Teaching content in practice: Investigating rehearsals of social studies discussions.
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ABSTRACT:
SUBMITTER: Kavanagh SS
PROVIDER: S-EPMC6919940 | biostudies-literature | 2019 Nov
REPOSITORIES: biostudies-literature
Publications
Teaching content in practice: Investigating rehearsals of social studies discussions.
Kavanagh Sarah Schneider SS Monte-Sano Chauncey C Reisman Abby A Fogo Brad B McGrew Sarah S Cipparone Peter P
Teaching and teacher education 20191101
Despite evidence of its benefits, discussion remains rare in history/social science classrooms. To address this problem, communities of teacher educators (TEs) have begun supporting novices to approximate discussion facilitation. Some scholars are concerned that this turn to practice will come at the cost of content preparation. Focusing specifically on rehearsals of discussion facilitation in three history/social science methods courses, our analysis investigates whether, how, and in what ways ...[more]
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Project description:ObjectiveAn increasing number of children are socially transitioning to live as their identified genders rather than their assigned sexes, yet little empirical work has examined the decision-making process surrounding social transitions. We aimed to understand (1) why parents and their gender nonconforming children do and do not consider social transitions and (2) whether families discuss social transitions both before and after initial social transitions.MethodsStudies 1 and 2 involved telephone interviews of parents of socially transitioned transgender children (N=60) and gender nonconforming children who were not socially transitioned (N=60), respectively. Study 3 involved an online survey of 266 parents of socially transitioned transgender children.ResultsParents of socially transitioned transgender children (Study 1) and parents of gender nonconforming children who are not socially transitioned (Study 2) often reported that their children had led the decision to transition or not. Most parents of gender nonconforming children who had not transitioned had discussed transitioning (Study 2) and most parents of socially-transitioned transgender children reported discussing the option of future re-transitions (Study 3).ConclusionsParents often report that they and their children are discussing social transitions, a process that children are leading. In contrast to possible concerns about discussing transitions, our results suggest that many families openly discuss the possibility of their children transitioning (or re-transitioning), yet these discussion do not inevitably lead to an imminent transition.
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Project description:BACKGROUND:Little is known about agreement between patients and physicians on content and outcomes of clinical discussions. A common perception of content and outcomes may be desirable to optimize decision making and clinical care. OBJECTIVE:To determine patient-physician agreement on content and outcomes of coronary heart disease (CHD) prevention discussions. DESIGN:Cross-sectional survey nested within a randomized CHD prevention study. SETTING AND PARTICIPANTS:University internal medicine clinic; 24 physicians and 157 patients. METHODS:Following one clinic visit, we surveyed patients and physicians on discussion content, decision making and final decisions about CHD prevention. For comparison, we audio-recorded, transcribed and coded 20 patient-physician visits. We calculated percent agreement between patient/physician reports, patient/transcription reports and physician/transcription reports. We calculated Cohen's kappas to compare patient/physician perspectives. RESULTS:Patients and physicians agreed on whether CHD was discussed in 130 visits (83%; kappa = 0.55; 95% CI 0.40-0.70). When discussions occurred, they agreed about discussion content (pros versus cons) in 53% of visits (kappa = 0.15; 95% CI -0.01-0.30) and physicians' recommendations in 73% (kappa = 0.44; 95% CI 0.28-0.66). Patients and physicians agreed on final decisions to take medication in 78% (kappa = 0.58; 95% CI 0.45-0.71) and change lifestyle in 69% (kappa = 0.38; 95% CI 0.24-0.53). They agreed less often, 43% (kappa = 0.13; 95% CI -0.11-0.37) about degree of involvement in decision making. Audio-recorded results were similar, but showed very low agreement between transcripts and patients' and physicians' self-report on discussion content and decision making. CONCLUSIONS:Disagreements about clinical discussions and decision making may be common. Future work is needed to determine: how widespread such agreements are; whether they impact clinical outcomes; and the relative importance of the subjective experience versus objective steps of shared decision making.
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Project description:BackgroundPatient portal secure messaging allows patients to describe health-related behaviors in ways that may not be sufficiently captured in standard electronic health record (EHR) documentation, but little is known about how cannabis is discussed on this platform.ObjectiveThis study aimed to identify patient and provider secure messages that discussed cannabis and contextualize these discussions over periods before and after its legalization for medical purposes in Pennsylvania.MethodsWe examined 382,982 secure messages sent by 15,340 patients and 6101 providers from an integrated health delivery system in Pennsylvania, United States, from January 2012 to June 2022. We used an unsupervised natural language processing approach to construct a lexicon that identified messages explicitly discussing cannabis. We then conducted a qualitative content analysis on a random sample of identified messages to understand the medical reasons behind patients' use, the primary purposes of the cannabis-related discussions, and changes in these purposes over time.ResultsWe identified 1782 messages sent by 1098 patients (7.2% of total patients in the study) and 800 messages sent by 430 providers (7% of total providers in the study) as explicitly discussing cannabis. The most common medical reasons for use stated by patients in 190 sampled messages included pain or a pain-related condition (50.5% of messages), anxiety (13.7% of messages), and sleep (11.1% of messages). We coded 56 different purposes behind the mentions of cannabis in patient messages and 33 purposes in 100 sampled provider messages. In years before the legalization (2012-2016), patient and provider messages (n=20 for both) were primarily driven by discussions about cannabis screening results (38.9% and 76.5% of messages, respectively). In the years following legalization (2017-2022), patient messages (n=170) primarily involved seeking assistance to facilitate medical use (35.2% of messages) and reporting current use (25.3% of messages). Provider messages (n=80) were driven by giving assistance with medical marijuana access (27.5% of messages) and stating that they were unable to refer, prescribe or recommend medical marijuana (26.3% of messages).ConclusionsPatients showed a willingness to discuss cannabis use over patient portal secure messages and expressed interest in use after the legalization of medical marijuana. Some providers responded to patient inquiries with assistance in obtaining access to medical marijuana, while others cautioned patients on the risks of use. Insight into cannabis-related discussions through secure messages can help health systems determine opportunities to improve care processes around patients' cannabis use, and providers should be supported to communicate accurate and consistent information.
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