Elder care as "frustrating" and "boring": Understanding the persistence of negative attitudes toward older patients among physicians-in-training

ObjectivesThis study explores the attitudes of physicians-in-training toward older patients. Specifically, we examine why, despite increasing exposure to geriatrics in medical school curricula, medical students and residents continue to have negative attitudes toward caring for older patients.MethodsThis study used ethnography, a technique used by anthropologists that includes participant-observation, semi-structured interviews, and facilitated group discussions. Research was conducted at two tertiary-care academic hospitals in urban Northern California, and focused on eliciting the opinions, beliefs, and practices of physicians-in-training toward geriatrics.ResultsWe found that the majority of physicians-in-training in this study expressed a mix of positive and negative views about caring for older patients. We argue that physicians-in-trainings' attitudes toward older patients are shaped by a number of heterogeneous and frequently conflicting factors, including both the formal and so-called “hidden” curricula in medical education, institutional demands on physicians to encourage speed and efficiency of care, and portrayals of the process of aging as simultaneously as a “problem” of inevitable biological decay and an opportunity for medical intervention.DiscussionEfforts to educate medical students and residents about appropriate geriatric care tend to reproduce the paradoxes and uncertainties surrounding aging in biomedicine. These ambiguities contribute to the tendency of physicians-in-training to develop moralizing attitudes about older patients and other patient groups labeled “frustrating” or “boring”.     

Sexual Health Education in OB-Gyn Residencies—The Program Directors’ Survey

Abstract

Objective: To evaluate U.S. obstetrics-gynecology (OB-Gyn) program Director appraisal of resident physician female sexual health training. Methods: An OB-Gyn resident sexual health curriculum survey was developed and sent to 237?U.S. OB-Gyn program directors. University/military programs were compared to community-based programs. Results: 115 OB-Gyn residency program directors responded (48.5% participation); 37.9% university/military and 43.2% community OB-Gyn Program Directors appraise the resident curriculum as “not well” preparing residents to manage sexual health therapies upon graduation. Topics not sufficiently covered include human sex trafficking, sexual health for women with disabilities, and cultural competency. Conclusions: This study identifies opportunities in OB-Gyn residency female sexual health education.     

Housing Concepts For and By the Elderly: From Subjects of Design to a Design Resource

ABSTRACT

The perception of elderly residents as a homogeneous group is challenged by the diversification of lifestyles and emphasis on individuality in housing. Recently, there has been a rise in Finland in housing projects initiated by groups of elderly people, where the seniors themselves are seeking to fill in qualitative gaps in the offering of housing. This article presents a comparative analysis of four senior housing concepts that represent both a producer-driven (“for the elderly”) and a resident-driven (“by the elderly”) approach. The study shows that elderly people can be a resource for residential development and that this necessitates a different “design logic” than in conventional senior housing.     

A Collaborative Approach to Service,Learning, and Scholarship

ABSTRACT

This article describes a research course that was a collaborative endeavor between a school of social work and a community organization. This project was guided by learning, service and scholarship goals. Specifically, the participants in this course provided a pro-bono evaluation for a community benefits district. The benefits district solicited assistance from the authors, with the caveat that district members not be involved in the data collection and analysis. The authors situate this project on a continuum of traditional versus participatory research, and propose a “mixed” model for collaborative university-community efforts. The authors suggest ways of engaging students in “real world” research that benefits the community and facilitates their own training as macro social work practitioners. Factors that facilitate and hinder such a project are also discussed.     

Chapter 2 Residents in Assisted Living Facilities and Visitation Patterns

Abstract

Resident visitation patterns within an assisted living facility provide insight into a resident's life satisfaction. This study investigated residents' perceptions of family and friend visitation. Thirty assisted living residents from Oklahoma participated in a comprehensive interview that included demographics, life satisfaction, visitation frequency, and perceptions of visitation patterns. A majority of the respondents (90%) perceived family and friend visitation as “important” to “very important” in their life. Visitation allows residents to reminisce with family members and friends, to fulfill the need to have outside contact, and to be reassured that they have not been forgotten. Results indicate residents do desire continued relationships with family and friends through visitation. Facilities should encourage activities involving outside members of a resident's support network and be aware of residents less visited, developing programs creating social contact and involvement.     

Japanese Contributions to Theory and Practice in Developmental Psychology

ABSTRACT

Despite the potential of digitally enhanced learning environments for supporting twenty-first-century learning and educational change, there is a dearth of research knowledge on students’ transformative agency in their use of digital technologies and media within these contexts. Transformative agency accounts for young people’s initiative and commitment to transform their activity and its context(s) for personal and/or academic ends. This paper reports an investigation of students’ transformative agency in a novel, student-centered design and learning environment, referred to as a makerspace. We present our empirical findings as a narrative, illustrating how transformative agency emerged and developed via three intertwined discursive and action-level manifestations of such agency, namely “deviating”, “switching”, and “transfiguring”, in the social activity of a group of four 5th grade students participating in the makerspace environment over one school semester. Our study makes an original contribution to the research on students’ transformative agency and its temporal unfolding in a novel digitally enhanced learning environment.     

When Bourgeois Utopias Meet Gentrification: Community and Diversity in a New Urbanist Neighborhood*

Abstract

Scholars have recently begun to explore how social and politically liberal gentrifiers make sense of the classed and racial inequalities linked to gentrification. In this article I ask how residents of one new urbanist “bourgeois utopia”—the Mueller Development in Austin, Texas—experience and give meaning to their neighborhood in a context of gentrification. Drawing on 31 in-depth interviews I explain how new urbanism has reimagined and marketed “diversity” and “community” to middle-class and wealthy consumers and provides these to affluent people as neighborhood amenities. I show how residents draw on diversity ideology and multicultural capital to neutralize what they see as their neighborhood’s role in gentrification. In doing so this article adds to our theoretical understanding of how contemporary urban development exploits pursuits for the social good as rhetorical tools to assuage privileged guilt while promoting profitable enterprises.     

Detecting and Decomposing the “Faith Factor” in Social-Service Provision and Absorption

Abstract

Faith-based provision and reception of social services may yield results that differ either randomly or persistently (via “fixed effects”) from the outcomes achieved under non-faith-based, but certainly not value-free, administration of these services. Yet attributing raw differences in performance to unobservable factors assumed to derive from “faith” should be a last resort. Instead, the objective of analysis should be to identify any such factors and their cost and strength operationally so that they can become a managed part of any program offered by existing providers or entrants.

These factors, or the cost effectiveness of employing them, could differ between secular and faith-based providers. Then members of the two groups optimally would use a different mix of means even if they were to pursue precisely the same ends. Yet program design and operation by both groups would stand to benefit from knowing the keys to their relative performance in particular areas of social service with particular groups of clients. Comparing the outcomes of experiments based on random assignment may provide little help in that regard. Micro-simulations may provide a superior approach to tightening the link between input-based model predictions and continuous learning from outcomes.     

The learning camera: A personalized learning model for online pedagogy in human services education

Abstract

This article describes the development of a personalized learning approach to human services online education that utilizes a “learning camera” as a metaphorical tool for undergraduate students’ development of knowledge, skills, and dispositions required for successful transition to professional practice. By highlighting students’ ongoing development as knowledge builders and constructivist learners, the online curriculum is enacted within each student’s area of interest and in their home communities. This “learning camera” model of online pedagogy for human services education is intended to serve as a resource for other institutions interested in praxis-oriented approaches to personalized online teaching and learning.     

The Internet and Demystifying Power Differentials

Abstract

Over the course of the past three years, a group of women residents of a forty-five-year-old public housing project have struggled with the housing authority to participate in the revitalization of that project. This article examines the emergence of a “critical consciousness” and action on the part of these women as a consequence of their going on-line on the Internet with their own home page. This article also looks at the historical and social context of their relationship with the local community and the housing authority as well as the women's ultimate challenge to the housing authority's sense of “exclusive” possession and use of information and data.     

Abstract

Abstract

Edmunds M W: Structure and nurse practitioner performance. The Nurse Practitioner 4: (3)42, May/June 1979

Are you a “new” nurse practitioner (NP) returning to your “old” practice setting? Are you a staff nurse, physician, receptionist in the “old” setting, wondering how to cope with this “new” nurse? This article is a MUST.

Simply and clearly, Ms. Edmunds illustrates the ingredients necessary to facilitate successful role transition.

Structural aspects requiring consideration are drawn from A. Donabedian and include:

1. adequacy of physical structure, facilities and equipment—office, exam room and equipment, telephone;

2. staff qualifications and organization-different mixes and levels of staff and/or reallocation of functions may be required;

3. fiscal arrangements—economic contributions to the practice should be recognized financially;

4. administrative, organization and/or programatic structures need to be reevaluated. Daily routine, patient assignment, collaboration-consultation time, development of new modes of health care delivery are examples.

Problems that may prove to be barriers to the role transition must be assessed and defined. Solutions potentiated should include attending to the structural aspects of the practice milieu. Ms. Edmunds offers valuable suggestions to avert or resolve “reentry” problems.     

Thinking the unthinkable: 'white liberal' defences against understanding in anti-racist training

Abstract

This article describes and analyses a range of group processes which occurred during anti-racist training workshops with qualifying social work students. The principal focus is to understand white students' defences against authentic learning about their own anxieties with respect to their black colleagues, and how unless these are surmounted they will constitute a continuing block to the possibility of a 'depth' engagement with racism.     

Utilizing and Evaluating ITV Workshops for Rural Community Leadership Training

SUMMARY

Interactive television has potential merit as a medium for reaching rural audiences. The Blandin Foundation has recently explored the use of ITV for its workshops for leadership training in rural Minnesota communities. This paper presents the findings of a formative evaluation of a pilot ITV workshop on “Attracting and Sustaining Community Volunteers,” in terms of its technical aspects, acceptability to participants, learning impacts, and accessibility. Criteria for selecting distance learning modalities and ITV networks and providers are suggested.     

Teaching without being taught how: social work practice faculty voices

ABSTRACT

Social work practice faculty have an important role in socializing MSW students to the field and practice of social work. This study, based on interviews with 15 faculty teaching an advanced clinical practice course in the United States, examines how faculty conceptualize teaching and learning. Faculty were asked about the theories or frameworks that guided their teaching, their own journeys to teaching and the resources that support their teaching. The study found that participants drew largely on their own experiences as student learners and social work practitioners and did not have much formal training in teaching and student learning. Furthermore, while half of the participants were able to identify a learning theory that guided their teaching, the other half were not. Finally, while participants articulated the need for support regarding their own teaching, many of the schools did not have formal faculty development opportunities. The paper ends with recommendations for supporting current and new faculty regarding teaching and student learning.     

Pharmaceutical Intimacy: Sex,Death, and Methamphetamine

ABSTRACT

In this article, I draw from ethnographic work conducted among residents of an “in-house” drug and alcohol treatment center in Baltimore, Maryland, to discuss the relationships born of pharmaceutical (ab)use. By looking in close detail at the autobiographical accounts of one man in treatment for addiction to methamphetamine, I attempt to chart the way life and death are at times brought into close proximity, and at others wedged firmly apart, by such things as love and avoidance. My concern is with the ethics of care that emerge through the so-called “small events” in everyday relations; that so often define a life or a relationship as falling under the category “normal” or “pathological.” I ask how such things as the known demands placed on the body by the need to maintain or avoid relations, whether pharmaceutically mediated or not, come to bear on the decision to “let die” or the resurgence of moral worlds. I end by discussing the different aspects of relatedness revealed by the dependencies and alliances formed by the kinship between pharmaceuticals and humans.

In compliance with current ethical research standards, the names of all informants have been changed to assure their anonymity.     

Creating New Patterns of Social and Economic Activity Through Planned Housing Environments

Abstract

HOPE VI programs have transformed distressed public housing areas into “planned neighborhoods.” This research highlights key results from an evaluation request by the Tampa Housing Authority to assess the social and economic impact of the local HOPE VI community. Findings suggest that the majority of residents enjoy the new neighborhood. Questions remain regarding the social cohesion among the mixed-income community residents and the potential for economic revitalization of the surrounding area. Implications for social workers are addressed.     

Judgments of Equity and Vote in a Presidential Election

Abstract

This paper reviews the studies of community satisfaction in “new towns” in Britain, Scandinavia, and the United States. In general, residents of the new towns respond positively to questions about their living conditions, although many of the studies reported have obvious methodological flaws. Research projects recently started in this country and in Scandinavia are designed to rectify these defects and make possible a more definitive answer to the question that forms the title of this paper.     

WHAT IF FAMILY THERAPY WERE A KIND OF PSYCHOTHERAPY? A READING OF THE HANDBOOK OF PSYCHOTHERAPY AND BEHAVIOR CHANGE*

Editor's Note. This piece by Grunebaum is not an “original article,” although his approach to presenting Garfield and Bergin's Handbook to a family therapy audience is certainly original; it does not meet the usual requirements as apiece for the “Connections” section of the Journal, although it certainly does forge such connections with the mental health world beyond family therapy; and it is not a typical “book review,” and thus, is appropriately described in its subtitle as a “reading,” rather than a review. It is a most creative demonstration of the fact that family therapists can learn a good deal of practical value from their colleagues who are “outside” our field.     

Heterosexism and Social Work

Abstract

This study examined heterosexism among 409 Illinois school social workers. Heterosexism was found to be negatively correlated with “education about” and “positive contacts with” gay and lesbian individuals and positively correlated with “religiosity.” Most respondents showed some level of heterosexism with a few having very high levels. Only 15% were non-heterosexist. Respondents reported receiving little or no education about sexual minorities in their social work training. Most indicated that the training received was not adequate preparation for working with gay and lesbian individuals. Amount of education received increased with each of CSWE's educational mandates about sexual minorities but had no significant effect on heterosexism.