Monday, June 4, 2012

Three New Papers from Biomed Central

Sullivan PB, Buckle A, Nicky G, Atkinson SH. Peer observation of teaching as a faculty development tool. BMC Medical Education 2012, 12:26 doi:10.1186/1472-6920-12-26


Background: Peer observation of Teaching involves observers providing descriptive feedback to their peers on learning and teaching practice as a means to improve quality of teaching. This study employed and assessed peer observation as a constructive, developmental process for members of a Pediatric Teaching Faculty.

Methods:  This study describes how peer observation was implemented as part of a teaching faculty development program and how it was perceived by teachers. The PoT process was divided into 4 stages: pre-observation meeting, observation, post-observation feedback and reflection. Particular care was taken to ensure that teachers understood that the observation and feedback was a developmental and not an evaluative process. Twenty teachers had their teaching peer observed by trained Faculty members and gave an e-mail 'sound-bite' of their perceptions of the process. Teaching activities included lectures, problem-based learning, small group teaching, case-based teaching and ward-based teaching sessions.

Results: Teachers were given detailed verbal and written feedback based on the observer's and students' observations. Teachers' perceptions were that PoT was useful and relevant to their teaching practice. Teachers valued receiving feedback and viewed PoT as an opportunity for insight and reflection. The process of PoT was viewed as non-threatening and teachers thought that PoT enhanced the quality of their teaching, promoted professional development and was critical for Faculty development.

Conclusions: This study demonstrated that PoT can be used in a constructive way to improve course content and delivery, to support and encourage medical teachers, and to reinforce good teaching.


Guedert JM, Grosseman S. Ethical problems in pediatrics: what does the setting of care and education show us? BMC Medical Ethics 2012, 13:2 doi:10.1186/1472-6939-13-2


Background: Pediatrics ethics education should enhance medical students' skills to deal with ethical problems that may arise in the different settings of care. This study aimed to analyze the ethical problems experienced by physicians who have medical education and pediatric care responsibilities, and if those problems are associated to their workplace, medical specialty and area of clinical practice.

Methods: A self-applied semi-structured questionnaire was answered by 88 physicians with teaching and pediatric care responsibilities. Content analysis was performed to analyze the qualitative data. Poisson regression was used to explore the association of the categories of ethical problems reported with workplace and professional specialty and activity.

Results: 210 ethical problems were reported, grouped into five areas: physician-patient relationship, end-of-life care, health professional conducts, socioeconomic issues and health policies, and pediatric teaching. Doctors who worked in hospitals as well as general and subspecialist pediatricians reported fewer ethical problems related to socioeconomic issues and health policies than those who worked in Basic Health Units and who were family doctors.

Conclusions: Some ethical problems are specific to certain settings: those related to end-of-life care are more frequent in the hospital settings and those associated with socioeconomic issues and public health policies are more frequent in Basic Health Units. Other problems are present in all the setting of pediatric care and learning and include ethical problems related to physician-patient relationship, health professional conducts and the pediatric education process. These findings should be taken into consideration when planning the teaching of ethics in pediatrics.

Taylor JAM, Bussières A. Diagnostic imaging for spinal disorders in the elderly: a narrative review. Chiropractic & Manual Therapies 2012, 20:16 doi:10.1186/2045-709X-20-16
The high prevalence of neck and low back pain in the rapidly aging population is associated with significant increases in health care expenditure. While spinal imaging can be useful to identify less common causes of neck and back pain, overuse and misuse of imaging services has been widely reported. This narrative review aims to provide primary care providers with an overview of available imaging studies with associated potential benefits, adverse effects, and costs for the evaluation of neck and back pain disorders in the elderly population. While the prevalence of arthritis and degenerative disk disease increase with age, fracture, infection, and tumor remain uncommon. Prevalence of other conditions such as spinal stenosis and abdominal aortic aneurysms (AAA) also increase with age and demand special considerations. Radiography of the lumbar spine is not recommended for the management of non-specific low back pain in adults under the age of 65. Aside from conventional radiography for suspected fracture or arthritis, computed tomography (CT) and magnetic resonance imaging (MRI) offer better characterization of most musculoskeletal diseases. If available, MRI is usually preferred over CT because it involves less radiation exposure and has better soft-tissue visualization. Use of subspecialty radiologists to interpret advanced imaging is recommended.

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