Virginia Reed - Academia.edu (original) (raw)
Papers by Virginia Reed
Practice Development in Health Care, 2008
Managing chronic non-malignant pain is a common and diffi cult issue for primary care physicians ... more Managing chronic non-malignant pain is a common and diffi cult issue for primary care physicians who seek to provide appropriate pain management while minimizing the potential for drug abuse. One promising approach is the use of opioid agreements or contracts with patients being treated with opioids for chronic pain. Despite the increasingly common use of such agreements, little has been written about their development and use in primary care settings. This article describes the initial implementation of a pain management agreement system in a primary care setting that refl ects a systems-based approach to practice development. Lessons learned and plans for future studies of outcomes are described.
Journal of General Internal Medicine, Aug 1, 2004
Increasing attention has been focused on developing professionalism in medical school graduates. ... more Increasing attention has been focused on developing professionalism in medical school graduates. Unfortunately, the culture of academic medical centers and the behaviors that faculty model are often incongruent with our image of professionalism. The need for improved role modeling, better assessment of student behavior, and focused faculty development is reviewed. We propose that the incentive structure be adjusted to reward professional behavior in both students and faculty. The third-year medicine clerkship provides an ideal opportunity for clinician-educators to play a leading role in evaluating, rewarding, and ultimately fostering professionalism in medical school graduates.
Education for health, 2011
Studies of HIV care in Pune, a high-HIV-prevalence city in India, have shown that a significant p... more Studies of HIV care in Pune, a high-HIV-prevalence city in India, have shown that a significant proportion of practitioners were not adhering to national guidelines due to inadequate awareness and understanding. This study examined the effectiveness of a pilot Internet-based continuing medical education course in increasing knowledge of pediatric HIV diagnosis and treatment among providers in Pune. The study also explored perceived factors limiting the effectiveness of the pilot course. The mixed methods evaluation design consisted of quantitative pre- and post-course knowledge assessments, and qualitative focus groups and in-depth interviews conducted on site with healthcare providers with experience treating HIV to explore the barriers to optimal course utilization, the applicability of the course content, and the systemic barriers to the implementation of physician knowledge. There were significant increases (p<0.05) in mean knowledge scores on the global knowledge assessment and for two of five individual course modules. Perceived barriers to optimal course utilization were identified as being related to Internet access. The course content was reported to be generally useful, although certain guidelines and information were described as not congruent with local resource availability. Participants reported that the major barriers to implementing their knowledge were stigma that prevented patients from seeking care and financial resource limitations affecting physician practice. This course resulted in a modest increase in pediatric HIV knowledge among Pune healthcare providers. Identification of perceived factors limiting the effectiveness of the course provides guidance for improving future Internet-based courses.
AAOHN Journal, 2011
Studies of the effect of shift work have identified several negative health outcomes, most notabl... more Studies of the effect of shift work have identified several negative health outcomes, most notably breast cancer. Disruption of circadian rhythm by exposure to light at night has been identified as the mechanism likely responsible for this outcome. This article recommends that health care institutions work with occupational health nurses to develop and implement hazard communication and policies concerning shift work, exposure to light at night, and increased risk for negative health outcomes, particularly breast cancer. B y the beginning of the 21st century, nearly 15% of full-time V.S. workers worked schedules described as alternative or non-standard, made up primarily of evening or night shifts, rotating shifts, or another type of employer-arranged irregular schedule (Bureau of Labor Statistics, 2005; Parent-Thirion, Macias, Hurley, & Vermeylen, 2007). Such work schedules are particularly common in the V nited States for those employed in health care, where 24.6% of practitioners and technical workers
Education for Health
Studies of HIV care in Pune, a high-HIV-prevalence city in India, have shown that a significant p... more Studies of HIV care in Pune, a high-HIV-prevalence city in India, have shown that a significant proportion of practitioners were not adhering to national guidelines due to inadequate awareness and understanding. This study examined the effectiveness of a pilot Internet-based continuing medical education course in increasing knowledge of pediatric HIV diagnosis and treatment among providers in Pune. The study also explored perceived factors limiting the effectiveness of the pilot course. The mixed methods evaluation design consisted of quantitative pre- and post-course knowledge assessments, and qualitative focus groups and in-depth interviews conducted on site with healthcare providers with experience treating HIV to explore the barriers to optimal course utilization, the applicability of the course content, and the systemic barriers to the implementation of physician knowledge. There were significant increases (p<0.05) in mean knowledge scores on the global knowledge assessment and for two of five individual course modules. Perceived barriers to optimal course utilization were identified as being related to Internet access. The course content was reported to be generally useful, although certain guidelines and information were described as not congruent with local resource availability. Participants reported that the major barriers to implementing their knowledge were stigma that prevented patients from seeking care and financial resource limitations affecting physician practice. This course resulted in a modest increase in pediatric HIV knowledge among Pune healthcare providers. Identification of perceived factors limiting the effectiveness of the course provides guidance for improving future Internet-based courses.
Despite rapid advances in the technology of the health sciences and in understanding of the basic... more Despite rapid advances in the technology of the health sciences and in understanding of the basic biology of diseases at the molecular level, most of the disease processes that in the postantibiotic age cause disability and death have behavioral roots. The statistics concerning behavioral risk factors noted in youth are particularly alarming. For example, among American high school students, 73.9% indicated that they had tried smoking by their senior year, while 24.7% admitted to smoking daily over the past month. Furthermore, 48% indicated that they had had at least one alcoholic drink within the past month. With regard to sex, 70% responded that they had had sexual intercourse by their senior year, with 18.5% reporting having had four or more sexual partners. As for suicide, 24% indicated that they had given serious consideration to the thought of suicide over the past year. Finally, 22% indicated that they had carried a weapon in the past month (Kann et al., 1995).
Medical Education Online, Dec 1, 2004
Context: There is evidence of significant career dissatisfaction among practicing physicians and ... more Context: There is evidence of significant career dissatisfaction among practicing physicians and those considering medicine as a profession. Most research on career satisfaction has examined practicing physicians. This study was undertaken to look at determinants of satisfaction in those at the earliest stage of their medical careers-medical students. Methods: As part of a larger study, students comprising one class at the University of Washington School of Medicine were surveyed three times over the course of their medical education. For the present study we examined measures specifically related to determinants of career satisfaction. Findings: Over time, students' sense of the importance of most measured determinants of satisfaction showed significant change, the majority of which were in the direction of decreased importance. However, most of the change was relative. That is, factors that students considered to be most important at the start of medical school continued to be most important throughout the educational experience and those factors students considered to be least important at Year 1 continued to be least important at Years 2 and 4. Discussion: These findings have implications for medical education, a time when students are forming expectations that will impact their career satisfaction. In addition to information on career satisfaction, students should understand the professional values of medicine, their own values and expectations, current practice patterns, economics, and the role of advocacy.
Routledge eBooks, Jun 23, 2023
Family medicine, 2008
Training programs designed to improve information management have been implemented but not adequa... more Training programs designed to improve information management have been implemented but not adequately tested. Three critical components for information management were tested in a randomized control study: (1) knowledge of valid, synthesized summary information, (2) skills to use Web-based resources that provide access to these summaries, and (3) use of Web-based resources in clinical practice. Twenty-four primary care practices were provided with computers and high-speed Internet access and then matched, with half randomly assigned to receive training and half to receive training at a later date. Training was designed to address knowledge, skills, and use of Web-based information. Outcomes were assessed by comparing baseline and follow-up questionnaires that focused on five conceptual domains related to Web-based resource use for patient care decisions and patient education. Compared to the delayed training group, the initial training group increased their knowledge and skill of We...
Handbook of Health Behavior Research IV, 1997
Despite rapid advances in the technology of the health sciences and in understanding of the basic... more Despite rapid advances in the technology of the health sciences and in understanding of the basic biology of diseases at the molecular level, most of the disease processes that in the postantibiotic age cause disability and death have behavioral roots. The statistics concerning behavioral risk factors noted in youth are particularly alarming. For example, among American high school students, 73.9% indicated that they had tried smoking by their senior year, while 24.7% admitted to smoking daily over the past month. Furthermore, 48% indicated that they had had at least one alcoholic drink within the past month. With regard to sex, 70% responded that they had had sexual intercourse by their senior year, with 18.5% reporting having had four or more sexual partners. As for suicide, 24% indicated that they had given serious consideration to the thought of suicide over the past year. Finally, 22% indicated that they had carried a weapon in the past month (Kann et al., 1995).
Teaching and Learning in Medicine, 2001
As emphasis in medicine has shifted to increasing the number of physicians who choose primary car... more As emphasis in medicine has shifted to increasing the number of physicians who choose primary care specialties, many studies of medical specialty choice have been conducted. Although researchers have approached the topic in a number of ways, most approaches have tended to focus on narrow elements of the choice, such as the effect of programs or curricula. A more comprehensive approach is possible by fitting the process to a preexisting broad theoretical framework. This synthesis of the literature examines specialty choice from the perspective of decision theory--with its aims of understanding how decisions are made, providing information about the quality of decisions, and improving the decision-making process. This approach has the potential to not only help deconstruct the process of decision making regarding specialty choice but also uncover information about the best ways to help medical students learn to make wise decisions.
Quality Management in Health Care, 2008
Objective-The Internet offers a significant information resource for health professionals. A stra... more Objective-The Internet offers a significant information resource for health professionals. A strategy to improve the use of these resources is for health care providers and staff to receive specific training. The aim of this study was to determine whether those who attended an Internet health care resource training intervention transferred knowledge and skills to others in the practice. Methods-Twenty-four primary care practices participated in the study in which 64 providers and staff attended a training intervention and 288 did not. A preintervention questionnaire that assessed knowledge, skill, and Internet usage was compared with a postintervention questionnaire. The main effect of interest in the linear model was the group by time interaction term, to determine whether knowledge and skill improved for both groups. Results-There were 41 attendees and 222 nonattendees that completed both pre-and postintervention questionnaires. There were 9 variables that showed a possible diffusion pattern, in which both attendees and nonattendees improved between pre-and postintervention. Overall, the training intervention seemed to have impacted knowledge and skills of the respondents and also reported improvements in the clinical area of patient education, but frequency of use for most Web resources for medical decision making did not improve. Conclusion-An improvement strategy that depends on a training intervention for a few members in a practice may not necessarily transfer relative to all aspects of patient care.
Education for Health: Change in Learning & Practice, 2003
Academic Medicine, 2004
Graduate medical education programs face new challenges as they seek to comply with the mandate f... more Graduate medical education programs face new challenges as they seek to comply with the mandate from the Accreditation Council on Graduate Medical Education to demonstrate that they are teaching and assessing residents on the six core competencies. The authors describe a project designed as a collaborative venture between the American Academy of Allergy, Asthma, and Immunology (AAAAI) and the Center for Educational Outcomes at Dartmouth College (CEdO) to provide residency programs in allergy/immunology with resources for teaching and assessing the core competencies. The goal was to create a set of learning and assessment resources that maximized the content knowledge expertise provided by the AAAAI and the learning expertise provided by CEdO.
Academic Medicine, 1998
No abstract available.
Practice Development in Health Care, 2008
Managing chronic non-malignant pain is a common and diffi cult issue for primary care physicians ... more Managing chronic non-malignant pain is a common and diffi cult issue for primary care physicians who seek to provide appropriate pain management while minimizing the potential for drug abuse. One promising approach is the use of opioid agreements or contracts with patients being treated with opioids for chronic pain. Despite the increasingly common use of such agreements, little has been written about their development and use in primary care settings. This article describes the initial implementation of a pain management agreement system in a primary care setting that refl ects a systems-based approach to practice development. Lessons learned and plans for future studies of outcomes are described.
Journal of General Internal Medicine, Aug 1, 2004
Increasing attention has been focused on developing professionalism in medical school graduates. ... more Increasing attention has been focused on developing professionalism in medical school graduates. Unfortunately, the culture of academic medical centers and the behaviors that faculty model are often incongruent with our image of professionalism. The need for improved role modeling, better assessment of student behavior, and focused faculty development is reviewed. We propose that the incentive structure be adjusted to reward professional behavior in both students and faculty. The third-year medicine clerkship provides an ideal opportunity for clinician-educators to play a leading role in evaluating, rewarding, and ultimately fostering professionalism in medical school graduates.
Education for health, 2011
Studies of HIV care in Pune, a high-HIV-prevalence city in India, have shown that a significant p... more Studies of HIV care in Pune, a high-HIV-prevalence city in India, have shown that a significant proportion of practitioners were not adhering to national guidelines due to inadequate awareness and understanding. This study examined the effectiveness of a pilot Internet-based continuing medical education course in increasing knowledge of pediatric HIV diagnosis and treatment among providers in Pune. The study also explored perceived factors limiting the effectiveness of the pilot course. The mixed methods evaluation design consisted of quantitative pre- and post-course knowledge assessments, and qualitative focus groups and in-depth interviews conducted on site with healthcare providers with experience treating HIV to explore the barriers to optimal course utilization, the applicability of the course content, and the systemic barriers to the implementation of physician knowledge. There were significant increases (p<0.05) in mean knowledge scores on the global knowledge assessment and for two of five individual course modules. Perceived barriers to optimal course utilization were identified as being related to Internet access. The course content was reported to be generally useful, although certain guidelines and information were described as not congruent with local resource availability. Participants reported that the major barriers to implementing their knowledge were stigma that prevented patients from seeking care and financial resource limitations affecting physician practice. This course resulted in a modest increase in pediatric HIV knowledge among Pune healthcare providers. Identification of perceived factors limiting the effectiveness of the course provides guidance for improving future Internet-based courses.
AAOHN Journal, 2011
Studies of the effect of shift work have identified several negative health outcomes, most notabl... more Studies of the effect of shift work have identified several negative health outcomes, most notably breast cancer. Disruption of circadian rhythm by exposure to light at night has been identified as the mechanism likely responsible for this outcome. This article recommends that health care institutions work with occupational health nurses to develop and implement hazard communication and policies concerning shift work, exposure to light at night, and increased risk for negative health outcomes, particularly breast cancer. B y the beginning of the 21st century, nearly 15% of full-time V.S. workers worked schedules described as alternative or non-standard, made up primarily of evening or night shifts, rotating shifts, or another type of employer-arranged irregular schedule (Bureau of Labor Statistics, 2005; Parent-Thirion, Macias, Hurley, & Vermeylen, 2007). Such work schedules are particularly common in the V nited States for those employed in health care, where 24.6% of practitioners and technical workers
Education for Health
Studies of HIV care in Pune, a high-HIV-prevalence city in India, have shown that a significant p... more Studies of HIV care in Pune, a high-HIV-prevalence city in India, have shown that a significant proportion of practitioners were not adhering to national guidelines due to inadequate awareness and understanding. This study examined the effectiveness of a pilot Internet-based continuing medical education course in increasing knowledge of pediatric HIV diagnosis and treatment among providers in Pune. The study also explored perceived factors limiting the effectiveness of the pilot course. The mixed methods evaluation design consisted of quantitative pre- and post-course knowledge assessments, and qualitative focus groups and in-depth interviews conducted on site with healthcare providers with experience treating HIV to explore the barriers to optimal course utilization, the applicability of the course content, and the systemic barriers to the implementation of physician knowledge. There were significant increases (p<0.05) in mean knowledge scores on the global knowledge assessment and for two of five individual course modules. Perceived barriers to optimal course utilization were identified as being related to Internet access. The course content was reported to be generally useful, although certain guidelines and information were described as not congruent with local resource availability. Participants reported that the major barriers to implementing their knowledge were stigma that prevented patients from seeking care and financial resource limitations affecting physician practice. This course resulted in a modest increase in pediatric HIV knowledge among Pune healthcare providers. Identification of perceived factors limiting the effectiveness of the course provides guidance for improving future Internet-based courses.
Despite rapid advances in the technology of the health sciences and in understanding of the basic... more Despite rapid advances in the technology of the health sciences and in understanding of the basic biology of diseases at the molecular level, most of the disease processes that in the postantibiotic age cause disability and death have behavioral roots. The statistics concerning behavioral risk factors noted in youth are particularly alarming. For example, among American high school students, 73.9% indicated that they had tried smoking by their senior year, while 24.7% admitted to smoking daily over the past month. Furthermore, 48% indicated that they had had at least one alcoholic drink within the past month. With regard to sex, 70% responded that they had had sexual intercourse by their senior year, with 18.5% reporting having had four or more sexual partners. As for suicide, 24% indicated that they had given serious consideration to the thought of suicide over the past year. Finally, 22% indicated that they had carried a weapon in the past month (Kann et al., 1995).
Medical Education Online, Dec 1, 2004
Context: There is evidence of significant career dissatisfaction among practicing physicians and ... more Context: There is evidence of significant career dissatisfaction among practicing physicians and those considering medicine as a profession. Most research on career satisfaction has examined practicing physicians. This study was undertaken to look at determinants of satisfaction in those at the earliest stage of their medical careers-medical students. Methods: As part of a larger study, students comprising one class at the University of Washington School of Medicine were surveyed three times over the course of their medical education. For the present study we examined measures specifically related to determinants of career satisfaction. Findings: Over time, students' sense of the importance of most measured determinants of satisfaction showed significant change, the majority of which were in the direction of decreased importance. However, most of the change was relative. That is, factors that students considered to be most important at the start of medical school continued to be most important throughout the educational experience and those factors students considered to be least important at Year 1 continued to be least important at Years 2 and 4. Discussion: These findings have implications for medical education, a time when students are forming expectations that will impact their career satisfaction. In addition to information on career satisfaction, students should understand the professional values of medicine, their own values and expectations, current practice patterns, economics, and the role of advocacy.
Routledge eBooks, Jun 23, 2023
Family medicine, 2008
Training programs designed to improve information management have been implemented but not adequa... more Training programs designed to improve information management have been implemented but not adequately tested. Three critical components for information management were tested in a randomized control study: (1) knowledge of valid, synthesized summary information, (2) skills to use Web-based resources that provide access to these summaries, and (3) use of Web-based resources in clinical practice. Twenty-four primary care practices were provided with computers and high-speed Internet access and then matched, with half randomly assigned to receive training and half to receive training at a later date. Training was designed to address knowledge, skills, and use of Web-based information. Outcomes were assessed by comparing baseline and follow-up questionnaires that focused on five conceptual domains related to Web-based resource use for patient care decisions and patient education. Compared to the delayed training group, the initial training group increased their knowledge and skill of We...
Handbook of Health Behavior Research IV, 1997
Despite rapid advances in the technology of the health sciences and in understanding of the basic... more Despite rapid advances in the technology of the health sciences and in understanding of the basic biology of diseases at the molecular level, most of the disease processes that in the postantibiotic age cause disability and death have behavioral roots. The statistics concerning behavioral risk factors noted in youth are particularly alarming. For example, among American high school students, 73.9% indicated that they had tried smoking by their senior year, while 24.7% admitted to smoking daily over the past month. Furthermore, 48% indicated that they had had at least one alcoholic drink within the past month. With regard to sex, 70% responded that they had had sexual intercourse by their senior year, with 18.5% reporting having had four or more sexual partners. As for suicide, 24% indicated that they had given serious consideration to the thought of suicide over the past year. Finally, 22% indicated that they had carried a weapon in the past month (Kann et al., 1995).
Teaching and Learning in Medicine, 2001
As emphasis in medicine has shifted to increasing the number of physicians who choose primary car... more As emphasis in medicine has shifted to increasing the number of physicians who choose primary care specialties, many studies of medical specialty choice have been conducted. Although researchers have approached the topic in a number of ways, most approaches have tended to focus on narrow elements of the choice, such as the effect of programs or curricula. A more comprehensive approach is possible by fitting the process to a preexisting broad theoretical framework. This synthesis of the literature examines specialty choice from the perspective of decision theory--with its aims of understanding how decisions are made, providing information about the quality of decisions, and improving the decision-making process. This approach has the potential to not only help deconstruct the process of decision making regarding specialty choice but also uncover information about the best ways to help medical students learn to make wise decisions.
Quality Management in Health Care, 2008
Objective-The Internet offers a significant information resource for health professionals. A stra... more Objective-The Internet offers a significant information resource for health professionals. A strategy to improve the use of these resources is for health care providers and staff to receive specific training. The aim of this study was to determine whether those who attended an Internet health care resource training intervention transferred knowledge and skills to others in the practice. Methods-Twenty-four primary care practices participated in the study in which 64 providers and staff attended a training intervention and 288 did not. A preintervention questionnaire that assessed knowledge, skill, and Internet usage was compared with a postintervention questionnaire. The main effect of interest in the linear model was the group by time interaction term, to determine whether knowledge and skill improved for both groups. Results-There were 41 attendees and 222 nonattendees that completed both pre-and postintervention questionnaires. There were 9 variables that showed a possible diffusion pattern, in which both attendees and nonattendees improved between pre-and postintervention. Overall, the training intervention seemed to have impacted knowledge and skills of the respondents and also reported improvements in the clinical area of patient education, but frequency of use for most Web resources for medical decision making did not improve. Conclusion-An improvement strategy that depends on a training intervention for a few members in a practice may not necessarily transfer relative to all aspects of patient care.
Education for Health: Change in Learning & Practice, 2003
Academic Medicine, 2004
Graduate medical education programs face new challenges as they seek to comply with the mandate f... more Graduate medical education programs face new challenges as they seek to comply with the mandate from the Accreditation Council on Graduate Medical Education to demonstrate that they are teaching and assessing residents on the six core competencies. The authors describe a project designed as a collaborative venture between the American Academy of Allergy, Asthma, and Immunology (AAAAI) and the Center for Educational Outcomes at Dartmouth College (CEdO) to provide residency programs in allergy/immunology with resources for teaching and assessing the core competencies. The goal was to create a set of learning and assessment resources that maximized the content knowledge expertise provided by the AAAAI and the learning expertise provided by CEdO.
Academic Medicine, 1998
No abstract available.