The importance of systems thinking, context, and inclusion when studying the feasibility of expanding the FoodShare (SNAP) outreach program to rural communities of Northern Wisconsin.

Evaluators often neglect to question whether a program has been appropriately designed for a new context prior to a feasibility study's commencement. In this paper, we document the results of a case study that closely examined context when determining the feasibility of implementing a FoodShare outreach program in rural northern Wisconsin. Using community-based participatory mixed methods, we examine how stakeholder engagement led to both study refinement and a more comprehensive understanding of community food security based on contextual factors and systems thinking. Lessons learned when conducting feasibility studies from this perspective are provided to improve evaluation practice.

Development and testing of the Clinical Research Appraisal Inventory-Short Form.

BACKGROUND AND PURPOSE: The National Academy of Sciences stressed the need for a doctorally prepared workforce and earlier entry into doctoral study in nursing and the behavioral, social, and basic sciences. Social Cognitive Career Theory (SCCT) suggests that self-efficacy for career related skills informs career choices. Thus, increasing clinical research self-efficacy early in students' studies could increase their choice of a research career. To test interventions, a psychometrically sound measure of clinical research self-efficacy is needed. METHODS: We examined the psychometrics of the Clinical Research Appraisal Inventory-Short Form (CRAI-SF) in undergraduate and first-year graduate students (N = 268). This scale is a modification of the Clinical Research Appraisal Inventory, which measures physician-scientists' clinical research self-efficacy. RESULTS: Content validity was supported by external review. Factor analysis revealed six factors explaining 75% of scale variance. Internal consistency of subscales and total scale ranged from .84 to .98. Differences in scores by gender (p = .016) and discipline of study (p = .000) supported construct validity. CONCLUSIONS: The CRAI-SF is a useful measure of undergraduate and first-year graduate students' perceived clinical research self-efficacy.

A shortened version of the Clinical Research Appraisal Inventory: CRAI-12.

PURPOSE: The original Clinical Research Appraisal Inventory (CRAI), which assesses the self-confidence of trainees in performing different aspects of clinical research, comprises 92 items. Completing the lengthy CRAI is time-consuming and represents a considerable burden to respondents, yet the CRAI provides useful data for evaluating research training programs. The purpose of this study is to develop a shortened version of the CRAI and to test its validity and reliability. METHOD: Trainees in clinical research degree and career development programs at the University of Pittsburgh's Institute for Clinical Research Education completed the 92-item CRAI between 2007 and 2012, inclusive. The authors conducted, first, exploratory factor analysis on a training dataset (2007-2010) to reduce the number of items and, then, confirmatory factor analyses on a testing dataset (2011-2012) to test the psychometric properties of the shortened version. RESULTS: Of 546 trainees, 394 (72%) provided study data. Exploratory factor analysis revealed six distinct factors, and confirmatory factor analysis identified the two items with the highest loadings per factor, for a total of 12 items. Cronbach alpha for the six new factors ranged from 0.80 to 0.94. Factors in the 12-item CRAI were strongly and significantly associated with factors in the 92-item CRAI; correlations ranged from 0.82 to 0.96 (P < .001 for each). CONCLUSIONS: The 12-item CRAI is faster and less burdensome to complete but retains the strong psychometric properties of the original CRAI.

Identifying the educationally influential physician: a systematic review of approaches.

INTRODUCTION: Previous studies have indicated that educationally influential physicians' (EIPs) interactions with peers can lead to practice changes and improved patient outcomes. However, multiple approaches have been used to identify and investigate EIPs' informal or formal influence on practice, which creates study outcomes that are difficult to compare. The purposes of this systematic literature review were to (1) compare approaches used to identify EIPs and (2) identify and compare shared characteristics of EIPs as defined by the included studies. METHODS: Articles in English were obtained from PubMed, CINAHL Plus, ERIC, PsycINFO, Web of Science, Google Scholar databases, and reference lists of identified articles. Studies were compared and contrasted based on terminology, identification approach, selection criteria, and EIP characteristics according to Cresswell's 5 steps in conducting a literature review. RESULTS: Thirty-one studies met the inclusion criteria. Sociometric questionnaires and peer informants were used most frequently to identify EIPs. Multiple and varied criteria, including physician ranking, nomination by peers, percentage of nominations received, and number of votes were used by researchers to select physicians who were classified as EIPs. The identified characteristics of EIPs varied by study, with some researchers adhering to characteristics previously described by Hiss, and others adding to or deviating from those characteristics, at times based on physician specialty. CONCLUSION: Selection of an EIP identification approach requires agreement on EIPs' characteristics, consistent approaches and identification criteria, and common terms and definitions. Additional research is needed to compare characteristics of EIPs and study outcomes based on the identification method employed.

Effects of an educational intervention on female biomedical scientists' research self-efficacy.

Women and people of color continue to be underrepresented among biomedical researchers to an alarming degree. Research interest and subsequent productivity have been shown to be affected by the research training environment through the mediating effects of research self-efficacy. This article presents the findings of a study to determine whether a short-term research training program coupled with an efficacy enhancing intervention for novice female biomedical scientists of diverse racial backgrounds would increase their research self-efficacy beliefs. Forty-three female biomedical scientists were randomized into a control or intervention group and 15 men participated as a control group. Research self-efficacy significantly increased for women who participated in the self-efficacy intervention workshop. Research self-efficacy within each group also significantly increased following the short-term research training program, but cross-group comparisons were not significant. These findings suggest that educational interventions that target sources of self-efficacy and provide domain-specific learning experiences are effective at increasing research self-efficacy for women and men. Further studies are needed to determine the longitudinal outcomes of this effort.

Faculty mentors' and students' perceptions of students' research self-efficacy.

Mentoring in nursing is an important process for socializing nurse researchers, developing a body of professional knowledge, and influencing career choices of students. Self-efficacy (Bandura, 1997) is concerned with one's perceived ability to perform tasks within a specific domain. The purpose of this study was to compare undergraduate and graduate student's perceptions of their abilities to pursue research (research self-efficacy) with their mentors' perceptions. A cross-sectional design was used to study mentors in any academic discipline who received external funding and worked with an undergraduate or graduate student on the research study. Recruitment and data collection were completed using the Internet and included 21 faculty mentors and student dyads. The Clinical Research Appraisal Inventory was used to measure research self-efficacy. Differences between the faculty mentor's perception of the student's confidence in research and students' perception were significant at p=<0.001. Misjudgment of efficacy appraisals can result in opportunities forsaken and careers not pursued. Assisting mentors to guide students' skill perfection may increase students' choice of research careers, promote the effectiveness of mentorship, aid in the development of a body of professional knowledge and benefit careers of both mentors and students.

Biomedical research competencies for osteopathic medical students.

BACKGROUND: Without systematic exposure to biomedical research concepts or applications, osteopathic medical students may be generally under-prepared to efficiently consume and effectively apply research and evidence-based medicine information in patient care. The academic literature suggests that although medical residents are increasingly expected to conduct research in their post graduate training specialties, they generally have limited understanding of research concepts.With grant support from the National Center for Complementary and Alternative Medicine, and a grant from the Osteopathic Heritage Foundation, the University of North Texas Health Science Center (UNTHSC) is incorporating research education in the osteopathic medical school curriculum. The first phase of this research education project involved a baseline assessment of students' understanding of targeted research concepts. This paper reports the results of that assessment and discusses implications for research education during medical school. METHODS: Using a novel set of research competencies supported by the literature as needed for understanding research information, we created a questionnaire to measure students' confidence and understanding of selected research concepts. Three matriculating medical school classes completed the on-line questionnaire. Data were analyzed for differences between groups using analysis of variance and t-tests. Correlation coefficients were computed for the confidence and applied understanding measures. We performed a principle component factor analysis of the confidence items, and used multiple regression analyses to explore how confidence might be related to the applied understanding. RESULTS: Of 496 total incoming, first, and second year medical students, 354 (71.4%) completed the questionnaire. Incoming students expressed significantly more confidence than first or second year students (F = 7.198, df = 2, 351, P = 0.001) in their ability to understand the research concepts. Factor analyses of the confidence items yielded conceptually coherent groupings. Regression analysis confirmed a relationship between confidence and applied understanding referred to as knowledge. Confidence scores were important in explaining variability in knowledge scores of the respondents. CONCLUSION: Medical students with limited understanding of research concepts may struggle to understand the medical literature. Assessing medical students' confidence to understand and objectively measured ability to interpret basic research concepts can be used to incorporate competency based research material into the existing curriculum.

Coping efficacy and perceived family support: potential factors for reducing stress in premedical students.

OBJECTIVE: This study investigated the relationship between perceived family support and coping efficacy in premedical (i.e. prior to entering medical school) students, an understudied subset of undergraduate students who are particularly at risk for academia- related stress. The relationships between students' perceived academic coping abilities and their academic behaviours and experiences of stress have been considered within the vocational literature. However, an understanding of factors that inform coping efficacy beliefs is lacking. METHODS: A total of 238 premedical students provided demographic information regarding themselves and their parents. Students also completed a paper questionnaire containing a coping efficacy scale and items assessing their level of family support. RESULTS: Correlational analyses revealed significant positive relationships between family support and students' perceived abilities to cope with anticipated academic barriers as hypothesised. Bivariate comparisons of mean coping efficacy scores revealed that racial or ethnic minority students reported significantly higher coping efficacy beliefs than did White students. Students with doctor mothers also reported significantly higher coping efficacy than students with mothers employed in other health-related fields. No significant differences in coping efficacy were found when those with doctor fathers versus those with fathers in other health-related fields were compared. CONCLUSIONS: Findings from the present study indicate that perceived family support plays a key role in establishing premedical students' confidence in their ability to cope with the challenges of academic life. These findings have important implications for further studies on coping and stress in premedical students.

A model of teaching-learning transactions in generalist-specialist consultations.

INTRODUCTION: A new paradigm in continuing medical education is characterized by emphasis on physicians' learning in practice. Consistent with this paradigm, our study examined a subset of clinical practice--generalist-specialist consultations--from an educational perspective. METHODS: We applied the grounded-theory method with semistructured interviews. Ten primary care physicians and 9 internal medicine subspecialists were interviewed regarding their approaches to learning and teaching during generalist-specialist consultations. RESULTS: Based on 48 formal and informal consultations reported by physicians, we developed a theory of teaching-learning transactions in generalist-specialist consultations. DISCUSSION: As a teaching-learning transaction, the mutual learning process in generalist-specialist consultations involves 3 components: needs assessment, dialogue, and sufficiency. Providers of continuing medical education may use the proposed theoretical framework to help clinicians and health care organizations analyze and enhance educationally valuable interactions at the interface of primary and secondary care.

Viewing clinical research career development through the lens of social cognitive career theory.

Issues such as, over commitment, insufficient time, and lack of funding, threaten physicians' entry and sustainability in a research career pathway. Social cognitive career theory is presented as a conceptual framework to critically examine the limitations of the National Institutes of Health's (NIH) efforts to promote the career development of physician-scientists. Special attention is given to the unique challenges of promoting this career pathway for women and underrepresented minorities. The authors propose enhanced recommendations for the career development of physician-scientists and research questions for future studies and program development aimed at advancing the nation's efforts to promote clinical research.

Survey of the impact of National Institutes of Health clinical research curriculum awards (K30) between 1999 and 2004.

BACKGROUND: This report summarizes a survey conducted in 2004 by the Association of Clinical Research Training Program Directors' Evaluation Committee. The purpose of this survey was to determine the early capacity of the 59 National Institutes of Health (NIH) K30 programs (funded between 1999 and 2004) to produce clinical investigators trained in core skills required in clinical research. METHODS: In July 2004, a 37-item Web-based survey was distributed to institutions funded by the NIH K30 award mechanism. Frequencies and proportions were computed for each categorical response, and means were calculated for nominal responses using SPSS, version 11.5 (SPSS, Chicago, IL). Items 7 (funding year) and 8 (recruitment year) were cross-tabulated to ascertain the tempo at which programs were able to establish their enrolment processes. RESULTS: Forty-five of the 59 programs funded by the K30 award (76%) responded to this survey. The average number of active trainees in each program is 32. Women constitute 53% of active trainees, and 22% of them are underrepresented minorities. Ninety-six percent of active trainees have medical degrees. The average number of graduates over the 5-year funding period is 18. Of the graduates, 50% are women and 17% are underrepresented minorities. Fifty-six percent of them earned certificates, 44% earned master of science degrees, and 13% earned other degrees. Sixty-one percent of K30 program graduates have some extramural funding to support their research. The average number of publications per trainee for all trainees (active and graduate) is 2.3. CONCLUSION: The K30 program has been a catalyst at multiple US institutions for improving the pedagogy for clinical research training. It has successfully fulfilled the mandate set forth by the 1998 NIH Director's Panel on Clinical Research (Nathan Report).

Who are physician-scientists' role models? Gender makes a difference.

PURPOSE: To determine for educational purposes whether differences exist in the role models physician-scientists-in-training or in their early years of career development envision when they self-assess their abilities to perform clinical research. METHOD: A 35-item clinical research self-efficacy questionnaire was administered to 251 health care professionals who attended programs at the University of Wisconsin-Madison from 2002-2004. Three questions were included to determine the sex, role, and qualities of the expert that are envisioned by participants. Frequency distributions were computed for each response and variables were compared by gender using chi-square analysis and Fisher exact test. RESULTS: Ninety-five physicians-in-training and junior faculty physicians responded to the questionnaire. Seventy-one percent of female and 95% of male respondents reported their envisioned experts to be male. The most frequently reported role of the envisioned expert was that of a mentor who was a faculty member in the respondent's own department (72% women, 60% men). The three most frequently reported qualities of the envisioned expert were "multiple publications," "scientific knowledge," and "supportiveness." However, women more frequently reported "communication skills" and "problem-solving abilities" than did men. This difference was statistically significant and largely due to the frequency of qualities selected by women whose envisioned expert was female. CONCLUSIONS: The results of this study emphasized the importance of a role model's gender in the career development of physician-scientists.

An academic writing needs assessment of English-as-a-second-language clinical investigators.

INTRODUCTION: Academic writing for publication is competitive and demanding for researchers. For the novice English-as-a-second-language (ESL) researcher, the pressure to publish compounds the difficulties of mastering the English language. Very few studies have used ESL graduate and post-graduate students as academic writing research subjects. The purpose of this project was to assess the learning needs of ESL clinical investigators regarding academic writing for English scholarly publication. METHOD: A qualitative evaluation approach was used to examine the gap between the current and desired proficiency level for the academic writing of ESL clinical investigators. We considered the perspectives of seven ESL clinical investigators plus three mentors and three writing instructors. Semi-structured questions were asked. Field notes were organized using a field-work recording system. They were analyzed using the constant comparative method. RESULTS: ESL clinical investigators do not accurately perceive their writing deficiencies. They have little knowledge of criteria for academic writing and they are influenced by their prior English learning experiences in their home culture, which engender passive attitudes toward seeking appropriate writing resources. Adequate time is especially needed to develop successful writing skills. DISCUSSION: Four basic steps are recommended to guide program planners in developing ESL writing activities for professional learning: (1) recognize discrepancies, (2) establish clear standards and performance criteria for scholarly writing, (3) develop individual plans, and (4) organize long-term writing assistance.

Gender differences among physician-scientists in self-assessed abilities to perform clinical research.

PURPOSE: To examine gender differences in physicians' self-assessed abilities to apply knowledge and skills in six core competencies for success as a clinical investigator. METHOD: A written questionnaire containing 35 learning objectives was administered to physicians involved in a clinical-research training program at the University of Wisconsin-Madison. Between 2000 and 2002, 57 postgraduate trainees (49% women) completed the questionnaire; 40 of the 57 completed the questionnaire a second time after a four-day intensive workshop in clinical research. The main outcome measure was gender differences in ratings for each question answered. RESULTS: Before the workshop, women physicians rated their abilities lower than men rated their own abilities on 22 of 35 learning objectives and women were significantly lower in rating their ability to spend sufficient time developing and advancing their own area of scientific knowledge and research. After the workshop, women rated themselves lower than men rated themselves on 33 of 35 objectives, with significant differences in seven. Women did not rate themselves significantly higher than men rated themselves on any of the 35 objectives assessed. CONCLUSION: Women physicians consistently rated their abilities to perform or apply knowledge and skills related to clinical research lower than men rated themselves, and a traditional training venue exacerbated these gender differences. This previously unexplored gender difference in self-perceived competency may indicate an additional barrier women face in academic career development and suggests that educational programs incorporate learning activities that address gender differences when training physicians for careers in clinical research.

Role of experience and context in learning to diagnose Lyme disease.

INTRODUCTION: A recent review of research in continuing medical education suggests that scholarship should be integrated with practice so that practical problems can be addressed with theoretically derived yet applicable solutions. This project develops a theory describing how physicians learn and formulate decisions in the context of diagnosing Lyme disease in order that educational programs can be designed to improve accuracy in diagnosis of this disease. METHODS: A qualitative study using grounded theory methodology was performed to explore the learning process of physicians when diagnosing Lyme disease. Nine physicians were interviewed, and the interview transcripts were coded into categories to form a theory about how physicians learn in practice. RESULTS: Patient-physician interactions initiate the learning process by setting a context for which physicians frame a problem according to familiarity. Repetitive, similar, and counter-experiences, combined with cognitive knowledge, contribute to that framework and influence how the problem is framed along a continuum of familiarity. Furthermore, these experiences serve as information that influences diagnostic decisions and physicians' behaviors. DISCUSSION: For teaching and learning, cases and examples should include sufficient variety, repetition, and counterexperiences that allow a physician to appropriately recognize and categorize a patient's signs and symptoms into a disease category. Resources for information should be readily available and current. Preceptors and physician colleagues should provide timely feedback on diagnostic accuracy, and case studies should be presented with contextual elements that facilitate the diagnosis of Lyme disease.

An evaluation plan to assess the process and outcomes of a learner-centered training program for clinical research.

In 1994, the National Center for Research Resources' Committee on Addressing Career Paths for Clinical Research reported that insufficient training in research methods, inadequate mentoring, and inappropriate timing of training presented major barriers to the development of clinical researchers. The National Institutes of Health responded to the need for additional training programs by supporting 57 institutions through the Clinical Research Curriculum Award (K30) Program. The ability to assess the success of these programs depends on the nature and extent of their evaluation plans. Evaluation plans for clinical research training programs should include means of assessing both process and outcomes of a program's implementation in its formative and summative stages. This article describes the University of Wisconsin-Madison's Clinical Investigator Preparatory Program and an evaluation plan that incorporates process and outcome assessments based on a theoretical framework of adult and professional education.