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Effectiveness of the "teaching the teachers" diagnostic US training program.

RATIONALE AND OBJECTIVES: The "Teaching the Teachers" training program was meant to establish standardized ultrasound education programs worldwide, reaching the largest possible number of physicians. The authors performed this study to evaluate the results of this training. MATERIALS AND METHODS: An open-ended test question format (ie, uncued testing) that would evoke responses from physicians in a manner ensuring the highest fidelity with a real clinical setting was selected. An examination was administered at the beginning and the end of the program and then again 6 months later to assess baseline knowledge, changes in knowledge, and knowledge retention, respectively. RESULTS: Scores on entry and end-of-program examinations were available for 112 participants. The mean entry test score was 35%, and the mean end-of-program examination score was 73%. All changes in scores were statistically significant (P < .001) as determined with paired t tests. Follow-up examinations were available for 27 of the 112 participants at the time of the analysis. On these examinations, mean total test scores increased by nearly 4 percentage points. Although follow-up test scores were available for only 27 participants, these mean test scores were comparable to those reported for the entire group on the end-of-program examination. CONCLUSION: The examinations administered at the end of the 3-month program showed marked improvement compared with the baseline assessment. That this improvement remained stable over 6 months indicates the success of the educational process.

Curriculum↗

A competency-based training program in early intervention.

This paper describes a federally funded training program developed to prepare entry-level occupational therapists to deliver early intervention services. The program had two phases. Phase I was designed to provide occupational therapy supervisors with advanced skills for supervising and teaching the students about the provision of early intervention services. These skills were specific supervisory strategies and learning techniques designed to facilitate optimal communication between the student, the supervisor, and the academic faculty members, as well as to facilitate consistency of information between workshops and practices in the clinic. Phase II involved a 12-week clinical fieldwork experience for the students in an early intervention program combined with didactic programs at the university. Both supervisors and students provided feed-back on the program. Supervisors reported that the training strengthened their supervisory skills and techniques. Students reported that the training helped them to clarify the role of occupational therapy in early intervention and that they had developed skills critical to providing family-centered early intervention. These skills included both providing direct treatment to children and working in partnership with families and caregivers.

Adolescent↗

A survey of cleft lip and palate surgery taught in Plastic Surgery Training Programs.

A mail survey was used to document the surgical methods for repair of cleft lip and palate being taught in Plastic Surgery Training Programs. The survey was completed by Senior Residents representing over 80% of the training programs in the United States. The results demonstrate that variation exists regarding methods and techniques for cleft lip and palate surgery.

Age Factors↗

Effects of a resistive training program on lipoprotein--lipid levels in obese women.

The purpose of this study was to determine the effects of a resistive training program on the time course of changes in strength, body mass index, lipids, lipoproteins, and apolipoproteins in sedentary obese women. Sixteen sedentary obese women strength trained 3 times . wk-1 for 12 wk performing three sets of six to eight repetitions per set with sets 1 and 2 at 60-70% of one-repetition maximum. During set 3, the subjects used the greatest weight possible so that failure occurred between six to eight repetitions. Six sedentary obese women served as controls. Blood samples for serum total cholesterol (TC), high-density lipoproteins (HDL-C), low-density lipoproteins (LDL-C), triglycerides (TG), TC/HDL-C ratio, apolipoprotein A-I (apo A-I), and apolipoprotein B-100 (apo B-100) were obtained pre, and after 4, 8, and 12 wk of training and approximately 3-4 d following the last training session. A 3-d dietary record was obtained on all subjects pre and post, and subjects were instructed not to alter their diet. The 12 wk of resistive training did not result in a significant change in body weight, BMI, or total kilocalories consumed per day but did show a mean improvement of 58% in muscular strength (P less than 0.05). The training program did not significantly alter the TC, HDL-C, LDL-C, TG, TC/HDL-C ratio, apo A-I, or apo B-100 levels, which suggests that this increase in strength owing to resistive training in the absence of body weight loss did not alter the lipid profiles in these sedentary obese women.

Adult↗

Cross-sectional and longitudinal evaluations of an endurance training program.

A comparison of the cardiorespiratory responses obtained using both a longitudinal and cross-sectional evaluation of an endurance training program was made in two groups of 60 young male military personnel. Both groups were initially tested (T1) and then retested 6 months later (T2). At T1, Group I was a sample of personnel not participating in a training program while Group II had undergone a 5-month endurance program (2-4 mile run/day). At T2, Groups I and II had been participating in the program for 6 and 11 months, respectively. Testing consisted of sub-maximal and maximal determinations of VO2, VE and heart rate (HR) using an interrupted treadmill test. VO2 max was 11% greater in Group II compared to Group I at T1 and increased 10% in Group I at T2. Similar results were also seen for HR submax, HR max and VE max. These results show that similar values indicative of an improved level of cardiorespiratory fitness can be obtained using either a cross-sectional or longitudinal design when relatively homogeneous groups are studied.

Adolescent↗

A patient care training program for volunteers.

Properly trained and interested volunteers can perform basic nursing skills in a clinical setting. Staff development educators should 1) assess the needs of the area; 2) assess the skills of the volunteers available to them; 3) construct goals and objectives for a thorough orientation program geared to people with nonmedical backgrounds; 4) select appropriate course content and methods of presentation based on the framework provided by the goals and objectives and on the regulations governing the institution in which the volunteer will work; 5) implement the course; and 6) evaluate the adequacy and thoroughness of the program and the competency of the volunteers trained. The potential service that qualified and adequately trained volunteers could offer in patient care areas that are understaffed in nursing personnel is great. Similar programs can be used to supply needed assistance in facilities with limited nursing personnel.

Ambulatory Care↗

[Postgraduate training program in laboratory medicine at a clinical teaching hospital].

The Tenri Hospital resident system was introduced in 1976 and the training program for laboratory medicine began in 1982. Thus, the author proposes goals for the the future on the basis of experience. It is appropriate that trainees study emergency tests, blood transfusion and microbiology(particularly Gram's stain and sputum culture) as practical matters, and in addition to these, learn how to reply to consultations from physicians, learn the laboratory flow(so-called laboratory system), and announce interpretations of laboratory data at reversed clinical pathological conference(R-CPC). The objectives of these training programs are to gain skills for appropriate laboratory utilization and interpretation, and develop communications and consultations with clinical pathologists and medical technologists. The key points of success in the training are close cooperation of the laboratory and teaching divisions. Particularly, cooperation with medical technologists is necessary, and it is essential medical practice for trainees because they will have to work with them in future. Finally it should be emphasized that there training has a limited effect because of the short duration. It is thus important to communicate and discuss clinical matters regularly in medicine.

Education, Medical, Graduate↗

Diagnostic laparoscopy for infertile patients as a training program.

During a 3-year period, 2650 cases of diagnostic laparoscopy were performed on selected infertility patients in a training program on gynecologic laparoscopy at hospitals in Egypt, the Sudan and Saudi Arabia. All cases were attended by the senior author. Most of the procedures were performed by physicians who either had never performed the procedure or had not had significant experience with it. This report presents the laparoscopic findings, complications and problems encountered. It shows that with emphasis on equipment care and handling, careful patient selection and observation of simple precautions during and after the operation, the procedure can be safely included in the training program of residents in obstetrics and gynecology.

Female↗

An evaluation plan to assess the process and outcomes of a learner-centered training program for clinical research.

In 1994, the National Center for Research Resources' Committee on Addressing Career Paths for Clinical Research reported that insufficient training in research methods, inadequate mentoring, and inappropriate timing of training presented major barriers to the development of clinical researchers. The National Institutes of Health responded to the need for additional training programs by supporting 57 institutions through the Clinical Research Curriculum Award (K30) Program. The ability to assess the success of these programs depends on the nature and extent of their evaluation plans. Evaluation plans for clinical research training programs should include means of assessing both process and outcomes of a program's implementation in its formative and summative stages. This article describes the University of Wisconsin-Madison's Clinical Investigator Preparatory Program and an evaluation plan that incorporates process and outcome assessments based on a theoretical framework of adult and professional education.

Adult↗

The California Statewide Family Health Education and Training Program 1981-1982.

Through support from the California State Department of Health Services, San Diego State University continued a statewide program in family life education, which consisted of: 1) establishment of a statewide advisory committee representative of many diverse points of view; 2) performance of a study of the teaching of family life education in the ninth and 10th grades of public schools in the state, as well as an examination of the present status of training of teachers; 3) provision of consultation and training programs for local school districts, including community support and implementation training, program development consultation teacher training and a limited number of small block grants to improve local family life education program efforts; and 4) preservice education classes to be conducted at teacher preparation campuses in the California State University system. The paper describes some of the findings of the study of the ninth and 10th grades, as well as the details of methodology of all four components of the statewide program.

California↗

The effects of a six-week, low-intensity Nautilus circuit training program on resting blood pressure in females.

Twenty-six healthy, untrained females were studied to determine the effects of a low-intensity Nautilus circuit training program on resting systolic and diastolic blood pressure. Thirteen subjects who were in good health with no personal history or family history of cardiovascular disease participated in a six-week training program on the Nautilus circuit (14 exercises) and trained at 30% of maximum. Measurements in blood pressure were made before, during (three times per week) and after the study. Another group of 13 females served as controls. An attempt was made to determine if strength increase (due to circuit training) would have an affect on reducing resting systolic and diastolic blood pressure. The following changes occurred in the treatment group: (1) resting systolic blood pressure dropped significantly (from 113 to 99 mmHg) after training and (2) diastolic blood pressure dropped significantly from (70.9 to 62.0 mmHg) after training. However, there were no differences in these decreases between the exercise and control groups. The investigators concluded that low-intensity, resistive training should not increase blood pressure in white, healthy females, ages 18 to 28 years.

Adolescent↗

The evaluation of a training program for improving residents' teaching skills.

As a response to the growing recognition of the need for improvement in medical instructional practices, a training program on teaching skills for resident physicians in the East Tennessee State University College of Medicine was implemented. The program consisted of 13 weekly, one-hour, small-group sessions attended by 20 residents. The microteaching method was utilized for practicing instructional techniques. Significant gains in teaching performance and in attitude toward participating in a teaching skills program were demonstrated, on the basis of videotaped teaching performances and a written questionnaire, indicating that short training programs can assist physicians in the process of instructional improvement.

Attitude of Health Personnel↗

The effects of a 20-week exercise training program on resting metabolic rate in previously sedentary, moderately obese women.

The present study was designed to investigate the effects of exercise training on resting metabolic rate (RMR) in moderately obese women. It was hypothesized that exercise training would increase resting metabolic rate. Nineteen previously sedentary, moderately obese women (age = 38.0 +/- 0.9 years, percent body fat = 37.5 +/- 0.8) trained for 20 weeks using either resistance training (RT) or a combination of resistance training and walking (RT/W). The high intensity resistance-training program was designed to increase strength and fat-free mass and the walking program to increase aerobic capacity. There was also a non-exercising control group (C) of 9 subjects in this study. Fat-free mass was significantly increased in both the RT (+1.90 kg) and RT/W (+1.90 kg) groups as a result of the training program. No group showed significant changes in fat mass or relative body fat from pre- to post-training. Aerobic capacity was slightly, though significantly, increased in the RT/W group only. The RT group showed a significant increase (+44 kcal x day(-1)), while the RT/W group showed a significant decrease (-53 kcal x day(-1)) in resting metabolic rate post-training. RT can potentiate an increase in RMR through an increase in fat-free mass, and the decrease in RMR in the RT/W group may have been a result of heat acclimation from the walk training.

Adipose Tissue↗

Adaptation to a standardized training program and changes in fitness in a large, heterogeneous population: the HERITAGE Family Study.

PURPOSE: This paper describes the variations in response to a standardized, computer-controlled training program. METHODS: Steady-state heart rate (HR) and oxygen intake (VO2) of 614 healthy, sedentary men and women aged 16-65 yr were measured during three cycle ergometer exercise tests. The HR associated with 55, 65, 70, and 75% of each subject's pretraining VO2max was used to prescribe exercise intensity. Subjects exercised three times a week, beginning at a HR associated with 55% VO2max for 30 min. Duration and intensity was gradually increased over 20 wk of training. The duration and HR of each training session were controlled by a computer. RESULTS: Using the linear relationship between HR, VO2 and power output (PO), PO were predicted for each of 60 training sessions at the respective programmed HR. The average ratio of the actual training HR to programmed HR was 0.99. It was hypothesized that participants whose actual training PO exceeded their predicted PO would improve VO2max more than those whose actual PO was less than their predicted PO. Using the ratio of actual/predicted PO determined after the training was over, participants were arbitrarily assigned to three groups: 128 participants had low (LO) ratios (0.65-0.84), 408 had average (AV) ratios (0.85-1.14), and 78 had high (HI) ratios (1.15-1.34). Secondary analysis showed that the training program significantly increased mean VO2max of all three groups. Those who had a smaller increase in training PO (LO) had significantly less increase in VO2max than those with larger increases in PO (HI). CONCLUSION: People who exercise at a HR associated with the same %VO2max can vary substantially in their training PO, in their rate of increase in PO over a 20-wk training program, and in improvement of their VO2max.

Adaptation, Physiological↗

A preliminary evaluation of emergency ultrasound in the setting of an emergency medicine training program.

In this article we seek to evaluate the diagnostic accuracy of emergency physicians performing emergency ultrasonography in the setting of an emergency medicine training program. A prospective observational study was performed at an inner city Level I trauma center with an emergency medicine residency training program. From July 1994 to December 1996 a convenience sample of ultrasound exams was recorded. The diagnostic quality ("acceptable or technically limited") was determined by a board-certified cardiologist or radiologist with fellowship training in ultrasonography. The emergency department interpretations were then compared to those of the blinded cardiologist or radiologist. Four hundred and fifty-six ultrasound examinations were videotaped and entered into the study; 408 (89%) of the studies performed were determined to be "acceptable." The diagnostic accuracy (sensitivity, specificity, positive and negative predictive values) of these studies were as follows: cardiac, to rule out effusion (n = 67; 0.83, 0.98, 0.88, 0.98); transabdominal, to rule out abdominal aortic aneurysms (AAA), cholelithiasis, or free peritoneal fluid (n = 263; 0.91, 0.89, 0.88, 0.92); renal, to rule out hydronephrosis (n = 45; 0.94, 0.96, 0.94, 0.96); pelvic, to rule in intrauterine pregnancy (n = 33; 1.0, 0.90, 0.96, 1.0). The 48 "technically limited studies" included: 39 transabdominal (33 gallbladder, 1 abdominal aortic aneurysm, 5 free peritoneal fluid), 6 cardiac, 2 renal, and 1 pelvic ultrasound. This study suggests that emergency physicians with a minimal amount of training display acceptable technical skill and interpretive acumen in their approach to emergency ultrasonography.

Clinical Competence↗

Action on worksite health and safety problems: a follow-up survey of workers participating in a hazardous waste worker training program.

In it's worker health and safety training program, the California-Arizona Consortium aims to promote worker action to improve health and safety conditions. To assess action on worker-identified health and safety problems, 278 trainees were interviewed 3-8 months after training. Associations with three outcomes were analyzed: (1) attempted action, (2) problem correction, and (3) trainee participation. Perceived management support was associated with all three outcomes, pointing to its key role in maximizing the impact of training. Odds of attempted action were 2-5 times greater with support than without. Trainees for whom English was not the primary language (mostly Spanish speakers) attempted action as often as English speakers. However, the odds of their correcting problems were half that of the English-speaking workers. It is suggested this was due to a perceived lack of control over organizational resources for change, not simply due to communication barriers.

Arizona↗

Cardiac dimensions in athletes in relation to variations in their training program.

The cardiac dimensions of male long-distance runners (LDR) and cycle racers (CR) were determined echocardiographically during four different training seasons, i.e., a preparation, a competitive, a slowing-down and a resting season, and were compared with those of control subjects (CS). Left ventricular hypertrophy (LVH) was also assessed from the electrocardiogram. The maximal aerobic performance was determined on a bicycle ergometer. In the athletes, left ventricular mass was significantly greater in all seasons than the values in the CS. This difference resulted from a thicker interventricular septum and left ventricular posterior wall as well as a larger left ventricular internal diameter. The existence of LVH was confirmed by the electrocardiographic findings. No differences were observed between the four different training seasons, despite considerable changes in the training program for weeks to months. The maximal aerobic performance test in LDR showed a significantly higher workload during the competitive than during the preparation season. The CR reached significantly lower values during the resting season than during the other seasons. The results indicate that the possible adaptation of the cardiac dimensions to variations in the heaviness of the training program is relatively slow.

Adolescent↗

Comparison between linear and nonlinear in-season training programs in freshman football players.

The purpose of this study was to compare linear (LT) with nonlinear (NL) in-season training programs in freshman football players during the course of 2 separate seasons. During the first year (n = 14, mean +/- SD = 177.3 +/- 4.8 cm, 88.0 +/- 9.7 kg), the LT program was employed 2 days per week. In the second year (n = 14, 175.0 +/- 7.1 cm, 94.2 +/- 20.5 kg), a 2 days per week LT was used. Subjects were tested for maximal strength in the squat (1 repetition maximum [1RM]) and bench press (1RM) exercises. A significant improvement in 1RM squat was seen in LT, but not in NL. No significant improvement in 1RM bench press was seen in either group. A significant difference between LT and NL was observed in Delta1RM squat (13.8 +/- 7.4 kg compared with 1.6 +/- 2.6 kg, respectively). Results of this study suggest that LT may be more effective in eliciting strength gains than NL in freshman football players during an in-season training program.

Adolescent↗