among four workshops and the reports of two of them—No. 1, (a) and (b), and No. 2—were printed in the August issue of California Medicine. The Reports herewith are those of the other two workshops.The conference was supported in part by Contract No. PH 108-67-158, Bureau of Health Manpower, Public Health Service, Department of Health, Education and Welfare.     

Medical Students’ Opinions About the Commercialization of Healthcare: A Cross-Sectional Survey

There are serious concerns about the commercialization of healthcare and adoption of the business approach in medicine. As market dynamics endanger established professional values, healthcare workers face more complicated ethical dilemmas in their daily practice. The aim of this study was to investigate the willingness of medical students to accept the assertions of commercialized healthcare and the factors affecting their level of agreement, factors which could influence their moral stance when market demands conflict with professional values. A cross-sectional study was conducted in three medical schools in Turkey. The study population consisted of first-, third-, and sixth-year students, and 1,781 students participated in total. Students were asked to state if they agreed with the assertions of commercialized healthcare. Of all students, 87.2 per cent agreed with at least one of the assertions, and one-fifth (20.8 per cent) of them agreed with more than half of the assertions. First-year students significantly agreed more with some assertions than third- and sixth-year students. Being female, having mid-level family income, choosing medicine due to idealistic reasons, and being in the third or sixth years of medical study increased the probability of disagreement. Also, studying in a medical school that included integrated lectures on health policies, rights related to health, and health inequities, along with early field visits, increased the probability of disagreement. This study suggests that agreement with the assertions of commercialized healthcare might be prevalent among students at a considerable level. We argue that this level of agreement is not compatible with best practice in professional ethics and indicates the need for an educational intervention in order to have physicians who give priority to patients’ best interests in the face of market demands.     

Medical Students’ Perceptions of Clinical Teachers as Role Model

Introduction

Role models facilitate student learning and assists in the development of professional identity. However, social organization and cultural values influence the choice of role models. Considering that the social organization and cultural values in South East Asia are different from other countries, it is important to know whether this affects the characteristics medical students look for in their role models in these societies.

Methods

A 32 item questionnaire was developed and self-administered to undergraduate medical students. Participants rated the characteristics on a three point scale (0 = not important, 1 = mildly important, 2 = very important). One way ANOVA and student''s t-test were used to compare the groups.

Results

A total of 349 (65.23%) distributed questionnaires were returned. The highest ranked themes were teaching and facilitating learning, patient care and continuing professional development followed by communication and professionalism. Safe environment and guiding personal and professional development was indicated least important. Differences were also observed between scores obtained by males and females.

Conclusion

Globally there are attributes which are perceived as essential for role models, while others are considered desirable. An understanding of the attributes which are essential and desirable for role models can help medical educators devise strategies which can reinforce those attributes within their institutions.     

Children’s Attitudes toward Cats on St. Kitts,West Indies

Little is known of the attitudes of Caribbean people toward freeroaming and pet cats, so we conducted a questionnaire survey of primaryschool children aged 5 to 13 years (n = 417, 206 girls and 209 boys, while two questionnaires did not indicate gender) in 23 schools around St. Kitts. Over 50% reported they owned or had owned a cat, and ownership was associated with feelings of happiness and comfort. Children reported 511 reasons for liking cats compared with 433 reasons for disliking them. They liked cats mainly for behavioral reasons (58%), such as cats being playful and providing companionship, and aesthetic reasons (47%), such as cats being colorful and beautiful. Children only infrequently reported liking cats for practical reasons (14%), such as removing vermin. Eighty-four percent of cat owners reported purchasing special food for their cats, and 96% provided water. Over 60% of non-cat owners provided water for free-roaming cats. Most school children (43%) thought there were too many cats on St. Kitts, while only 28% thought this was not the case. The children principally owned cats because they loved animals (43%) and cats controlled vermin (28%). Seventy-two percent of children thought there were too many rodents on St. Kitts. Most children (61%) were aware that cats were associated with human diseases but were principally afraid of cats because of the possibility of being bitten or scratched (54%). In summary, our study shows that primary-school children on St. Kitts mostly have positive attitudes toward free-roaming cats and are concerned for cats’ wellbeing. Although important in their own right, children’s attitudes often reflect those of their families and so our findings could facilitate decisionmaking on cat welfare issues in the region.     

A Survey of Veterinarians’ Attitudes toward Euthanasia of Companion Animals in Japan

This study investigated veterinarians’ attitudes toward euthanasia of companion animals in Japan. A nationwide survey was conducted with 932 veterinarians in small animal practices. It examined the number of times they administered euthanasia, their moral criteria for choosing euthanasia for animals, and their behavioral criteria for suggesting euthanasia to owners. According to the data analyses, on average the veterinarians administered euthanasia 2.48 times a year. For many veterinarians, two conditions were necessary to justify euthanasia for animals: “the animals are incurable and suffering” and “the owners request to euthanize the animals.” In the absence of either condition, the veterinarians were inclined to disapprove of choosing euthanasia. If the owners requested further treatment, 67% showed clear disapproval of choosing euthanasia for animals with serious medical conditions. Meanwhile, more than 76% showed clear disapproval of euthanizing healthy animals when the owners requested it. These results indicate that the owners’ request takes precedence over the animals’ condition for suffering animals, but not for healthy animals. For animals with serious medical conditions, 56% of the veterinarians answered that they would or might suggest euthanasia to the owners even though the owners requested further treatment. In this situation, for some veterinarians, the animals’ condition rather than the owners’ request might become a determinant in suggesting euthanasia to owners, even if their moral judgments were against choosing euthanasia for the animals. A decrease in the owners’ or the animals’ quality of life and the owners’ inability to pay were not primary factors in choosing or suggesting euthanasia. Having an experience of euthanizing their own animals was a key factor for the veterinarians which increased not only the number of times they administered euthanasia but also the degree of their moral approval of choosing euthanasia and their behavioral willingness to suggest it to owners.     

Students’ Perceptions of Peer-Organized Extra-Curricular Research Course during Medical School: A Qualitative Study

Early integration of research education into medical curricula is crucial for evidence-based practice. Yet, many medical students are graduating with no research experience due to the lack of such integration in their medical school programs. The purpose of this study was to explore the impact of a peer-organized, extra-curricular research methodology course on the attitudes of medical students towards research and future academic careers. Twenty one medical students who participated in a peer-organized research course were enrolled in three focus group discussions to explore their experiences, perceptions and attitudes towards research after the course. Discussions were conducted using a semi-structured interview guide, and were transcribed and thematically analyzed for major and minor themes identification. Our findings indicate that students’ perceptions of research changed after the course from being difficult initially to becoming possible. Participants felt that their research skills and critical thinking were enhanced and that they would develop research proposals and abstracts successfully. Students praised the peer-assisted teaching approach as being successful in enhancing the learning environment and filling the curricular gap. In conclusion, peer-organized extra-curricular research courses may be a useful option to promote research interest and skills of medical students when gaps in research education in medical curricula exist.     

Adolescents’ Experience and Knowledge of,and Attitudes toward,Bees: Implications and Recommendations for Conservation

Invertebrates are generally regarded with apathy, distaste, and fear in Western society. These negative sentiments likely contribute to the disparity in wildlife conservation efforts, which largely favor vertebrate organisms. Bees represent one of the most ecologically and economically important invertebrate groups, yet bee diversity and abundance is declining worldwide, mirroring the general decline of invertebrate biodiversity. Developing and implementing successful conservation efforts requires interdisciplinary research that considers the ecological and social realities of today’s world. To better inform conservation efforts related to bees, we examined adolescents’ experiences and knowledge of, and attitudes toward, bees and investigated how these dimensions related to one another. A total of 794 eighth-grade science students from the suburbs of Chicago, USA completed a 48-item, paper questionnaire. The results indicated that adolescents were only somewhat knowledgeable about bee biology and services, and they confused bees with other flying insects, especially those with black-and-yellow coloration. Adolescents regarded bees with a generally neutral attitude; their knowledge and attitudes were correlated in a positive manner. Various bee-related experiences were linked to adolescents’ knowledge and attitudes and may have influenced bee-related behavior. In particular, students who engaged in gardening and lawn-care activities demonstrated higher levels of knowledge and more positive attitudes. This study provides insight into the relationships between experiences and knowledge of, and attitudes toward, invertebrates and suggests that engaging in certain outdoor activities may promote positive attitudes toward bees among adolescents.     

Effect of High-Fidelity Simulation on Medical Students’ Knowledge about Advanced Life Support: A Randomized Study

High-fidelity simulation (HFS) is a learning method which has proven effective in medical education for technical and non-technical skills. However, its effectiveness for knowledge acquisition is less validated. We performed a randomized study with the primary aim of investigating whether HFS, in association with frontal lessons, would improve knowledge about advanced life support (ALS), in comparison to frontal lessons only among medical students. The secondary aims were to evaluate the effect of HFS on knowledge acquisition of different sections of ALS and personal knowledge perception. Participants answered a pre-test questionnaire consisting of a subjective (evaluating personal perception of knowledge) and an objective section (measuring level of knowledge) containing 100 questions about algorithms, technical skills, team working/early warning scores/communication strategies according to ALS guidelines. All students participated in 3 frontal lessons before being randomized in group S, undergoing a HFS session, and group C, receiving no further interventions. After 10 days from the end of each intervention, both groups answered a questionnaire (post-test) with the same subjective section but a different objective one. The overall number of correct answers of the post-test was significantly higher in group S (mean 74.1, SD 11.2) than in group C (mean 65.5, SD 14.3), p = 0.0017, 95% C.I. 3.34 – 13.9. A significantly higher number of correct answers was reported in group S than in group C for questions investigating knowledge of algorithms (p = 0.0001; 95% C.I 2.22–5.99) and team working/early warning scores/communication strategies (p = 0.0060; 95% C.I 1.13–6.53). Students in group S showed a significantly higher score in the post-test subjective section (p = 0.0074). A lower proportion of students in group S confirmed their perception of knowledge compared to group C (p = 0.0079). HFS showed a beneficial effect on knowledge of ALS among medical students, especially for notions of algorithms and team working/early warning scores/communication.     

Saudis’ Attitudes toward Chemical Pollution of the Environment,Al-Baha Region,Saudi Arabia

The results of a public opinion survey were used to assess the variation in attitudes toward the chemical pollution of the environment among Saudi residents of the Al-Baha region, Saudi Arabia. A total of 17 statements were given to respondents, addressing general opinions about health risks from chemical pollution. The main findings of this study are: (1) Most Saudis consider the place where they live unhealthful; (2) there was substantial concern about exposure to chemicals with more than 77% of respondents indicating a conscious effort to avoid chemicals in their daily life; (3) chemicals were seen as predominantly being “dangerous” and leading to more harm than good, and they see that the more a person is exposed to chemicals causing cancer the more likely he/she will get cancer; (4) Respondents see that chemicals in the environment are less harmful than chemicals from lifestyle factors and they disagree with the statement that “use of chemicals has improved their health more than it has harmed them”; (5) Saudis are not prepared to accept some health risks in order to benefit the economy. The study did not find any potential relationship between gender, age range, place of residence, and education level and attitude toward chemical pollution among Saudi residents.     

Pituitary Adenoma: A Clinician’S Perspective

ObjectiveTo review the underlying causes of pituitary lesions, a rational approach to their diagnosis, and therapeutic options.MethodsThe types of pituitary lesions and their clinical manifestations are reviewed, and treatment strategies and long-term follow-up are discussed.ResultsA pituitary adenoma is quite common and poses a challenge to the clinician to determine the clinical significance, the appropriate diagnosis, the need for treatment, and the appropriate therapy or therapies. The treatment of a pituitary adenoma depends on the type of tumor; a prolactinoma is treated medically with a dopamine agonist drug, and other lesions are usually treated by transsphenoidal surgical removal. Replacement of a deficient hormone or hormones is necessary for optimal functioning. Some patients require more than one treatment, including surgical intervention, replacement of a hormone or hormones, medications to lower hormone hypersecretion to normal (for prolactinoma, acromegaly, or Cushing disease), pituitary radiation therapy (optimally with focused irradiation such as the Gamma Knife or LINEAC), and, in the situation of persistent Cushing disease, bilateral adrenalectomy as a last resort. Lifelong monitoring is necessary for all these patients.ConclusionThe goal is to decrease the mass effect of the adenoma, to restore normal pituitary function, and to suppress hormone hypersecretion. Achievement of this goal necessitates the cooperation and interdisciplinary efforts of several medical specialties. (Endocr Pract. 2008;14:757-763)     

Factors Associated with Primary School Teachers’ Attitudes Towards the Inclusion of Students with Disabilities

Objective

Teachers'' attitudes toward inclusion are often based on the practical implementation of inclusive education rather than a specific ideology and understanding of inclusiveness. This study aimed to identify the factors associated with primary school teachers'' attitudes towards inclusion of students with all disabilities in regular schools.

Method

Seventy four primary school teachers participated in a cross-sectional survey conducted in Western Australia. Teachers'' attitudes and efficacy toward integration of students with disabilities were measured using the Opinions Relative to Integration of Students with Disabilities scale and Bandura''s Teacher Efficacy scale respectively.

Results

Four teacher attributes—age, gender, teaching self-efficacy and training collectively explained 42% of the variability in teachers'' attitude toward including students with disabilities.

Conclusion

The current study further contributes to the accumulation of knowledge that can unpack the complex pattern of factors that should be considered to promote positive attitudes towards inclusive schools.