One year's experience with a program to facilitate personal and professional development in medical students using reflection groups.

PURPOSE: (1) to integrate sociobehavioral science concepts into the early curriculum through a continuity ambulatory clinical experience in primary care, and (2) to expose students to a learning environment in which self-awareness and emotional development are nurtured in the context of dealing with the stresses of an early clinical experience. METHODS: Second-year students spent half a day twice monthly in a primary care community practice, kept a journal of their experiences, and attended biweekly 60-minute Reflection Groups designed to foster personal awareness and empathic witnessing. Analysis of journal entries and Reflection Group field notes identified stressors occurring during the students' clinical encounters. RESULTS: Three sources of stress are illustrated: the role and responsibility of the physician, death and dying, and racial issues. Reflection Groups provided students with opportunities to identify and describe stressors, to feel less isolated, to begin the process of self-awareness development, and to integrate behavioral and social science concepts into clinical practice. Our program incorporates students' early clinical experience with facilitated opportunities to reflect on the emotional challenges of becoming a physician.

Virtual seminars for medical nutrition education: case example.

Nutrition educators are exploring Web-based strategies for delivering course material. This report describes an effort to use computer-mediated communication between medical students and experts. A "virtual seminar" designed to help students apply nutrition knowledge to patient care was added to an existing traditional clinical skills course. There are few models for online nutrition education. Since these efforts are expensive in time, money, or both, it is important to share preliminary findings, including new methods of evaluating participation and effectiveness. Although medical student activity in the seminar was greater than anticipated, the return rate for the online evaluation survey was disappointing.

Teaching medical students cancer risk reduction nutrition counseling using a multimedia program.

BACKGROUND AND OBJECTIVES: There are many barriers to medical students receiving education about the linkage between nutrition and cancer, including the lack of role models and teachers and insufficient curricular time. We tested the use of a multimedia program as a possible solution to teaching diet-risk assessment and counseling skills. METHODS: Images of Cancer Prevention, The Nutrition Link is a CD-ROM multimedia program that was developed and evaluated by 147 medical students. Pre-use and post-use surveys, computer log files, and recorded response sessions were used to determine the learner's 1) ease in using the program, 2) attitudes about the treatment of the content, 3) knowledge gain, and 4) attitudes about the role of physicians in nutrition assessment and counseling for cancer risk reduction. RESULTS: Students improved their knowledge of dietary guidelines for cancer risk reduction and made positive changes in their attitudes toward the role of physicians in dietary counseling. However, most students reported that they would not use the program unless it was required that they do so. CONCLUSIONS: The multimedia program was successful; it affected students' knowledge and attitudes concerning nutrition as a modifiable risk factor for some cancers. In addition, the design and delivery of the multimedia product was positively reviewed by the students for ease of access, message design, individualized instruction, and flexibility. Despite these favorable ratings, it was not clear that students would use the program unless required to do so.

Food behaviors of southern rural community-living elderly.

OBJECTIVE: To examine how food behaviors and indicators of nutritional status of elderly living in rural communities might relate to age, race, income, medication use, activities of daily living and instrumental activities of daily living, living arrangements, and other lifestyle and health measures. DESIGN: In-home survey administered by trained interviewers. SETTING: Communities in rural North Carolina. PARTICIPANTS: A total of 2178 adults, aged 60 years and older, representing a 2% random stratified example of the region's elderly. MAIN OUTCOME MEASURES: Weight status described by body mass index, functional status as activities of daily living and instrumental activities of daily living, and self-reported food and health behaviors. RESULTS: Substantial diversity exists among households by age, race, residential location, and household size. Almost three fourths of respondents had seen a physician in the last 6 months. More than 33% of women and 28% of men were obese, but none reported having been prescribed a weight-loss diet. About 18% of the respondents were underweight. Weight was not related to income, perceptions of health, chronic disease, medication use, feelings of depression, instrumental activities of daily living, or exercise. Most (65%) ate three meals per day, and almost all were able to eat without assistance. Few drank much liquid or participated in structured exercise programs. Research is needed to determine the impact of weight status on the quality of life of elderly persons living in rural areas. CONCLUSIONS: Current literature descriptions of food behaviors and nutritional status of the elderly may not appropriately describe rural elderly. Attention should be given to the identification and treatment of malnutrition in the elderly.

Senior students' evaluations of the usefulness of the Glaxo Pathway Evaluation Program.

PURPOSE: To examine the influence of the Glaxo Pathway Evaluation Program on fourth-year medical students' specialty-choice decisions. METHOD: In February 1992, 274 seniors at three medical schools were asked to complete a 19-item questionnaire regarding their evaluations of the usefulness of the Pathway program in helping them to make their specialty-choice decisions. RESULTS: A total of 237 seniors responded to the survey (though not all responded to all 19 items), indicating that they found the program to be moderately useful. More than half of the students (107 of 207, 51.7%) reported that they had followed the program's decision-making model and found it moderately useful. The students' responses indicated that those components intended to facilitate self-assessment and provide information about the various specialty options were fairly well utilized, i.e., 59.9% of the students had reevaluated the Critical Factors, and 73.6% had compared their individual profiles with the Specialty Profiles, finding both exercises moderately useful. Other follow-up activities had been used variably. CONCLUSION: The students evaluated the program as being moderately useful. The authors conclude that the program is a useful, comprehensive, and reasonably objective tool. Whether students using the program achieve long-term commitment to and satisfaction in their chosen specialties remains to be determined.

Leadership development for medical students--beyond the prescription pad.

BACKGROUND: Physicians are often perceived as leaders in their communities and are expected to participate in politics, business, and volunteer activities. Medical students receive little guidance about becoming effective community leaders. PROGRAM DESCRIPTION: We developed a leadership training program for medical students. Participation in the program was voluntary. The principal forum for this program was a dinner seminar series, which emphasized presentations by current community leaders and identification of leadership opportunities in which medical students could participate. PROGRAM EVALUATION: Information collected at the onset of the program identified the students' concern and priorities regarding leadership activities. Seventy-seven percent of participating students identified good communication skills as the most important quality of a leader. In identifying an issue in which physicians might become involved, students noted only medically related issues, such as access to health care. No long term evaluation data are available to assess the effect of this program. CONCLUSION: Medical school curricula should teach students the leadership skills they will need to participate in community activities.