Faculty Bibliography

OBJECTIVE: Medical students are presented with unique challenges when they care for patients with limited English proficiency. Students must learn a complex set of skills needed to care for patients across cultural and language barriers and to understand the impact of their own attitudes and beliefs about caring for these patients. We developed and piloted a multimedia interactive Web-based module aimed at teaching students effective strategies for working with interpreters and diverse patient populations, and at raising their awareness of important legal, ethical, and cultural issues. DESCRIPTION: First the learner completes a 37-multiple-choice-question (MCQ) pre-test that assesses attitudes, factual knowledge, and ability to analyze written clinical scenarios relevant to the module's content. Learners are then shown a series of professionally produced video vignettes, which reflect diverse patient populations, interpreters, and effectiveness of interpretation strategies (e.g., a Russian-speaking woman with chest pain whose daughter interprets, a medical student interpreting for a Chinese-speaking man using herbal medication, a Haitian woman told of an abnormal mammogram through a trained simultaneous interpreter). In each case, learners submit short answers to on-screen questions analyzing the effectiveness of the interpretation strategies demonstrated. Immediate feedback is given comparing student responses with those of experts. At any time during the module, the learners may view video commentary by legal, ethics, and cultural experts, or access a glossary and Web site links. Students conclude the module by again taking the MCQ test. A final screen compares their pre- and post-MCQ test responses and shows best answers, allowing them to assess their learning. The learners also complete a survey, providing personal cultural information and feedback on the module. DISCUSSION: All 160 first-year medical students completed the module and evaluated its effectiveness this year. On average, students improved by 20% on the MCQ post-test and 86% of the students were satisfied with the learning experience and acquired new knowledge. As a result of their participation in the module, students examined their own cultural and linguistic backgrounds and made the following comments: 'I am interested in exploring the way my own culture and cultural biases could impact my working with patients from other cultures'; 'This module has opened my eyes to the fears and concerns of immigrants who do not speak English.' Therefore, this pilot of the module effectively imparted guidelines for, and raised awareness of, medical interpreting. The most common critique of the module was that as a result of technical difficulties, it was time-consuming. A more rigorous evaluation is planned for the next academic year. We are also working to enrich and enhance the module for more experienced clinicians (GME and CME). As a complementary educational tool, the Internet has the advantages of allowing students to work at their own paces, view engaging video clips, and participate in interactive learning with immediate feedback and self-assessment

The American College of Women's Health Physicians has been exploring an on-line educational tool-concept mapping-to facilitate the development of an interdisciplinary and woman-centered women's health curriculum, and to implement The Women's Health Care Competencies for Medical Students. By using an on-line concept map of the menstrual cycle, we have built upon a standard piece of curricula that describes a unique aspect of female physiology and transformed it into a knowledge framework that builds capacity. The concept map highlights relationships between concepts and across disciplines, connecting the competencies to enable meaningful learning so that a learner can adapt their knowledge to multiple settings, incorporate new learning, and generate new knowledge to grow the interdisciplinary field of women's health. The on-line format allows access from multiple sites and courses, and allows the curricula to grow organically over time without upsetting current curricular design

The comparative in vitro activity of GAR-936 and 12 other drugs against 602 North American isolates of methicillin-susceptible (MSSA) and methicillin-resistant (MRSA) Staphylococcus aureus was determined. The GAR-936 MICs ranged from 0.06 to 1.0 mg/l. The MIC(50)s and MIC(90)s were 0.12 and 0.25 mg/l for MSSA and 0.25 and 0.5 mg/l for MRSA

If health officials confirm that the man acquired the infection through the organ transplant or a blood transfusion, it would be a new route of transmission of West Nile virus. The possibility that the man acquired his infection through the known means, a mosquito bite, has not been ruled out, officials said. No case of transmission of West Nile or closely related mosquito-borne virus through blood or organ transplants has been reported in this country, a spokesman for the Centers for Disease Control and Prevention in Atlanta said. The West Nile virus was first detected in this hemisphere in 1999, in New York City. Dr. Julie L. Gerberding, the director of the disease centers, said, ''We have to take this case seriously and have an open mind about the possibility because transmission of the West Nile virus through blood and organs is biologically plausible.'' The C.D.C. is responsible for protecting the public's health from infections like West Nile fever

The researchers exposed the cells to vaccinia virus, a relative of the smallpox virus used since the 18th century as a smallpox vaccine. The degree to which the immune system cells responded to the virus offers a rough indication of immunity, the researchers said. The researchers said the participants could not recall how many times they had been vaccinated. Four of the participants in the North Carolina study had last received smallpox vaccinations within five years according to federal guidelines because they worked with the vaccination virus. Nine others were vaccinated from 6 to 35 years earlier. The researchers said the samples from all 13 vaccinated participants showed a robust immune response. Another author of the textbook, Dr. D. A. Henderson, who led the health organization's smallpox eradication effort and who is now a top government adviser on bioterrorism, said he had ''no idea'' how the new findings correlated with protection against natural exposure to smallpox. Dr. Henderson said it was ''perfectly obvious that one successful vaccination does not protect for a lifetime.''

The researchers exposed the cells to vaccinia virus, a relative of the smallpox virus used since the 18th century as a smallpox vaccine. The degree of the immune system cells' response to the virus offers a rough indication of immunity, the researchers said. The researchers said the participants could not recall how many times they had been vaccinated. Four study participants had last received smallpox vaccinations within five years, according to federal guidelines because they worked with the vaccination virus. Nine others were vaccinated from six to 35 years earlier. The researchers said the samples from all 13 vaccinated participants showed a robust immune response

The steps include opening new laboratories; improving the ability to detect microbiological and chemical agents; monitoring emergency rooms for certain ailments; adding more antibiotics and vaccines to the emergency stockpile; educating health care professionals; and teaching the newest epidemiologists how to quickly respond to an emergency. At a news conference yesterday, the director of the centers, Dr. Julie L. Gerberding, and other top officials said they had made it a priority to upgrade the agency's emergency operations center. This and other changes stemmed from consultations with experts on how to improve the agency's response in the event of another bioterrorist attack. To evaluate the speed of the health system's response to an outbreak, the agency is analyzing the time between the ordering of a blood test by a doctor who suspects that a patient is infected with the West Nile virus and the confirmation of the diagnosis by a state or local health department. The disease control agency is relying on state laboratories to report West Nile cases and is not confirming each case itself

Gro Harlem Brundtland said she would not run for re-election next year as director general of the World Health Organization. Dr