RESUMEN
The ultimate objective of our epidemiological research is to complete a longitudinal population-based study to document the prevalence and impact of acute, recurrent, and chronic pain in children and adolescents. As the first phase of our epidemiological research, we developed a comprehensive screening instrument for identifying children with acute, recurrent, and chronic pain, the Pain Experience Interview. We designed this interview to provide information about the lifetime and point prevalence of various pains, and also to provide information about the intensity, affect, duration, and frequency of children's pain. The primary objective of this study was to validate the Pain Experience Interview using the discriminant validation procedure of group differences. The secondary objectives of our study were to obtain descriptive data on children's acute, recurrent, and chronic pain experiences and to conduct exploratory analyses on age- and gender-related differences in children's pain experiences. We interviewed 187 children from five different health groups (arthritis, cancer, enuresis, recurrent headaches, and healthy) to provide distinct subsets of children with respect to their acute, recurrent, and chronic pain experience, and from four different age groups (5-7, 8-10, 11-13, and 14-16 years) to provide distinct subgroups with respect to children's developmental level. To test the interview we determined a priori several study predictions about children's pain experiences. These included four predictions about the common response patterns that we would expect to observe for all children based on our understanding of acute pain caused by trauma/disease, and six predictions about the distinct response patterns that we would expect to observe based on the known differences among children in their experiences of headache, acute treatment-related pain, recurrent pain, and chronic pain. All study predictions were confirmed, demonstrating that the Pain Experience Interview is a valid screening instrument for differentiating children with different types of pain problems. The interview can provide estimates for the lifetime and point prevalence of various pains in children, and data on the intensity, affect, duration, and frequency of their pain experiences.
Asunto(s)
Dolor/diagnóstico , Dolor/epidemiología , Enfermedad Aguda , Adolescente , Factores de Edad , Niño , Preescolar , Enfermedad Crónica , Factores de Confusión Epidemiológicos , Análisis Discriminante , Humanos , Ontario/epidemiología , Dimensión del Dolor , Prevalencia , Recurrencia , Reproducibilidad de los ResultadosRESUMEN
Possible distributive justice frameworks for providing health care by general practitioners are discussed. The ethical considerations before and after the recent changes to the British National Health Service are contrasted, with particular emphasis on a possible ethical divide that has been produced between fund-holding and non-fund-holding general practitioners. It is argued that general practitioners in non-fund-holding practices can continue as ethical advocates for their patients and distribute health care within an egalitarian framework. However, those in fund-holding practices may now be seen as interest advocates and may have to practise utilitarian distributive justice. Patient groups may be needed to ensure that these general practitioners are seen to act justly in the distribution of the health care resources for which they are now responsible.
Asunto(s)
Beneficencia , Teoría Ética , Ética Médica , Medicina Familiar y Comunitaria/normas , Asignación de Recursos para la Atención de Salud/normas , Obligaciones Morales , Selección de Paciente , Asignación de Recursos , Medicina Estatal/normas , Costos de los Medicamentos , Humanos , Defensa del Paciente , Autonomía Personal , Relaciones Médico-Paciente , Derivación y Consulta , Justicia Social , Reino UnidoRESUMEN
Many of the problems which are presented to family physicians are not covered by their medical training. In a residency program, these aspects of family medicine must be stressed-preferably by the same teacher, preferably over a period of time not less than two three-month blocks. The political implications of this emphasis are many and varied, but all of them lead to the same endpoint: the need for a clearly stated curriculum. The only way critics of family medicine training programs can be answered is by clear statements of content intended to produce a particular type of physician.
RESUMEN
The purpose of this paper is to show that evaluation is not an isolated facet of the educational process; on the contrary, it is part of a cyclical system. Evaluation is something from which many teachers and students shy away needlessly. This article outlines some positive steps towards making evaluation a sharing of information between teacher and learner.
RESUMEN
The Department of Family Medicine at the University of Western Ontario has been training family practice residents in community based group practices for four years. The methods used to select and evaluate the residents and their practice experience are outlined in this article. Despite difficulties which arose as a result of geographical distance, the experience was felt to be worthwhile by those who participated. The program has been approved by the Department of Family Medicine for expansion and continuation.
RESUMEN
The Department of Family Medicine at the University of Western Ontario has been in existence for ten years. During this time there has developed a wealth of experience in helping members of the Department, both fulltime and part-time, to improve their skills as family practice teachers. The current faculty development program has dealt with the transition period from practitioner to teacher, the interaction of teacher and student and current concepts of learning theory. It is now working on the development of scholarship within the department. An outline of the master of clinical science program is given. We hope this program will facilitate the successful development of the next generation of family medicine teachers.
RESUMEN
In 1966, two formal training programs in family medicine were launched in Canada, with a total of three residents. Now there are 16 programs with almost 700 residents. There are three current educational trends in family medicine: increased flexibility of the curriculum; increased emphasis on self-directed learning, and increased amounts of office and community based training.The issues to be faced are:1. the necessity of assisting each undergraduate to make an appropriate career choice;2. the improvement of working relationships with other clinical departments;3. the need for improved methods of educating the educators;4. the development of research and scholarship within academic departments;5. the need for agreement on a core curriculum;6. the need to find a solution to questions surrounding licensure.