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Publications (3)6.11 Total impact

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    ABSTRACT: Clinical instruction for medical students traditionally occurs in hospitals and offices, whereas patients and families face many health issues in their homes. This is particularly true for frail older adults, those with chronic illness, and patients at the end of life. The authors sought to incorporate geriatrics, primary care, and palliative care into house calls for medical students by integrating a home visit experience into their ambulatory clerkship. Using a guide jointly developed by geriatrics, primary care, and palliative care faculty, students conduct three home visits with a patient from their community preceptor's practice. The first visit focused on medical diagnoses and symptoms, the second on functional assessment/geriatric syndromes, and the third on social/cultural and end-of-life values. Students completed a 2,000-word write-up, including a narrative using the "voice" of the patient. Students presented the cases in small groups facilitated by geriatric and palliative care faculty. Eighty-three percent of students reported positive feedback about the experience. Based on write-ups and program evaluation, students voiced improved knowledge of functional assessment, geriatric syndromes, and progression of chronic illness. Students also poignantly expressed advantages of home visits in exploring psychosocial aspects of medicine, including affirming the humanity of medicine, understanding family systems, providing patient-centered care, and understanding patient beliefs. Several students expressed pursuing a house calls career. A longitudinal home visit experience for medical students can successfully enhance the geriatric, ambulatory care, and palliative care curricular content of undergraduate education and positively affect student's attitudes toward the chronically ill and homebound.
    Journal of the American Geriatrics Society 03/2005; 53(2):336-42. · 4.22 Impact Factor
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    ABSTRACT: Purpose – To provide a rationale regarding the importance of physician behavior change counseling. To describe the double helix behavior change curriculum at the University of Rochester (UR). To provide initial evidence that the curriculum is effective. Design/methodology/approach – Evidence that physician use of the 5A's model is effective in changing important patient health behaviors is summarized. The behavior change curriculum is described. Initial evidence assessing knowledge, attitudes and skills for behavior change counseling is reviewed. Findings – Physicians will be better prepared to intervene to improve their patients quality and quantity of life if they consistently counsel patients using a brief standard model (the 5A's) that integrates biological, psychological, and social aspects of disease and treatment. Past efforts in the UR's curriculum have demonstrated that students adopt broader “biopsychosocial values” when the curriculum supports their learning needs. Initial evidence demonstrates that double helix curriculum students learn this model well and are able to provide the counseling in a patient-centered style. Research limitations/implications – These results are limited by the observational design, and the reliance on student self-reports and standardized patient observations of student behavior rather than change in patient behavior. Practical implications – Strong evidence exists that physicians can be effective in providing behavior change counseling. Additional research is called for to create, implement, and fully evaluate behavior change counseling curricula for medical students. Originality/value – An example of a behavior change curriculum is provided for medical educators, and initial evidence of its effectiveness is provided.
    Health Education 01/2005; 105(2):142-153.
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    ABSTRACT: In 1996 the University of Rochester School of Medicine, Rochester, New York, began a major curricular reform called the Double Helix Curriculum, integrating basic science and clinical training over 4 years of medical school. This transition provided a unique opportunity to develop and implement a fully integrated, comprehensive palliative care curriculum. In this three-part paper, we will describe: (1) our process of finding curricular time, setting priorities, and deciding on pedagogical strategies; (2) an overview of how palliative care teaching was integrated into the general curriculum, including examples of different teaching opportunities; and (3) our evaluation process, and some ongoing challenges. Because palliative care is a core element in the care of all seriously ill patients, we chose to integrate our teaching into multiple courses over 4 years of undergraduate medical education, and not isolate it in a particular course. We view this report not as an ideal curriculum to be emulated in its entirety but as a work in progress that may be somewhat unique to our institution. We intend to illustrate a process of incremental curriculum building, and to generate some fresh teaching ideas from which palliative care educators can select depending on their own curricular needs and objectives.
    Journal of Palliative Medicine 07/2003; 6(3):365-80. · 1.89 Impact Factor