Are you Mordechai Alperin?

Claim your profile

Publications (7)11.02 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: Immigrant physicians are a valued resource for physician workforces in many countries. Few studies have explored the education and training needs of immigrant physicians and ways to facilitate their integration into the health care system in which they work. Using an educational program developed for immigrant civilian physicians working in military primary care clinics at the Israel Defence Force, we illustrate how an outcome-based CME program can address practicing physicians' needs for military-specific primary care education and improve patient care. Following an extensive needs assessment, a 3-year curriculum was developed. The curriculum was delivered by a multidisciplinary educational team. Pre/post multiple-choice examinations, objective structured clinical examinations (OSCE), and end-of-program evaluations were administered for curriculum evaluation. To evaluate change in learners' performance, data from the 2003 (before-program) and 2006 (after-program) work-based assessments were retrieved retrospectively. Change in the performance of program participants was compared with that of immigrant physicians who did not participate in the program. Out of 28 learners, 23 (82%) completed the program. Learners did significantly better in the annual post-tests compared with the pretests (p <.01) and improved their OSCE scores (p <.001). Most program graduates (90%) rated overall satisfaction as very good or excellent. In comparison with nonparticipants, program graduates performed better on work-based assessments (Cohen's d =.63). Our intensive, outcome-based, longitudinal CME program has yielded encouraging results. Other medical educators, facing the challenge of integrating immigrant physicians to fit their health care system, may consider adapting our approach.
    Journal of Continuing Education in the Health Professions 12/2011; 31(1):34-42. · 1.32 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Clinicians often fail to adequately meet prostate cancer patients' information needs, and patients may receive different kinds of information from their doctors. This study aims to describe urologists' attitudes regarding information sharing with prostate cancer patients and to compare these findings with the previously published attitudes of Israeli family physicians. A questionnaire (11 items) was mailed to 87 board-certified practicing urologists. Fifty-four physicians (66%) completed the questionnaires. Sixty-one percent of respondents stated that patients should be told the complete truth about their disease. Ninety-six percent of respondents felt competent at breaking bad news and stated they would discuss emotions with patients. The majority of physicians would provide general information when referring for a medical procedure, discussing treatment options or a patient's prognosis. Fifty-seven percent of respondents preferred that patients be autonomous in their decision making. Only 26% of respondents believed that family physicians should communicate medical information to patients at the preliminary diagnostic stages. There was no significant difference in the attitudes expressed by urologists and family physicians towards the amount of information they would share with prostate cancer patients and in their preferences regarding treatment decision making. Urologists in Israel recognize the importance of sharing information with prostate cancer patients. Although urologists share similar attitudes with family physicians, they do not recognize the role that family physicians play in caring for prostate cancer patients. Further studies are needed to design and implement effective ways to improve the communication and collaboration between urologists and family physicians for the benefit of prostate cancer patients.
    Journal of Cancer Education 10/2010; 26(2):315-21. · 0.88 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: This study aimed to describe family physicians' perceptions regarding the concerns of men with prostate cancer as well as their beliefs and attitudes toward information sharing and decision making with prostate cancer patients throughout the course of their disease. A questionnaire (44 items) was mailed to 780 board-certified family physicians registered in the 2003 computerized database of Clalit Health Services, Israel's largest health maintenance organization. Three hundred eighty-two (50%) physicians completed the questionnaires. Overall, respondents believed that patients have substantial concerns throughout the cancer trajectory and that the most troubling issue is the fear of disease progression. There were no significant differences in the amount of information physicians were willing to share with patients throughout the course of the disease. Sixty-four percent of respondents stated that they would tailor the information to the patients' wishes and characteristics. Seventy percent felt competent at breaking bad news and 74% would discuss emotions with patients. Fifty-five percent of respondents preferred that patients be autonomous in their decision making. Family physicians in Israel are aware of patients' concerns and recognize the importance of sharing information with prostate cancer patients. Further studies are needed to examine the practice of these attitudes and to verify whether they are compatible with patients' expectations in the relevant cultural and ethnic context.
    Supportive Care Cancer 12/2007; 16(8):955-61. · 2.65 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: The review of international literature yielded unsatisfactory performance of guidelines for secondary prevention of cardiovascular diseases. This study aimed to evaluate records of the implementation of guidelines published in 1995, for the treatment and follow-up of patients after myocardial infarction in family medicine. In a retrospective sectional cohort study we identified all the patients with previous myocardial infarction in the practices of 6 family physicians, with an overall total of 97 patients. All data was gathered from manual medical records. The quality of care was evaluated according to follow-up indicators such as performance of blood pressure measurement, LDL cholesterol tests and according to secondary prevention indicators such as: treatment with aspirin, beta blockers and statins. In the cohort of 97 patients, 20.6% had diabetes, 53.6% had hypertension and 88.7% performed blood pressure follow-up, 100% cholesterol and fasting glucose tests, and 86.6% LDL cholesterol tests. Of the eligible patients, 98% received aspirin, 81% received beta-blockers and 76.2% were treated with statins. The target LDL cholesterol was not achieved by 66.7% of the patients. During the years 1993-1998 the quality of secondary prevention in the study was better than findings reported in international publications in corresponding years. However, the treatment of hypercholesterolemia should be improved.
    Harefuah 05/2006; 145(4):266-8, 319.
  • [Show abstract] [Hide abstract]
    ABSTRACT: We have previously described a breaking bad news (BBN) training program for primary care physicians [Ungar L, Alperin M, Amiel GE, Beharier Z, Reis S. Breaking bad news: structured training for family medicine residents. Patient Educ Couns 2002;48:63-68]. In this paper, we present the assessment of an educational intervention aimed at improving this important skill. The assessment tool was an eight station objective structured clinical examination (OSCE) utilizing standardized patients (SPs). Intervention and control groups of 17 general practitioners (GP) each were evaluated before and after an educational intervention, or a Balint group (control). Intervention group GPs significantly increased their average grade on the post-test as compared to the pre-test (58.5, S.D. 12.7 versus 68.4, S.D. 9.2), effect size 0.94. Improvement in the control group was minimal (pre-test 57, S.D. 10.4 versus 58.1, S.D. 9.5 for the post-test), effect size 0.23. Reliability of the OSCE was alpha = 0.81. The performance assessment used in this study proved to be a reliable and valid tool to assess the ability of physicians to break bad news. It provided evidence of the effectiveness of the intervention. BBN training can and should be evaluated by valid and reliable measures. SPs can serve as reliable evaluators of BBN training.
    Patient Education and Counseling 02/2006; 60(1):10-5. · 2.60 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Previous research has shown that physicians experience incompetence and difficulty in dealing with patients' feelings after they have broken bad news to them. During the past 10 years, we have implemented a longitudinal training program targeting these issues. The present article describes this training and discusses its contribution to doctors' skills at approaching distressed patients. In order to cope with breaking bad news to patients and their families, physicians should be skilled at crisis intervention and communication techniques. They should also be aware of their personal attitudes and emotional reactions when breaking bad news. Each session encompassed these areas, as well as the most prominent issues arising when breaking bad news. In a 1-5 Likert scale, the course received an overall score of 4.47 (S.D. 0.51). Participants noted that they had gained relevant communication skills for future patient encounters.
    Patient Education and Counseling 10/2002; 48(1):63-8. · 2.60 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Most of the published documents proposing teaching objectives for undergraduate clerkships were prepared by expert bodies. Seldom have the clinical teachers, who are critical to the learning process and to the implementation of the teaching objectives, been the actual proponents of its core content. To develop a national-scale proposal of teaching objectives for the family medicine clerkship in medical school, using a consensus method and the actual, community-based teachers as the expert body. The Delphi method was chosen for that purpose. In the first round all 189 family medicine teachers in Israeli medical schools were asked to propose five teaching objectives. In the second round the objectives, which were generated in the first round, were characterized by key words and were sent to the participants as a second round for ranking according to their importance. A total of 116 family medicine teachers (61.38%) responded in the first round and 91 of the 116 (78.5%) in the second round. They formulated 51 teaching objectives listed in order of importance, covering a wide array of themes and including knowledge, attitude and skills objectives. The most important objectives were common problems in primary care, recognition of the biopsychosocial model, and understanding the importance of the doctor-patient relationship. The structure of the list provides a unique insight into the relative importance of each objective in the context of the whole core content of the clerkship. Constructing a proposal for teaching objectives is feasible using the Delphi method and the field instructors as the selecting body. The process and its results can provide faculty with relevant and important suggestions on the content and structure of the family medicine clerkship.
    The Israel Medical Association journal: IMAJ 01/2002; 3(12):978-81. · 0.98 Impact Factor