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PubMed2006

Eight months later: Hurricane Katrina aftermath challenges facing the Infectious Diseases Section of the Louisiana State University Health Science Center.

The effects of Hurricane Katrina have caused the long-term sequelae of a diminished patient base, of a reduced number of available health care professionals, and of closing hospitals in New Orleans, Louisiana. These changes have substantially impacted the academic infrastructure of New Orleans. This article outlines the post-Katrina response of the Louisiana State University Health Science Center (LSUHSC) Infectious Diseases Section and Health Care Services Division to maintain existing HIV and infectious diseases programs. Although several challenges delayed the immediate reopening of the New Orleans location of the HIV Outpatient Program clinic, the LSUHSC Infectious Diseases Section and Health Care Services Division established clinics outside New Orleans for the care of HOP patients immediately following the hurricane. The HOP clinic reopened in New Orleans (in a temporary location) in early November 2005. Several recommendations for academic clinical, training, and research programs are outlined, to assist other centers that might face disaster aftermath challenges.

Academic Medical Centers↗
PubMed1989

Medical education and primary health care in tropical Africa: evidence for change.

Many aspects of Primary Health Care call for a complete revision of approach, emphasis and mental attitudes in medical education. This appears to be a pre-requisite for the promotion of total health involving all elements (i.e. favourable biological, social and physical environment) in the improvement of the general health status of the community. However, the training of medical students is still, in the main, hospital based, with a relatively insignificant clinical exposure in the community setting. Consequently, medical students have been ill-equipped by the training institutions to appreciate the necessary comprehensive health role they would be expected to perform, especially in relation to Primary Health Care, on their eventual return to the community as medical practitioners. An assessment of the attitude and response of a group of final year medical students to the traditional basic medical and clinical disciplines revealed important deficiencies which are discussed: Suggestions are proffered for wider adoption of a community based training programme.

Adult↗
PubMedDate not supplied

The practice of acupuncture: who are the providers and what do they do?

PURPOSE: This study provides basic information about the training and practices of licensed acupuncturists. METHODS: Randomly selected licensed acupuncturists in Massachusetts and Washington state were interviewed and asked to record information on 20 consecutive patient visits. RESULTS: Most acupuncturists in both states had 3 or 4 years of academic acupuncture training and had received additional "postgraduate" training as well. Acupuncturists treated a wide range of conditions, including musculoskeletal problems (usually back, neck, and shoulder) (33% in Massachusetts and 47% in Washington), general body symptoms (12% and 9%, respectively) such as fatigue, neurological problems (10% and 12%, respectively) (eg, headaches), and psychological complaints (10% and 8%, respectively) (especially anxiety and depression). Traditional Chinese medicine (TCM) was the predominant style of acupuncture used in both states (79% and 86%, respectively). Most visits included a traditional diagnostic assessment (more than 99%), regular body acupuncture (95% and 93%, respectively), and additional treatment modalities (79% and 77%, respectively). These included heat and lifestyle advice (66% and 65%, respectively), most commonly dietary advice and exercise recommendations. Chinese herbs were used in about one third of visits. Although most patients self-referred to acupuncture, about one half received concomitant care from a physician. Acupuncturists rarely communicated with the physicians of their patients who were providing care for the same problem. CONCLUSIONS: This study contributes new information about acupuncturists and the care they provide that should be useful to clinicians interested in becoming more knowledgeable about complementary or alternative medical therapies available to their patients.

Acupuncture↗
PubMed1994

Policy statement for general internal medicine fellowships. Society of General Internal Medicine.

Fellowship programs in general internal medicine should be designed to train outstanding academic internists to serve as future faculty and leaders in the field. Although programs may vary widely in their specific components, all should share a number of characteristics and goals. In this document, the Society of General Internal Medicine outlines basic principles and guidelines for fellowship training, states that its own PCIM Directory will explicitly require that programs indicate how they conform to them, and indicates its interest in considering a formal fellowship accreditation process in the future.

Fellowships and Scholarships↗
PubMed1991

Postgraduate medical fellowship training in alcoholism and drug abuse: national consensus standards.

This paper describes the historical background of the Consensus Standards for Postgraduate Medical Fellowships in Alcoholism and Drug Abuse, developed for the American Academy of Psychiatrists in Alcoholism and Addictions and the Association for Medical Education and Research in Substance Abuse. These standards were prepared by a National Advisory Committee of the Center for Medical Fellowships in Alcoholism and Drug Abuse, which includes 23 leading figures in academic medical training in the addiction field. The standards define general information, facilities and resources, the educational program, and the specific knowledge and skills appropriate to fellowship training. The standards were designed to provide a model for optimal training for residency affiliated fellowships to be used by faculty, trainees, and organizations setting training standards.

Alcoholism↗
PubMedDate not supplied

Minority international research training program: global collaboration in nursing research.

In the current century, nurses, along with other health professionals, require preparation for their roles in international health. For faculty and students to practice and learn in this global community, they also will want to have added knowledge of economics, business, and public policy. To gain an immersion experience in global health, nursing faculty and students will need to spend time abroad collaborating with nursing colleagues in other countries. This report describes an academic-research training program (Minority International Research Program [MIRT]) established 7 years ago to enhance the international health experience of minority nursing students. Qualified undergraduate and graduate nursing students are recruited and paired with faculty mentors to conduct short-term research abroad for a period of 10 to 14 weeks. The purpose of international research experiences for minority nursing students is to develop leaders in nursing science and to increase collaboration in the resolution of global health issues. To date, 26 undergraduate students, 22 graduate students, 6 postdoctoral trainees, and 11 faculty mentors have participated and completed the program through research immersion experiences in 9 countries. The program is described in terms of its strengths, challenges, and lessons learned, as well as opportunities for future activities.

Chicago↗
PubMed1991

Knowledge and perceptions of residents regarding case management of acute diarrhea.

The knowledge and perceptions about case management of acute diarrhea were studied amongst 330 resident doctors working in Pediatric Departments of various Medical Colleges in the country. Our observations highlight the inadequacies in the medical curriculum and deficient clinical training in the management of acute diarrhea in the teaching institutions. Knowledge of signs of dehydration was correctly perceived by only 79.8% interns, 80.9% house physicians and 81.1% postgraduate students. It was appalling to observe that despite spending 1-3 years in pediatric wards, the knowledge and perceptions of postgraduate students had not significantly improved. On the contrary, the responses of postgraduate students were poorer as compared to interns in their perceptions of use of ORT in moderate dehydration (p less than 0.005) and in presence of vomiting (p less than 0.05). Adequate thrust on diarrhea and its management during undergraduate as well as during postgraduate teaching and proper training in diarrhea case management with "hands on training" needs to be viewed as a priority in the teaching institutions.

Acute Disease↗
PubMedDate not supplied

Training family practice residents in abortion and other reproductive health care: a nationwide survey.

The majority of residents responding to a 1995 survey of program directors and chief residents at 244 family medicine residency programs in the United States reported they had no clinical experience in cervical cap fitting, diaphragm fitting or IUD insertion and removal. For all family planning methods except oral contraceptives, no more than 24% of residents had experience with 10 or more patients. Although 29% of programs included first-trimester abortion training as either optional or routine, only 15% of chief residents had clinical experience providing first-trimester abortions. Five percent of residents stated they certainly or probably would provide abortions, while 65% of residents stated they certainly would not provide abortions. A majority (65%) of residents agreed that first-trimester abortion training should be optional within family practice residency programs. Residents were more likely to agree with inclusion of optional abortion training and with the appropriateness of providing abortions in family practice if their program offered the training.

Abortion, Induced↗
PubMed1992

[Quantitative and qualitative stock-taking of scientific research in pediatrics in The Netherlands (1986-1990)].

All Dutch academic and non-academic pediatric training centres were requested to give a survey of all scientific publications produced from 1986 to 1990. The initiative came from the board of the Dutch Pediatric Association. During the observation period (1986-1990) the number of international publications with an external reference system was twice when compared with 1981-1985. The quality of the publications was similar. In at least four of the participating academic pediatric hospitals most publications came from the subspecialty area of metabolic diseases, oncology/hematology, immunology/infectious diseases, and cardiology, both during the first and the second observation period. From 1986 to 1990 the total number of theses in which a pediatrician was the main promoter or promoter in charge came to 84.

Academic Medical Centers↗
PubMedDate not supplied

Cuba: on the road to a family medicine nation.

Beginning with an overview of developments during the last 30 years, this article focuses on the current Cuban plan to convert the country into a family practice nation by creating a new primary care system. The new system is based on the training and placement of no less than 20,000 family physician and nurse teams by 1992. Cuba has come a long way in 30 years, as demonstrated by major health indicators.

Cuba↗
PubMed1996

Sex differences in academic advancement. Results of a national study of pediatricians.

BACKGROUND: Although the numbers of women in training and in entry-level academic positions in medicine have increased substantially in recent years, the proportion of women in senior faculty positions has not changed. We conducted a study to determine the contributions of background and training, academic productivity, distribution of work time, institutional support, career attitudes, and family responsibilities to sex differences in academic rank and salary among faculty members of academic pediatric departments. METHODS: We conducted a cross-sectional survey of all salaried physicians in 126 academic departments of pediatrics in the United States in January 1992. Of the 6441 questionnaires distributed, 4285 (67 percent) were returned. The sample was representative of U.S. pediatric faculty members. Multivariate models were used to relate academic rank and salary to 16 independent variables. RESULTS: Significantly fewer women than men achieved the rank of associate professor or higher. For both men and women, higher salaries and ranks were related to greater academic productivity (more publications and grants), more hours worked, more institutional support of research, greater overall career satisfaction, and fewer career problems. Less time spent in teaching and patient care was related to greater academic productivity for both sexes. Women in the low ranks were less academically productive and spent significantly more time in teaching and patient care than men in those ranks. Adjustment for all independent variables eliminated sex differences in academic rank but not in salary. CONCLUSIONS: Lower rates of academic productivity, more time spent in teaching and patient care and less time spent in research, less institutional support for research, and lower rates of specialization in highly paid subspecialties contributed to the lower ranks and salaries of female faculty members.

Academic Medical Centers↗
PubMed1985

Health personnel training in the Nicaraguan health system.

The "Unified National Health System" of Nicaragua was established in 1979, in an attempt to transform some of Latin America's worst health indices. This system, based on the stated principles of planning, regionalization, public participation, and primary care, has prioritized the development of health professions training programs appropriate to its special needs and principles. Public Health and Epidemiology training was inaugurated in 1982. A new campus of the School of Medicine was opened in 1981, increasing the number of medical students by a factor of five. Formal residency training (never before available within the country) in primary care specialties has been established. Training for allied health personnel has been formalized in several fields, with the establishment of the Polytechnical Institute of Health. The rapid increase in number and size of training programs has created a tremendous need for educational resources both human and material. This article reviews the status of health personnel training in Nicaragua today, the integration of these programs into planning for the health system, and problems arising from their rapid appearance.

Allied Health Personnel↗
PubMed2001

The health care crisis: impact on surgery from a chief executive officer's perspective.

Kaiser Permanente, in conjunction with the surrounding academic institutions, trains 64 surgical residents annually in Northern California. Although the current health care crisis has made resident education increasingly difficult, we are committed to maintaining and expanding our programs. The current health care crisis reflects the effect that for-profit health plans, hospitals, and pharmaceutical groups have had on medicine. Their negative impact has not been simply the extraction of resources from the delivery system to their equity shareholders, but the implementation of an authorization process designed to frustrate and deny. As executive director and chief executive officer of the Permanente Medical Group, I believe that resident training allows us to attract outstanding clinicians, train the physicians of the future, and improve the clinical care of our patients. The multispecialty nature of our medical group and our size allows us to work collaboratively, offer evidence-based approaches, preserve professional independence, and implement innovative programs to increase quality and service. Although it is uncertain how health care will evolve in the future, we at Kaiser Permanente are committed to maintaining and expanding our involvement in the education of the next generation of surgeons.

Academic Medical Centers↗
PubMed1992

Teaching community oriented primary care in a traditional medical school: a two year progress report.

Efforts are being made to extend the practice of Community Oriented Primary Care by reorienting existing health services or restructuring medical education curricula. Nevertheless, changes in education must be simultaneous to changes in health services so that health professionals trained in COPC will find areas to practice COPC. The experience described in this article presents an effort in these two directions. A teaching program was introduced in a traditional medical school curriculum and was extended to six health services by training the directors of the health service as teaching instructors of COPC or closely coordinating actions with the director of the health service. The results of the program show fulfillment of learning objectives and student satisfaction with the program. Evaluations of the development of COPC in the health services involved show modifications in health programs to meet community needs and stronger community leadership and organization.

Colombia↗
PubMed1998

A model for making outcomes research standard practice in clinical dietetics.

In today's rapidly changing health care environment, it is imperative that dietitians demonstrate the importance of their role as health care providers by initiating and participating in outcomes research. Patient care should be based on empirical studies, and clinical dietitians should participate in or be at the helm of such investigations. Nutrition research is usually accomplished and reported by persons with MD or PhD degrees who do not have clinical training in nutrition and does not often address situations encountered by dietitians in clinical settings. This article examines the extent to which clinical dietitians are conducting and reporting outcomes research, their attitudes about such research, and how they think they could best acquire the skills needed to incorporate outcomes research into their practice. Results indicate that clinical dietitians are not writing a substantial percentage of articles and that reports of outcomes research are not commonly included in clinical nutrition journals. Clinical dietitians appear to value the inclusion of research in clinical practice, but they are not spending a great amount of time doing research. Dietitians report being comfortable about participating in research but not about designing, conducting, and reporting research. Results from several surveys were used to develop a model for integrating research in clinical practice. This model includes the research process as a basis for clinical practice. A model for collaborative efforts between clinical and academic dietitians is also proposed and emphasizes the responsibility of academic dietetics training programs in the integration of research and clinical practice.

Attitude of Health Personnel↗