A questionnaire to measure medical students' attitudes towards occupational medicine.

BACKGROUND: Occupational medicine is not well represented in medical curricula. Educational programmes should aim at raising the interest of medical students in occupational medicine. AIMS: To develop a questionnaire to measure the attitude of medical students towards occupational medicine. METHODS: We drew up statements about attitudes. We used a 5-point Likert scale to elicit answers from second-year medical students. We analysed the questionnaires with exploratory factor analysis to find common scales. After item reduction, we used the questionnaire in third-year medical students from another medical faculty, before and after education. RESULTS: Responses from 141 second-year and 208 third-year medical students were available. Analysis resulted in 18 statements in three scales: a career as an occupational physician, occupational medicine as an interesting speciality and role of the occupational physician. We measured modest changes following an occupational medicine programme. Further development of the questionnaire with qualitative research will lead to better usability. CONCLUSIONS: This questionnaire can be used to measure attitude towards occupational medicine; however, this questionnaire needs to be developed further.

Undergraduate teaching of occupational medicine in European schools of medicine.

PURPOSE: General practitioners play or should play a role in occupational medicine (OM), either in diagnosing occupational diseases or in counseling on return to work. Nevertheless, their training has been reported to be insufficient in most single country studies. AIMS: The objectives of this study were to analyze the content and extent of undergraduate teaching of OM in European medical schools. METHODS: An e-mail questionnaire survey of the teaching of OM to undergraduates was undertaken from December 2010 to April 2011 in all medical schools and medical faculties listed in 27 European countries (n = 305). RESULTS: Among the 305 universities identified, 135 answered to the questionnaire, giving a response rate of 44%. The mean number of hours given to formal instruction in occupational medicine to medical undergraduates was 25.5 h. Nevertheless, this number of hours varied widely between countries, but also within countries. Overall, 27% of medical schools gave their students 10 h of teaching or less, 52% 20 h or less and 69% 30 h or less. Whereas occupational diseases and principles of prevention were covered in most schools, disability and return to work were very poorly represented among the topics that were taught to students. CONCLUSION: Dedicated undergraduate teaching on occupational health or OM in European medical schools is present in most medical schools, usually at a low level, but is very variable between and within countries. Medical schools across Europe are very unequal to provide qualifying doctors education on the topics they will frequently come across in their working lives.

Case-based e-learning to improve the attitude of medical students towards occupational health, a randomised controlled trial.

OBJECTIVES: Undergraduate medical teaching in occupational health (OH) is a challenge in universities around the world. Case-based e-learning with an attractive clinical context could improve the attitude of medical students towards OH. The study question is whether case-based e-learning for medical students is more effective in improving knowledge, satisfaction and a positive attitude towards OH than non-case-based textbook learning. METHODS: Participants, 141 second year medical students, were randomised to either case-based e-learning or text-based learning. Outcome measures were knowledge, satisfaction and attitude towards OH, measured at baseline, directly after the intervention, after 1 week and at 3-month follow-up. RESULTS: Of the 141 participants, 130 (92%) completed the questionnaires at short-term follow-up and 41 (29%) at 3-month follow-up. At short-term follow-up, intervention and control groups did not show a significant difference in knowledge nor satisfaction but attitude towards OH was significantly more negative in the intervention group (F=4.041, p=0.047). At 3-month follow-up, there were no significant differences between intervention and control groups for knowledge, satisfaction and attitude. CONCLUSIONS: We found a significant decrease in favourable attitude during the internship in the experimental group compared with the control group. There were no significant differences in knowledge or satisfaction between case-based e-learning and text-based learning. The attitude towards OH should be further investigated as an outcome of educational programmes.

Placental urocortins and CRF in late gestation.

Placental corticotropin-releasing factor (CRF) are thought to induce labor via activation of CRF receptor type 1 (CRF-R1) leading to several feed forward mechanisms in the placental, fetal and maternal compartments. Recently, receptor type 2 (CRF-R2) selective ligands called urocortin 2 and 3 (Ucn 2, Ucn 3) were characterized as neuropeptides in the brain. We studied the expression of Ucn 1, 2 and 3 in feto-placental tissues qualitatively (by immunohistochemistry) and quantitatively (by radioimmunoassay) and compared these with expression of placental CRF. The presented placental Ucn 2 and 3 peptide quantification, characterization and ex-vivo release results are novel. Reversed-phase HPLC fractionation of placental extracts revealed several peaks containing immune-reactive (ir)-like Ucn 2 or 3, of which the main peaks had the same retention time as the synthetic Ucn 2 and 3 peptides. Placental tissues contained between 6 and 10 times more ir-CRF than ir-Ucn 1, 2 or 3. The placental Ucn 1, 2 and 3 peptide contents correlated with each other. Our immunohistochemical results showed that all urocortins were mainly localized in the syncytiotrophoblasts of the placental villi. Placental urocortins were actively released during ex-vivo perfusion of cotyledons. From these results it can be concluded that Ucn 2 and 3 peptides are present in placental and fetal membrane tissues, and released by ex-vivo perfused cotyledons. Therefore, placental urocortins may function as paracrine or endocrine messengers during pregnancy and parturition.

The effectiveness of an educational programme on occupational disease reporting.

BACKGROUND: Occupational diseases are under reported. Targeted education of occupational physicians (OPs) may improve their rate of reporting occupational diseases. AIM: To study the effectiveness of an active multifaceted workshop aimed at improving OPs' reporting of occupational diseases. METHODS: We undertook a comparative study with 112 OPs in the intervention group and 571 OPs as comparisons. The intervention was a 1-day workshop. Measurements of occupational disease reporting activity in both groups in 6-month periods before and after the intervention were collected via the national registration system. Measurements of OPs' knowledge, self-efficacy and satisfaction were made in the intervention group. Differences between the groups and predictive factors for reporting were subsequently analysed statistically. RESULTS: The percentage of reporting OPs after the intervention was significantly higher in the intervention group compared to the comparison group at 19 versus 11% (P < 0.01). No differences were found in the average number of reported occupational diseases per reporting physician after the intervention: 3.7 (SD 5.37) versus 3.4 (SD 4.56) (not significant). The self-efficacy score was a predictive factor for reporting occupational diseases (P < 0.05). Measurements of knowledge and self-efficacy increased significantly (both parameters P < 0.001) and remained after half a year. Satisfaction was high (7.85 of 10). CONCLUSIONS: An active, multifaceted workshop on occupational diseases is effective in increasing the number of physicians reporting occupational diseases. Self-efficacy measures are a predictive factor for such reporting.

Factors predictive of successful learning in postgraduate medical education.

PURPOSE: To establish which personal and contextual factors are predictive of successful outcomes in postgraduate medical education. METHOD: We performed a follow-up study of 118 doctors on a postgraduate occupational health training programme on the management of mental health problems. The following personal and contextual variables were measured as potential predictors of outcome: gender; age; years of experience as a doctor; university of graduation; learning style (Kolb); present employer (occupational health service), and educational format (problem-based or lecture-based). The main outcome measures were: scores on knowledge tests consisting of true/false and open answer questions, and performance in practice based on self-report and performance indicators. To determine the effect of potential predictive factors univariate analyses of variance and repeated measurement analysis of variance was applied. RESULTS: The mean scores of knowledge (P < 0.001) and performance (P = 0.001) of the participants increased after the educational programme. After multivariate analysis female gender was positively related to accruements in both knowledge and performance (both P < 0.05), independently of the influence of other factors. Accommodator learning style showed a relation with knowledge increase (P = 0.05), but had no influence on performance (P = 0.79). The problem-based educational format yielded a better performance outcome (P = 0.05), but had no influence on knowledge tests (P = 0.31). CONCLUSION: Gender and learning style were found to be related to an increase in knowledge. Gender was also found to be related to improvement in performance after a postgraduate medical education programme. We found no interactions with course design (i.e. problem-based or non problem-based learning formats), but further research could reveal other cues, suggesting practical consequences of student characteristics for course design in postgraduate training.

Problem based learning in continuing medical education: a review of controlled evaluation studies.

Reviews of undergraduate medical education cautiously support the short term and long term outcomes of problem based learning compared with traditional learning. The effectiveness of problem based learning in continuing medical education, however, has not been reviewed. This review of controlled evaluation studies found limited evidence that problem based learning in continuing medical education increased participants' knowledge and performance and patients' health. There was moderate evidence that doctors are more satisfied with problem based learning.

Evaluation of a postgraduate educational programme for occupational physicians on work rehabilitation guidelines for patients with low back pain.

OBJECTIVES: The postgraduate educational programme for occupational physicians on guidelines for work rehabilitation of patients with low back pain was evaluated as to what extent did knowledge of the guidelines increase, and did the workers improve their performance at work. METHODS: An experimental group (n=25) attended an educational programme and a reference group did so (n=20) 6 months later. Knowledge and performance were assessed for both groups, before and after education of the experimental group. Knowledge was assessed for the reference group after education. RESULTS: Knowledge increased significantly more in the experimental group. The reference group's score increased further after education. The experimental group's adjusted gain score for performance indicators was significantly positive. Analysis of covariance also showed a significant effect for the experimental group for increased performance score. CONCLUSIONS: The educational programme improved the quality of care because knowledge and performance of occupational physicians improved and complied better with practice guidelines.