Jeffrey Borkan

Bio: Jeffrey Borkan is an academic researcher from Brown University. The author has contributed to research in topics: Health care & Curriculum. The author has an hindex of 37, co-authored 116 publications receiving 3941 citations. Previous affiliations of Jeffrey Borkan include University of Massachusetts Amherst & Rappaport Faculty of Medicine.

Fostering and evaluating reflective capacity in medical education: developing the REFLECT rubric for assessing reflective writing

Abstract: Purpose Reflective writing (RW) curriculum initiatives to promote reflective capacity are proliferating within medical education. The authors developed a new evaluative tool that can be effectively applied to assess students’ reflective levels and assist with the process of providing individualized written feedback to guide reflective capacity promotion. Method Following a comprehensive search and analysis of the literature, the authors developed an analytic rubric through repeated iterative cycles of development, including empiric testing and determination of interrater reliability, reevaluation and refinement, and redesign. Rubric iterations were applied in successive development phases to Warren Alpert Medical School of Brown University students’ 2009 and 2010 RW narratives with determination of intraclass correlations (ICCs). Results The final rubric, the Reflection Evaluation for Learners’ Enhanced Competencies Tool (REFLECT), consisted of four reflective capacity levels ranging from habitual action to critical reflection, with focused criteria for each level. The rubric also evaluated RW for transformative reflection and learning and confirmatory learning. ICC ranged from 0.376 to 0.748 for datasets and rater combinations and was 0.632 for the final REFLECT iteration analysis. Conclusions The REFLECT is a rigorously developed, theory-informed analytic rubric, demonstrating adequate interrater reliability, face validity, feasibility, and acceptability. The REFLECT rubric is a reflective analysis innovation supporting development of a reflective clinician via formative assessment and enhanced crafting of faculty feedback to reflective narratives.

Mixed methods studies: a foundation for primary care research.

Abstract: Two articles in this issue focus on mixed methods or multimethod techniques, offering a tantalizing glimpse of the potential of such investigations for primary care. One provides a taxonomy of criteria and models for constructing these types of studies, whereas the other represents an example of

A report from the Second International Forum for Primary Care Research on Low Back Pain. Reexamining priorities.

Abstract: Study Design. Consensus process. Objectives. Reexamining and redirecting the research agenda for low back pain in primary care. of Background Data. Most research, publications, and funding have traditionally. Deen directed toward specially and biologically oriented investigations of spinal disorders from biomedical and biomechanical perspectives. Beginning in the mid-1980s, primary care researchers began to investigate this field in earnest, focusing on lower back pain as a pain syndrome within an individual, family, and community context. Unfortunately, more progress has been made on what should not be done in diagnosing and treating lower back pain than on what should be done. Methods. This was a modified group process designed to reach consensus among an international group of primary care lower back pain researchers. Results. Nearly all of the research priorities from the initial 1995 forum are still thought to be important, although only modest progress has been made on most of them. The priorities perceived to be the most feasible to investigate and the ones in which the greatest strides have been achieved are in methodologic rather than substantive areas. Identifying subgroups of people with lower back pain is still given top ranking in 1997, but the priorities nave changed dramatically. Greater emphasis is given to finding predictors and risk factors for lower back pain chronicity, improving self-care strategies, and stimulating self-reliance. New items now make up 50% of the top 10 priorities. In general, the additions reflect a greater emphasis on expanding methodologic avenues of inquiry. Conclusions. Methodologic advances, the enlistment of new techniques and disciplines, and redirected research efforts may tacilitate progress in the diagnosis and treatment of lower back pain.

Referrals for alternative therapies.

Abstract: Background The purpose of this study was to examine how allopathic physicians participate in the decision to refer patients for alternative therapies. Methods A pretested, self-administered, structured questionnaire was distributed simultaneously to all area physicians at community locations in Washington State, New Mexico, and southern Israel. The primary outcome measures were monthly and yearly rates of referral to alternative therapies. Results More than 60% of all physicians made referrals to alternative providers at least once in the preceding year and 38% in the preceding month. Referrals were generally based on patient requests, synergy between the alternative therapy and the patients' cultural beliefs, failure of conventional treatment, and the belief that patients have "nonorganic" or "psychological" disease. There was no relationship between the rate of referral and the referring physician's level of knowledge about, beliefs about the effectiveness of, or familiarity with alternative therapies. Conclusions Primary care physicians are more likely than other medical specialists to be knowledgeable about, personally subscribe to, and refer patients for alternative therapies. Physicians who use alternative techniques for themselves and their families or who adopt complementary therapies into their practices have higher rates of referrals. Referral rates and patterns were similar between sites despite considerable cross-cultural and health system differences. Given the high rate of referral and the absence of an apparent internal logic for such recommendations, guidelines and physician education may be advisable.

The qualitative research interview

Abstract: BACKGROUND Interviews are among the most familiar strategies for collecting qualitative data. The different qualitative interviewing strategies in common use emerged from diverse disciplinary perspectives resulting in a wide variation among interviewing approaches. Unlike the highly structured survey interviews and questionnaires used in epidemiology and most health services research, we examine less structured interview strategies in which the person interviewed is more a participant in meaning making than a conduit from which information is retrieved. PURPOSE In this article we briefly review the more common qualitative interview methods and then focus on the widely used individual face-to-face in-depth interview, which seeks to foster learning about individual experiences and perspectives on a given set of issues. We discuss methods for conducting in-depth interviews and consider relevant ethical issues with particular regard to the rights and protection of the participants.

Qualitative methods for health research

Abstract: Qualitative methods for health research , Qualitative methods for health research , کتابخانه مرکزی دانشگاه علوم پزشکی تهران

Depression and pain comorbidity: a literature review.

Abstract: Because depression and painful symptoms commonly occur together, we conducted a literature review to determine the prevalence of both conditions and the effects of comorbidity on diagnosis, clinical outcomes, and treatment. The prevalences of pain in depressed cohorts and depression in pain cohorts are higher than when these conditions are individually examined. The presence of pain negatively affects the recognition and treatment of depression. When pain is moderate to severe, impairs function, and/or is refractory to treatment, it is associated with more depressive symptoms and worse depression outcomes (eg, lower quality of life, decreased work function, and increased health care utilization). Similarly, depression in patients with pain is associated with more pain complaints and greater impairment. Depression and pain share biological pathways and neurotransmitters, which has implications for the treatment of both concurrently. A model that incorporates assessment and treatment of depression and pain simultaneously is necessary for improved outcomes.