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Pharmaceutical services in family practice medical residency training programs.

The extent and nature of pharmacists' involvement in family practice medical residency training programs was assessed using a national survey. Department chairmen of all 386 approved family practice residency training programs in the United States were contacted and asked to provide the names and addresses of pharmacists in charge of pharmaceutical services in the centers. A 46-item, six-page questionnaire was mailed to each pharmacist with a follow-up mailing, then a telephone call, to nonresponders. Department chairmen of 68 (18%) of the programs reported having at least one pharmacist in the center. Responses to the questionnaire were obtained from 53 (78%) of the pharmacists, four of whom were no longer involved with family practice centers. Most of the remaining 49 pharmacists were men (76%) between 30 and 40 years old (59%) with an academic appointment (67%) and a doctor of pharmacy degree or some type of postgraduate training. Drug-distribution services were provided in 37% of the centers. All pharmacies offered clinical services. Almost all pharmacies (92%) offered educational services to both medical and nursing staffs, and pharmacists in 74% of the centers were involved in research. Few family practice medical residency training centers have pharmaceutical services conducted by a pharmacist; centers with pharmacists have a wide variety of distributive and clinical services.

Family Practice

Evaluation of a training program in breast cancer nursing.

A training program in breast cancer nursing was evaluated in terms of its effects on 55 nurse participants and 18 breast cancer patients who were assigned to a control or to a program group. The quasi-experimental evaluation design employed both standard and investigator-developed instruments. Pre- and posttests were used to measure nurse participants' knowledge and attitudes and appraisal of usefulness and satisfaction with the program. Effect on patient outcomes was measured by means of a Perception of Care Questionnaire, a Breast Cancer Knowledge Quiz, and the Multiple Affect Adjective Checklist. In the cognitive and attitude domains, nurse participants improved significantly and appraised the program as highly useful and satisfactory. Program group patients scored significantly higher scores on the Perception of Care and Breast Cancer Knowledge Questionnaires and exhibited significantly less anxiety than control group patients. Results support the use of evaluation as a part of systematic program development. The evaluation of patient outcomes is a challenging but essential component of program evaluation.

Breast Neoplasms

Comparison of cardiology training programs in Canada and the United States.

To compare the composition of cardiology training programs in Canada and the USA, we surveyed the directors of all Canadian and American training programs. We found that Canadian trainees performed significantly fewer procedures than USA trainees and that the chief determinants of numbers of procedures performed are duration of time spent in a rotation and the type of hospital where the program is based.

Canada

Supportive personnel training program based at a technical college.

A supportive personnel training program based at a technical college is described. During the nine-month curriculum, the students spend time in the classroom and in a laboratory on the college campus. Part of the program is taught by the college faculty, providing the students with courses on basic chemistry, anatomy and physiology, medical vocabulary, typing, and math fundamentals. The other part of the curriculum is taught by pharmacists, including courses on hospital pharmacy, pharmacology, and pharmacy mathematics. The students' first experiences with unit-dose and i.v.-admixture programs are in an artificial laboratory under controlled conditions. Later in the program, the students rotate through each of the participating hospitals for thorough on-the-job training. By combining the resources of a local technical college and the area hospitals, a uniform program of training supportive personnel has been implemented that produces enough technical support for all the participating hospital pharmacies.

Curriculum

Residents' experiences of abuse, discrimination and sexual harassment during residency training. McMaster University Residency Training Programs.

OBJECTIVE: To assess the prevalence of psychological abuse, physical assault, and discrimination on the basis of gender and sexual orientation, and to examine the prevalence and impact of sexual harassment in residency training programs. DESIGN: Self-administered questionnaire. SETTING: McMaster University, Hamilton, Ont. PARTICIPANTS: Residents in seven residency training programs during the academic year from July 1993 to June 1994. Of 225 residents 186 (82.7%) returned a completed questionnaire, and 50% of the respondents were women. OUTCOME MEASURES: Prevalence of psychological abuse, physical assault and discrimination on the basis of gender and sexual orientation experienced by residents during medical training, prevalence and residents' perceived frequency of sexual harassment. RESULTS: Psychological abuse was reported by 50% of the residents. Some of the respondents reported physical assault, mostly by patients and their family members (14.7% reported assaults by male patients and family members, 9.8% reported assaults by female patients and family members), 5.4% of the female respondents reported assault by male supervising physicians. Discrimination on the basis of gender was reported to be common and was experienced significantly more often by female residents than by male residents (p < 0.01). Ten respondents, all female, reported having experienced discrimination on the basis of their sexual orientation. Most of the respondents experienced sexual harassment, especially in the form of sexist jokes, flirtation and unwanted compliments on their dress or figure. On average, 40% of the respondents, especially women (p < 0.01), reported experiencing offensive body language and receiving sexist teaching material and unwanted compliments on their dress. Significantly more female respondents than male respondents stated that they had reported events of sexual harassment to someone (p < 0.001). The most frequent emotional reactions to sexual harassment were embarassment (reported by 24.0%), anger (by 23.4%) and frustration (20.8%). CONCLUSION: Psychological abuse, discrimination on the basis of gender and sexual harassment are commonly experienced by residents in training programs. A direct, progressive, multidisciplinary approach is needed to label and address these problems.

Adult

Self-management of fibromyalgia: the role of formal coping skills training and physical exercise training programs.

There has been growing interest in the use of formal self-management training programs for people with fibromyalgia (FM). In these programs, health care professionals serve as trainers and provide education about FM and guided instruction in specific self-management strategies. A review of the literature on formal self-management training programs for FM suggests that they can be divided into groups: 1) those emphasizing training in coping skills (e.g., relaxation, activity pacing, and problem-solving techniques), and 2) those emphasizing training in physical exercise (e.g., cardiovascular fitness, strength, and endurance training). In this article, we review studies that have tested the efficacy of both types of programs. In addition, we identify key individual and contextual variables that are related to outcome and highlight future directions in the research and development of self-management programs.

Adaptation, Psychological

The effect of an aerobic interval training program on intermittent anaerobic performance.

The effects of a 9-week aerobic interval training program on anaerobic intermittent performance were investigated. Intermittent work consisted of four repeat 30-sec maximal efforts on a cycle ergometer (Wingate test) with 3-min recovery intervals. Thirteen men trained 3 days a week on the cycle ergometer, completing 3-min work-to-rest intervals and progressing from 5 to 10 reps. Relative and absolute values of aerobic power increased significantly for the training group (p < .05). No significant change was observed for the control group (n = 11). The training group demonstrated significant increases in the four anaerobic variables of short-term peak power (SPP), short-term anaerobic capacity (SAC), intermediate-term peak power (IPP), and total work (TW), and across the four 30-sec maximal repeats for anaerobic performance (T1-T4) (p < .05). Greater percentages of increase occurred for IPP and TW, especially during Repeats 3 and 4. The control group only demonstrated a significant increase in SPP for Repeat 3. These data suggest that the type of interval training program used in the study increased aerobic power and also enhanced performance in repeated high intensity, short duration work.

Adult

A survey of child and adolescent psychiatry residents: perceptions of the ideal training program.

A survey instrument was developed to examine several issues relevant to training in child and adolescent psychiatry. Forty percent of the residents representing 56% of the training programs in the United States completed the questionnaires. A descriptive profile of the typical training experiences of child and adolescent psychiatry residents is presented, as is a report of their satisfaction with each component of their program and their expectations of an ideal training program. In general, satisfaction with residency training experiences was found to be highly related to the amount of emphasis reportedly placed on the various training experiences. The implications of the findings for training directors are discussed.

Adolescent Psychiatry

Teaching models in an ambulatory training program.

Ambulatory care training is increasingly important in internal medicine. Such training centers on the practice where residents and faculty see their patients; thus, features of the practice model influence what residents learn. A resident-faculty group practice affiliated with a division of general internal medicine has many advantages. In such a practice, learning centers on resident-patient interactions, around which a comprehensive teaching program must be built. Major features of such a program include the mentoring of residents by faculty who work with them longitudinally and the presence of a well-balanced structured curriculum addressing clinical and nonclinical topics related to patient care. Teaching residents to interact and communicate with patients is crucial; approaches include role-modeling by faculty, use of videotaping, and role-playing and other innovative methods. Feedback is integral to learning and helps shape the attitudes and values that permeate residents' practices.

Ambulatory Care

A driver training program for the disabled.

This is a report of results of a driver training program for a selected group of disabled individuals at the Long Beach Veterans Administration Medical Center. A total of 167 eligible candidates elected to enter our driver training program, of whom 154 (92%) were successful. Dropouts were the result of educational deficiencies, physical inability, and/or stress in performance ability.

Automobile Driver Examination

Traditional obstetrics; a Nigerian experience of a traditional birth attendant training program.

A survey was conducted of 150 Traditional Birth Attendants (TBA) living in the peri-urban slum area of Ibadan, Oyo State, Nigeria. The purpose was to determine demographic characteristics as well as knowledge about midwifery practices prior to introducing a training program. The participants in the survey had volunteered for a free, 3-week training program in modern obstetrics. Information was collected by questionnaire which was read to the participants. The findings show that: (1) useful service is being rendered by the TBAs; (2) there are areas where the introduction of simple methods of aseptic technique, changes in some nutritional practices and increased knowledge on the benefits of immunization may improve the outcome for mothers and infants living in traditional societies in Nigeria. The findings serve as a guide for the development of content of TBA training programs.

Delivery, Obstetric

A survey of Cleveland Clinic training-program alumni. Implications for evaluation of graduate medical education.

The graduate of a medical training program is in a unique position to evaluate that program in comparison with the realities of medical practice. A survey of alumni of the Cleveland Clinic's graduate training programs was conducted in September 1986. The alumni's perceptions of the quality of their programs and the educational services provided by the Division of Education are discussed in relation to the educational administrative structure and evaluation process at The Cleveland Clinic Foundation. The need for such evaluation methods, as well as additional techniques to provide a comprehensive evaluation system in graduate medical education, is emphasized.

Attitude of Health Personnel

A model curriculum for substance abuse education in child and adolescent psychiatry training programs.

Child psychiatry training recognizes substance abuse as a problem requiring an educational effort to provide fellows with adequate clinical skills to manage these patients. The components of a substance abuse educational module which may be integrated into existing child psychiatry fellowships are presented, with a discussion of practical problems raised by the expansion of child psychiatry into this neglected area.

Adolescent

Treadmill training program for a bilateral below-knee amputee patient with cardiopulmonary disease.

This study was undertaken to determine the degree of progress an elderly bilateral below-knee amputee with cardiopulmonary disease could achieve by endurance training on a treadmill. Aspects of medications, orthotic/prosthetic evaluation, and energy expenditure are discussed. The subject was a 63-year-old Class IV cardiac patient with combined restrictive-obstructive pulmonary disease of moderate severity. He had undergone a coronary artery bypass graft (two-vessel) followed by a bilateral below-knee amputation for an ascending dry gangrene. The initial ambulatory aerobic evaluation showed the patient achieving only 50% of predicted maximal heart rate and 20% of maximal oxygen consumption. An individualized daily training program started the patient walking at .5 mph, 0% elevation, for five repetitions at two minutes each. By the end of the six-month training program the workload reached 1.4 mph at 2.5% elevation, for 30 minutes of total external work. The final exercise test evaluation showed an overall increase in age-predicted maximal heart rate (90%) and oxygen consumption (55%). The patient improved from cardiac Class IV to Class II, and therapeutically from Class E (bed rest) to Class C (moderate exercise restriction). These findings suggest a need for endurance training programs for patients with cardiopulmonary disease hindered by additional physical disabilities. The program enabled the participant to engage in significantly higher levels of activity for daily living within the community.

Activities of Daily Living

The effect of a training program on the reliability of examiners evaluating amalgam restorations.

There have been long-term problems in establishing agreement among clinical and preclinical examiners in dentistry. The purpose of this study was to develop a training program and study its effect on examiner agreement when judging the clinical service ability of amalgam restorations. Ten examiners with varying backgrounds, levels of experience, and no previous training with methods to standardize clinical evaluation evaluated 44 amalgam restorations in 17 patients before and after a brief training session. The restorations were judged as either acceptable (leave alone), or unacceptable (replacement or alteration required). The training program was brief and consisted of the introduction of a rating scale with descriptive criteria, followed by a clinical session where the examiners practiced using the rating scale and criteria to arrive at operational decisions. Intraexaminer and intraexaminer agreement were calculated for both evaluation sessions. The training program improved the reliability of the examiners evaluating the clinical service ability of the amalgam restorations. Although the gain was not to the level commonly accepted in the literature, it clearly demonstrates a step in the right direction.

Adolescent

Response of age forty and over military personnel to an unsupervised, self-administered aerobic training program.

The Army recently extended mandatory physical training and testing to include personnel 40 yrs of age and older. The purpose of this study was to describe the profile of aerobic fitness in a representative group from this age population and to evaluate the response of such a group to a self-administered, unsupervised training program. Maximal oxygen uptake (Vo2 max) and percent body fat (%BF) were assessed in 260 military personnel (40-53 yrs of age) before and after 6 mo of physical training consisting of a progressive walk/run mode of exercise. Before training the mean +/- S.D. for Vo2 max and %BF for all subjects was 38.1 +/- 6.2 ml/kg . min and 26.1 +/- 4.7%, respectively. Subjects were divided into three groups based upon their initial level of physical activity determined by interview as follows: inactive, moderately active and active. Upon retesting after 6 mo, 40% of the inactive group had not participated to any appreciable degree in the program and subjects of this group who did participate showed only a slight and insignificant increase (4.4%) in Vo2 max. The pretraining level of Vo2 max for the total population studied was similar to that reported in other studies on comparably aged subjects. However, changes with training were well below those seen with supervised group programs of 6 mo duration.

Adult

How uniform are post-graduate training programs in medical oncology in the European Union?

BACKGROUND: Medical oncology is a relatively new discipline whose rapid evolution is not paralleled by advances in the academic curricula. The present study was designed to provide a description of the status of post-graduate training programs in medical oncology in the European Union. RESULTS: Our survey shows that 'some form' of training in medical oncology is available in 10 countries of the European Union, but that there are officially recognized Schools of Specialization in this discipline in only four (Great Britain, Portugal, Republic of Ireland and Spain). Italy and France offer training programs in medical oncology as specific tracks of the School of Specialization in Oncology. A 'special competence' in medical oncology, within the specialty of internal medicine, is issued in 3 additional countries (Denmark, Belgium and the Netherlands). Finally, training in medical oncology is linked to that in haematology in Germany. A wide variation was found among the different European countries regarding the requirements for admission to these training programs. Similarly, the duration of the programs in the various schools ranges between 2 and 6 years and the total number of years from graduation to achievement of the title of specialist ranges from 4 to 9 years. CONCLUSIONS: Our survey discloses a broad heterogeneity of academic attitude regarding medical oncology in the European Union and points to the need for recognition of this discipline as a specific and essential specialization.

Education, Medical, Graduate