Tricia S. Tang

Purpose The goal of this study is to describe the process of developing a program that trains peers to facilitate an empowerment-based diabetes self-management support intervention. Methods To guide and advise the development process, the authors formed a peer leader training action committee. The committee was an interdisciplinary group (principal investigator, nurse—certified diabetes educators, dietitian— certified diabetes educators, nutritionist, physician, and 3 community members) that met every 3 months over a 1-year period for continuous quality improvement meetings. During meetings, the committee reviewed and supervised the curriculum development, provided feedback, and informed modifications and improvements. Results The resulting peer leader training program is a 46-hour program with 2 training sessions conducted per week over a 12-week period. The competency-based training program is based on the theory of experiential learning, and it consists of 3 major components—namely, building a diabetes-related knowledge base, developing skills (communication, facilitation, and behavior change), and applying skills in experiential settings. All components are integrated within each training session using a range of instructional methods, including group brainstorming, group sharing, role-play, peer leader simulations, and group facilitation simulations. Conclusion Through the process described above, the authors developed a training program that equips peer leaders with the knowledge and skills to facilitate empowerment-based diabetes self-management support interventions. Future directions include conducting and evaluating the peer training program.

Background : Interactive theatre (IT) has been used to train faculty the skills and strategies to address challenging dynamics in educational settings. Purpose : This study described the development, implementation, and evaluation of an IT approach to improve preceptors' skills for increasing patients' acceptance of medical student participation in clinical care. Methods : Focus groups were conducted with faculty, residents, medical students, and clinic staff to discuss issues related to patients declining medical student participation. Findings were used to develop a faculty development session using an IT approach. At a Family Medicine grand rounds presentation, faculty and resident preceptors (n = 42) participated in the IT workshop and completed a pre–post survey assessing skills specific to increasing students' training opportunities in patient care and educational impact of the session. Results : Following the IT session, preceptors reported greater self-efficacy for helping patients feel more comfortable with medical students in the exam room (p =.031, d = 0.338) and increased comfort level with talking to patients about medical students performing sensitive exams (p =.010, d = 0.357). Eighty-eight percent of preceptors agreed or strongly agreed that the session was relevant to improving clinical precepting skills and helped them develop strategies for enhancing medical student involvement in care. Conclusions : Findings suggest that the interactive theatre approach to faculty development is an innovative and effective method to increase preceptors' comfort with discussing medical student involvement with patients.

Background: Research on patients' decision to have medical students participate in clinical care has been examined predominantly from the patients' perspective rather than the students' perspective. Purpose: This study investigated 3rd-year medical students' experiences with and perceptions of patients declining medical student participation in clinical care and identified factors associated with this decision. Methods: Third-year medical students (n = 103) completed a survey assessing demographic background, experiences with patients declining medical student participation in clinical care, preceptors' approach to obtaining patient consent for student participation, and ratings of preceptors' clinical education skills. Results: Fifty-nine percent, 22%, and 25% of students encountered patients declining student involvement in care (3 times or more) based on student's training status, student's gender, and in the context of a gynecological/urological exam, respectively. Patient consent obtained by clinic staff (r =.661, p < .001) was a significant predictor for patients declining based on training status. Gender (d = 40, p < .003) and patient consent obtained by clinic staff (r = .349, p < .001) were predictors of patients declining in the context of a gynecological/urological exam. Conclusions: A majority of medical students have encountered multiple experiences with patients declining student participation in outpatient clinical care. The approach preceptors use to obtain patient consent may be important in increasing training opportunities for students.

Objectives: Although rates for first-time and recent mammography screening have increased for women in the US in the past decade, rates for repeat mammography remain low. This study aimed to conduct an analysis of women's mammography experience, to examine the rates of repeat mammography and to identify the significant predictors of repeat mammography within 12 and 18 months of the index mammogram. Methods: Participants were 397 women obtaining a screening mammogram (i.e. index) at three university-affiliated radiology clinics. Following the index mammogram, women completed the measures assessing demographic background, health history, breast cancer knowledge, risk, and screening history, and aspects of the mammography experience. Eighteen months following the index mammogram, 296 women were contacted via telephone to assess repeat mammography behavior. Results: Factor analysis of a mammography experience survey yielded four major components including satisfaction with clinic services, physical experience, psychological experience, and communication with clinic staff. Twelve-month and 18-month repeat mammography rates were 37 and 68%, respectively. Logistic regression models found lifetime number of mammograms to predict repeat mammography at 12 and 18 months. In addition, the number of clinical breast exams obtained in the past 5 years predicted repeat mammography at 12 months, while having scheduled a mammography appointment predicted repeat mammography at 18 months. Conclusions: Based on these findings, strategies to increase mammography adherence include implementing a formal reminder system that prompts patients (e.g. postcard, automated telephone call) to schedule an annual mammogram or training clinic staff to automatically schedule an annual mammogram at the time of the current screening appointment. Copyright © 2008 John Wiley & Sons, Ltd.

Patients' receptivity towards medical student participation has been examined predominantly from the patient and/or the medical student perspective. Few studies have investigated the preceptor's perspective. The study examined preceptors' experience with patients declining medical student participation in clinical care and identified preceptor-related factors associated with this experience. Preceptors (n = 42) were recruited from a Family Medicine educational presentation and completed a survey assessing encounters with patients declining medical student participation, methods for obtaining patient consent, and self-rated clinical education skills. Forty-eight percent and 62% of preceptors have "sometimes" or "often" had patients decline student involvement due to student's status and in the context of a gynecological/urological exam, respectively. Fifty-eight percent "never" or "seldom" obtain patient consent with the student outside the exam room, while 46% "often" or "always" have the student directly inform patients about his/her involvement. Being a faculty preceptor (versus resident preceptor) (r = 0.463, p = 0.026) and feeling uncomfortable talking to patients about students performing the exam (r = -0.482, p = 0.020) were associated with patients declining student participation for a genital exam. Findings indicate that preceptors encounter patients declining medical student involvement in general and sensitive exam scenarios. In addition, patients are more likely to decline student participation when preceptors are faculty members and less comfortable discussing student involvement.

Purpose The purpose of this study was to examine social support and its relationship to diabetes-specific quality of life and selfcare behaviors in African Americans with type 2 diabetes. Methods The study followed a cross-sectional, observational design and recruited 89 African American adults, age 40 and older (mean = 60, SD = 10.5), diagnosed with type 2 diabetes. Participants completed measures assessing dia- betes-specific quality of life, self-care behaviors (healthy eating, physical activity, self-monitoring of blood glucose, foot care, medication and/or insulin use), demographic background, and diabetes-related social support. Diabetes-related social support variables included amount of social support received, satisfaction with support, positive support behavior, negative support behavior, and primary source of support. Results Stepwise regressions, controlling for demographic variables, were conducted to identify predictors of diabetes-specific quality of life and selfcare behaviors from the diabetes-related social support variables. Satisfaction with support was a predictor for improved diabetes-specific quality of life (r = –.579, P < .001) and blood glucose monitoring (r = .258, P < .05). Positive support behavior was a predictor for following a healthy eating plan (r = .280, P < .05), spacing out carbohydrates evenly throughout the day (r = .367, P < .01), and performing physical activity at least 30 minutes per day (r = .296, P < .05). Negative support behavior was a predictor for not taking medication as recommended (r = –.348, P < .01). Conclusions Findings indicate that social support plays a role in diabetes-specific quality of life and self-management practices. Social support encompasses multiple dimensions that differentially influence specific diabetes health-related outcomes and behaviors.

To compare patient-provider differences in diabetes-related perceptions between African-American and White patients and to examine its association with self-care behaviours. One hundred and thirty patient-provider pairs were recruited from the greater Detroit area. Patients and providers completed a survey assessing perceptions about diabetes-related concepts and demographic background. The Diabetes Semantic Differential Scale was used to measure diabetes-related perceptions. Patients also reported the frequency of performing self-care behaviours, including following a healthy eating plan, engaging in physical activity, blood glucose monitoring, and taking medication and/or insulin. There were a greater number of patient-provider differences in diabetes-related perceptions for the African-American patients (nine of 18 concepts) compared with the White patients (four of 18 concepts). Stepwise regression analyses found patients' semantic differential scores to be significantly associated with five self-care behaviours for African-American patients and two self-care behaviours for White patients. Providers' semantic differential scores emerged as predictors of self-care behaviours for African-American patients, but not for White patients. Our findings suggest that compared with White patients, African-Americans differ in a greater number of diabetes-related perceptions than their providers. Patients' and providers' perceptions of diabetes care concepts have a significant impact on a greater number of self-care behaviours for African-American patients than White patients.