Dissertations / Theses on the topic 'Medical Elective'

Background: The purpose of this study was to develop a preclerkship elective and assess its effectiveness in supplementing medical students' education. Methods: A group of medical students under the guidance of two faculty advisors developed an elective consisting of six sessions covering a variety of practical aspects of diabetes care/education taught by an interprofessional team. Following the course completion, a survey was emailed to the enrollees who attended at least one session. The results were analyzed using Wilcoxon signed-rank and descriptive analyses. Results: A total of 14 medical students were enrolled (nine first year and five second year). An average of 4.4 sessions/student was attended. Thirteen students attended at least one session and were surveyed. The survey response rate was similar to 62% (8/13). All eight students indicated that the course was valuable and would recommend it to their colleagues. A Wilcoxon signed-rank test revealed a statistically significant increase in students' confidence in all five areas assessed following participation in the course, P<0.05 with a large effect (r>0.5). Conclusion: This study suggests the feasibility of developing disease state-specific preclerkship elective courses and that such courses can be beneficial in supplementing medical student education with practical knowledge.

Tort laws aim to deter risky medical practices and increase accountability for harm. This research examines their effects on deterrence of a high-risk obstetric practice in the United States: elective early-term (37-38 weeks gestation) induction of labor. Using birth certificate data from the Natality Detail Files and state-level data from publicly available sources, this study analyzes the effects of tort laws on labor induction with multilevel models (MLM) of 665,491 early-term births nested in states. Results reveal that caps on damages are associated with significantly higher odds of early-term induction and Proportionate Liability (PL) is associated with significantly lower odds compared to Joint and Several Liability (JSL). The findings suggest that clinicians are more likely to engage in practices that defy professional guidelines in tort environments with lower legal burdens. I discuss the implications of the findings for patient safety and the deterrence of high-risk practices.

This thesis paper defends a novel conception of the child's best interest in regard to elective pediatric surgeries (EPS). First, children's capacity for decision-making is examined, and the best decision-making model for EPS is identified as the Best Interest Standard. What follows is a discussion of the interests of children in EPS, the correlation of fundamental interests to rights, and guidelines for weighing children's competing interests. Next, the role of families is considered, especially the rights and duties of parents. Finally, a reinterpretation of the Best Interest Standard is proposed, identifying as paramount a child's ability to make elective medical decisions for herself when she reaches maturity.

In Hong Kong, access to elective surgeries in public hospitals is often associated with lengthy waiting times. Facing resource constraints and increasing demands from a rapidly ageing population, the Hospital Authority (HA) is constantly confronted by the healthcare rationing dilemma. To date, publicized data on elective surgery waiting times at the HA remain limited, and a standardized way of measuring waiting time is currently lacking. Recognizing that the definition of waiting time will form the basis for future policies in addressing the issue, a three-step approach will be taken in this paper. First, a comparison will be drawn for the varying definitions of waiting time worldwide. Next, a suitable definition will be proposed for Hong Kong, followed by analysis of where policy interventions are most needed for reducing waiting times. Finally, best practices for managing waiting times will be extrapolated from England, Canada, Australia, and Spain to serve as guidance for Hong Kong’s future policy direction.
published_or_final_version
Public Health
Master
Master of Public Health

Trots att det i sjukvården betraktas som normalt att föda barn vaginalt väljer en del kvinnor att föda sina barn med hjälp av kejsarsnitt utan att det föreligger någon medicinsk indikation, varken för mor eller barn (elektivt sectio). Den medicinska vetenskapen visar att det både är säkrare och bättre i de flesta fall att föda vaginalt, men antalet elektiva kejsarsnitt ökar årligen. Kunskap om vad som driver kvinnor att önska elektivt kejsarsnitt kan öka möjligheten att minska kejsarsnitt som görs utan medicinsk indikation. Kunskapen är viktig för barnmorskor som kan hjälpa gravida kvinnor att i högre grad välja att föda sitt barn vaginalt då det inte föreligger indikation för kejsarsnitt. Syftet med arbetet var att beskriva kvinnors önskan om att föda sitt barn med hjälp av  elektivt kejsarsnitt utan att det föreligger någon medicinsk indikation för kejsarsnitt. En litteraturstudie har genomförts där sökningar efter artiklar gjorts i databaserna PubMed, CINAHL och APA PsychInfo. Till studiens resultat har 20 vetenskapliga artiklar, både kvalitativa och kvantitativa artiklar använts. De publicerade studierna är genomförda i  olika länder, en del i höginkomstländer och en del i medelinkomstländer enligt måttet bruttonationalprodukt per person och år, vilken beskriver ett lands produktion utifrån dess befolkningsutveckling (BNP per capita). Samtliga artiklar är publicerade mellan åren 2009-2019, och är etiskt godkända.  Kvinnors anledning att önska elektivt kejsarsnitt utan medicinsk indikation sammanfattas i detta arbete med två övergripande teman: Vaginal förlossning ett hot och Kejsarsnitt garanterar hälsa och trygghet. Kvinnornas rädsla för vaginal förlossning var en framträdande anledning till att önska kejsarsnitt. Rädslan hade sitt ursprung i egna eller andras negativa erfarenheter av vaginal förlossning. Rädslan grundades också i en oro för att kvinnans utseende och hennes relation skulle påverkas av en vaginal förlossning. Önskan om kejsarsnitt utan medicinsk indikation grundades i en tro om att ingreppet skulle garantera hälsa och trygghet för mor och barn, något som vaginal förlossning inte kunde erbjuda.  Den mest framträdande anledningen till att kvinnor önskade kejsarsnitt utan medicinsk indikation var en intensiv rädsla för en vaginal förlossning. Kvinnorna hade uppfattningen att ett kejsarsnitt skulle garantera säkerhet för mor och barn. Det kan inte uteslutas att önskan om elektivt kejsarsnitt kan bero på brist på kunskap.  Det finns ytterligare behov av forskning på ämnet, förslagsvis på interventioner från sjukvården som fokuserar på att utbilda födande kvinnor om vinsterna med vaginal förlossning.

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In this research the object of study was the psychic suffering of the medicine students. The general goal was to discuss stressors e possible abuses or violences of the medical course according to the perception of medicine students from a public university in the center west part of Brazil, analyzing the contributions of an elective course offered in the medical school, in which stress coping strategies were explored. The project is in accordance with the ethics aspects of Resolution 466/12. It is a descriptive-exploratory using the qualitative approach characterized as case study. The sample was 33 medicine students in 2011 and 76 in 2013. The data collection was made through focus groups, semi-structured questionnaires and notes from the teachers during the time spent with the students. The data was registered, organized and analyzed with the use of a software that support qualitative analysis called WebQDA. The analysis of the content was based on the methodology of Bardin. The results were presented in articles about the stress factors with the following categories: curriculum, evaluations, relation with teachers, support structure, interpersonal relations, professional perspectives, personal expectations, fear and insecurity, the coping strategies divided in distractions and relief or comprehension and resolution; the way the students deal with pain were characterized as negation and escape or reflexive and the violence and abuse during the medical course were seen as abuse of power or institutional fragilities; the perceptions about the changes after doing the elective about the coping strategies include more self-reflection, improvement in assertiveness and communication. It was concluded that among other stressors is the excessive work load, too much content to be learned, exams, seminars and numerous group works, big responsibilities, insecurity and fear of failing, competitive environment, verbal abuse, violence in the freshmen’s hazing. As examples of the coping strategies there are: going out with friends, searching support from religion, physical activities, doing other things apart from university, support from family/friends, sharing the difficulties. Many react to pain by denying it. After doing the elective course the majority of the students reported less stress symptoms than in the begging of the semester, more use of coping strategies, considering the course as an useful moment to learn new techniques with a higher self-reflection and they realized positive changes in their own life. The elective discipline meant theoretical and practical learning, brought benefits from the class itself, moments of reflection and psychic and emotional changes.
Na presente investigação o objeto de estudo foi o sofrimento psíquico dos estudantes de Medicina. O objetivo geral foi discutir a percepção dos acadêmicos de Medicina de uma Universidade Pública na região Centro-Oeste do Brasil quanto a fatores estressores e possíveis abusos ou violências do curso médico e sua forma de enfrentamento, analisando as contribuições de uma disciplina eletiva oferecida no curso de Medicina, na qual são discutidas estratégias de enfrentamento do estresse. O projeto está de acordo com os aspectos éticos recomendados pela Resolução 466/12. Estudo do tipo descritivo-exploratório utilizando abordagem qualitativa caracterizada como estudo de caso. A amostra constituiu-se de 33 acadêmicos de medicina em 2011 e 76 em 2013. A coleta de dados ocorreu por meio da utilização de grupo focal, questionários semiestruturados e anotações da pesquisadora nos momentos presenciais com os alunos. Os dados foram registrados, organizados e analisados por meio do Software de Apoio à Análise Qualitativa denominado WebQDA. A análise do conteúdo seguiu a metodologia sugerida por Bardin. Os resultados foram apresentados em artigos abordando fatores de estresse com as categorias currículo, avaliação, relação com os professores, estrutura de apoio, falta de tempo, relações interpessoais, perspectivas profissionais, cobrança, medo e insegurança; as estratégias de enfrentamento divididas em distrações e alivio ou compreensão e resolução; a forma como os estudantes lidam com a dor estão nas categorias negação e fuga ou reflexiva e as violências e abusos no curso médico são percebidas pelos alunos como abuso de poder ou fragilidades institucionais; as percepções quanto às mudanças após cursar a disciplina eletiva sobre estratégias de enfrentamento do estresse curso de graduação incluem maior autorreflexão, melhora na assertividade e comunicação. Concluiu-se que os fatores de estresse são a carga horária excessiva, muito conteúdo a ser aprendido, provas, seminários e trabalhos numerosos, grande responsabilidade, insegurança e medo do fracasso, ambiente competitivo, abuso verbal, violência dos trotes ao recepcionar os calouros. Entre as estratégias de enfrentamento estão o ato de sair para se distrair com amigos, buscar apoio da religião, atividades físicas, investir em assuntos alheios à faculdade, receber apoio dos pais/familiares, compartilhar suas dificuldades. Muitos reagem à dor, negando-a. Após a disciplina, a maioria dos alunos relatou menos sintomas de estresse do que no início do semestre, utilizam mais estratégias de enfrentamento, consideraram que foi um momento útil onde aprenderam novas técnicas e aumentaram a autorreflexão e perceberam mudanças positivas na própria vida. A disciplina significou aprendizado teórico e prático, trouxe benefícios da aula em si, mudanças psíquicas e emocionais; e momento de reflexão.

Background: For an individual a surgery may involve strains and risks. Many patients experience a loss of its own identity and often an inability to control the situation while going through a surgical operation. Fear of pain or to not wake up from the anesthetic or that the surgery will fail are worrying factors that some people experiences. Purpose: The purpose was to describe patients’ perceptions of preoperative information in connection to elective surgeries. Method: The literature review was based on 13 scientific articles within the area. The research was performed in the databases ELIN, Medline and Cinahl as well as manually. The results were presented according to the Antonovskys model; ability to comprehend, manage and meaningfulness. Result: Majority of patients wished to receive oral as well as written information. The patients wanted information about the disease, surgery, anaesthetics and what complications the surgery may cause. The information brought forth experience of having knowledge. Knowledge gave the patients a view of the situation and therefore the experience of having some control, something that created feelings of safety and hope. A few patients didn´t want any preoperative information. Conclusion: Preoperative information may reduce anxiety and give understanding of what is to happen. It is important that the information is adapted to the individual needs of the patient.

Abstrakt Bakgrund: Forskning visar att generell anestesi kan bidra till kognitiv dysfunktion postoperativt. En alltför djup anestesi och/eller en lång duration av anestesi är två faktorer som kan inverka på kognitionen med besvär såsom minnesproblem och koncentrationssvårigheter. Anestesisjuksköterskans roll är att individanpassa anestesin för att inte orsaka för djup anestesi och därmed har det blivit alltmer vanligt att monitorera anestesidjupet för att minska på onödigt lidande för patienten. Syfte: Syftet är att kartlägga anestesidjup och anestesiduration  hos patienter med självskattad  kognitiv svikt efter elektiv ortopedisk operation. Metod: För att kartlägga detta valdes en retrospektiv observationsstudie med tvärsnittsdesign med insamlad data från kvalitetsregister. Resultat: Av 920 patienter var det 116 patienter som uppgav kognitiv dysfunktion dag 1 postoperativt och upp till över 16 dagar postoperativt med  ett genomsnittsvärde på 37,7 i entropy och 104,4 minuter i anestesiduration. Slutsats: Desto längre duration av anestesin och ju djupare anestesi desto mer kognitiv påverkan postoperativt. Anestesidjupsmonitorering bör användas mer frekvent och önskvärt är att bedöma kognition preoperativt med ett mätinstrument för att kunna se om skillnad finns postoperativt.

Advances in medical technology have altered the need for certain types of surgery to be performed in traditional inpatient hospital settings. Less invasive surgical procedures allow a growing number of medical treatments to take place on an outpatient basis. Hospitals face growing competition from ambulatory surgery centers (ASCs). The competitive threats posed by ASCs are important, given that inpatient surgery has been the cornerstone of hospital services for over a century. Additional research is needed to understand how surgical volume shifts between and within acute care general hospitals (ACGHs) and ASCs. This study investigates how medical technology within the hospital industry is changing medical services delivery. The main purposes of this study are to (1) test Clayton M. Christensen’s theory of disruptive innovation in health care, and (2) examine the effects of disruptive innovation on appendectomy, cholecystectomy, and bariatric surgery (ACBS) utilization. Disruptive innovation theory contends that advanced technology combined with innovative business models—located outside of traditional product markets or delivery systems—will produce simplified, quality products and services at lower costs with broader accessibility. Consequently, new markets will emerge, and conventional industry leaders will experience a loss of market share to “non-traditional” new entrants into the marketplace. The underlying assumption of this work is that ASCs (innovative business models) have adopted laparoscopy (innovative technology) and their unification has initiated disruptive innovation within the hospital industry. The disruptive effects have spawned shifts in surgical volumes from open to laparoscopic procedures, from inpatient to ambulatory settings, and from hospitals to ASCs. The research hypothesizes that: (1) there will be larger increases in the percentage of laparoscopic ACBS performed than open ACBS procedures; (2) ambulatory ACBS will experience larger percent increases than inpatient ACBS procedures; and (3) ASCs will experience larger percent increases than ACGHs. The study tracks the utilization of open, laparoscopic, inpatient and ambulatory ACBS. The research questions that guide the inquiry are: 1. How has ACBS utilization changed over this time? 2. Do ACGHs and ASCs differ in the utilization of ACBS? 3. How do states differ in the utilization of ACBS? 4. Do study findings support disruptive innovation theory in the hospital industry? The quantitative study employs a panel design using hospital discharge data from 2004 and 2009. The unit of analysis is the facility. The sampling frame is comprised of ACGHs and ASCs in Florida and Wisconsin. The study employs exploratory and confirmatory data analysis. This work finds that disruptive innovation theory is an effective model for assessing the hospital industry. The model provides a useful framework for analyzing the interplay between ACGHs and ASCs. While study findings did not support the stated hypotheses, the impact of government interventions into the competitive marketplace supports the claims of disruptive innovation theory. Regulations that intervened in the hospital industry facilitated interactions between ASCs and ACGHs, reducing the number of ASCs performing ACBS and altering the trajectory of ACBS volume by shifting surgeries from ASCs to ACGHs.

A Thesis submitted to The University of Arizona College of Medicine - Phoenix in partial fulfillment of the requirements for the Degree of Doctor of Medicine.
Background: Integrative Medicine offers an approach to medical practice which addresses the public’s increasing use of complementary and alternative medicine (CAM), personal, professional, and federal calls for more patient-centered care, and medical professionals’ deficiencies in self-care and reflection. Though the need for exposure to IM in medical school has been well articulated and many schools offer exposure to the field, the impact of such experiences is largely unknown. The University of Arizona’s Center for Integrative Medicine (AxCIM) re-designed its month-long elective in 2004 to better introduce students to the discipline. This paper reports the preliminary findings of a study examining changes in medical students’ attitudes about IM after participation in this elective. Methods: The Integrative Medicine Attitudes Questionnaire (IMAQ) was administered to medical students participating in the AzCIM’s bi-annual, month long IM elective at the beginning of the elective, at the end, 6 months after completion and 1 year after the elective. Results: 66 complete IMAQ scores were collected at baseline, 36 six months post-elective and 23 1 year after. Post-elective scores were significantly higher than at baseline. No difference from baseline was found in scores 6 months and 12 months post-elective. Conclusions: The preliminary results are encouraging regarding the elective’s improving attitudes toward IM immediately after its completion. This study serves as a resource and encouragement for IM education assessment and evaluation.

Thesis (Ph. D.)--Tufts University, 1998.
Submitted to the Dept. of Economics. eContent provider-neutral record in process. Description based on print version record. Includes bibliographical references.

Zhu, Fang.
Thesis (Ph.D.)--Chinese University of Hong Kong, 2013.
Includes bibliographical references (leaves 171-185).
Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web.
Abstracts also in Chinese.

This thesis seeks to evaluate the International Pediatric Emergency Medicine Elective (IPEME) as a case study of a peace-through-health initiative. Using the reasoning of Scolnik (2006), IPEME is first evaluated in terms of narrow, short-term outcomes and subsequently considered in terms of the greater body of peace-through-health work. A novel evaluation tool was designed to examine change in students’ ethical and professional attitudes over the course of the four-week elective. Supplementary qualitative data was collected to shed light on evaluation findings and provide insight into the advantages and disadvantages of the IPEME curriculum. Ethics and professionalism were defined in terms of the WHO 5 Star Global Criteria for Global Doctors conceptualized by the World Health Organization (Boelen, 1996). This research discusses these findings in light of the study’s limitations and considers their implications for IPEME as a medical elective and for its contribution to the greater body of peace-through-health work.

The field of global health has grown rapidly over the past two decades. In response, academic institutions have established new educational practices and training opportunities for students. One flourishing area of global health training is in international medical electives (IMEs) in which medical students experience medicine in a different political, cultural, and epidemiological context for a short period of time. Scholarly literature on IMEs has been published and disseminated widely, and various discourses establish the way that IMEs are understood and experienced. However, rather than offering neutral descriptions, discourses actively shape the world in favor of certain viewpoints. When accepted uncritically, dominant discourses can reproduce inequalities by legitimizing certain practices. In the field of global health, dominant discourses have been largely unexamined and unquestioned. Informed by social constructionist and post-structuralist views of language, this study critically examines IME discourses in 60 journal articles published between 2000 and 2011. A method for analyzing discourse influenced by the French philosopher Michel Foucault was used to emphasize the intricate relationship between discourse, knowledge, and power. The findings reveal that two dominant discourses cohere to produce commonly accepted and appropriate knowledge about IMEs. The discourse of “disease and brokenness” depicts IMEs as situated in faraway lands plagued by “exotic” diseases, and the discourse of “romanticizing poverty” portrays developing countries as trapped in time. These discourses emphasize and privilege certain meanings, while discrediting and silencing others. Moreover, IME discourses constitute uneven power relations and are characterized by a language that relies on dichotomies. In both of the identified discourses, medical students are privileged subjects while inhabitants are marginalized. As a result, inequalities between developed and developing countries are reproduced and the possibilities for forming mutually beneficial relationships during IMEs are constrained. Recognizing that reality is constituted through language, the findings indicate that prevailing representations are constructed rather than inevitable “truths”. Furthermore, this study suggests that dominant meanings can be resisted, articulates how current “truths” can be destabilized, and proposes a new way of conceptualizing IMEs. By critically reflecting on their work, students, researchers, and practitioners in the field of global health can engage in more socially just practices.