Use of learning contracts in an office-based primary care clerkship.

OBJECTIVES: This paper describes implementation of the learner-centred learning goal within the primary care clerkship at a Midwestern, United States medical school. DESIGN: The learner-centred learning goal exercise was developed to tailor students' educational activities to their personal level of development and to enhance their commitment to life-long learning in medicine. In the learner-centred learning goal exercise, each student records three specific learning goals early in the primary care clerkship. Students record the methods by which they will pursue and document achievement of each goal. Attainment of the learner-centred learning goal is evaluated based on an oral presentation at the end of the clerkship. We compiled presented learning goals along with the corresponding grade. Students' ratings of the learner-centred learning goal exercise were also compiled. Evaluations and ratings were made on a 1-5 Likert scale, where 1 is the best rating and 5 is worst. SETTING: Department of Medicine, Northwestern University Medical School, Chicago, USA. SUBJECTS: One hundred and seventy-seven third- and fourth-year medical students who presented learner-centred learning goals between 1 July 1995 and 30 June 1996. RESULTS: Students rated pursuing their individual learning goals more worthwhile than most clerkship lectures but less worthwhile than the office experience. Several learning goals were chosen by a disproportionate number of students, potentially indicative of some perceived deficiencies elsewhere in the curriculum. Third-year students ranked the learner-centred learning goal exercise more favourably than fourth-year students (2.14 vs. 2. 51, P = 0.03). CONCLUSIONS: The learner-centred learning goal exercise is a feasible and well-received method within our primary care clerkship. Further study is required to determine whether the exercise promotes independent learning after formal medical school education is completed.

Assessing functional status of elderly adults via microcomputer.

Geriatric adults (at least 65 years of age) completed the Functional Status Questionnaire twice, first using the original paper-and-pencil format and again using one of six computer-based interactive methods. Scoring via original and computer-based methods was identical. Satisfaction with computers was high. Of the interactive methods, touchscreen required least training and questionnaire completion time and was rated most useful.

Cross-sectional psychometric assessment of the Functional Status Questionnaire: use with geriatric versus nongeriatric ambulatory medical patients.

OBJECTIVE: The Beth Israel/UCLA Functional Status Questionnaire (FSQ) is a multidimensional self-report instrument used for assessing the physical, social, and psychological status of children and adults. This study assessed the appropriateness of the FSQ for use with geriatric (at least 65 years of age) ambulatory medical patients. METHOD: Concurrent cohort convenience samples of forty geriatric and eighty-five nongeriatric ambulatory patients were drawn from a general internal medicine clinic. Patients completed the FSQ while waiting to see their physician. Analyses were conducted in order to: 1) address the magnitude and pattern of missing responses that are generated when the FSQ is administered to small groups; 2) assess whether, as was intended, each of the different FSQ subscales is unidimensional; 3) evaluate the magnitude and pattern of variances and covariances of items constituting FSQ subscales; 4) compare profiles of FSQ scores between geriatric versus nongeriatric samples; and 5) investigate whether FSQ subscales correlate with different self-report outcome measures in a convergent or divergent manner. RESULTS: For both samples, FSQ subscales were internally consistent and moderately variable. Cross-sectional comparisons revealed both convergent and divergent relationships between FSQ subscales and measures of social support and satisfaction with health. CONCLUSIONS: The FSQ appears to be appropriate for use with geriatric ambulatory medical patients. Findings highlighted the positive influence of intermediate activities of daily life--involving moderate levels of physical activity--on satisfaction with health, and the negative effect of depression on physical activity.