Incorporating a Whole-Person Perspective in Consumer-Generated Data: Social Determinants, Resilience, and Hidden Patterns.

Given the complex health and social needs of older adults, the rapid growth of the aging population, and the increasing use of information technology in healthcare, there is a critical need for informatics solutions that advance gerontological nursing care and knowledge discovery. This article illustrates the value of standardized data for healthcare quality improvement throughout the life cycle of data capture and reuse. One such informatics solution is the MyStrengths+MyHealth app, which incorporates a whole-person perspective through the Simplified Omaha System Terms assessment, including the social and behavioral determinants of health, as well as resilience. The data describe whole-person health of older adults from MyStrengths+MyHealth for use in clinical encounters and as raw data for research. There is potential to use such standardized data to improve gerontological nursing care at the bedside and for population health management and research.

Results of a Preceptor Improvement Project.

BACKGROUND AND OBJECTIVES: The majority of medical students receive some of their training with a community preceptor. Nearly all of these preceptors are motivated by a desire to give back to their profession through teaching and they want to learn how to teach more effectively. Designing effective educational programs to improve preceptor teaching is important to upholding the quality of medical education. METHODS: We designed an educational program consisting of readings, short videos, handouts and posters, as well as one-on-one sessions with a trained standardized medical student. The standardized student visited the community physician's office both before and after the preceptor engaged with the educational materials related to a subject area of the preceptor's choosing. We assessed the preceptor's teaching using three tools: self-evaluation, student reporting of observed behaviors, and an overall rating of teaching effectiveness. RESULTS: Thirteen preceptors took part in this the educational intervention. Per the self-assessment, preceptors showed improved teaching competency for all items on the questionnaire, with 12 of the 21 items (57%) showing statistically significant results (P<.05). The standardized student reported that preceptors used more of eight desired teaching behaviors in the second mock preceptor encounter than they used in the first, with a mean increase of 1.46 (P=.001). Overall teaching effectiveness scores increased, with a mean increase of 1.15 (P=.001) on the 10-point scale. Moreover, all participants indicated they were either satisfied or highly satisfied with the program and that they would recommend this program to a colleague. CONCLUSIONS: Our preceptor-improvement intervention led to demonstrable improvement in preceptor teaching, as measured by preceptor evaluation and evaluation by the standardized student. More research is needed to see if these results can be replicated and, in particular, to determine which aspects of the intervention were most useful.

Teaching Competencies for Community Preceptors.

BACKGROUND AND OBJECTIVES: Although community physicians provide one-fourth of the outpatient training received in medical school, usually there is no formal training of the preceptor. Currently there is no agreed-upon list of teaching competencies for community physician-preceptors. Using a modified Delphi process, the authors aimed to identify core teaching competencies for community preceptors for use in training and evaluation. METHODS: A medical educator and three faculty members with expertise in faculty development created a list of teaching competencies organized in five domains. These competencies were finalized through a multiround modified Delphi technique with key stakeholder groups including (1) nonphysician medical educators, (2) academic physicians involved in faculty development, (3) community physicians who regularly precept medical students, (4) family medicine residents, (5) third-year medical students in a 9-month-long longitudinal clerkship. Proposed competencies were retained if 70% of the participants ranked it as "very or extremely important." RESULTS: In the first round, 24 competencies were evaluated by 40 physician preceptors participating in a rural faculty development conference. These were refined, and four additional competencies were added by the cohort. Subsequent rounds utilized a survey approach with broader audiences resulting in a final list of 21 competencies in five domains. CONCLUSIONS: Five competency domains with 21 teaching competencies can now be used to guide community preceptors' training and evaluation.

Heart failure treatment: Keeping up with best practices.

This article briefly reviews the diagnosis and initial evaluation of the patient with suspected heart failure and then describes how newer treatments fit within heart failure management priorities and strategies.

Precepting Medical Students in the Patient's Presence: An Educational Randomized Trial in Family Medicine Clinic.

BACKGROUND AND OBJECTIVES: Many medical student-patient encounters occur in the outpatient setting. Conference room staffing (CRS) of student presentations has been the norm in the United States in recent decades. However, this method may not be suitable for outpatient precepting, being inefficient and reducing valuable direct face time between physician and patient. Precepting in the Presence of the Patient (PIPP) has previously been found to be an effective educational model in the outpatient setting but has never been studied in family medicine clinics, nor with non-English speaking patients, nor patients from lower socioeconomic backgrounds with low literacy. METHODS: We used a randomized controlled trial of educational models comparing time spent using PIPP with CRS in two family medicine clinics. Patient, student, and physician satisfaction were also measured using a 5-point Likert scale; total encounter time and time spent precepting were also recorded. RESULTS: PIPP is strongly preferred by attending physicians while patients and students were equally satisfied with either precepting method. PIPP provides an additional 3 minutes of physician-patient face time (17.39 versus 14.08 minutes) in an encounter that is overall shortened by 2 minutes (17.39 versus 19.71 minutes). CONCLUSIONS: PIPP is an effective method for precepting medical students in family medicine clinics, even with non-English speaking patients and those with low literacy. Given the time constraints of family physicians, PIPP should be considered as a preferred, time-efficient method for training medical students that is well received by patients, students, and particularly by physicians.

Validation of a brief mental health screener for Karen refugees in primary care.

BACKGROUND: Karen refugees from Burma are one of the largest refugee groups currently resettling in the USA. Karen people have endured decades of civil war and human rights violations, leaving them more likely to develop serious mental health disorders. There is a noted lack of brief, culturally validated tools present in primary care settings for detecting posttraumatic stress disorder (PTSD) and major depressive disorder (MDD) in Karen refugees. OBJECTIVE: To create the Karen Mental Health Screener, a five-question screening tool used to identify depression and PTSD and to validate it against a clinical reference standard. METHODS: This validation study was conducted during a primary care visit. Participants completed a 20-item questionnaire using a 4-point visual aid and the PTSD and MDD portions of the Structured Clinical Interview for DSM Disorders (SCID-CV for DSM-IV) as the reference standard. Both the questionnaire and the relevant sections of the SCID-IV were rigorously translated and administered by trained researchers along with a trained Karen interpreter. RESULTS: Logistic regression models and receiver operating characteristic curve analyses were used to determine a subset of items that could be used to construct a screener to identify Karen patients who were most likely to have PTSD and/or MDD. A final five-question screener was created with very strong performance characteristics. With a clinical cut score of 4, these items displayed very strong performance characteristics with sensitivity = 0.96, specificity = 0.97, positive predicted value = 0.83 and negative predicted value = 0.99. CONCLUSION: The Karen Mental Health Screener is a valid measure for detecting PTSD and major depression in Karen people from refugee backgrounds presenting in a primary care setting.