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Opinions of practitioners and program directors concerning accreditation standards for postdoctoral pediatric dentistry training programs.

PURPOSE: This study was performed to assess opinions of program directors and practitioners about the importance and necessary numbers of experiences required by current accreditation standards for training of pediatric dentists. METHODS: A 32-item questionnaire was sent to all program directors of ADA-accredited postdoctoral pediatric dentistry training programs and to a random sample of 10% of the fellow/active membership of the American Academy of Pediatric Dentistry. RESULTS: An overall response rate of 56% was obtained from the single mailing. Practitioners and program directors differed significantly (P < or = 0.05) only in their opinions about the number of submucosal and intravenous sedation cases required for proficiency of eight experiences surveyed. The two groups differed significantly in 3 of 12 areas in terms of importance attributed for practice of contemporary pediatric dentistry: initiating and completing a research paper, biostatistics/epidemiology, and practice management. Program directors had little difficulty obtaining required experiences, and program dependence on Medicaid did not negatively affect quality of education. CONCLUSION: Practitioners and program directors agreed on the importance of most experiences and activities required by current accreditation standards.

Accreditation↗

Designed experience: a multiple, goal-directed training program in family therapy.

A family-therapy training program, one of three main branches of the "Boston model," is described in detail. Salient features of the program include planned integration of a multiplicity of experiential and cognitive learning modes; grounding in a unified, theoretical framework that is neither eclectic nor limited to a single school of thought; focus on nonpathological process in families; and systematic structuring in terms of specific, articulated, training objectives. The goal-directed design process by which training units are developed is explained.

Affect↗

Physically aggressive elderly: a social skills training program.

The present investigation utilized a social skills training program to eliminate physically aggressive behavior in a group of six institutionalized elderly patients. The treatment package consisted of instructions, modeling, role playing and feedback. Dependent measures included confirmed incidents of physically aggressive behavior monitored across an ABAB design with a 5-month follow-up period. Results indicated that physically aggressive behavior can be significantly decreased in a group training setting and subsequently generalized to ward and other socialized behavior. Ancillary aspects of the study include the differential properties associated with physical and verbal aggression, the role of vicarious reinforcement on behavior, and generalization effects.

Aged↗

Pulmonary function testing reference values and interpretations in pediatric training programs.

A questionnaire was sent to all pediatric training programs to evaluate the use of pulmonary function reference standards and the interpretation of pulmonary function test results. Responses were obtained from 107 of 130 institutions, and 94 of these had pulmonary function laboratories available. Of the 94, 60 used one of three reference standards. The primary reason the reference standards were chosen was either unknown or because they came with the spirometer (24), were recommended by another person or were those used in that person's training (34), or were thought to be the best standards available or most applicable to the population to be tested (31). To define abnormality, most used an 80% predicted cutoff for forced vital capacity, forced expiratory volume in 1 second, and forced expiratory flow at 25% to 75% vital capacity. For a change in an individual through time, most used a 10% change for forced vital capacity, forced expiratory volume in 1 second, and forced expiratory flow at 25% to 75% vital capacity. Thirteen used statistical methods to define abnormal individuals and none used statistical methods to define a significant change over time. Although there are a few guidelines for reference standards and interpretations of pulmonary function tests, it appears that most laboratories are not using those guidelines and that further guidelines and education are needed.

Adolescent↗

[Effects of a high intensity training program on patients with chronic obstructive airways disease (COAD)].

UNLABELLED: In a controlled/prospective clinical trial we examined 125 patients with moderate COAD, 84 of which performed a high-intensity training program on cycle ergometers. METHODS: All participants (controls n = 39, training-group n = 84, age 48.7 versus 48.1 years, FEV1 62.3 % vs. 63.1 % of predicted) were examined spiroergometrically (ramp protocol, increment 10 W/min), the anaerobic threshold (AT) determined and a training intensity calculated (AT + 40 % of the difference to peak exercise). Training was carried out on cycle ergometers with 5 training units weekly at 40 minutes each. We aimed at a minimum of 22 training units during 4 weeks. RESULTS: Both groups improved in the lung function at rest (FEV1 + 11 % versus + 12 % in the controls). Only for the training group we found a statistically significant improvement in maximum exercise capacity (O2 uptake + 286.4 ml vs. + 72.4 ml, maximum workrate + 20.0 watts vs. + 5.7 W), of the anaerobic threshold (AT improved by 8.4 watts vs. 5.1 W) as well as in the metabolic load (lactate decreased by 1.3 mmol vs. 0.2 mmol, ventilation decreased by 3.8 l/min vs. 2.3 l/min). In most subscales of the SF-36 questionnaire quality of living improved more clearly in the training group, whereas the LAQ questionnaire showed no group-specific differences and no improvement after training. CONCLUSION: We conclude from the result that a high intensity training program can be recommended as a useful and low-risk component in pulmonary rehabilitation programs.

Educational Measurement↗

Developing competency in the neonatal intensive care unit: a hospital training program.

There are few specialized programs available to train occupational therapists and physical therapists to treat competently in a neonatal intensive care unit (NICU), yet hospitals are trying to fill such positions, and the need for advanced training is essential. A hospital-based program that provides clinical NICU training to therapists from other hospitals is presented. The program is short-term and highly individualized and emphasizes learning pertinent medical information, nonintrusive evaluation skills, and therapeutic intervention with advanced clinical judgment.

California↗

Effect of an 18-wk weight-training program on energy expenditure and physical activity.

The purpose of this study was to examine the effect of an 18-wk weight-training program on average daily metabolic rate (ADMR). Before the intervention and in weeks 8 and 18 (T0, T8, and T18, respectively) data on body composition, sleeping metabolic rate (SMR), food intake, energy cost of the weight-training program (EEex), and nontraining physical activity (accelerometer) were collected in the exercise group (EXER, n = 18 males). ADMR was determined in a subgroup (EX12, n = 12) by using doubly labeled water. At T0 and T18, data (except ADMR) were also collected in a control group (Con, n = 8). Body mass did not change in EXER or Con. Fat-free mass increased only in EXER with 2.1 +/- 1.2 kg, whereas fat mass decreased in EXER as well as Con (2.0 +/- 1.8 and 1.4 +/- 1.0 kg, respectively). Initial ADMR (12.4 +/- 1.2 MJ/day) increased at T8 (13.5 +/- 1.3 MJ/day, P < 0.001) with no further increase at T18 (13.5 +/- 1.9 MJ/day). SMR did not change in EXER (4.8 +/- 0.5, 4.9 +/- 0.5, 4.8 +/- 0.5 kJ/min) or Con (4.7 +/- 0.4, 4.8 +/- 0.4 kJ/min). Energy intake did not change in EXER (10.1 +/- 1.8, 9.7 +/- 1.8, 9.2 +/- 1.9 MJ/day) or Con (10.2 +/- 2.6, 9.4 +/- 1.8, 10.1 +/- 1.5 MJ/day) and was systematically underreported in EX12 (-21 +/- 14, -28 +/- 18, -34 +/- 14%, P < 0.001). EEex (0.47 +/- 0.20, 0.50 +/- 0.18 MJ/day) could only explain 40% of the increase in ADMR. Nontraining physical activity did not change in both groups. In conclusion, although of modest energy cost, weight-training induces a significant increase in ADMR.

Adult↗

A physician extender training program based on clinical algorithms.

The ability of physician extenders to provide patient care in a variety of settings has been reported widely. Less attention has been paid to training programs, especially those of short duration, for physician extenders. A three-month training program for physician extenders at a large teaching hospital was based on teaching the skills needed to run 39 clinical algorithms. The course content and the methods used to test the students during the three months may prove of value to those preparing similar programs.

California↗

Postgraduate training programs in veterinary clinical pathology in the United States and Canada (1998 to 2002).

BACKGROUND: Residency and graduate programs in veterinary clinical pathology provide specialized training for board certification and are important pathways to careers in clinical pathology diagnostics, teaching, and research. Information about training opportunities is useful for assessing disciplinary needs, outcomes, and changes, garnering program support, and providing objective data for program evaluation by faculty, trainees, and prospective applicants. OBJECTIVES: The goals of this study were to 1) compile detailed information on the number and types of postgraduate training programs in veterinary clinical pathology in the United States and Canada, 2) describe the goals, activities, strengths, and weaknesses of the programs, 3) assess the desirability of program accreditation and program standards, 4) identify supplemental training opportunities, and 5) evaluate changes in programs, trainees, and faculty 4 years later. METHODS: In July 1998, the American Society for Veterinary Clinical Pathology Education Committee sent a survey to representatives at the 31 schools and colleges of veterinary medicine in the United States and Canada and 31 diagnostic laboratories, private hospitals, and pharmaceutical companies. Survey data were compared with updated information obtained from training program coordinators in November 2002. RESULTS: Survey response rate was 94% for universities, 39% for nonuniversity institutions, and 66% overall. In 1998, there were 20 clinical pathology training programs, including residencies (n=10) and graduate programs combined with residency training (n=10), with 36 total training positions. In 2002, there were 25 training programs (14 residencies, 11 combined), with 52 total positions. The median faculty:trainee ratio was 2.0 in both years. Of 67 faculty members involved in training in 1998, 57 (85.1%) were board-certified in clinical pathology and 53 (79.1%) had DVM/PhD degrees. Net faculty numbers increased by 17 (25.4%) but the median per institution remained at 3.0. Primary program goals were 1) eligibility for and successful achievement of board certification in clinical pathology by the American College of Veterinary Pathologists, 2) proficiency in laboratory diagnostics, and 3) contemporary basic or applied research training. Many programs cited research opportunities, caseloads, and training in hematology and cytology as strengths. Program weaknesses included insufficient funding, too few faculty, and limited training in clinical chemistry and laboratory operations/quality assurance. Trainees completing programs within the past 5 years (n=70) were employed in academia (28.6%), diagnostic laboratories (32.9%), and industry (18.6%). For trainees completing programs between 1999 and 2002 (n=38), these percentages were 52.6%, 21.1%, and 7.9%, respectively. Most (62.5%) respondents supported program standards and accreditation, and 76% supported board review sessions for trainees. CONCLUSIONS: Opportunities for postgraduate training in veterinary clinical pathology increased between 1998 and 2002, with 5 new programs and 16 new training positions. These additions and the increased emphasis on diagnostic proficiency, efforts to strengthen training in clinical chemistry and quality assurance, and continuation of combined PhD-residency programs will help address the perceived need for increased numbers of qualified clinical pathologists in academia, diagnostic laboratories, and industry.

Accreditation↗

A prospective randomized trial of a residents-as-teachers training program.

PURPOSE: To develop, implement, and evaluate a course for improving the teaching skills of surgery residents. METHOD: Responses from residents at four general surgery training programs to a needs assessment survey were used to develop a two-day course for improving teaching skills. Residents at two surgical training programs were randomly assigned to experimental and control groups, and experimental residents participated in and evaluated the newly devised course. Six to seven months later, experimental and control residents' teaching performances were evaluated using a five-station objective structured teaching evaluation (OSTE). Differences between the residents' performances were calculated using Mann-Whitney U, chi-square analysis, or Fisher's exact test. RESULTS: Participating residents rated the course highly. They considered the interactive nature of the course its greatest strength. As measured by the OSTE, the performances of the residents differed least significantly in the feedback station, where the residents in the experimental groups showed significant improvement on only one of seven items at one institution, and only one of nine items at the other. The greatest differences occurred in the microskills teaching station, where the residents at one institution performed significantly better than did their control counterparts on four of five items and in overall performance. CONCLUSION: This study demonstrates the value of a needs assessment in developing a course to improve residents' teaching skills. Such courses must provide active learning with opportunities for practicing skills and, following the course, ongoing feedback to maintain changes in teaching behaviors. The curriculum developed in this study has been put into a transportable form that includes an instructor's manual providing guidelines and suggestions for implementation.

Education, Medical, Graduate↗

Echocardiographic dimensions in athletes in relation to their training programs.

The cardiac dimensions of long-distance runners (LDR), cycle racers (CR), and weight lifters (WL) were determined echocardiographically and were compared with those of control subjects (CS). Left ventricular hypertrophy (LVH) was also assessed from the electrocardiogram. Training information was obtained through a questionnaire. The maximal aerobic performance was assessed on a cycle ergometer. Comparison of the cardiac dimensions revealed that left ventricular mass (LVmass) was significantly increased in LDR and CR as compared to CS. This resulted from thickening of the interventricular septum and left ventricular posterior wall as well as from enlargement of the left ventricular internal diameter. The existence of LVH was confirmed by electrocardiographic investigation. Although the left ventricular wall was enlarged in WL, their LVmass was not significantly increased as compared with CS. These results are in agreement with the training program followed. Weight lifters almost exclusively performed strength training, while LDR and CR were mainly involved in endurance training. The LDR and CR reached significantly higher maximal aerobic performance levels than WL. The present results suggest a close relationship between the type of cardiac enlargement and the training program followed by the athletes.

Adolescent↗

The status of diagnostic radiology training programs and their graduates in 1999.

OBJECTIVE: To address job market concerns, the American College of Radiology studied the employment of 1999 graduates from diagnostic radiology training programs and the programs' status and plans. MATERIALS AND METHODS: In late April to the beginning of June 1999, the American College of Radiology surveyed a 50% random sample of diagnostic radiology residency directors about the employment status of their 1999 residency and fellowship graduates as well as about plans for their training programs. Seventy-seven percent responded. We compared findings from the 1999 survey with similar findings from earlier surveys using a p value of less than or equal to 0.05 to define statistical significance. RESULTS: As of the survey, 95% of residency graduates and 96% of fellowship graduates were reported to have commitments for positions. Ninety-two percent of graduating residents and 95% of graduating fellows reportedly had commitments for positions that reasonably matched their training and personal goals. Completed plus planned changes in residency program size since 1993 would, if implemented, lead to an 8% reduction. Similar to previous years, 96% of the beginning-year residency slots were filled. Program directors reported that the job market had improved compared with that of recent years. The percentage of graduating fellows with commitments for positions was similar in almost all fields. CONCLUSION: Fellows found jobs earlier than in past years, when unemployment among graduates decreased to 1-2% by 6 months after graduation. Results in 1999 should be at least as good. Employment prospects across all subspecialties are about the same. Planned program reductions are much smaller than those reported in 1998 and may continue to evaporate.

Education, Medical, Graduate↗

The effect of a new oral hygiene training program on approximal caries in 12-15-year-old Brazilian children: results after three years.

This study evaluated the effects of a new oral hygiene training program on approximal caries in a population of 12-13-year-old Brazilian schoolchildren with a well-established habit of daily toothbrushing with a F dentifrice. Two hundred twenty-two children were randomly allocated into two test groups (I and II) and one control group (III). Group I subjects were trained to establish needs-related oral hygiene habits based on self-diagnosis and a new behavioral principle, the 'linking method', for establishment of habits. The first three visits (20 minutes each) were scheduled at two-day intervals. They were recalled for a monthly check-up during the first 4 months, and then every 3 months for reevaluation of the results based on self-diagnosis. Group II subjects were recalled at the same intervals for detailed oral hygiene instruction on how to clean every tooth surface using dental tape, toothbrush, and fluoride dentifrice. Group I developed significantly fewer (p < 0.001) new approximal manifest (dentin) caries lesions than groups II and III. The mean values (SEM) were 2.3 (0.29), 4.7 (0.59), and 5.3 (0.68), respectively. The conclusions from our study are: In a toothbrushing population using fluoride dentifrices and fluoridated drinking water, the oral hygiene training program with behavioral modification significantly reduced caries incidence on approximal surfaces. Frequent repetition of training in meticulous oral hygiene is almost redundant.

Adolescent↗

Incidence of temporomandibular symptoms in patients with major skeletal malocclusions: a survey of oral and maxillofacial surgery training programs.

A survey was done of 116 graduate training programs in oral and maxillofacial surgery to determine (1) the percentage of patients screened for orthognathic surgery who had symptoms of temporomandibular pain and dysfunction preoperatively and (2) how many who were asymptomatic preoperatively developed temporomandibular symptoms postoperatively. Of the fifty-one programs that responded, most reported that fewer than 20% of the patients were symptomatic before surgery and that few patients had symptoms postoperatively. The implications of these findings are discussed.

Humans↗

Psychosocial support in residency training programs.

A representative sample (n = 481) of residency training programs in six medical specialties (family practice, obstetrics/gynecology, pediatrics, psychiatry, internal medicine, and surgery) was surveyed to examine the frequency and kinds of psychosocial support offered to residents. Residency programs in family practice and psychiatry were generally more likely than programs in the other specialties surveyed to offer to residents the 10 types of support covered by the survey. In addition, the survey revealed residency programs were less likely to offer support related to personal or family problems as opposed to medical/professional issues.

Adult↗

A distance-assisted training program for nuclear medicine technologists.

We have developed training materials for nuclear medicine technologists to be used in distance-assisted training programs. We have completed our first pilot project in Asia and report that there will be nearly 500 students around the world, in Asia, Africa, Central America and South America, using our materials during the coming year.

Allied Health Personnel↗

A demographic, service, and financial survey of anesthesia training programs in the United States.

UNLABELLED: In February 2000, a demographic, service, and finance survey was sent to the directors of anesthesiology training programs in the United States under the auspices of the Society of Academic Anesthesia Chairs/Association of Academic Program Directors. In August of 2000, 2001, and 2002, shorter follow-up surveys were sent to the same program directors requesting the numbers of vacancies in faculty positions and certified registered nurse anesthetists (CRNA) positions. The August 2001 survey also inquired if departments had positive or negative financial margins for the fiscal year ending June 2001. The August 2002 survey included the questions of the 2001 survey and additionally asked if the departments had had an increase or decrease in institutional support and the amount of that current support. The survey results revealed that the average program had 36 anesthetizing locations and 36 faculty. Those faculty spent 69% of their time providing clinical service. Approximately one-half of the departments paid for some of their residents, whereas the other 50% paid for none. Eighty-five percent of the departments employed CRNAs who were funded by the hospital in one third of the departments. In 2000, departments received $34,319/yr in support per faculty full-time equivalent (FTE) from their institutions and had a mean revenue of $407,000/yr/faculty FTE. In 2002, the department's institutional support per FTE increased to $59,680 (a 74% increase since 2000). The departments in academic medical centers paid 20% in overhead expenses, whereas departments in nonacademic medical centers paid 10%. In 2000, 2001, and 2002, the percentage of departments with positive margins was 53%, 53%, and 65%, respectively, whereas the departments with a negative margin decreased from 44% in the year 2000 to 38% in 2001 and 33% in 2002. For the departments with a positive margin, the amount of margin per FTE over this 3-yr period was approximately $50,000, $15,000, and $30,000, respectively. Although the percentage of departments with a negative margin has been decreasing, the negative margin per FTE seems to be increasing from approximately $24,000 to $43,000. The number of departments with open faculty positions has decreased from 91.5% in the year 2000 to 83.5% in 2001 and 78.4% in 2002; in these departments, the number of open faculty positions has also decreased from 3.8 in 2000 to 3.9 in 2001 to 3.4 in 2002. The number of open CRNA positions seems to have been relatively constant with approximately two thirds of the departments requiring an average of approximately four CRNAs each. Overall, academic anesthesiology departments fiscal security seems to have eroded with an increased dependence on institutional support. Departments pay larger overhead rates relative to private practice, and there seems to be a continued, but possibly decreasing, shortage of faculty. IMPLICATIONS: A survey was conducted of anesthesia training program directors that demonstrated that their departments' financial conditions have been eroding over the years 2000 to 2002. During this same period of time, departments were receiving an increase in institutional support from $34,319/full-time equivalent (FTE) faculty in the year 2000 to $59,680/FTE in the year 2002. Although there seems to be an approximate 10% shortage in academic faculty, the number of departments with open positions has progressively decreased from 91% to 73% over the past 3 yr. On average, the financial condition of the training departments has deteriorated over the past 3 yr despite a significant increase in institutional support to enable departments to recruit and retain faculty in an era of an apparent national shortage of anesthesiologists.

Accreditation↗