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PubMed1991

[How one achieves the practice of medicine in Puerto Rico--1990].

We have gathered information of particular interest to students of medicine and recent graduates about the law that regulates the practice of medicine in Puerto Rico. We have also reviewed the current information about how to obtain the examination of the Puerto Rico Board of Medical Examiners, and the requirements to obtain the provisional licenses for postgraduate training (internship and residency), for the compulsory year of government service and for the regular license. We have compared 1980, 1986, and 1990 as to the number of internships in the 28 programs available. At present it is quite likely that physicians with marginal credentials will have a difficult time finding a place in fully accredited programs. Since July 1980 the unauthorized practice of practice medicine is considered a serious offense. The increasing number of malpractice suits and the recent changes in the law have made the practice of medicine in Puerto Rico increasingly risky.

Accreditation↗
PubMedDate not supplied

Demographics and quality profile of applicants to pediatric dentistry residencies.

PURPOSE: The purpose of this study was to use Postdoctoral Application Support Service (PASS) data to study the quality and demographic trends for pediatric dentistry residency applicants. METHODS: PASS data on grade point average (GPA) and National Dental Board Exam, Part I (NBI) scores were used to determine applicant quality. PASS demographic data included: (1) gender; (2) citizenship; (3) ethnicity; (4) previous practice of dentistry; and (5) completion of a residency or internship. RESULTS: GPAs showed a significant increase for the 6 years investigated. NBI scores also indicated a significant increase. Significantly more females than males applied to pediatric dentistry residencies. A significant increase in US/Canadian applicants was found. Ethnicity was similar to that of dental school graduates, with minor exceptions. In several of the years studied, there were significant differences in applicants who previously practiced dentistry or completed a residency/internship vs applicants who had no such previous experience. CONCLUSIONS: Significant increases in grade point averages and National Dental Board Exam, Part I scores suggest a high quality of pediatric dentistry residency applicants and this trend seem to be continuing. There are significantly more female than male applicants. More research is warranted on actual acceptance data.

Canada↗
PubMed1988

Clinical skills of medical residents: a review of physical examination.

Students are introduced to techniques of physical examination at medical school. However, their skills are deficient at the time of graduation, and with the increasing shift of clinical teaching away from the bedside and into the conference room it is expected that these skills will weaken in succeeding generations of physicians. A practical and satisfactory method of addressing this problem during internship and residency training has not been forthcoming because of the lack of a regular forum for the teaching of clinical skills in busy tertiary referral hospitals and the shortage of teachers with the necessary skills and commitment to teaching a large number of house staff. We describe a program whose unique hierarchical approach has permitted a detailed ongoing review of physical examination. One clinician was able to teach 24 residents by instructing a small group of senior residents, who in turn, after practising with clinical clerks, taught groups of junior residents.

Clinical Clerkship↗
PubMed1979

Longitudinal study of career choices of a SUNY-Upstate cohort of medical students.

A SUNY-Upstate cohort was observed during the four-year matriculation (1974--1978) of the students for changes in their career choices. Medical school exposure seemed to increase students' interest in all major specialties, with the exception of family practice for which there was an overall 3% decrease. Internship and residency appointments accepted indicated that 75% entered primary care specialties, 8% more than the national average for 1978.

Adult↗
PubMed2005

Residents' end-of-life decision making with adult hospitalized patients: a review of the literature.

PURPOSE: The authors performed a structured literature review to understand residents' experiences with end-of-life (EOL) decision making with adult hospitalized patients, specifically regarding decisions to withhold or withdraw advanced life-support measures. METHOD: An Ovid-based strategy was used to search Medline, ERIC, PsychINFO, and CINHAL databases for articles published between 1966 and February 2005, combining the domains of "resuscitation orders," "decision making," and "internship and residency." All quantitative and qualitative studies examining residents' EOL decision making with adult hospitalized patients were included. The authors developed and applied a scoring system for relevance and quality, performed data abstraction and quality assessment independently and in duplicate, then met to collate findings and identify factors in residents' EOL decision making. RESULTS: The searches yielded 884 articles, of which 26 were included. Variable methodologies precluded meta-analysis. In these studies, residents felt unprepared to handle patient EOL decision making, although exposure to EOL discussions helped them gain confidence. Residents' attitudes, skills, and knowledge were key determinants of whether EOL decisions were addressed. Many misinterpreted the terms "DNR" and "futility." Residents' understanding of the patient EOL decision-making process could be extremely variable, and their do-not-resuscitate discussions suboptimal. Residents' lived practice experience of the patient EOL decision-making process was often at odds with what they were taught in formal curricula. CONCLUSIONS: Educational strategies aimed at changing residents' knowledge, skills and attitude should address the hidden curriculum for the patient EOL decision-making process that is part of the experienced culture of every day practice. Future studies of this experienced culture would inform specific educational interventions.

Adult↗
PubMed1990

[The emergency room as a setting for clinical training].

The undergraduate medical curriculum does not include supervised training in emergency services. Medical students and residents are expected to acquire skills and experience related to emergency medicine during their clerkships in the clinical wards. Consequently, Israeli medical graduates often have difficulty in coping with common situations in primary care and emergency medicine. In response to the perceived need of emergency training, we modified the undergraduate teaching program of the clinical clerkship. During their medical clerkship, students spent several weeks in the emergency ward. Residents were similarly assigned to the emergency ward on a rotating basis for 3-month periods. Both the positive feedback of the trainees and the practical relevance of the program and its feasibility, suggest that it may be a worthwhile addition to the undergraduate and graduate clinical curriculum. However, we have no data for evaluating the outcome. We feel that all aspects of emergency medicine should be included in the teaching programs of the various clinical specialties, and suggest that the emergency room should be used as a teaching setting during the clinical clerkship, the internship and residency training.

Clinical Clerkship↗
PubMed1975

Career and training patterns of students entering Canadian medical schools in 1965.

This paper follows the careers of the 1128 students who entered Canadian medical schools in 1965, most of whom graduated in 1969. The type of career pursued (whether general or specialty practice or some combination thereof), the type of specialty undertaken, the place of internship and residency training and the 1973 practice location of the graduates are examined. The wide variation in careers followed by the 12 schools' graduates provides the major focus of the paper.

Canada↗
PubMed2004

Women in U.S. psychiatric training.

OBJECTIVE: The number of women in psychiatric training is predicted to increase over time. This article aims to review and evaluate the existing literature on the topic and identify present areas of concern and recommend future areas for research. METHOD: A Medline search from 1964 to the present day was conducted. Literature on female physicians in psychiatry, internship and residency, career choices, and medical education was reviewed. RESULTS: Much has changed, for the better, to accommodate the needs of this population. The areas of role integration, career choices, and pregnancy remain issues of concern. These concerns will continue as the percentage of female physicians increases. CONCLUSIONS: The multiple issues surrounding the pregnant resident need to be formally addressed and recognized to avoid strain on all residents, patients and departmental systems. Political, social, and departmental issues need to be addressed to help female residents with role integration. Psychiatry should lead the way among medical specialties in advocating for excellent family leave policies and childcare. Academic psychiatry will have to use creative strategies to effectively recruit and maintain female faculty.

Career Choice↗
PubMed1997

A survey of family-violence curricula in Virginia medical schools and residencies at university medical centers.

PURPOSE: To examine the status (as of 1995) of family violence curricula at Virginia's three medical schools and their affiliated residencies. METHOD: Questionnaires were sent in the fall of 1995 to the deans of undergraduate medical education at the three schools and the directors of the 69 fully accredited residencies at the university medical center. The questionnaires inquired about the presence of particular family-violence topics in the curricula (battered women, child abuse, elder abuse) and whether teaching about family violence was required or elective. In addition, the medical schools' departments were asked to identify faculty who were experts in the area of family violence. RESULTS: All three schools responded about undergraduate education, showing considerable variability among departments concerning whether instruction was required or elective and what instructional methods were used. A total of 48 (70%) of the 69 residencies responded. Twenty-six (54%) indicated that they had at least some curriculum content related to particular family-violence topics: child abuse, 20 (42%); battered women, 13 (27%); and elder abuse, nine (19%). A total of 27 faculty with expertise in family violence were identified, and 16 were experts in identifying and treating injuries related to family violence. No expert was identified in such areas as mental health sequelae or violence prevention. CONCLUSION: The results allowed for the development of recommendations regarding medical education about family violence in Virginia, including the formal integration of family-violence curricula into medical school and internship and residency programs, and the coordination of disciplines within Virginia in family-violence prevention.

Curriculum↗
PubMedDate not supplied

The clinical experience in medical education: past, present, future.

In the nineteenth century, clinical education in the United States was entirely didactic. Medical students attended lectures all day and were expected to commit the many details to rote memory. In the modern era, the clinical clerkship transformed students from passive observers to active participants in the learning process. In addition, the internship and residency provided learners the opportunity to assume responsibility in patient care. The strength of this clinical experience depends not only on the will of medical faculties but on the quality of the hospital learning environment.

Academic Medical Centers↗
PubMedDate not supplied

Hospital postgraduate training: factors affecting prospective interns' ranking of a municipal hospital program in internal medicine.

This study examines the statistical relationship between potential influencing factors and the rank that prospective intern applicants assigned to Boston City Hospital in the National Internship and Residency Matching Program. Types of factors examined include personal considerations, the applicant's experience during the personal interview, hospital attributes, the academic program itself, and perceived house officer experience. A brief questionnaire was mailed to prospective interns ranked by the Department of Medicine. Analysis of questionnaire data indicates that personal reasons and two hospital characteristics, ancillary staff and type of hospital, were predominant influencing factors.

Boston↗
PubMed1993

Arranging affiliation agreements and outside rotations.

Affiliation agreements are necessary when a sponsoring institution makes arrangements for all or part of the education elements of an internship or residency program to be delivered at another hospital. The sponsoring institution may be a college of osteopathic medicine or an osteopathic hospital. Some basic considerations, which are outlined herein, should be reviewed when the sponsoring institution enters such agreements. Some of these considerations are requirements of the American Osteopathic Association, while others are necessary to avoid later complications. Agreement should be reached on negotiable factors, accepted by both institutions, and then referred for legal review by appropriate authorities.

Internship and Residency↗
PubMed1997

Comparisons between older and usual-aged medical school graduates on the factors influencing their choices of primary care specialties.

PURPOSE: To examine whether there are differences between older (30+ years) and usual-aged graduates in the factors that influence their decisions to enter primary care. METHOD: A national survey of primary care physicians was conducted by mail in early 1993. The survey population comprised physicians who had graduated from U.S. allopathic medical schools in 1983 and 1984. The questionnaire consisted of four parts: practice characteristics, 19 variables influencing the physicians' decisions to enter primary care (rated on a scale from 5 = very strong influence to 1 = no influence), the timing of the decision to enter primary care, and demographic and personal information. Data were analyzed through several statistical methods. RESULTS: In all, 355 (22%) older and 1,241 (78%) usual-aged graduates who were practicing in primary care specialties responded. Compared with the usual-aged graduates, the older graduates were more likely to have grown up in rural or inner-city areas, to have obtained a second academic degree, and to have made the decision to enter primary care earlier. The older graduates' decisions to enter primary care had been more influenced by children and familial responsibilities, whereas the usual-aged graduates had been more influenced by internship and residency experiences and by parents and role models before medical school. CONCLUSION: This study provides empirical evidence to support the notion that nontraditional students (i.e., older ones) are more likely to commit themselves earlier to a career decision and less likely to be influenced by the socialization process during medical school. In this regard, age-specific factors should receive more attention in the analysis of the physician workforce.

Adult↗