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PubMed2006

Important demographic variables impact the musculoskeletal knowledge and confidence of academic primary care physicians.

BACKGROUND: Although most musculoskeletal illness is managed by primary care providers, and not by surgeons, evidence suggests that primary care physicians may receive inadequate training in musculoskeletal medicine. We evaluated the musculoskeletal knowledge and self-perceived confidence of fully trained, practicing academic primary care physicians and tested the following hypotheses: (1) a relationship exists between a provider's musculoskeletal knowledge and self-perceived confidence, (2) demographic variables are associated with differences in the knowledge-confidence relationship, and (3) specific education or training affects a provider's musculoskeletal knowledge and clinical confidence. METHODS: An examination of basic musculoskeletal knowledge and a 10-point Likert scale assessing self-perceived confidence were administered to family practice, internal medicine, and pediatric faculty at a large, regional, academic primary care institution serving both rural and urban populations across a five-state region. Subspecialty physicians were excluded. Individual examination scores and self-reported confidence scores were correlated and compared with demographic variables. RESULTS: One hundred and five physicians participated. Ninety-two physicians adequately completed the musculo-skeletal knowledge examination. Fifty-nine (64%) of the ninety-two physicians scored < 70%. Higher examination scores were associated with male gender (p = 0.01) and participation in a musculoskeletal course (p = 0.009). Practitioners who took elective courses demonstrated higher scores compared with those who took required courses (p = 0.014). Greater musculoskeletal confidence was associated with the number of years in clinical practice (p = 0.045), male gender (p = 0.01), residency training in family practice (p < 0.00001), and prior participation in a musculoskeletal course (p = 0.0004). Physicians demonstrated greater confidence with medical issues than with musculoskeletal issues (mean confidence scores, 8.3 and 5.1, respectively; p < 0.00001). Higher scores for musculoskeletal knowledge correlated significantly with increasing levels of musculoskeletal confidence (r = 0.416, p < 0.0001). CONCLUSIONS: Although a large proportion of primary care visits are for musculoskeletal symptoms, the majority of primary care providers tested at a large, regional, academic primary care institution failed to demonstrate adequate musculoskeletal knowledge and confidence. Further characterization of the relationship between knowledge and confidence and its association with demographic variables might benefit the education of musculoskeletal providers in the future.

Clinical Competence↗
PubMed2005

Assessment of epidemiologic capacity in state and territorial health departments--United States, 2004.

In November 2001, the Council of State and Territorial Epidemiologists (CSTE) conducted a survey of state and territorial health departments to assess their core epidemiologic capacity. The survey was completed just before distribution of approximately $1 billion in terrorism preparedness and emergency response funds in fiscal year 2002, intended to improve the U.S. public health infrastructure. Results of the 2001 survey, published in 2003, indicated inadequate capacity in six of eight key epidemiology program areas (all except infectious disease and chronic disease) to fully perform the essential public health services most dependent on epidemiology. In 2004, CSTE conducted a follow-up survey that assessed epidemiologic capacity in the United States and its territories in the same eight program areas, estimated the number of additional epidemiologists needed for full performance, and identified education and training needs. This report summarizes the results of that 2004 follow-up survey, which indicated a 26.9% increase from 2001 in the overall number of epidemiologists working in state and territorial health departments, increased capacity in two program areas (i.e., terrorism preparedness and emergency response; maternal and child health) and decreased capacity in six other program areas (i.e., infectious disease, chronic disease, environmental health, injury, occupational health, and oral health). Results also revealed that 28.5% of epidemiologists lacked any formal training or academic coursework in epidemiology. Creation of a strong public health infrastructure fully capable of performing essential services will require additional trained epidemiologists in state and territorial health departments.

Epidemiology↗
PubMed1989

Training for primary health care.

New courses in health services studies have been launched at Helsinki University. They offer undergraduates a chance to study this subject to degree and doctoral standards without previous medical training of any kind.

Finland↗
PubMed2002

Effects of conflict resolution training integrated into a high school social studies curriculum.

The authors examined the effectiveness of conflict resolution and peer mediation training among California high school students. The authors randomly assigned 2 of 4 classes to receive 5 weeks of conflict resolution and peer mediation training integrated into the required social studies curriculum. The remaining 2 classes studied the same social studies curriculum for an identical amount of time (105 min every other day) without conflict resolution and peer mediation training. The authors investigated 2 issues. The 1st was the effectiveness of the conflict resolution and peer mediation training. The trained students, compared with the untrained students, learned the integrative negotiation and peer mediation procedures better, applied the procedures more completely, chose an integrative over a distributive approach to negotiation, and developed more positive attitudes toward conflict. The 2nd issue was the impact of the training program on academic achievement. Integrating conflict resolution and peer mediation training into an academic course promoted higher achievement, greater long-term retention of the academic learning, and greater transfer of academic learning in social studies to language arts.

Adolescent↗
PubMed1999

Early efforts of blacks in the fight against heart disease and stroke.

This article highlighted the early efforts of some individuals whose vision and dedication helped to set the stage for later progress in the fight against heart disease, who forged links to those who eagerly took up the cause of creating an appropriate place for minority participation in the specialty of cardiovascular diseases, and to contribute to efforts to establish programs for the reduction of morbidity and mortality and for prevention in African Americans. This is only one view of what was an exciting period of fitful progress and controversy. Dr Wilson reviewed the still deplorable state of affairs in regard to minorities and the medical profession in 1986, stating: A meaningful role for minorities will not exist until there is access to academic postgraduate training programs that will lead to faculty positions and research opportunities for minorities to serve as role models for future students. The Association of Academic Minority Physicians was established to foster greater progress in this regard across disciplines. Again, while much has been accomplished, including Donald Wilson's becoming the first African-American dean of a nonminority medical school, much remains to be done as we approach the end of the 20th century.

Black or African American↗
PubMed1990

Psychology doctoral training in work and health.

Psychology as a profession has an opportunity and obligation to advocate for and develop healthy work environments. This will require the design and conduct of doctoral-level training in occupational health psychology. A model for training might well be based on the assumptions that there is a viable role for occupational health psychologists trained at the doctoral level for both academic and applied work settings, and that doctoral training would be based on the integration of health psychology and public health. Issues remaining to be addressed in the development of doctoral training programs include appropriate predoctoral training, academic standards, the interdisciplinary nature of faculties, and appropriate settings for training. Future directions in establishing doctoral training in occupational health psychology will best be taken in dialogue with several other professions and institutions that share a common interest in reducing leading work-related diseases and injuries and promoting public health in the workplace.

Curriculum↗
PubMed2000

Employment-seeking experiences of residents in 1996: a window into the neurology marketplace.

OBJECTIVE: To assess career choice and employment-seeking experience of senior neurology residents in 1996. METHODS: Graduating residents in adult and pediatric neurology (n = 573) were surveyed to obtain career plans, initial job selection, health care attitudes, and demographic information. Results were compared with 1996 data on all United States neurologists and data from an American Medical Association (AMA) resident survey regarding the employment status of new physicians. RESULTS: Survey response rate was 71%. There was a significant increase in international medical graduates and women entering neurology compared with the current workforce. Seventy-four percent of graduates planned to enter a fellowship position; 19%, private practice; 5%, an academic position; and 2%, a career outside of clinical medicine. Neurology residents differ from aggregate national data because only 28% of residents responding to an AMA survey across all specialties applied to fellowships in 1996. Overall, 44% of neurology graduates planned an academic career. CONCLUSIONS: Changing demographics and career choice of recent graduates may require continued monitoring and could be important in neurology workforce planning. The high rate of fellowship training and plans for academic careers in 1996 is of interest and may reflect both resident response to new demands in the changing health care market and a need to modify residency programs to enhance academic training and competitiveness of neurology graduates.

Adult↗
PubMed1998

Role of the SEAMEO TROPMED Network in health human resources development. Southeast Asian Ministers of Education Organization. Tropical Medicine and Public Health.

The Southeast Asian Ministers of Education Organization (SEAMEO) is a chartered international organization for the promotion of regional cooperation in education, science, technology and culture. The Regional Tropical Medicine and Public Health Network (TROPMED) operates through four specialized Centers in Indonesia, Malaysia, the Philippines and Thailand, with a coordinating unit, the TROPMED Central Office in Bangkok, Thailand. In line with the overall mission of SEAMEO, the role of TROPMED is to promote health and to prevent or control disease, thus improving the quality of life of people in the Asia-Pacific Region. Toward this end, SEAMEO TROPMED serves to facilitate the strengthening of national and institutional capabilities in research and training through postgraduate academic programs; short-term training courses; scientific fora; publications and information dissemination and as such, has been in the mainstream of health human resources development since its inception in 1967. To date, a total of 3,353 TROPMED alumni have benefited from training in 26 regular course offerings; of these, 1,596 were females and 1,757, males. From 1991 to 1995, a total of 434 key health personnel have attended short-term training courses, with increasing attendance from Cambodia, Lao PDR and Vietnam. TROPMED's effectiveness comes from the collective strength of and the spirit of cooperation among its host institutions and partners. Faced with a health scenario of both developing and developed economies, SEAMEO TROPMED aims to further its role as an international forum for health development thus, addressing the need for effective strategies for health sector reform and advocacy of relevant health, environmental and development policies through its various programs and activities.

Asia, Southeastern↗
PubMed2004

A time of accelerated change in academic cardiovascular medicine: implications for academic divisions of cardiology and their training programs.

With the vast epidemic of vascular disease predicted to be the leading cause of death and disability by a growing margin over the next 30 years, academic medical centers with cardiology training programs have a special responsibility. Given the dramatic advances of biotechnology in producing highly effective but expensive strategies of prevention and treatment, cardiovascular specialists should assist their academic centers in envisioning the future to prepare trainees for a different environment. Cardiologists of the future must be able to adapt to a societal need for patient-oriented, team-based clinical care and rapidly evolving technology, while maintaining the fundamental skills and knowledge required for individual patient interaction. Academic programs should benchmark their activities to ensure responsible resource allocation so that cardiologists of the future will be trained in an environment stimulating excellence and creativity.

Cardiology↗
PubMed2002

[European Center for Humanitarian Health (CESH). Providing operational know-how directly applicable in crisis situations].

Founded in 1997 at the initiative of Charles Mérieux, the European Center for Humanitarian Health Care (French acronym, CESH) is a Public Interest Organization comprising 7 members, i.e., Lyon 1 Claude Bernard University, Aix-Marseille II University of the Mediterranean, the Public Hospital System of Lyon, the Public Hospital System of Marseille, the French Army Health Corps, the Mérieux Foundation, and the National School of Veterinary Medicine in Lyon. The CESH is a multifunctional resource dedicated to providing education, information, and research in the field of humanitarian action. The objectives of the CESH's Educational Program are to increase awareness of the complexity of humanitarian action and teach the principles and methods necessary to integrate experienced teams already in the field. Courses including a three-week study program sanctioned by an Interuniversity Degree in Public Health and several 2-to-3-day training modules are open to all humanitarian actors including field workers and decision-makers, health-care professionals, and governmental or other administrative agents. Thanks to a diverse faculty with academic, humanitarian, training, civilian and military backgrounds and to a wide-ranging curriculum, the CESH helps to promote communication and to open up closed pathways of cooperation between the different groups involved in humanitarian action. The module entitled "Humanitarian Assistance and Civilian and Military Cooperation" exemplifies the effort of the CESH to generate collaborative behavior among civilian and military actors. The CESH's Research Program is aimed at providing practical tools for decision-making in the field. The web site of the CESH [http://cesh.univ-lyon1.fr] presents the mission and activities of the Center as well as information on course enrolment and humanitarian action.

Altruism↗
PubMed2004

Achieving competency in psychological assessment: directions for education and training.

This article provides an overview of issues related to the development and evaluation of competency in psychological assessment. Specifically, we delineate the goals, ideas, and directions identified by the psychological assessment work group in the Competencies Conference: Future Directions in Education and Credentialing in Professional Psychology. This is one of a series of articles published in this issue of the Journal of Clinical Psychology. Several other articles that resulted from the Competencies Conference will appear in Professional Psychology: Research and Practice and The Counseling Psychologist. The psychological assessment group was charged with the tasks of: (a). identifying the core components of psychological assessment competency; (b). determining the central educational and training experiences that will aid competency development; (c). explicating strategies for evaluating competence; and (d). establishing future directions for furthering the identification, training, and evaluation of competence in psychological assessment. We present a set of eight core competencies that we deemed important for achieving psychological assessment competency and discuss four guidelines for training in the domain of psychological assessment. A variety of methods for evaluating competencies in this domain are suggested, with emphasis on using a collaborative model of evaluation. Recommendations for future directions include strengthening the academic prerequisites for graduate school training; increasing training in culturally sensitive measures; incorporating innovative assessment-related technologies into training; and addressing discontinuities between academic training, internship, and practice environments.

Competency-Based Education↗
PubMed2000

Integration of geriatrics in oncology training--the relationship between the academic center and the community.

The aging of the population and the ensuing large increase in the number of older cancer patients require that the subspeciality of Medical Oncology respond quickly and effectively to this need. Sixty percent of all cancer occurs in persons aged 65 years or older and there is an unprecedented growth of this segment of the population. Their treatment is further complicated by the preexisting medical conditions and their unique social and economic needs. The response of both the academic and private practice communities will greatly effect the future of cancer care for the elderly. There is an immediate need for physicians and other health care providers to better understand the influence of advancing age on diagnosis and treatment of cancer. Integration of geriatric and medical oncology training would be an important step in this process. This paper discusses various aspects of a combined educational proposal.

Academic Medical Centers↗
PubMed1994

Strategies for training generalists and subspecialists.

A strategy is proposed for attracting trainees to careers in general internal medicine coupled with a program that attracts a smaller number of trainees to research careers without attracting trainees into careers in the practice of the subspecialties. A novel training track analogous to the Medical Scientist Training Program, the Specialty Training and Academic Research (STAR) Program has been established. It is anticipated that within the next 5 years, 80% of the trainees in the department of medicine at the University of California, Los Angeles, Medical Center will be training for practice in general internal medicine; the remaining 20% will be enrolled in the STAR Program.

Career Choice↗
PubMed1988

A model community psychiatry curriculum for psychiatric residents.

The ability of mental health practitioners to work well with persons with serious long-term mental illness has expanded significantly over the past two decades. Learning to do this well involves acquiring a broad base of knowledge and a complex range of skills. Such knowledge and experience must be incorporated into the basic residency curriculum for general psychiatrists, though with some notable exceptions this has not occurred for a number of important reasons, including money and the new image that psychiatry is trying to assume. The key elements of such a curriculum include 1) specific learning goals, 2) working within an effective treatment system with high quality clinical rotations, 3) good role models, 4) high quality psychiatric supervision, 5) a well-grounded didactic program, and 6) high quality clinical rotations. We discuss these elements in detail, and we describe the training program in community psychiatry at the University of Wisconsin Medical School Department of Psychiatry. Our residency training program and supervising faculty are affiliated with and partially funded by the Mental Health Center of Dane County to the benefit of both. This marriage between the public-sector mental health care provider and the academic psychiatric training program has created benefits for both parents plus a fertile environment for training future generations of psychiatrists.

Chronic Disease↗