Results of ALIVE: A Faith-Based Pilot Intervention to Improve Diet Among African American Church Members.

BACKGROUND: A key intervention to address Black-White health disparities in cardiovascular disease (CVD) is to improve diet quality, especially vegetable consumption, among African Americans. However, effective and sustainable interventions are lacking for this population. OBJECTIVE: Conduct a proof-of-concept study to measure the feasibility of implementing and rigorously assessing a novel, culturally tailored church-based intervention to improve vegetable consumption and total diet quality among African Americans. METHODS: The study was designed and implemented by a community-based participatory research (CBPR) partnership between researchers, pastors, and church leaders. The Abundant Living in Vibrant Energy (ALIVE) intervention included a Bible study and small group-based nutrition education delivered by pastors and church members in 24 two-hour sessions over 9 months as well as church-wide activities. Overall, 206 people enrolled across five African American churches. RESULTS: Participants attended 56% of sessions. The mean number of daily vegetable servings at baseline was 3.04; this increased by one serving at the 9-month follow-up (p < .001). Vegetable servings increased by more than one in 47% of participants. Total diet quality also increased (p < .01) and significant reductions were found in weight (-1.0 kg; p < .001), systolic blood pressure (-3.91 mm Hg; p = .002), and diastolic blood pressure (-2.18 mm Hg; p = .001). CONCLUSIONS: The ALIVE intervention was flexibly adapted by a range of churches; successfully implemented by pastors, deacons, and church leaders; and rigorously evaluated across a range of church settings. Further study of this intervention is warranted given the evidence for potential efficacy and a high level of external validity.

Chaplains and quality improvement: can we make our case by improving our care?

To date, the field of health care chaplaincy has little information about what constitutes "quality spiritual care. "A qualitative study of four focus groups in New York, Illinois, Arizona, and California was conducted to gather preliminary information about how health care chaplains' experience and understand "quality" and "quality improvement" in spiritual care. The study revealed that many chaplains feel a tension inherent in the task of measuring spiritual care services; how does one evaluate interactions that may seem ineffable? The study also enumerated chaplains' creative efforts, often shaped by institutional contexts and cultures, to address these difficulties in measuring spiritual services. To encourage local efforts to improve the quality of spiritual care and increase chaplains' contributions to improving health care quality, this article focuses on these context-specific projects and ideas. It also makes general recommendations aimed at promoting the development of promising practices for the field.

Learning to provide end-of-life care: postgraduate medical training programs in Michigan.

PURPOSE: A statewide survey of postgraduate medical training programs was conducted to determine the current status of training related to end-of-life (EOL) care and hospice care training. METHODS: A mail survey of 275 program directors was conducted with a response rate of 70%. The questionnaire focused on information about training in EOL care and hospice care: specific content, required and elective experiences, teaching formats, and program directors' ratings of the perceived adequacy of training. This study received Institutional Review Board (IRB) approval. RESULTS: Less than half (46%) of the residency programs reported any formal training in EOL care, and less than one third (31%) reported training in hospice care. A majority of programs with EOL and/or hospice training required it for all residents. Of the programs with required hospice training, only half included a clinical component; fewer programs with EOL training reported a clinical component. Most program directors rated their programs as adequate or excellent in terms of EOL and hospice care, whether they had formal training or not. CONCLUSIONS: The results of the survey demonstrate considerable variability in training with respect to hospice and EOL care. Training through direct clinical experience was infrequently reported. There has been little formal adoption of published curricula in this area. The high level of adequacy in the rating of training by program directors contrasts with relative lack of reported curriculum content and implementation, suggesting that improvements in EOL care training will be slow to come if left in the hands of program directors.

Ethics, professionalism, and humanities at Michigan State University College of Human Medicine.

This article describes the variety of approaches used at Michigan State University's College of Human Medicine for teaching ethics, professionalism, and humanities to undergraduate medical students: courses in ethics and health policy; mentoring programs; selectives in history, literature, and spirituality; structured patient care experiences; and discussions with students in their clinical years on the ethical and professional challenges confronting them in their clinical experiences. Some of these approaches, such as the structured patient-care experience, may be unique to Michigan State. The authors place special emphasis on discussing the challenges that confront this curriculum, including struggles to keep up with the pace of change in the health care system, preserving and highlighting the linkages between the "ethics" and the "professionalism" strands of the curriculum, making optimal use of Web technologies, successfully communicating to students the ultimately practical importance of the medical humanities other than ethics, and solving the problems of geography created by a widely dispersed community campus system.

Muddling through a merger: a qualitative study of two combined family practice residencies.

BACKGROUND AND OBJECTIVES: Mergers of residency training programs have become more common, but little has been published about their educational impact. Following our own merger, we sought to understand this process and its aftermath by conducting focus groups. METHODS: Three 1-hour focus groups were conducted-one with third-year residents, one with first- and second-year residents, and one with core faculty members. The interview script was based on a five-factor transitional model where each factor represented a potential fracture point that could result in organizational conflict. The five factors were curriculum, corporate culture, day-to-day operations, teaching environment, and financial resources. Focus group audiotapes were transcribed, and the investigators independently identified themes using an immersion and crystallization approach. Feedback from participants was obtained. RESULTS: Themes identified included unmet potential of the combined curriculum, a blending of two disparate cultures resulting in feelings of loss and displacement for some, and a sense of rapid policy change and lack of resident and faculty accountability. Faculty recommendations for other programs involved in mergers include creating frequent facilitated retreats, acknowledging loss, and establishing new rituals for the combined program. CONCLUSIONS: The transition through a merger of two residency programs is difficult and has direct educational and emotional impact. Such difficulties can, in part, be predicted, and improved communication and planning may facilitate this process.