Evaluation of an evidence-based medicine educational intervention in a regional medical campus.

BACKGROUND: Enhanced educational activities were developed by a regional medical campus (RMC) in order to incorporate evidence-based medicine (EBM) practice in the learning process of medical students. This study aimed to measure the effectiveness of these activities. METHODS: The experimental group was made up of third-year students from the RMC. The comparison group included students from the main campus of the medical school and another of its RMCs. The experimental group received additional training on EBM: one additional hour in class, plus skills development exercises throughout the semester. During the regular academic sessions, clinical questions requiring EBM literature searching skills were incorporated in the curriculum. Tests on knowledge and self-assessment of competencies were administered to all participants at the beginning and at the end of the semester. Data were analyzed using repeated measures analysis of variance and post hoc tests for within and between groups comparison. RESULTS: The Friedman test demonstrated a statistically significant effect of the intervention on knowledge (p <0.0001). The score of the knowledge test was significantly higher for the experimental group, when compared with baseline testing and with the comparison group (p <0.0001). Repeated measures analysis of variance demonstrated a statistically significant effect of the intervention on the score of the self-assessment of competencies (p=0.032). The score for the self-assessment of competencies was significantly higher for the experimental group when compared to baseline score (p <0.0001), but not with respect to the comparison group. CONCLUSION: Our study demonstrated the effectiveness of additional training and longitudinal integrated skills development leading to an increase in medical student knowledge and self-perception of competencies in EBM practice.

Physician perceptions of recruitment and retention factors in an area with a regional medical campus.

BACKGROUND: The factors that influence physicians to establish and maintain their practice in a region are variable. The presence of a regional medical campus (RMC) could influence physicians' choice. The objective of this study was to explore the factors influencing physician recruitment and retention, and in particular the role of a RMC, in a region of Quebec. METHODS: A literature review of factors influencing physicians to stay in a rural area was conducted in order to create an interview guide. Questions were divided into sections: general information, family situation, medical training, career choice, current practice, intent to stay in the region, and impact of the RMC. Thirteen semi-structured individual interviews were conducted with practicing physicians. Data were analyzed using QDAMiner. RESULTS: Recruitment factors were divided into six major themes: type of practice, spousal interest, opportunity for teaching, training in a region, workforce planning, and quality of life. Participants identified positive and negative factors associated with retention. In both cases, family and quality of work environment were mentioned. The RMC was perceived as having important impacts on the quality of professional life, research, medical practice, and regional development. CONCLUSION: This study highlights the role of RMCs in physician recruitment and retention via multiple impacts on the quality of practice of physicians working in the same area.

CONTEXTE: Les facteurs influençant les médecins à s'établir et à rester dans une région sont variables. La présence d'un campus médical régional (CMR) pourrait influencer ce choix. L'objectif de cette étude était d'explorer les facteurs de recrutement et de rétention influençant les médecins ayant choisi de pratiquer dans la région du Saguenay-Lac-Saint-Jean au Québec, en particulier le rôle du CMR. MÉTHODES: Une synthèse de la littérature a permis d'identifier différents facteurs influençant les médecins dans leur choix de lieu de pratique. Un guide d'entrevue a été élaboré à partir de ces facteurs. Les questions étaient séparées selon les sections suivantes: informations générales, situation familiale, études médicales, choix de carrière, pratique actuelle, intention de rester dans la région, impact du CMR. Treize entrevues semi-dirigées individuelles ont été réalisées avec des médecins en pratique. Les données ont été analysées avec QDA Miner. RÉSULTATS: Les facteurs influençant le recrutement étaient séparés en six thèmes majeurs : type de pratique, intérêt du conjoint, opportunité d'enseigner, formation en région, planification gouvernementale des effectifs médicaux et qualité de vie. Les participants ont identifié des facteurs de rétention négatifs et positifs. Ceux-ci concernaient la famille et la qualité de l'environnement de travail. D'après les participants, le CMR avait un impact direct sur la qualité de la vie professionnelle, la recherche, la pratique médicale et le développement régional. CONCLUSION: Cette étude a permis de mettre en évidence le rôle des CMRs dans le recrutement et la rétention via de multiples impacts sur la qualité de pratique des médecins exerçant dans la même région.

Pain perception in schizophrenia: evidence of a specific pain response profile.

OBJECTIVE: Ever since the characterization of schizophrenia, clinicians have noted abnormal pain sensitivity in their patients. The published literature, however, is inconsistent concerning the nature of the change reported. The objective of this study was to characterize the pain response profile of schizophrenic patients by providing both acute and prolonged (i.e., rapidly repeating) painful stimuli to schizophrenic participants and control subjects. PARTICIPANTS: Twelve schizophrenic subjects and eleven controls were included in the final analysis. Diagnosis was made according to Diagnostic and Statistical Manual of mental disorders-4th edition, text revision (DSM-IV-TR) criteria. METHODS: Intermittent, transcutaneous stimulations of the left sural nerve were administered to all participants. Painful sural nerve stimulations provoked a nociceptive flexion reflex response which was measured using an electromyographic recording of the bicep femoris muscle. Pain ratings were obtained using a 0-10 verbal numerical scale. Among schizophrenic participants, the relationship between subjective pain, reflex amplitude, and clinical features was investigated. The Positive and Negative Syndrome Scale, Calgary Depression Scale for Schizophrenia, and Subjective Scale to Investigate Cognition in Schizophrenia were used to evaluate clinical features. RESULTS: Compared with controls, schizophrenic subjects showed increased sensitivity to acute pain (i.e., lower pain thresholds; P = 0.019), but decreased subjective pain sensitization (P = 0.027). Group differences in subjective pain sensitization were not accompanied by group differences in nociceptive reflex activity (P = 0.260), suggesting supraspinal origins to the change in pain experienced by schizophrenic subjects. Moreover, positive symptoms correlated negatively with pain threshold values among schizophrenic participants (r = -0.696, P = 0.012), suggesting that distortions of thought and function relate to pain sensitivity in schizophrenic patients. CONCLUSION: Results indicate that schizophrenic subjects present a specific experimental pain response profile, characterized by elevated sensitivity to acute pain but reduced sensitivity to prolonged pain.

Efficacy of cognitive therapy for depression among women with metastatic cancer: a single-case experimental study.

Although depression is frequent among patients with advanced cancer, very few studies have been conducted on its treatment. The objective of this study was to evaluate the efficacy of cognitive therapy for depression in women with metastatic cancer, using a multiple baseline experimental design. Six participants were enrolled in the study and were asked to complete daily and weekly mood assessments. Intervention time-series analyses conducted on daily mood data showed statistically significant improvement of depression symptoms, more importantly anhedonia, and associated features (i.e., anxiety, fatigue) for each participant. These improvements were also found to be clinically significant at post-treatment.