Background. Qualitative research explores complex phenomena encountered by clinicians, health care providers, policy makers and consumers. Although partial checklists are available, no consolidated reporting framework exists for any type of qualitative design. Objective. To develop a checklist for explicit and comprehensive reporting of qualitative studies (indepth interviews and focus groups). Methods. We performed a comprehensive search in Cochrane and Campbell Protocols, Medline, CINAHL, systematic reviews of qualitative studies, author or reviewer guidelines of major medical journals and reference lists of relevant publications for existing checklists used to assess qualitative studies. Seventy-six items from 22 checklists were compiled into a comprehensive list. All items were grouped into three domains: (i) research team and reflexivity, (ii) study design and (iii) data analysis and reporting. Duplicate items and those that were ambiguous, too broadly defined and impractical to assess were removed. Results. Items most frequently included in the checklists related to sampling method, setting for data collection, method of data collection, respondent validation of findings, method of recording data, description of the derivation of themes and inclusion of supporting quotations. We grouped all items into three domains: (i) research team and reflexivity, (ii) study design and (iii) data analysis and reporting. Conclusions. The criteria included in COREQ, a 32-item checklist, can help researchers to report important aspects of the research team, study methods, context of the study, findings, analysis and interpretations.

Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups

Basics of qualitative research: Grounded theory procedures and techniques

Experience and Educationis the best concise statement on education ever published by John Dewey, the man acknowledged to be the pre-eminent educational theorist of the twentieth century. Written more than two decades after Democracy and Education(Dewey's most comprehensive statement of his position in educational philosophy), this book demonstrates how Dewey reformulated his ideas as a result of his intervening experience with the progressive schools and in the light of the criticisms his theories had received. Analysing both "traditional" and "progressive" education, Dr. Dewey here insists that neither the old nor the new education is adequate and that each is miseducative because neither of them applies the principles of a carefully developed philosophy of experience. Many pages of this volume illustrate Dr. Dewey's ideas for a philosophy of experience and its relation to education. He particularly urges that all teachers and educators looking for a new movement in education should think in terms of the deeped and larger issues of education rather than in terms of some divisive "ism" about education, even such an "ism" as "progressivism." His philosophy, here expressed in its most essential, most readable form, predicates an American educational system that respects all sources of experience, on that offers a true learning situation that is both historical and social, both orderly and dynamic.

经验与教育 = Experience and education

According to W. Edwards Deming, American companies require nothing less than a transformation of management style and of governmental relations with industry. In Out of the Crisis, originally published in 1982, Deming offers a theory of management based on his famous 14 Points for Management. Management's failure to plan for the future, he claims, brings about loss of market, which brings about loss of jobs. Management must be judged not only by the quarterly dividend, but by innovative plans to stay in business, protect investment, ensure future dividends, and provide more jobs through improved product and service. In simple, direct language, he explains the principles of management transformation and how to apply them.

Out of the Crisis

Lincoln, Yvonna, and Egon Guba, "Postpositivism and the Naturalist Paradigm," pp. 14-46 in Yvonna Lincoln and Egon Guba, Naturalistic Inquiry . Beverly Hills, CA: Sage, 1985.*

Understanding what influences oncology clinicians' communicating with dying patients: Awareness of one's own mortality may be one key.

This qualitative study explored the challenges associated with practicing geriatric physical therapy and the implications for graduate physical therapy education. A total of 4 focus groups were conducted between June 1999 and January 2000 with the intent of identifying challenges associated with treating older adults. The groups were a group of practicing physical therapy clinicians and faculty, 2 groups of master's-levelphysical therapist students, and a group of elderly respondents who had received physical therapy services during 1999. Findings indicate that the role of the physical therapist in the treatment of patients, including elderly patients, is one that includes a combination of technical and relationship-building competencies. Relationship-building competencies were emphasized by students and patients and to a lesser degree by clinicians and faculty. Given the current health care environment, some therapists were not able to provide the level of services they felt necessary for quality care. In particular, they felt that elements of the therapist-patient relationship were likely to be affected where time constraints were apparent. Students were unsure whether content related to relationship-building competencies belonged in the curriculum, commenting that learning these skills through experience is most effective. Faculty also had similar beliefs and questioned whether these skills could actually he taught in a classroom setting. In order to prepare students to practice physical therapy in a health care system that does not always value the importance of the therapist-patient relationship, academic and clinical educators must overcome a number of educational barriers. Key Words: Geriatric physical therapy. Graduate education. Patient-therapist relations. INTRODUCTION Today, nearly 13% of the US population, 34 million, is 65 years of age or older, and by the year 2030, this percentage is expected to grow to 20%, or 70 million.1 Given the increase in the number of older adults and their respective health needs, this will result in an increased demand for physical therapists (PTs) who are well educated in geriatrics. Currently, 37% of physical therapy practice involves providing service to elderly people.2 Nearly half of the PTs who treat patients over age 65 years practice in nursing home-type environments.2 Based on this growing trend, it is imperative that the physical therapy profession continue to seek opportunities to better understand practice as it relates to elderly people and to find opportunities to improve the services provided to this sector of society. A potential area for improvement is in the professional education provided to PT students in the areas of gerontology and geriatrics. Over the past 15 years, there has been an increased effort on the part of PT and physical therapist assistant (PTA) programs to infuse aging-related content into existing curricula as well as to increase the number of geriatric clinical experiences for students. In comparison to a 1984 study conducted by the US Department of Health and Human Services,3 a 1990 survey conducted by the American Physical Therapy Association (APTA) Department of Accreditation revealed increases in aging-related curhcular content and clinical experiences.4 The APTA study also revealed harriers to the incorporation of geriatric content, including a lack of time, funding, and qualiBed faculty.4 Barriers restricting the expansion of geriatric clinical internship sites include a lack of student interest in working with elderly people, stereotyped visions of the geriatric client, limited numbers of sites with qualified practitioners who have geriatric expertise, reduced numbers of PTs on staff, variety of patients, and lack of geographic accessibility.4,5 Researchers have studied the beliefs and attitudes of PT students.6,7 According to Wong,7 negative student perceptions related to geriatrics include (1) poor rehabilitation potential of elderly people, (2) elderly people are unmotivated and uncooperative, and 3) working in geriatrics means working in a nursing home setting. …

Challenges Associated with Providing Physical Therapy for Elderly People: Implications for Graduate Education

Our Stories, Ourselves

OBJECTIVES Periodic health examinations (PHEs) are the most common reason adults see primary care providers. It is unknown if PHEs serve as a "safe portal" for patients with mental health needs to initiate care. We examined how physician communication styles impact mental health service delivery in PHEs. STUDY DESIGN Retrospective observational study using audio-recordings of 255 PHEs with patients likely to need mental health care. METHODS Mixed-methods examined the timing of a mental health discussion (MHD), its quality, and the relationship between MHD quality and physician practice styles. MHD quality was measured against evidence-based practices as a 3-level variable (evidence-based, perfunctory, or absent). Physician practice styles were measured by: visit length, verbal dominance, and elicitation of a patient's agenda. A generalized ordered logit model was used. RESULTS Many patients came with mental health concerns, as over 50% of the MHDs occurred in the first 5 minutes of the visit. One-third of the 255 patients had an evidence-based MHD, another third had a perfunctory MHD, and the remaining had no MHD. MHD quality was significantly associated with physician communication styles. Visits with physicians who tend to spend more time with patients, fully elicit patients' agendas, and let patients talk (instead of being verbally dominant) were more likely to deliver evidence-based MHD. CONCLUSIONS If done well, PHEs could be a safe portal for patients to seek mental health care, but most PHEs fell short. Improving PHE quality may require reimbursement for longer visits and coaching for physicians to more fully elicit patients' agendas and to listen more attentively.

Periodic health examinations and missed opportunities among patients likely needing mental health care

OBJECTIVE This study sought to validate the ability of a "Medical Error Disclosure Competence" (MEDC) model to predict the effects of physicians' communication skills on error disclosure outcomes in a simulated context. METHOD A random sample of 721 respondents was assigned to 16 experimental disclosure conditions that tested the MEDC model's constructs across 2 severity conditions (i.e., minor error and sentinel event). RESULTS Severity did not affect survey respondents' perceptions of the physician's disclosure style. Respondents who viewed the nonverbally skilled disclosure perceived the disclosure as more adequate compared to respondents in the "low nonverbal skill" disclosure condition. Interpersonal adaptability did not affect respondents' adequacy ratings. Consistent with the MEDC model, those who viewed the physician's error disclosure as inadequate indicated that they would be more prone to engage in relational distancing behaviors, while those who rated the disclosure as adequate were more likely to reinvest into their relationship with their physician. These respondents also had higher resilience scores. In the context of a sentinel event, perceived adequacy significantly predicted endorsing legal redress or remedies (e.g., lawsuit). Verbal apology (e.g., "I'm sorry," "I apologize") did not predict any significant variance in the model beyond the physician's nonverbal skill. CONCLUSION In a simulated disclosure setting, physicians' communicative skills-particularly effective nonverbal communication during a disclosure-trigger outcomes that affect the patient, the physician, and the provider-patient relationship. Findings from this study suggest that MEDC guidelines may be helpful in reducing financial and reputational risks to individual providers and institutions, particularly in the context of a sentinel event.

Richard M. Frankel

Papers

Understanding what influences oncology clinicians' communicating with dying patients: Awareness of one's own mortality may be one key.

Challenges Associated with Providing Physical Therapy for Elderly People: Implications for Graduate Education

Our Stories, Ourselves

Periodic health examinations and missed opportunities among patients likely needing mental health care

"It Matters What I Think, Not What You Say": Scientific Evidence for a Medical Error Disclosure Competence (MEDC) Model.