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[General vaccination in the 19th century. The relationship between the physician and the population as the background of smallpox vaccination in the Lucerne canton].

This summary describes the vaccination practices in a rural area in Switzerland in the 19th century. Using reports of the vaccinating physicians and records of the local authorities a differentiated picture of the interests and behaviors of the involved social groups was obtained. Efforts at compulsory vaccination were counteracted by a variety of factors like shortage of vaccine, opposition by the people on the grounds of interference with private lives and mistrust in modern medicine and academically trained physicians, and even reservation by the vaccinating physicians themselves. Nevertheless, the practice of vaccination became a significant factor in the general process of medicalization, thus improving the position of the medical profession and furthering the public health movement by strengthening the the bonds between medical knowledge and state power.

Communicable Disease Control↗

[Perspectives in psychiatric research in Latin America for the 21st century].

Psychiatric research in Latin America lacks in originality and methodological rigor, and the human and economic resources are extremely limited. However, there are groups in several countries that have used their initiative and resources with a high level of efficiency, particularly in the psychosocial area. Epidemiological investigation in Latin America is exemplary and can, indeed, be one of the most significant contributions of our psychiatry. Assisted by social scientists, psychiatric researchers can study the most pressing problems in the region (alcoholism, substance abuse, violence, problems with children, adolescents and the elderly), as well as traditional areas of clinical investigation such as neuroses and psychoses. Biomedical investigation will continue in selected centers with a clear understanding of priorities and costs. Psychiatric research in Latin America requires realism and gradulism in its planning, multidisciplinary and intercountry collaboration, adequate publication of its findings, and academically trained personnel. Some countries have accumulated expertise in specialized areas and that, together with the contribution of Latin American researchers in other continents, should be positively utilized.

Forecasting↗

[Abuse of psychotropic drugs during driving].

The responsibility of psychotropic drugs as a cause of road traffic accidents remains difficult to evaluate with precision. Different studies performed in many countries provide a certain precision in relation to percentage of injured drivers whose blood contained psychotropic substances (8 to 10% according to studies). On the other hand, it is practically impossible to really know either these products were or were not the cause of the accidents because underlying or associated pathologies can equally create problems such as lack of attention and other vigilance deficits. There is also a possibility of suicidal or aggressive tendencies. A certain number of circadian and other chronobiological parameters also complicate the problem since the schedule (hour) as well as the day of the week or even the season can considerably modify vigilance and reaction time. Available medications able to create such problems are numerous and their mechanisms of action varied. They can influence vision, impulsiveness and vigilance. They can act either by direct mechanisms of sedation or, on the contrary, by raising inhibition through secondary mechanisms: delay in drug elimination or provoked insomnia. For the most part, incriminated medications belong to the different classes of sedative medicines: benzodiazepines, antiepileptics, some antihistaminic agents, some antidepressants, some thymo-regulators and some anti-hypertensives. Also included are desinhibitors or stimulant classes: amphetamines and related drugs, caffeine and codeine. Some of them can be used for their psychodysleptic properties: codeine and anticholinergic drugs. Finally, drug and medicinal associations can have unforeseen effects: for example, anticholinergics + alcohol + valpromide, etc. If it appears methodologically impossible that research could ever precisely quantify the share of responsibility of psychotropic drugs in causing road traffic accidents, this relation remains highly probable. It is therefore necessary that in the course of university and post-academic training, potential prescribers might regularly be advised of these risks. Lastly, public needs to be constantly informed.

Accidents, Traffic↗

Managed-care organizations' teaching role: its importance in medical education.

One of the central issues driving integrated system development is educating physicians in managed care. Managed-care organizations need to become more involved in medical education, especially its clinical teaching functions. This affects largely the ambulatory aspects of care and generalist physician training. Academic medical centers and managed-care organizations can achieve this mission through collaboration.

Education, Medical↗

Examination of the impact of information-skills training on the academic work of health-studies students: a single case study.

AIM: To examine the impact of information-skills training on the academic studies of student midwives. Objectives include ascertaining whether student confidence increases, learning experiences are enhanced and academic standards are improved. METHODS: A student midwives' discussion group at a higher education institution, plus an in-depth interview with the students' course leader. RESULTS: Students reported increased confidence in using library and information resources. Appropriate and timely information-skills training embedded into health-studies curricula can lead to students becoming independent and lifelong learners, as well as improving the standard of their academic work. CONCLUSION: Information skills for health-studies curricula in higher education can be developed and delivered collaboratively by both library and academic staff. This can have very positive effects on both student perceptions and experiences and standards of teaching and learning.

Adult↗

Physician resources and postgraduate training in canadian academic rheumatology centers: a 5-year prospective study.

OBJECTIVE: To describe the trends in physician resources, changes in activity profiles, and the output of the postgraduate training programs in Canadian academic rheumatology centers from 1998-2002. METHODS: In 1998, the Canadian Council of Academic Rheumatologists (CCAR) established a prospective database to monitor physician resources, activity profiles, and recruitment within 15 academic rheumatology units in Canada. Information was also collected on residents pursuing subspeciality training in rheumatology. RESULTS: Over the 5 year period there was an increase in the number of rheumatologists from 157 to 168. The majority of this increase (91%) was attributable to changes in full-time staff. The mean age of rheumatologists increased from 47.9 to 48.9 years over the same period and the ratio of male to female rheumatologists decreased incrementally from 2.5:1 to 1.9:1. The overall allocation of time for clinical care (54-53%), teaching (17-16%), research (21-23%), and administration (7%) remained stable over time. Unfilled staff positions varied between 18-25 per year and were spread between 9-12 centers. The number of trainees in adult and pediatric rheumatology fell incrementally from 38 to 22 over the first 4 years of the study, with an increase to 30 in 2002. The majority of trainees were located at 2 centers and the number of active training programs varied between 6 and 12 per year. Funding for clinical fellowship training was provided by government (27-51%), the Arthritis Society (21-33%), and alternative sources (23-40%). CONCLUSION: These results indicate that rheumatology physician resources within Canadian academic units are inadequate to fulfill responsibilities in the delivery of clinical service and academic programs. Enrollment in rheumatology training programs is falling and is insufficient to meet the present and future needs for patients with rheumatic diseases in Canada.

Academic Medical Centers↗

The effects of EMG-assisted relaxation training on the academic performance, locus of control, and self-esteem of hyperactive boys.

This study investigated effects of EMG-assisted relaxation training on the academic performance, locus of control, and self-esteem of hyperactive junior high school-age boys. Twenty-four subjects each were randomly assigned to the treatment and control condition. Treatment consisted of six 20 to 25-minute sessions conducted biweekly. Pretreatment frontalis EMG, math, reading, and language performance, locus of control, and self-esteem were assessed for both groups. Outcome measures were again obtained on these dependent variables 2 weeks after the last treatment session. Experimental subjects demonstrated significantly higher posttreatment reading and language performance. Math performance gain did not reach statistical significance. A significant internal shift in locus of control was observed; however, self-esteem did not improve to that level. These outcomes correlated with significantly lower posttreatment frontalis EMG in the experimental group. EMG level did not change during the course of this study for control subjects. Implications of these findings are discussed in terms of existent research.

Achievement↗

Academic and personality correlates of career indecision in medical students entering training.

The academic and personality correlates of medical career indecision were investigated in two separate studies. In the first, the effect of career indecision on academic performance was examined in a group of ninety-eight (eighty male, eighteen female) medical students entering Texas Tech University School of Medicine over a 2-year period. These medical students voluntarily completed the Medical Specialty Preference Inventory (MSPI) as part of a routine preadmission test battery. Subjects were assigned to one of three conditions-decided, high-interest undecided and low-interest undecided--based on results from the MSPI. As predicted, 'low-interest undecided' students achieved significantly lower initial medical school grades relative to 'decided' students, whereas 'high-interest undecided' students did not differ from the 'decided' students. The second study investigated the influence of career indecision upon personality. Subjects for this study were eighty-eight (sixty-six male, twenty-two female) medical students entering Texas Tech University School of Medicine over a 1-year period. These students voluntarily completed the MSPI and several personality measures as part of a pre-admission test battery. The results only partially supported the stated hypotheses. Although 'low-interest undecided' students demonstrated less personal integration compared with 'decided' students, they were no more anxious.

Adult↗

Training for an academic career in neonatal medicine.

The rapid evolution of the subspecialty of neonatology, biologic sciences, and health care delivery provide a myriad of career opportunities. The expected complexity of a academic career in neonatal medicine in the 21st century will require training in patient care, basic and clinical sciences, and teaching and an understanding of local and national issues that have impact on care of newborns. The training of skilled neonatal health care workers and health of our infants will depend on the preparation of neonatologists who will provide clinical care and training and generate new knowledge related to the care of newborn infants and their families.

Career Choice↗

Robotic surgical training in an academic institution.

OBJECTIVE: To detail robotic procedure development and clinical applications for mitral valve, biliary, and gastric reflux operations, and to implement a multispecialty robotic surgery training curriculum for both surgeons and surgical teams. SUMMARY BACKGROUND DATA: Remote, accurate telemanipulation of intracavitary instruments by general and cardiac surgeons is now possible. Complex technologic advancements in surgical robotics require well-designed training programs. Moreover, efficient robotic surgical procedures must be developed methodically and safely implemented clinically. METHODS: Advanced training on robotic systems provides surgeon confidence when operating in tiny intracavitary spaces. Three-dimensional vision and articulated instrument control are essential. The authors' two da Vinci robotic systems have been dedicated to procedure development, clinical surgery, and training of surgical specialists. Their center has been the first United States site to train surgeons formally in clinical robotics. RESULTS: Established surgeons and residents have been trained using a defined robotic surgical educational curriculum. Also, 30 multispecialty teams have been trained in robotic mechanics and electronics. Initially, robotic procedures were developed experimentally and are described. In the past year the authors have performed 52 robotic-assisted clinical operations: 18 mitral valve repairs, 20 cholecystectomies, and 14 Nissen fundoplications. These respective operations required 108, 28, and 73 minutes of robotic telemanipulation to complete. Procedure times for the last half of the abdominal operations decreased significantly, as did the knot-tying time in mitral operations. There have been no deaths and few complications. One mitral patient had postoperative bleeding. CONCLUSION: Robotic surgery can be performed safely with excellent results. The authors have developed an effective curriculum for training teams in robotic surgery. After training, surgeons have applied these methods effectively and safely.

Academic Medical Centers↗

[The research course in geriatrics at the Robert Bosch Foundation--new scientific geriatric academicians from a German view].

The medical needs of the aging population, accentuated by demographic changes, are poorly reflected by the present academic medical training programs. Geriatric medicine does not receive the attention it should have to meet the rapidly increasing demands of the aging population. This is true for Germany but also for Switzerland and Austria as well as many other European countries. The Robert Bosch Foundation with the goal of improving social conditions and scientific competence through innovative projects is engaged in improving the situation of the aging population by a number of projects. Aware of the deficits in geriatric medicine and in response to the need of a training program in academic geriatric medicine, the Foundation initiated a research training program in Geriatrics in 2002 together with initially five now seven academic centers in Germany and Switzerland. The program is aimed at young researchers having graduated in medicine and interested in a career in academic geriatric medicine. Two types of grants are given: an early career award for young postdocs at the beginning of their scientific training for two years and a mid career stipend for medical scientists coming from other disciplines and interested in a career in geriatric medicine. The goal of the training program is developing competence in clinical research and in geriatric medicine. A research council advises the Foundation in the grant allocation and monitors the program as well as the individual progress of the award recipients. Currently, 10 trainees are in the program. The initiative of the Robert Bosch Foundation is an enormous help to establish academic geriatric medicine in Germany.

Biomedical Research↗

Training future leaders of academic medicine: internal programs at three academic health centers.

The authors review the need for internal programs for leadership training at academic health centers and then describe in detail three programs of this type that have operated during the 1990s: (1) the Allegheny Leadership Institute, founded by the Allegheny Health, Education and Research Foundation, Pittsburgh, Pennsylvania; (2) the Physician Executive Management Development Program (PEMDP) of Saint Louis University School of Medicine; and (3) the University of Nebraska Medical Center Leadership Institute. Educational elements common to these programs include having a small class size and participants from many areas of academic medicine and health care, focusing on educational strategies that draw on participants' experiences and training, conducting the training away from the participants' institutions, having short sessions, using faculty from both within and outside the participants' institutions, and creating strategies to reinforce learning. Lessons learned reflect the unique context of each institution; the authors list the major lessons learned by each of the three programs they surveyed (e.g., leaders of the Saint Louis University PEMDP program believe that it is important to help participants implement desired changes in their work areas once they return to work, and are investigating how to do this). The authors conclude with an extensive list of recommendations to optimize the effects of leadership development training carried out in AHCs' internal programs (e.g., "Focus on specific skills that can be learned, and link the learning experiences to real work situations in health care and higher education") and explain why they think internal leadership institutes have at least three distinct advantages over external programs.

Academic Medical Centers↗

Preparing for "diastole": advanced training opportunities for academic hospitalists.

Academic hospital medicine can be described as comprising periods of "systole," during which hospitalists provide clinical care, and periods of "diastole," the portion of a hospitalist's time spent in nonclinical activities. Far from being a period of relaxation, diastole is an active component of a hospitalist's work, the time devoted to the pursuit of career advancement. This period is a critical opportunity for career development in terms of medical research, education, quality improvement, or administration. An appropriate balance of systole and diastole may potentially prevent burnout and allow hospitalists opportunities to focus on academic advancement. Although an increasing number of residency graduates opt for a career in academic hospital medicine, few are prepared for the period of diastole. This article describes several career options in academic hospital medicine, specifically, opportunities in education, research, quality improvement, and administrative opportunities. By informing future hospitalists about the career opportunities within academic hospital medicine possible through managing their diastolic time, we hope that future generations of trainees will be better prepared to enter this field.

Education, Medical, Graduate↗

Endoscopic training in the academic GI program. Program Directors Workshop, March 29 and 30, 1984, Atlanta, Georgia. How the GI pathologist can interact best with the GI trainee.

Effective collaboration between endoscopists is essential if optimal results from gastrointestinal biopsy are to be achieved. Agreed upon ways to enhance communication should be established, such as special requisition forms and regular conferences to discuss biopsy findings. Endoscopists and pathologists should know about and feel free to discuss the other specialist's procedures and techniques. Furthermore, all procedures and techniques for obtaining, handling, and reaching diagnostic conclusions from biopsy specimens need to be carefully examined and optimized. Recommended approaches are presented.

Biopsy↗