PUBLIC HEALTH BRIEFS
TABLE 2-PhysIcIans' Ratings of the Impact of Factors on the Development of Their Attitudes Regarding Abortion Degree of Impact Factors Influencing Attitudes
Patients Religion Desire to provide comprehensive services for patients Experiences with children Family of orientation Family of procreation Hospital policies Colleagues Significant professor in medical school Professional journals Other written materials Professional organizations Hospital staff Friends Financial considerations
26.2%(17) 23.1%(15) 21.5%(14) 18.5%(12) 10.8%(7) 9.3%(6)
16.9%(11) 12.3%(8) 12.3%(8) 10.8%(7) 7.7%(5) 18.5%(12)
10.8%(7) 13.8%(9) 13.8%(9) 12.3%(8) 15.1%(10) 15.1 %(10)
43.1 %(28) 50.8%(33) 50.8%(33) 56.9%(37) 64.6%(42) 55.4%(36)
3.1 %(2) 0.0%(O) 1.5%(1) 1.5%(1) 1.5%(1) 1.5%(1)
7.7%(5) 6.2%(4) 6.2%(4) 6.2%(4) 4.6%(3) 1.5%(1) 0.0%(0)
4.6%(3) 12.3%(8) 6.2%(4) 3.1 %(2) 13.8%(9) 10.8%(7) 0.0%(0)
13.8%(9) 32.3%(21) 15.1%(10) 12.3%(8) 12.3%(8) 16.9%(11) 10.8%(7)
72.3%(47) 44.6%(29) 67.7%(44) 73.8%(48) 66.2%(43) 69.2%(45) 86.2%(56)
1.5%(1) 4.6%(3) 4.6%(3) 4.6%(3) 3.1%(2) 1.5%(1) 3.1%(2)
in the pilot study suggest, however, that physicians' beliefs regarding the causes of and problems associated with unwanted pregnancy may have a marked influence on their reactions to requests for abortions and on their general attitudes regarding abortion. Subsequent reports of the full study will include analysis of this area, as well as of physicians' attitudes toward birth control, their social values, and the broad range of beliefs and experiences directly related to abortion.
REFERENCES 1. Blake, J., Abortion and Public Opinion: The 1960-1970 Decade. Science, 171:540-549, 1971. 2. Bourne, J. P., Influences on Health Professionals' Attitudes. Hospitals, Journal of the American Hospital Association, 46:8083, 1972. 3. Mileti, D. S., Barnett, L. D., Nine demographic Factors and their Relationship to Attitudes Toward Abortion Legislation. Social Biology, 19:43-50, 1972. 4. Wolf, S. R., Sasaki, T. T., Cushner, I. M., Assumption of Attitudes Toward Abortion During Physician Education. Obstetrics and Gynecology, 37:1, 141-147, 1971.
An Introductory Course In Prescription Drugs For Community Health Workers Developed By A Systems Approach MATTHEW H. LIANG, MD, MPH
Introduction During 1972-1973 an introductory course in prescniption drugs was given to community health workers at the pilot Address reprint requests to Dr. Liang, Department of Medicine (Immunology), Stanford University School of Medicine, Medical Center, Stanford, CA 94305. At the time this study was made, Dr. Liang was with the Harvard Medical Service, Boston City Hospital, Boston, MA.
Family Health Center (Boston City Hospital). The major objectives of the 16-hour course were to: (1) provide a background for understanding the major indications and major side effects and adverse reactions of the 30 most commonly prescribed drugs in the Boston City Hospital ambulatory care setting, and (2) to assist the workers in patient education. The course was developed by a systems approach' and evaluated by a pre- and post-testing of the stated objectives of instruction. AJPH March, 1976, Vol. 66, No. 3
PUBLIC HEALTH BRIEFS
family health workers' role was undertaken by literature review and discussion with the professionals and paraprofessionals at the Center. A preliminary list of goals and their relative importance was determined. These goals were then verified by family health workers and their training coordinator to examine the goals in terms of their usefulness, their relevance to the family health worker's job, and the ease with which the material could be mastered. As a result, the course was modified to narrow the number of specific drugs, to provide guidelines for the situations in which problems should be referred to other members of the health
The Family Health Center at Boston City Hospital organized its medical care around the concept of primary care delivered by health teams. The prototype of the team consisted of eight family health workers, a social worker, 3 nurse practitioners, a pharmacist, a pediatrician, and an internist (ML). The role of the family health workers has been reviewed.2 3 In general, these are minimally trained health workers from the community who facilitate health encounters, reinforce patient education, and act as ombudsmen for patients in the health care system. The students, eight men and women from the inner city, were selected for the project to represent a variety of ethnic (Black, Puerto Rican, and Micmac Indian) and educational backgrounds. Six of the eight had completed high school, one had taken college level subjects, and another had received credits in sociology. All students had completed a general health course of 18 credits at Northeastern University in Boston followed by a course given at the Center emphasizing specific, common diseases, nursing arts, nutrition, first aid, and family planning. Their curricula is outlined in Table 1. The idea for the course came from the family health workers who wanted to learn more about the drugs which their patients were taking. A total of $50 was available to provide teaching materials and books.
team, and to include a discussion of drug abuse and birth control devices. From a revised set of prioritized goals, specific tasks were developed for each goal; each task was then analyzed for the specific steps required. Subsequently, these tasks were analyzed and grouped into "performance objectives" or "skill/knowledge objectives". Performance objectives are statements of post-course professional tasks which specify what the student will be able to do in relation to professional performance tasks in the real world. Skill/knowledge objectives are statements describing what students will be able to do to demonstrate their understanding of the relevant component skills and knowledge associated with the performance objectives. From these groups evolved the details of the lesson plans and the questions for the various quizzes and examinations.
The curriculum was developed in a systems approach at the Harvard School of Public Health.1 An analysis of the
The syllabus of the course is given in Table 2. Mention of specific drugs was kept to a minimum and particular
TABLE 1-Background Health Training of Family Health Workers, 1972-73. Course
Foundations of Medical Science I, II
Division of Health Sciences Northeastern University Boston, Massachusetts
Spanish Pediatric Growth and Development First Aid Family Planning & Sex Education
AJPH March, 1976, Vol. 66, No. 3
6 Credits 2 Credits
in Family Health Health, Disease and Disability 1, 11 Human Growth and Development: Pre-
School Age Child Personal and Community Health Introduction to Clinical Medicine Nursing Arts Medical Terminology Nutrition Introduction to
Credits or Time Spent
6 Credits 2 Credits 2 Credits
Boston City Hospital Staff
80 Hours 20 Hours 16 Hours 10 Hours
American Red Cross Greater Boston Chapter Boston Family Planning Project
10 Weeks 50 Hours
PUBLIC HEALTH BRIEFS TABLE 2-Syllabus-Introduction to Prescription Drugs for Family Health Workers-1973 Title
1. The Problem of - Drug 10, non-com-
1. Pretest 2. Assigned reading: Folk Nosology: When Textbook isn't good enough. Barr, Reuben, Hospital Physician 6:43-55, 1971
pliance The Hot-Cold Theory
Discussion: Why don't people take their medicines?
(Xerox Copies) 2. The High Cost of Drugs Generic vs Brand Names
II. Sedatives/ Tranquilizers
III. Drugs for Anemia
New Handbook of Prescription Drugs. Burack, Richard, Ballantine Press, rev edition, 1970 ($1.25)
1. Barbiturates, Chloral Hydrate,
Chlordiazepoxide (Librium), Diazepam (Valium), Phenothiazines 2. Drug Overdose/Addiction Poison Control Center First Aid How to use the Product Identification Section of the Physician's Desk Reference.
Have students identify unknown pills and capsules and phone Poison Control Center for Information
1. B12Shots, FeSO4
Physician's Desk Reference (1972). 26th Edition, Medical Economics, Inc.
2. Multiple Vitamin Preparations
V. Drugs for Lung
1. Penicillin, Tetracycline INH, Ethambutol 2. The VD Problem 3. Tuberculosis in the Inner City 1. Antihistamines, Aminophylline, Ephedrine
VI. Review Session
VIl. Taking A Drug History When to Refer a Problem
VIII. Drugs for Endo-
1. Insulin, oral hypoglycemic agents,
X-ray of cavitary Tbc. Lecture 1. Divide into smaller groups to solve clinical vignettes on problems with drugs 2. Discuss vignettes 3. Anonymous test Illustrate placebo effect by conducting a "Drug Experiment" on students*
X. TheTeam Approach to Problem Solving
1. 2. 3. 4.
Digoxin Anticoagulants Antiarrhythmics Antihypertensives
Small groups to solve clinical vi-
"Described in: Demonstration to Medical Students of Placebo Responses and Non-drug Factors. Blackwell, B.,
Assigned reading: Drugs and the Doctor-Patient Relationship. Sherman, R.W., Arch Int Med, 131:601-5, 1973 (xerox copies)
2. Birth Control Pills
IX. Drugs for Heart Disease and Hypertension
Test taken anonymously
Assigned reading: Birth Control Handbook (revised edition, 1970) Students' Society of McGill University, 3840 McTavish St., Montreal, Que. $35/1,000 The Pill: Facts and Fallacies About Today's Oral Contraceptives. Kistner, Robert W., Dell Publishing Company, N.Y. 1970 (950 per copy) x-ray of congestive heart failure
cortisone preparations, thyroid pills
35mm Slides showing Strep throat, stages of syphilis
et al. Lancet
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PUBLIC HEALTH BRIEFS
emphasis was given to general indications, side effects, and adverse reactions. Problem-solving sessions were done in smaller groups to simulate working with a team. Nurse practitioners participated in these groups and acted as resources only. Teaching materials were selected for their readability, cost, and brevity.
questions during the course, and 20 new questions. Again, all questions were derived from the skill and knowledge objectives which had been developed in the original task analysis. The results of the evaluation (Table 3) support the success of the course and measure how effectively the skill/knowledge objectives were learned.
Evaluation A pre-course examination was developed from the stated objectives of the course and administered. Several quizzes were used during the course to reinforce learning and stimulate discussion. These were taken anonymously to create an atmosphere of learning for its own merit. The results of the quizzes were analyzed to provide topics for future discussions. Finally a comprehensive final examination was given and included 100 per cent of the pre-test questions, 70 per cent of the most frequently missed quiz
A 16-hour introductory course in prescription drugs for community health workers was developed by a systems approach. It featured an emphasis on: (I) learning the broad indications, side effects, and adverse reactions of the 30 most commonly prescribed drugs in the outpatient clinic, and (2) aiding the workers in patient education. Teaching materials were simple and inexpensive. An evaluation based on a pretest of the course's objectives compared to a final test documented the success of the instruction.
REFERENCES TABLE 3-Evaluation of Prescription Drug Course
PRE-TEST (25 questions)* FINAL: Pre-test questions (25 questions)* Quiz Questions (7 questions) New Questions (20 questions)
(52 Questions) *Identical Questions
80.6 6.4 15.4
70-90 5-7 12-18
1. Systematic Curriculum Design, A Guide for Teachers of Community Medicine and Public Health by Teacher Preparation Program Staff assisted by Office for Instructional Development, President and Fellows of Harvard College, 1972. 2. Wise, H. B., Torrey, E. F., McDade, A., Perry, G., Bograd, H., The family health worker. Am. J. Public Health 58:1828-38, 1%8. 3. Simpson, G. A., The family health worker at the community field level. Ann N.Y. Acad Sci, 166:916-26, 1969.
Acknowledgments It is a privilege to acknowledge the aid and guidance of Dr. Ascher Segall and Ms. Lori Vanderschmidt who teach teachers how to teach and to be responsible for what they teach.
I INTERNATIONAL CONFERENCE ON SCABIES AND PEDICULOSIS I An International Conference on Scabies and Pediculosis will be held May 22-23, 1976, at the Medical School, University of Minnesota, Minneapolis, MN. Developed under the auspices of the National Program for Dermatology of the American Academy of Dermatology, the Conference is supported, in part, by the National Institutes of Health. Co-sponsors include the Center for Disease Control, the American Medical Association, and the Universities of Minnesota, California at San Francisco, and Pennsylvania. The Conference will bring together current scientific and clinical information for physicians and other health care professionals concerned with the identification, treatment and control of these conditions. The faculty will include Bj0rn Heilesen of Denmark, and Kenneth Mallanby of England. For further information contact Drs. Milton Orkin and Howard Maibach or the Office of Continuing Medical Education, Box 293 Mayo Memorial Building, University of Minnesota, Minneapolis, MN 55455.
AJPH March, 1976, Vol. 66, No. 3