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PubMed2001

The otolaryngology research paradox.

OBJECTIVE: To determine the attitude toward and the state of research within the field of otolaryngology-head and neck surgery. DESIGN: A questionnaire was sent to the chairpersons of departments of otolaryngology where residency training is provided. PARTICIPANTS AND SETTING: Program directors of academic otolaryngology training programs. MAIN OUTCOME MEASURE: Responses to questionnaire. RESULTS: Questionnaires were sent to 95 programs from which 86 responses were received. Respondents believed strongly that research was important to the specialty. Only two thirds of the full-time clinical faculty, however, do research, and on average they devote only 17% of their time to this activity. About a third of those doing research have funding, and the National Institutes of Health support only 12% of clinician-investigators. Although program directors believe that clinicians should do research, three fourths stated that clinicians were too busy to accomplish this goal. Surprisingly, half of the respondents were unaware of residency programs that offered 2 years of research training, aimed to develop clinician-investigators, who can become competitive for attainment of research funding. CONCLUSIONS: Although leaders within our specialty believe that research is important, clinicians are not provided with enough time to conduct research. Furthermore, pathways that would enhance their competitiveness to obtain research funding are not recommended to our future clinicians.

Attitude of Health Personnel↗
PubMed1990

A new faculty training model for countries developing academic family medicine programs.

Medical schools in many countries wish to start academic programs in family medicine but do not have specifically trained faculty available. When the only medical school in Malta faced this situation, it agreed to try a new model for training potential faculty. This model was an intensive eight-month course for a selected group of ten experienced Maltese general practitioners to train in Malta with a visiting professor of family medicine. These adult learners were heavily involved in designing and contributing to an intensive course in family medicine and in teaching. Maltese teaching resources were used, and training occurred in the context of the society and health care system in which course members would ultimately teach. Subjective and objective measurements of course achievement were made. Results were compared with certification standards of the Canadian College of Family Physicians. This model merits consideration by other medical schools that wish to start academic programs in family medicine.

Communication↗
PubMed1986

A review of ten years' experience with surgical equipment in international health programs.

The Johns Hopkins Program for International Education in Gynecology and Obstetrics (JHPIEGO) began in June of 1973 with financial assistance from the Agency for International Development (AID). The purpose of the organization was to provide training and medical equipment to physicians in developing countries to update their education in reproductive health. JHPIEGO began by offering courses in the United States and shortly thereafter began training at centers in the developing countries themselves. Because of its important contributions to gynecological diagnosis in addition to its use in fertility management, laparoscopic equipment has been a major item in JHPIEGO reproductive health training. This paper details the development and role of laparoscopic training in JHPIEGO's program. Laparoscopic training begins with selection of trainees from appropriate institutions. Training itself begins with a didactic session at Baltimore or an in-country center. Trainees then receive clinical training and perform a minimum number of procedures, after which the practitioner, if he or she has successfully completed the clinical practice, can be named eligible to receive medical equipment to be donated to his or her institution. When equipment is installed, a field visit is made by a JHPIEGO consultant to insure the proper use and upkeep of equipment, and the understanding and implementation of standards and procedures. JHPIEGO has trained almost 3000 physicians in laparoscopy techniques between 1973 and 1984.

Developing Countries↗
PubMed2003

The role of the academic medical center library in training public librarians.

PURPOSE: This project enhanced access to and awareness of health information resources on the part of public libraries in western Pennsylvania. SETTING/PARTICIPANTS/RESOURCES: The Health Sciences Library System (HSLS), University of Pittsburgh, conducted a needs assessment and offered a series of workshops to 298 public librarians. BRIEF DESCRIPTION: The National Library of Medicine-funded project "Access to Electronic Health Information" at the HSLS, University of Pittsburgh, provided Internet health information training to public libraries and librarians in sixteen counties in western Pennsylvania. Through this project, this academic medical center library identified the challenges for public librarians in providing health-related reference service, developed a training program to address those challenges, and evaluated the impact of this training on public librarians' ability to provide health information. RESULTS/OUTCOME: The HSLS experience indicates academic medical center libraries can have a positive impact on their communities by providing health information instruction to public librarians. The success of this project--demonstrated by the number of participants, positive course evaluations, increased comfort level with health-related reference questions, and increased use of MEDLINEplus and other quality information resources--has been a catalyst for continuation of this programming, not only for public librarians but also for the public in general. EVALUATION METHOD: A training needs assessment, course evaluation, and impact training survey were used in developing the curriculum and evaluating the impact of this training on public librarians' professional activities.

Academic Medical Centers↗
PubMed2000

Report of the 1997 SCAROP survey on resident training. Society of Chairmen of Academic Radiation Oncology Programs.

RATIONALE AND OBJECTIVES: Members of the Society of Chairmen of Academic Radiation Oncology Programs (SCAROP) were surveyed in November 1997 to evaluate the current status of radiation oncology training in the United States and to help determine how it should be carried out in the coming decade. MATERIALS AND METHODS: A detailed questionnaire was sent to all members of SCAROP; 68 of 82 questionnaires were returned, for a response rate of 83%. RESULTS: The responses to the survey show a serious shortage of radiation oncologists in university settings, despite an apparent surplus in private practice. Although recent changes in health care have added additional clinical responsibilities for radiation oncologists in university practices, approximately 75% of the chairpersons answering the survey continue to give their faculty protected time for research. Even with additional research and teaching responsibilities, the average radiation oncologist in university practice saw 206 patients per year in 1997, a number similar to that reported by the Patterns of Care Study for radiation oncologists overall. Approximately two-thirds of respondents believe that academic chairs should strive to have all clinical faculty members participating in research. Nevertheless, most think that basic research is better performed by dedicated researchers with PhD degrees rather than radiologists with MD degrees. Most respondents believe that the training programs adequately prepare radiation oncologists for a career in academic medicine but do not provide good training in research. Eighty-four percent agreed that resident performance on the American Board of Radiology examination should be considered in the accreditation of residency programs in radiation oncology but should not be the major criterion. CONCLUSION: There is a shortage of academic radiation oncologists in the United States despite the large number of radiation oncologists completing training. This probably is due to a variety of factors, including a relatively small pool of candidates for academic positions, increasing demands for performance from academic physicians (to see more patients, perform research, publish, write grants, and teach), and competition from the private sector for recruitment of these individuals.

Data Collection↗
PubMed2006

Resident training in obstetric anesthesia in the United States.

BACKGROUND: Limited information exists on obstetric anesthesia experience and training within residency training programs in the United States. METHODS: A survey was sent to every academic anesthesiology training program in the United States (n=120), with follow-up reminders to non-responders. The survey included 14 questions divided into staffing, didactic teaching and epidemiology regarding the practice of obstetric anesthesia at each academic institution. RESULTS: A response rate of 78% (93/120) was achieved. The returned surveys were grouped into three tiers by the number of deliveries/year from the lowest (Group 1) to the highest (Group 3). The total number of obstetric deliveries at each institution ranged from 340 to 15 800. The average number of residents/month rotating on obstetric anesthesia was 2.6 and the number of months spent on the obstetric anesthesia service was 2.7. The average number of obstetric anesthesia lectures given was 12 per month. A total of 21.5 obstetric anesthesia fellows were reported to train at these institutions, with fellows being more common in larger institutions. Group 1 institutions were more likely to have anesthesiologists covering the main operating room and obstetric suite simultaneously. The average number of obstetric anesthesia staff members/institution was 4.3. The average cesarean section rate was 27.8%, with 5.8% being performed under general anesthesia. Neuraxial techniques were used in an average of 70.3% of laboring parturients, with combined spinal epidurals accounting for 24.6% of the techniques. CONCLUSION: The average number of obstetric deliveries per year for institutions with a resident training program was 3498+/-2383. Dedicated obstetric anesthesia staffing was more common when >3700 deliveries/year were performed; the presence of this staffing corresponded with a reduction in the use of general anesthesia for cesarean deliveries. Few differences in the resident lecture didactic exposure were observed in terms of numbers of lectures and months on the obstetric anesthesia service, although a significantly greater number of clinical cases was available to each resident in those institutions with greater overall numbers of obstetric cases.

Anesthesia, Conduction↗
PubMed2004

DentSim - a future teaching option for dentists.

Apart from a requirement to acquire more and more academic knowledge, during their training, dental students need to acquire a full range of highly precise manual and technical skills, including excellent hand/eye coordination, to enable them to visualize and understand how to prepare cavities, prior to placing restorations. Furthermore, unlike medical students, dental students are in the position of administering treatment to patients very early in their training. The increasing academic workload means that these skills have to be mastered in a short space of time. This you will gain in the future only through the use of effective methods of the educations - for example by the use of the computer-assisted dental simulators (DentSim/DenX), which serves the visual-, audio- and practical learning channel simultaneously. Unlike the conventional phantom heads, the DentSim-unit has the following advantages - the acquisition of knowledge takes place in a multimedia learning environment with a high audio-visual content and degree of interaction and complexity, - problem-oriented learning takes place through clinically relevant work, - individual students can work to personalized programs through the digital tutor function, - two-dimensional knowledge is transferred into three-dimensional spatial work, - three-dimensional preparations can be easily analysed by two-dimensional error analysis, - all preparation exercises are recorded for error and effectiveness analysis. Apart from student training, the computer-assisted simulators can also be used for the evaluation of the effectiveness or the quality control of various teaching methods in the context of Evidence Based Dental Education.

Computer Simulation↗
PubMed1997

Predictors of Success on the NATABOC Certification Examination.

OBJECTIVE: To determine the degree to which a selected number of variables could predict success on the first attempt at the National Athletic Trainers' Association Board of Certification Examination. DESIGN AND SETTING: Data were obtained from the student records of subjects who were enrolled in the same undergraduate athletic training education program for a minimum of two years, maintained a minimum GPA of 2.5 on a 4.0 scale, and had taken the National Athletic Trainers' Association Board of Certification Examination. A telephone survey of the subjects was used to supplement these records. SUBJECTS: Fifty-two subjects (38 male, 14 female) who had been enrolled for a mean of seven semesters (+/-2.57) participated in this study. Subjects maintained a mean overall GPA of 3.27 (+/- 0.39), with an athletic training mean GPA of 3.34 (+/-0.43) and an academic minor mean GPA of 2.91 (+/-0.46). The mean ACT composite score was 18 (+/-4.02). MEASUREMENTS: Subjects sat for the National Athletic Trainers' Association Board of Certification Examination. Examination passing status, rather than subjects' scores on individual sections, was used in the analysis. RESULTS: Analysis using forward multiple linear regression indicated that no single independent variable predicted examination success. However, a strong interrelationship was present between several of the independent variables. Multiple discriminant analysis was used to determine the nature and strength of these interrelationships. A composite set of variables was formed to include overall academic GPA, athletic training GPA, academic minor GPA, ACT composite score, and number of semesters of university enrollment. This composite set explained 42% of the variance in predicting successful completion of the entire examination on the first attempt. The predictive power of the composite set greatly decreased after the first examination attempt. CONCLUSIONS: Academic variables are the strongest predictors of first-time success on the overall National Athletic Trainers' Association Board of Certification Examination and its component sections.

Journal Article↗
PubMed1982

Training the internist for primary care: a view from Nevada.

The recent establishment of primary care residencies at the University of Nevada School of Medicine has raised important questions about local priorities in the training of physicians to provide primary care for adults. Because the amount of money available for health care training is decreasing, these questions also have national importance. Primary care internal medicine, not synonymous with general internal medicine, offers distinct advantages to patients over family practice adult care and primary care offered by internist subspecialists. The University of Nevada has a singular opportunity to organize a strong primary care internal medicine residency, but national problems of internal medicine emphasis exist. Nationwide changes in internal medicine residency programs (ongoing) and American Board of Internal Medicine nationalization of the fledgling primary care internal medicine fellowship movement are suggested. Specifically proposed is an extra year for primary care training with a single examination after four years, producing general internists with a primary care "minor." Alternately, and ideally, there would be a full two-year primary care fellowship with a separate internal medicine primary care subspecialty board examination. Either of the above options would provide necessary training and academic credibility for primary care internists, and would redirect internal medicine certification and training.

Fellowships and Scholarships↗
PubMed1998

Survey of research activity, training needs, departmental support, and career intentions of junior academic general practitioners.

BACKGROUND: Recent changes in the organization of the National Health Service have created new roles and responsibilities for academic general practice. Previous work on the constraints and opportunities of a career in academic general practice is largely anecdotal and is often based on the views of more senior members of the profession. AIM: To survey the research activity, perceived level of training, support needs, and career intentions of junior academic general practitioners (GPs). METHOD: A postal, validated, semistructured questionnaire was sent to the 121 eligible junior academic GPs in the academic departments of general practice in the United Kingdom and Dublin. Main outcome measures were 'research activity score', as measured by publications in peer-reviewed journals and involvement in research projects, 'training score' devised from 13 skills required for both research and teaching, and perceived level of departmental support assessed by six different support mechanisms. RESULTS: Response rate was 89% (n = 108). Forty-six responders (43%) had no publications. Twenty-five responders (23%) had no principal project. Thirty-nine responders (37%) had a mentor. Research activity appeared to be dependent on sex, having a predominantly research role rather than a full-time teaching role, and a positive perception of academic training (P < 0.05). Increasing departmental 'support scores' and length of time in the department were both significantly associated with more positive perceptions of academic training (P < 0.05). Only 29 (27%) responders wanted to progress to senior positions within academic general practice. CONCLUSION: Training and departmental support and guidance available to junior academics in primary care are perceived as variable and often inadequate. If academic general practice is to thrive, improved academic training is required, such as taught Master's degrees, supervised personal projects or 'apprenticeship' as a co-investigator, and improved methods of departmental support.

Career Choice↗
PubMed2001

Publishing trends in otorhinolaryngology from January 1997 to December 1999 in the UK.

In the last 10 years there have been many changes in otorhinolaryngology training and academic resources. The Calman reforms were introduced to our speciality in July 1996 and the last decade has also seen the number of professorial chairs in the UK rise from two to 12. One would therefore expect an increase in academic output, in terms of published works, despite the impediments generated by the Calman Training System. A search of eight leading English language otorhinolaryngology journals was carried out from January 1997 to December 1999 looking for articles with British authors. The results were compared with similar research carried out 10 years ago. There has been no major growth in the output of otorhinolaryngological publications from the UK in the last 10 years.

Bibliometrics↗
PubMed1990

The availability of fellowship training for foreign family physicians.

The authors surveyed the 49 U.S. fellowship programs in family medicine listed in the 1988 Fellowship Directory published by the Society of Teachers of Family Medicine. The past experience and future intentions of the 47 responding programs toward non-immigrant foreign family physicians coming to the United States to undergo fellowship training in academic family practice were studied. Only a minority of the programs (22%) had ever trained a foreign fellow, and of these only five of 11 were definitely able to do so in the future. Over half (52%) of the programs that had never trained a foreign fellow stated that they were not prepared to train a foreign physician. Although foreign family physicians are encouraged by the American Academy of Family Practice to come to the United States for fellowships, this study shows that it is extremely difficult for these physicians to find programs willing to act as host.

Directories as Topic↗
PubMed2001

A study of primary care teaching comparing academic and community-based settings.

OBJECTIVE: To compare teaching activity and content between academic and community-based practices used in third year medical student primary care training. SETTING: Academic and community-based primary care practices participating in third-year internal medicine, family medicine, and primary care core clerkships. PARTICIPANTS: Five-hundred thirteen preceptor-student encounters involving 32 preceptors and 26 third-year medical students were evaluated. DESIGN: Student-preceptor pairs collected a convenience sample of data from shared patient encounters. Preceptors recorded the content of teaching interventions, and students independently documented learning points received for each clinical encounter. MEASUREMENTS AND MAIN RESULTS: Comparison of problem exposure, frequency and content of teaching interventions, and the effect of patient complexity and patient care workload on teaching frequency was made between the academic and community-based practices. Several small differences were found in the frequency of clinical problem exposure between the 2 settings. The frequency and focus of teaching interventions did not differ by practice type. Teaching by community-based preceptors tended to decrease with increased patient care workload, but increased in academically based practices. CONCLUSIONS: Although several differences exist between educational experiences in community- and academically based primary care practices, they appear to be minor and of minimal educational significance.

Education, Medical, Undergraduate↗
PubMed2003

Academic detailing to improve antihypertensive prescribing patterns.

Several studies indicate that treatment of hypertension in the United States does not follow recommendations from expert bodies. We thus implemented a program using academic detailers to increase practitioner compliance with antihypertensive treatment guidelines. Five Veterans Affairs medical facilities including academic medical centers and community based outpatient clinics were chosen for the intervention. Pharmacists were trained as academic detailers, and the intervention included lectures, educational materials, provider profiling, and meetings with 25 to 50 providers each. After intervention, the proportion of hypertensives receiving calcium antagonists decreased from 43% to 38% (P <.001), whereas the proportion receiving a beta blocker or thiazide diuretic increased from 58% to 64% (P <.001). For hypertensive subjects with diabetes mellitus or congestive heart failure, the proportion receiving an angiotensin converting enzyme inhibitor or angiotensin receptor blocker increased from 72% to 76% for the former and from 74% to 78% for the latter (P <.001 for both). Among hypertensive subjects with coronary artery disease an increase in beta blocker use was noted after intervention (P <.001 for change from baseline). Prescribing patterns after academic detailing more closely followed national recommendations.

Academic Medical Centers↗
PubMed2005

Integration of academia and practice in preparedness training: the Harvard School of Public Health experience.

Given the need for public health professionals well trained in emergency preparedness and response, students in public health programs require ample practical training to prepare them for careers in public health practice. The Harvard School of Public Health Center for Public Health Preparedness has been instrumental in the creation and implementation of a course entitled, "Bioterrorism: Public Health Preparedness and Response." This course features lectures on specific applications of public health practice in emergency preparedness and response. In addition, it provides students the opportunity to operationalize and apply their knowledge during an interactive tabletop exercise. In light of their university affiliations and expertise in providing preparedness training, other Academic Centers for Public Health Preparedness have the opportunity to be instrumental in providing similar training to graduate students of public health.

Bioterrorism↗
PubMed1997

Training surgically competent doctors for South African rural settings.

The training of surgically competent doctors for South African rural settings is governed by several factors and determinants which include population demographics, distribution of doctors, infrastructural development and socio-economic conditions of the communities. Demands will be influenced by the disease profile, available facilities and academic support. Training options will include community-oriented/based (undergraduate) curriculum and restructured internship training period and acquisition of skills. Postgraduate diplomas and fellowships and continuing medical education and academic support will form an integral part of the training.

Education, Medical, Continuing↗
PubMed2001

Threats to the surgical residency in the academic medical center.

Threats to the current form of surgical training in the academic medical center include financial pressures from the government and managed care organizations. A diminishing medical student interest in surgical careers has been noted. The constraints of managed care hold the potential to introduce weaknesses in surgical training in the academic medical center.

Academic Medical Centers↗
PubMedDate not supplied

[How Italian midwives contribute to breastfeeding promotion: a national experience of "cascade" training].

Social changes of the last century have increasingly transformed maternity and newborn care into a medical act and have greatly reduced the number of breastfeeding women. In Italy, the explicit aim of the Ministry of Health concerning mother and child health (Progetto-Obiettivo Materno-Infantile) is to bring this process back to a more natural activity. The prevalence of women who breastfed after the third month of life has been set as an indicator of the effectiveness of mother and child health services. However, the percentage of fully breastfeeding women at the fourth month of the newborn varies greatly among Italian regions, from 18 to 56%. As in many other Countries in the European Union, in Italy the initial education of the mother and child caregivers often lacks a specific formal training on breastfeeding promotion, as do academic midwife-training courses. In 2004 the Italian Federation of the Colleges of Midwives implemented a cascade training project in collaboration with the Istituto Superiore di Sanita, to train trainer-midwives who in turn would train midwives, either already working (Continuing Medical Education) or during their formal academic education. Contents, techniques and methods have been the same as those adopted for the World Health Organization's 40+40 hours course "Breastfeeding: counselling: a training course" for trainers. A total of 39 training coordinators and teachers of academic midwifery courses have participated, in two separate groups. In their turn, the trainers have trained 74 working midwives, from almost every Italian region. Throughout the training program, the trainers were supervised by two tutors who assessed their learning-teaching performance and provided a final certificate. The program allowed the trainers and the other participants to reach a standard level of knowledge on the issue, regardless of their initial knowledge. Moreover, it helped to build and share a common language and attitude on the protection, promotion and support of breastfeeding. In the original course the final certification was not included; it was introduced in the present course to ensure high qualitative levels of teaching and to let the training groups better integrate with already existing training groups within the Local Health Authorities. To translate the training experience into an effective improvement of health objectives, as much as possible caregivers should be exposed to this kind of courses, from the beginning of their training. The WHO/UNICEF model proved to be a good basic model even for academic education, maybe with some additional elements aimed at the specific professionals. At present about half of the courses for midwives throughout Italy employ at least one teacher who is also in charge of the WHO/UNICEF course.

Breast Feeding↗