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PubMed1997

Do victims of an out-of-hospital cardiac arrest benefit from a training program for emergency medical dispatchers?

In this paper, we assessed the effects of a training course for emergency medical dispatchers on the handling of out-of-hospital cardiac arrest cases in the dispatch center of a two-tiered emergency medical services system. A total of 112 cardiac arrest cases were studied; 64 before and 48 after the training course. Before the course, all relevant information was obtained in 36% of cases, only partial information in 56% and no useful medical information in 8%. The corresponding figures after the training program were 62, 38 and 0%, respectively (2 x 3 chi2 test, P = 0.01). Trends towards an increase in the percentage of cases in which a second-tier team was sent immediately after the initial call (58 vs 75%; chi2 test, P = 0.06) and towards shorter overall intervals between receipt of the call and dispatch of the second-tier team (logrank test, P = 0.10) were noticed. Similarly, the survival rate increased from 2% before, to 8% after the training course (chi2 test with Yates' correction, P = 0.24). We conclude that our training program for emergency medical dispatchers produced some beneficial effects.

Apnea↗
PubMedDate not supplied

Evaluation of two training programs for laparoscopic cholecystectomy: incidence of major complications.

To determine the need for a training program for laparoscopic cholecystectomy, we evaluated two programs by surveying perioperative complications. The two programs were completed by eight surgeons in each. Program A consisted of 10 supervised operations and program B of only 2. A total of 1054 operations were performed, and 12 major complications required conversion to open surgery owing to transection of the bile duct in 5 cases, laceration of the common bile duct in 1 case, delayed perforation of the common hepatic duct in 1 case, bile leakage in 2 cases, duodenal injury in 1 case, and bleeding from the cystic artery in 2 cases. The incidence of a major complication was significantly higher in group B than in group A, and six of the nine major complications in group B occurred during the initial seven independent operations. Overall, the most common major complication was an injury during the operation to the common bile duct or to the hepatic duct. Four of the five transections of the bile duct required Roux-en-Y hepaticojejunostomy, and the other required end-to-end anastomosis with T-tube drainage; one laceration required simple suture closure; and the one delayed perforation required T-tube drainage. The mean duration of hospitalization for 7 patients with an injury to the bile duct was 74.4 days (range 16-151 days). We recommend that a training program for laparoscopic cholecystectomy should include at least 10 operations to prevent a major complication during the initial 10 operations.

Adolescent↗
PubMed1997

An assessment of the efficacy of sports vision training programs.

BACKGROUND: The claim that sports vision training programs can enhance visual skills and the level of sporting performance was investigated. METHODS: Thirty young subjects were assigned equally to visual training, reading (placebo), and control groups. Visual and motor tests were administered before and after 4 weeks of training or control activity to determine whether any improvements in performance had occurred. RESULTS: Significant improvements on some aspects of vision were apparent for the visual training group, but their improvements in both vision and motor performance were no greater than for either of the other groups. DISCUSSION: There was no evidence for visual training improving either visual or motor performance beyond levels due simply to test familiarity. The benefits of the visual training exercises commonly used by optometrists to enhance sports performance are therefore open to question.

Accommodation, Ocular↗
PubMed1981

Accuracy of DSM-III diagnoses following a training program.

The authors describe a 2 1/2-day training program designed to teach mental health professionals how to use a new DSM-III classification scheme. The 251 participants had previous clinical training but no prior exposure to DSM-III. They were asked to diagnose three cases from a series of five videotapes case vignettes; the authors then compared the participants' diagnoses with the expert opinion of clinical faculty. The degree of agreement among the participants with the expert opinion varied across the five cases, but the overall level of agreement was high (74.2%). These results indicate that with adequate training the new DSM-III classification scheme can be accurately applied to diagnostic situations.

Clinical Competence↗
PubMed1983

The outcomes of mental health training programs: a review of the literature.

In these times of fiscal austerity, educators are asked increasingly to justify their programs. This review of literature indicates there are few controlled studies focusing on outcomes of mental health training programs, largely because the goals of training programs have been poorly identified and/or infrequently used as a basis for evaluation. In addition, these studies lack adequate criteria of success and standardized measures of success. Educators are, therefore, unable to critically evaluate the impact of the trained worker on patient care.

Community Mental Health Services↗
PubMed1980

Evaluation of a training program for certified alcoholism counselors.

Evaluation of a training program for alcoholism counselors indicated that such training resulted in significant gains in knowledge, changes in attitude, greater ego strength and capacity for self-disclosure, as well as higher ratings of trainees on scales of effectiveness of counseling.

Adult↗
PubMed1988

Audiology training in Nigeria--II: A cost-effective approach to training programs.

The purpose of this article is to provide some ways and means so that an audiology training program can be implemented in a developing country (Nigeria). Specific problems facing students, faculty and the training process itself are examined. Suggestions are provided to reduce these problems. In addition to mobilization of local resources, it is suggested that international cooperation be sought in the development, establishment and implementation of audiology training programs in developing countries. While the present approach may not be unique, it may provide some cost-effective means for meeting the shortage of hearing health care professionals in many developing countries.

Audiology↗
PubMedDate not supplied

An evaluation of the dyslexia training program: a multisensory method for promoting reading in students with reading disabilities.

The development of reading and spelling skills in students with dyslexia, by definition, is delayed and often remains delayed despite years of instruction. Three qualities are thought to facilitate reading development in these children: the provision of a highly structured phonetic-instruction training program with heavy emphasis on the alphabetic system, drill and repetition to compensate for short-term verbal memory deficits, and multisensory methods to promote nonlanguage mental representations. The Dyslexia Training Program, a remedial reading program derived from Orton-Gillingham methods, embodies these qualities. Following their 2-year program, students displaying dyslexia demonstrated significantly higher reading recognition and comprehension compared with a control group. The two groups did not differ in spelling. In addition, the degree of improvement in reading demonstrated by students who received the Dyslexia Training Program by videotape and by those who received it live from instructors did not differ.

Achievement↗
PubMed1996

Voucher-based reinforcement of attendance by unemployed methadone patients in a job skills training program.

This study evaluated the use of voucher reinforcement for maintaining attendance of unemployed methadone patients in a job skills training program. Participants received vouchers for attending daily 2-h computer data entry training sessions. The vouchers had monetary values and were exchangeable for goods and services. During the first 6-week condition, daily vouchers were initially worth $8, increased by $0.90 for every consecutive day of attendance to a maximum of $34.10, and reset to $8 following any day of missed attendance. During the second 6-week condition, voucher values decreased each day by 20% of that individuals' earnings on the previous day. During a final 4-week condition, the highest pay level previously achieved by each individual was reinstated and stayed at that level for the remainder of the condition, except that voucher values reset back to $8 following any missed session. Five of 7 participants completed the study. For those 5 participants, 94% and 98% attendance rates were sustained during first and second high pay conditions, respectively. Four of 5 subjects stopped attending when pay fell to $6-$9 (median = $7) per session in the descending pay amount condition (the fifth subject continued to attend throughout). Mean percent of work days attended was significantly higher during the two high pay conditions than during the decreasing pay condition (P < 0.001). All participants acquired data entry skills. Participants reliably rated the work experience as 'interesting', 'enjoyable', 'challenging', and 'helpful'. Mean ratings for these adjectives obtained on all days attended were significantly higher than ratings of the experience as 'frustrating', 'boring', or a 'waste of time' (P < 0.001). These data show that voucher-based reinforcement can promote sustained attendance of chronically unemployed substance abusers in intensive employment training programs and support the continued evaluation of these incentive procedures under a wider range of worksite training conditions.

Adult↗
PubMed1999

The employment status of 1995 graduates from radiation oncology training programs in the United States.

PURPOSE: To quantify the employment status of 1995 graduates of radiation oncology training programs in the United States. METHODS AND MATERIALS: All senior residents (149) and fellows (36) who completed training in 1995 were mailed an employment survey questionnaire by the Association of Residents in Radiation Oncology (ARRO). Telephone follow-up of nonrespondents achieved a 100% response rate. Twenty graduates who chose to continue training and five who returned to their home countries were removed from the study. Of the 160 who attempted to enter the U.S. workforce, 106 were men and 54 were women. Initial job status and job status at 6-8 months following graduation were determined. RESULTS: Unemployment was 6.9% at graduation and 4.4% at 6-8 months. Underemployment (part-time employment) was 10.6% at graduation and 11.9% at 6-8 months postgraduation. Of those working part-time 6-8 months after graduation, 63% (12 of 19) did so involuntarily after unsuccessfully seeking full-time employment. For the 20 graduates who chose to continue training with fellowships, seven (35%) did so solely to avoid unemployment, four (20%) were partially influenced by the job market, and nine (45%) were not influenced by the job market. Adverse employment search outcome was defined as being either unemployed as a radiation oncologist or involuntarily working part-time. Excluding those who chose to work part-time, a total of 19 (11.9%) graduates at 6-8 months following graduation, compared to 22 (13.8%) at graduation, were either unemployed or involuntarily working part-time. In terms of gender, this represented 18.5% (10 of 54) of females and 8.6% (9 of 105) of males. In terms of geographic restrictions in the job search, 56% of males and 70% of females with an adverse employment outcome limited their job search to certain parts of the country. This compares to 62% of all graduates in this study with geographic restrictions in their job search. In terms of perceptions of the workforce and employment opportunities, 95% of all graduates believed there was an oversupply of radiation oncologists and 95.5% believed the job market was worse than what they had anticipated on entering training. Only 42.8% of all graduates were satisfied with the job opportunities available to them. A significant number of private practice positions (41%) did not offer a partnership track, and those that did so had an increased median employment period before partnership (3.25 years) compared to previous years. CONCLUSION: This is the only employment survey for any specialty in which a 100% response rate was achieved. Upon graduation, a significant number of residents and fellows were either unemployed or involuntarily underemployed. The job market absorbed only a fraction of them at 6-8 months. Most graduates, including those employed full-time, were not satisfied with the practice opportunities available to them during their job search. Many private-sector jobs did not offer a partnership track, and those that did required an increased employment period. A higher rate of involuntary part-time employment was seen for female graduates. Geographic restrictions in job search alone could not account for graduates being unemployed or underemployed, and could not account for gender differences. An overwhelming majority of 1995 radiation oncology graduates believed that the job market had deteriorated and that there was an oversupply of radiation oncologists. As one of two major studies tracking the employment status of radiation oncology graduates, we believe this study to be superior in methodology. We also believe this study presents data in a manner useful to medical students, training program directors, and healthcare policymakers.

Employment↗
PubMed1995

Psychomotor disturbances in psychiatric patients as a possible basis for new attempts at differential diagnosis and therapy. Part VI. Evaluation of psychomotor training programs in schizophrenic patients.

Parts I-III of this series established signs of disturbed motor performance--the "psychotic motor syndrome" (PMS)--in schizophrenic and endogenous depressed patients, which was not found in neurotic/reactive depressed nor healthy persons. Part IV yielded EEG signs of concomitant brain dysfunction in these patients, which were demonstrated by other (SPECT/PET) neuroimaging methods also. In part V we engaged in the development of motor-training programs applied both actively and mentally, using the PMS as target syndrome in depressed patients. We hypothesized that motor training would not only improve disturbed motor behaviour, but ameliorate other symptoms of psychopathology additionally, which was supported for these patients. Part VI is the final paper of this series demonstrating favourable results of our motor-training programs in 96 schizophrenic inpatients in two separate investigations. A general discussion to the whole series attempts to link motor symptoms to neuroimaging findings of brain dysfunction during motor challenge and to modern three- and four-factor models of schizophrenic symptomatology. A final version of our complete training programs will be published as an appendix to this paper along with information regarding the abbreviated test battery.

Adolescent↗
PubMed1994

The reading habits of RACGP Training Program doctors.

AIM: To describe the reading habits of a cohort of Western Australian RACGP Training Program doctors undertaking general practice terms in 1992. METHOD: A questionnaire that included a list of journals and books relevant to general practice was distributed to trainees. Information obtained included demographic data, the frequency of journal reading and the number of books read. RESULTS: There were 68 respondents from a total of 100. Time spent in medical reading ranged from one to 12 hours per week, with a mean of 3.3. The number of journal titles read in the past six months ranged from three to 16. The number of books actually read (from the 39 titles presented) ranged from zero to 17. The most frequently read were the reference type books. Very few of the 'core' books about the nature, scope and philosophy of general practice had been read. CONCLUSIONS: RACGPTP doctors read mainly for information. To produce educated doctors knowledgeable about their chosen discipline, the Training Program will need to place greater emphasis on introducing their vocational trainees to the writings of the thinkers and philosophers of general practice and family medicine.

Adult↗
PubMed1978

Ambulatory neurology in residency training programs: a perspective.

Inpatient care and teaching have been the central theme in academic medicine, including neurology, for the last several decades. However, pressures from within and outside of medicine are building to create a renewed commitment to ambulatory care and education. Most neurology training programs have not yet made that commitment. They should do so for the benefit of both the patients and residents served by the programs. Effective outpatient clinic training programs should include full-time staff devoted to ambulatory care, teaching, and research. The practicing clinical neurology staff could be used more effectively. Regular chart review, case management conferences, and other teaching strategies, and the reorganization of the clinic to include private patients, as well as group practice and interdisciplinary team concepts, could improve both the patient care and resident training in the neurology clinic.

Ambulatory Care↗
PubMed1992

What is the legal 'standard of medical care' when there is no standard medical care? A survey of the use of home apnea monitoring by neonatology fellowship training programs in the United States.

In treating a patient, a doctor is obliged to use the skill and care that is ordinarily used by reasonably well-qualified doctors in similar cases. In addition, the only way in which a juror may decide whether the defendant used the skill and care which the law required of him or her is from evidence presented by doctors called as expert witnesses (cf Illinois Pattern Jury Instructions). However, what should be done if expert opinions differ concerning the care that is "ordinarily used"? Home apnea monitoring (HAM) is prescribed at times for graduates of neonatal intensive care units despite the fact that indications for its use are not well established and efficacy is completely unknown. The authors attempted to determine standards for HAM as it is currently practiced in neonatology training programs. The primary teaching hospital for each of the 99 neonatology training programs in the United States was identified. Both the medical director (MD) and a neonatal intensive care unit nurse manager (RN) were asked about the use of HAM in their own nursery for four clinical vignettes. Each vignette depicted a 1000-g birth weight infant, currently 7 weeks old and ready for discharge. In three vignettes, the infant had demonstrated no apnea, mild apnea (resolved by 2 weeks of age), or moderate apnea (requiring theophylline therapy at discharge) during the hospital course. In the fourth vignette, the infant had no apnea but was to be discharged home with supplemental oxygen. For 67 of 99 training programs, paired responses of RN managers and MD directors were obtained.(ABSTRACT TRUNCATED AT 250 WORDS)

Aftercare↗
PubMed1977

Governmental peer review of training programs in child psychiatry.

The authors present the results of a review of grant applications from 84 child psychiatry training programs that was conducted by the Psychiatry Education Branch of NIMH during fiscal year 1975. They found that training programs whose applications were approved were (among other things) university based and successful in filling training positions; they provided experiences in two or more treatment modalities in varied settings and with diverse types of patients, had active liaison with community organizations and with departments of pediatrics, and provided research opportunities for trainees.

Child Psychiatry↗
PubMed1996

Results of an office-based training program in clinical breast examination for primary care physicians.

BACKGROUND: This study hypothesized that an office-based training program in clinical breast examination (CBE) would improve the lump-detection skills of primary care physicians. METHODS: A one-group pretest-posttest design was utilized, without outcome measurements taken prior to instruction, immediately afterwards, and six months later. Fifty physicians from 117 practices that had been randomly selected and met program eligibility criteria elected to participate. The intervention was a one-hour office-based CBE training program based on the MammaCare method, a standardized approach to teaching the detection of breast lumps using silicone breast models. RESULTS: There were five lumps in the silicone model. The mean number of correct lump detections increased significantly, from 0.66 before to 3.2 after instruction, and this gain was maintained at six-month follow-up. The mean number of false positives decreased from 2.9 before to 1.16 after instruction, increasing slightly to 1.6 at six-month follow-up. Ninety-six percent of the physicians reported that they had modified their methods of CBE as a result of the training. CONCLUSIONS: This office-based instruction using an academic detailing model improved the participating physicians' abilities to correctly detect lumps in a silicone breast model and was received favorably.

Adult↗
PubMed2000

Evaluation of communication training programs in nursing care: a review of the literature.

An important aspect of nursing care is communication with patients. Nurses' major communication tasks are not only to inform the patient about his/her disease and treatment, but also to create a therapeutically effective relationship by assessing patients' concerns, showing understanding, empathy, and providing comfort and support. In this review, 14 studies, which focus on the evaluation of the effects of communication training programs for nurses, have been evaluated. The selected studies were screened on several independent, process and outcome variables as described by Francke et al. [8]. In this way not only is the training program taken into account as a variable which may be responsible for nurses' behavioural change and for changes in patient outcomes, but also a range of other variables which can give more nuanced explanations for a training program's degree of effectiveness. On the whole, the studies reviewed showed limited or no effects on nurses' skills, on nurses' behavioural changes in practice, and on patient outcomes. Finally, the majority of the studies had a weak design. The use of experimental research designs should be pursued in future studies in order to eliminate the influence of confounding variables.

Clinical Competence↗