Analysis of the chief complaints of older patients seeking chiropractic care at a teaching clinic and potential implications for clinical education.

OBJECTIVE:: To describe the chief complaints of people older than 65 years who seek chiropractic care at a chiropractic teaching clinic and assess the case mix available at the clinic. METHODS:: One hundred patient files were included in this study. Patient files were included if the patient was older than 65 years when he or she initiated care at the teaching clinic. Data on age, sex, and chief complaints were recorded. RESULTS:: Of the patients included in this study, 55% were female. The mean age of patients was 69.5 years, with an age range of 65-88 years. The most common chief complaint was low back pain, with 45% of patients reporting this as their chief complaint. The second most prevalent complaint was neck pain, followed by patients seeking care with no presenting complaints (14%) and patients with extremity complaints (8%). Groin pain, hip pain, balance problems, headaches, and visceral complaints were also reported. CONCLUSION:: The most common reasons that older patients presented for chiropractic care were for back and neck pain. The case mix was considered similar to practices in the country.

Differences in learning retention when teaching a manual motor skill with a visual vs written instructional aide.

OBJECTIVE:: This study aimed to determine if a written or visual teaching aid influenced learning retention when teaching a manual motor skill. METHODS:: Seventy chiropractic students who had completed an upper cervical specific chiropractic technique course were evaluated for technique-specific recall before and after a review using either a visual teaching aid or a written guide. Two randomized groups reviewed original course-written guides ( n = 33) or new visual teaching aids ( n = 37). Repeated-measures analysis of variance and post hoc t tests compared group differences in reevaluation scores. RESULTS:: Performance of both groups improved postintervention ( F[1, 68] = 182.56, p < .001). However, the visual teaching aid group improved more than the written guide group ( F[1, 68] = 4.66, p = .03). The visual teaching aid group percentage score improved by 24.4% (SD ± 12.3%, p < .01); the written guide group improved by 17.7% (SD ± 13.7%; p < .01). CONCLUSION:: The mean learning retention improved in both the visual and the written teaching guide groups, but there was greater improvement in the visual aid group. This study suggests that visual teaching aids may be more useful than written guides when students attempt to recall information related to learning a manual motor skill.

Teaching undergraduate students in rural general practice: an evaluation of a new rural campus in England.

INTRODUCTION: One approach to facilitating student interactions with patient pathways at Keele University School of Medicine, England, is the placement of medical students for 25% of their clinical placement time in general practices. The largest component is a 15-week 'student attachment' in primary care during the final year, which required the development of a new network of teaching practices in a rural district of England about 90 km (60 mi) from the main campus in North Staffordshire. The new accommodation and education hub was established in 2011-2012 to enable students to become immersed in those communities and learn about medical practice within a rural and remote context. Objectives were to evaluate the rural teaching from the perspectives of four groups: patients, general practice tutors, community hospital staff and students. Learning outcomes (as measured by objective structured clinical examinations) of students learning in rural practices in the final year were compared with those in other practices. METHODS: Data were gathered from a variety of sources. Students' scores in cohort-wide clinical assessment were compared with those in other locations. Semi-structured interviews were conducted with general practice tutors and community hospital staff. Serial focus groups explored the perceptions of the students, and questionnaires were used to gather the views of patients. RESULTS: Patients reported positive experiences of students in their consultations, with 97% expressing willingness to see students. The majority of patients considered that teaching in general practice was a good thing. They also expressed altruistic ideas about facilitating learning. The tutors were enthusiastic and perceived that teaching had positive impacts on their practices despite negative effects on their workload. The community hospital staff welcomed students and expressed altruistic ideas about helping them learn. There was no significant difference between the rurally placed students' objective structured clinical examination performance and that of their peers in other locations. Some students had difficulty with the isolation from peers and academic activities, and travel was a problem despite their accommodation close to the practices. CONCLUSIONS: Students valued the learning opportunities offered by the rural practice placements. The general practice tutors, patients and community hospital staff found teaching to be a positive experience overall and perceived a value to the health system and broader community in students learning locally for substantial periods of time. The evaluation has identified some student concerns about transport times and costs, social isolation, and access to resources and administrative tasks, and these are being addressed.