Background: Some researchers think that patients with higher expectations for CAM therapies experience better outcomes and that enthusiastic providers can enhance treatment outcomes. This is in contrast to evidence suggesting conventional medical providers often reorient patient expectations to better match what providers believe to be realistic. However, there is a paucity of research on CAM providers' views of their patients' expectations regarding CAM therapy and the role of these expectations in patient outcomes.
Methods: To better
understand how CAM providers view and respond to their patients' expectations
of a particular therapy, we conducted 32 semi-structured, qualitative
interviews with acupuncturists, chiropractors, massage therapists and yoga
instructors identified through convenience sampling. Interviews were recorded,
transcribed and analyzed thematically using Atlas ti version 6.1.
Results: CAM
providers reported that they attempt to ensure that their patients'
expectations are realistic. Providers indicated they manage their patients'
expectations in a number of domains--- roles and responsibilities of providers
and patients, treatment outcomes, timeframe for improvement, and treatment
experience. Providers reported that patients' expectations change over time and
that they need to continually manage these expectations to enhance patient
engagement and satisfaction with treatment.
Conclusions:
Providers of
four types of CAM therapies viewed patients' expectations as an important
component of their experiences with CAM therapy and indicated that they try to
align patient expectations with reality. These findings suggest that CAM
providers are similar in this respect to conventional medical providers.
Byszewski A,
Hendelman W, Mcguinty C, Moineua G. Wanted: role models - medical students'
perceptions of professionalism. BMC Med Educ 2012, 12:115 doi:10.1186/1472-6920-12-115
ABSTRACT
Background:
Transformation
of medical students to become medical professionals is a core competency
required for physicians in the 21st century. Role modeling was traditionally
the key method of transmitting this skill. Medical schools are developing
medial curricula which are explicit in ensuring students develop the
professional competency and understand the values and attributes of this
role.The purpose of this study was to determine student perception of
Professionalism at the University of Ottawa and gain insights for improvement
in promotion of professionalism in undergraduate medical education.
Methods: Survey on
student perception of professionalism in general, the curriculum and learning
environment at the University of Ottawa, and the perception of student behaviors,
was developed by faculty and students and sent electronically to all University
of Ottawa medical students. The survey included both quantitative items
including an adapted Pritzker list and qualitative responses to eight open
ended questions on professionalism at the University of Ottawa. All analyses
were performed using SAS version 9.1 (SAS Institute Inc. Cary, NC, USA).
Chi-square and Fischer's exact test (for cell count less than 5) were used to
derive p-values for categorical variables by level of student learning.
Results: Response
rate was 45.6% (255 of 559 students) for all four years of the curriculum. 63%
of the responses were from students in years 1 and 2 (pre-clerkship). Students
identified role modeling as the single most important aspect of
professionalism. The strongest curricular recommendations included faculty-led
case scenario sessions, enhancing inter-professional interactions and the
creation of special awards to staff and students to "celebrate"
professionalism. Current evaluation systems were considered least effective.
The importance of role modeling and information how to report lapses and
breaches was highlighted in the answers to the open ended questions.
Conclusions:
Students
identify the need for strong positive role models in their learning
environment, and for effective evaluation of the professionalism of students
and teachers. Medical school leaders must facilitate development of these
components within the MD education and faculty development programs as well as
in clinical milieus where student learning occurs.
Davis MA, Mackenzie
TA, Coulter ID, Whedon JM, Weeks WB. The United States Chiropractic Workforce:
An alternative or complement to primary care? Chiropr
Man Ther 2012, 20:35 doi:10.1186/2045-709X-20-35
ABSTRACT
Background:
In the
United States (US) a shortage of primary care physicians has become evident.
Other health care providers such as chiropractors might help address some of
the nation's primary care needs simply by being located in areas of lesser
primary care resources. Therefore, the purpose of this study was to examine the
distribution of the chiropractic workforce across the country and compare it to
that of primary care physicians.
Methods: We used
nationally representative data to estimate the per 100,000 capita supply of
chiropractors and primary care physicians according to the 306 predefined
Hospital Referral Regions. Multiple variable Poisson regression was used to
examine the influence of population characteristics on the supply of both practitioner-types.
Results: According to
these data, there are 74,623 US chiropractors and the per capita supply of
chiropractors varies more than 10-fold across the nation. Chiropractors
practice in areas with greater supply of primary care physicians (Pearson's
correlation 0.17, p-value < 0.001) and appear to be more responsive to
market conditions (i.e. more heavily influenced by population characteristics)
in regards to practice location than primary care physicians.
Conclusion:
These
findings suggest that chiropractors practice in areas of greater primary care
physician supply. Therefore chiropractors may be functioning in more
complementary roles to primary care as opposed to an alternative point of
access.
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