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PubMed2003

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↗
PubMed1991

A successful physician training program in cholesterol screening and management.

METHOD: Thirty-six resident physicians received a blood cholesterol training program which included training in blood cholesterol screening using a fingerstick method and a desktop analyzer, diet assessment and counseling, and a management protocol for follow-up diet and drug treatment. The program also included feedback to residents about their blood cholesterol screening activity, incentives, and biweekly articles in the department newsletter. RESULTS: Between 1986-1987 (baseline) and 1987-1988 (intervention), the percentage of the target patient population (ages 20-65 years, nonpregnant, not screened in the previous year) that was screened for hypercholesterolemia in this primary care practice increased from 16.2 to 23.2% [rate difference (RD) = 7.0; 95% confidence interval (CI) = 4.75-9.25]. The mean value of the screening tests decreased from 5.36 mmol/liter (207.2 mg/dl) to 5.08 mmol/liter (196.6 mg/dl; t = 2.98, P = 0.003) and the percentage of the population screened needing further evaluation decreased from 36.8 to 27.6% (RD 9.2; CI = 2.00-14.00). In the intervention year, compared with the baseline year, patients with a borderline blood cholesterol and cardiovascular risk factors were more likely to have a follow-up test (28.8% vs 11.9%, RD = 16.9; 95% CI = 0.80-33.00) and the low-density lipoprotein cholesterol test was used less for screening (8.2% vs 19.4%, P less than 0.0001). Conclusion. We conclude that this program was effectively integrated into a busy primary care practice, leading to improvement in blood cholesterol screening and management practices.

Adult↗
PubMed1989

A nutrition/health training program for Peace Corps volunteers.

Nutrition and health education is a crucial component of the overall mission of the Peace Corps program. Individuals selected to work as Peace Corps volunteers need to be well prepared to perform this complex and challenging job in recipient countries. This article presents a model for a training program for Peace Corps trainees that was conducted over a 5-week period. The program was planned in accordance with some specific training guidelines that were provided by the Peace Corps. The trainees included nine women ranging in age from 22 to 61 years with diverse backgrounds; however, all had a BA/BS in a health-related discipline. Training curriculum included fundamental nutrition and health-related areas: basic nutrition, foods, clinical nutrition, maternal and child health, communicable diseases and sanitation, health strategies, and community development. Fifty percent of the curriculum was devoted to "hands-on" practical and clinical activities. Maternal and child health was emphasized in the training curriculum as this is an area of concern in all developing countries. The trainees were evaluated by weekly quizzes as well as completion of a special project involving applications of all their newly acquired skills. Implications of the training program are discussed.

Adult↗
PubMed2002

Changes of immune system in military recruits after the training program.

The aim of the exercise was to improve body health including the immune system function. However, several studies have observed the suppression of immune response in athletes who were trained with strenuous exercise. Recruits who have been in the recruitment-training program for 8 weeks might also have immune suppression. Twenty males, aged from 21 to 23 years in Chulachomklao Royal Military Academy infantry battalion volunteered to participate in this study. They were asked to wear a Polar Accurex Plus Telemetric heart rate monitor during the training period. Tuberculin skin test which is the screening method for cellular immune responses was significantly decreased at post-training compared to the pre-training (p<0.02). The levels of serum IgG and IgM at pre-training, 4th week, 8th week and one week post-training were significantly decreased at the initiation period, which were compared with pre-training and 4th week of training (p<0.01), and returned to normal at the 8th week of training and one week post-training. The level of circulating immune cells and number of CD markers (CD3, CD4, CD8, and CD56) were not significantly changed throughout the training period. This study demonstrated that subjects who underwent the recruit-training program were able to improve their health after the period of training i.e., in the adaptation period. The decrease in the initiation period could be compensated with proper diet and enough rest.

Adult↗
PubMed1991

Specialized physical training programs: effects on serum lipoprotein cholesterol, apoproteins A-I and B and lipolytic enzyme activities.

To determine the effects of different types of physical training on lipid metabolism, serum lipids, lipoprotein cholesterol, apoproteins A-I and B, hepatic (HTGL), extrahepatic (LPL) and total (PHLA) post-heparin lipoprotein lipase activities were studied in elite athletes engaged in aerobic ("B", no. 13), anaerobic ("C", no. 17) and mixed ("D", no. 9) training programs and in a group of sedentary controls ("A", no. 15). In the aerobic and mixed groups serum triglycerides were significantly lower compared to sedentary controls while total serum cholesterol and LDL cholesterol, as well as serum apoprotein B levels were only slightly lower. HDL cholesterol and HDL2 cholesterol were slightly higher while serum cholesterol/HDL cholesterol (2.89 +/- 0.37 vs 3.6 +/- 0.47, p less than 0.01) and LDL cholesterol/HDL cholesterol (1.69 +/- 0.38 vs 2.23 +/- 0.43, p less than 0.05) ratios were significantly lower only in aerobic athletes compared to the control group. PHLA and LPL activities were slightly higher in the aerobic group than in controls, while PHLA and HTGL were significantly lower in aerobic and mixed athletes. No significant correlations were found between HDL cholesterol and energy expenditure during training, indexes of adipose mass or lipolytic enzyme activities. The results of this cross-sectional study seem to indicate that specialized training programs have a different effect on lipoprotein pattern and lipolytic enzyme activities, and only aerobic exercise has a potentially antiatherogenic effect.

Adult↗
PubMed1997

Evaluation of a worksite injury and illness prevention program: do the effects of the REACH OUT training program reach the employees?

In this article the authors report the findings of a 2-year study evaluating the effectiveness of REACH OUT, a train-the-trainer program developed to assist small businesses comply with California legislation, Senate Bill 198 (1989), requiring employees to implement a worksite Injury and Illness Prevention Program. Data from a case study sample of 8 companies, drawn from 151 Southern California small businesses participating in the larger study, are reported. Diagnostic walk-throughs were performed, and employee surveys collected at the case study companies approximately 2 months before the treatment group received the intervention and again 1 year later. Results indicate that greater corporate compliance led to employees' perceptions of increased health and safety meetings and training sessions, which led to greater employee health and safety knowledge and improved employee health outcomes.

Accidents, Occupational↗
PubMed2000

Utility of a brief self-efficacy scale in clinical training program evaluation.

Self-efficacy is often studied as a predictor of professional practice behaviors or as an outcome of clinical training, using brief scales with little validation. This study examines the utility of a brief self-efficacy scale in the evaluation of a clinical training program. Subjects were 119 registered dietitians who participated in diabetes training. Hypothesized relationships between self-efficacy ratings and indices of skill mastery, participation in training, and subsequent practice change were examined. Self-efficacy ratings after training correlated significantly with relevant prior experience (r = .4 and .29, p < .01) but not total experience and with knowledge post-test score (r = .21, p < .02). Self-efficacy for all 12 program objectives increased significantly after training. Post-training self-efficacy for two program objectives correlated significantly with self-reported successful practice changes related to those objectives (r = .4, p < .04 and r = .51, p < .01). The data suggest that brief self-efficacy assessments can contribute meaningfully to clinical training program evaluation.

Analysis of Variance↗
PubMed1993

Choices of training programs and career paths by women in internal medicine.

PURPOSE: To examine the choices of career paths of women in internal medicine, specifically to determine (1) whether women continue to prefer primary care practice more often than men do and (2) whether differences in career paths between men and women result from differences in the natures of the training programs they complete. METHOD: A database containing demographic, training, and clinical-practice information on 19,151 physicians (3,569 women and 15,582 men) who had been trained in internal medicine was constructed by merging data from the National Resident Matching Program matches in internal medicine for 1977-1982 with data from the 1985 American Medical Association Physician Masterfile, which contains physician practice profiles. RESULTS: Similar percentages of the men and the women chose primary care residencies (8% versus 9%, ns) and trained in the 100 major medical centers (49% versus 50%, ns). The women more frequently trained in programs affiliated with medical schools in the top prestige quartile (38% versus 33%, p < .05). The attrition rates of residents who left their training for careers in other medical fields were the same for the men and the women (14%). Fewer women obtained board certification (74% versus 80%, p < .01). The women chose to practice general internal medicine more frequently than did the men (52% versus 45%, p < .0001), regardless of the training program completed (primary care or traditional). CONCLUSION: The women pursued primary-care-oriented internal medicine to a significantly greater degree than did the men, regardless of the type of training program completed (primary care or traditional).

Career Choice↗
PubMed1992

The effect of participation in an exercise training program on cardiovascular reactivity in sedentary middle-aged males.

Exaggerated cardiovascular reactivity to mental stressors may be a risk factor for cardiovascular disease. To determine if participation in a moderate intensity aerobic exercise training program reduces cardiovascular reactivity to laboratory stressors, 40 sedentary middle-aged males were randomly assigned: training group (n = 25) and control group (n = 15). Cardiovascular reactivity during and after three mental stressors (passive responding, push-button Stroop and verbal Stroop) and mild exercise (bicycle ergometer) was assessed before and after an 8-week intervention. VO2(peak) was determined using the Balke protocol. Among 19 subjects who completed the training, VO2(peak) increased 13.7%. Also, trained compared to untrained subjects showed significant reductions in baseline and absolute heart rate responses to all stressors. Baseline adjusted heart rates were significantly lower during push-button Stroop recovery and during verbal Stroop. Blood pressure, T-wave amplitude, finger pulse amplitude and pulse transit time responses were unaffected by exercise training. It was concluded that participation in a short-term, moderate intensity aerobic exercise training program may have a cardioprotective effect by significantly reducing absolute and baseline-adjusted heart rate responses to stressors.

Adult↗
PubMed1993

Occupational medicine training program surveys.

Although the quantity of Occupational Medicine (OM) residents in training programs has risen in the past 15 years, there remains a significant shortage of OM physicians in the United States. A survey of OM residency program directors and residents and fellows (trainees) was accomplished to answer questions relevant to recruiting and supplying OM trained physicians. Twenty-six of 29 program directors (89.7%) replied. One hundred forty-three of 174 (82.2%) trainees responded. Fifty percent of responding program directors were satisfied with the current quantity of program applicants. Medical students were provided a median of 3 hours (range, 0 to 20 hours; mean, 5.35 hours) of formal OM teaching by the responding programs. Almost half of trainees, 68 (48.6%), did not receive formal OM instruction in medical school. An average of 5.4 +/- 13.3 hours of OM was taught to OM trainees in medical school. Disproportionate numbers of trainees were taught OM as fourth-year medical students and in other residencies. Reasons for pursuing OM training were diverse and often related to postgraduate clinical experience with OM. Only a total of 84 primary care residents (0.32%) rotate through the OM residency programs in an average year. We conclude that an insufficient quantity of qualified applicants, combined with limited exposure to OM in medical schools and low levels of contact with residents in primary care programs, will continue to hinder efforts to reduce the shortage of OM residents and physicians. Further training specifically targeting the fourth year of medical school and the primary care residencies may have the most impact on recruitment.

Certification↗
PubMed1992

[A multi-stage cognitive training program for improving cognitive functions of chronic alcoholic patients].

In accordance with neuropsychological findings, that chronic alcohol abuse can lead to cognitive impairment, a multi-phased cognitive training program (MKT) developed by Sagstetter was conducted with a group of chronic alcoholic patients. In this article this program is introduced and evaluated with regard to chronic alcoholic patients and their improvement in certain cognitive functions. The study group consisted of 11 chronic alcoholics, who regularly took part in the program. The control group consisted of 11 patients who took part on a behavior therapy program offered by the clinic and had similar social and pathological histories to those of the study group. The two groups were compared with each other with the help of a follow-up study design after approximately seven weeks. The results reveal that this present cognitive training program promotes, above all, cognitive functions such as visual short-time memory, concentration, form perception as well as combination and organisation ability.

Adult↗
PubMed1994

Efficacy of a home-based training program for older adults using elastic tubing.

The purpose of this study was to investigate the efficacy of, and the adherence to, a 12-week home-based progressive resistance training program for older adults utilizing elastic tubing. Sixty-two adults (mean age, 71.2 years) qualified to participate in the study. Subjects were randomly assigned to either the exercise (E) (n = 31) or non-exercise (NE) group (n = 31). Pre- and post-testing included isokinetic (1.05 rad.s-1) concentric/eccentric knee extension/flexion strength testing and flexibility measures of the hip, knee, and ankle. The E group trained three times per week, performing one to three sets of 10-12 repetitions for each of 12 resistance exercises. The exercises involved muscles of both the lower and upper body. Within the E group, 25 of the 31 subjects (80.6%) completed the study. Of the E subjects completing the study adherence to the three training sessions per week was 90% (range 72%-100%). Training resistances used during workouts increased significantly with the average estimated increase being 82% (P < 0.001). The E group also demonstrated significant (P < 0.05) increases in isokinetic eccentric knee extension (12%) and flexion (10%) strength. No other significant changes were observed between E and NE groups. These results suggest that home-based resistance training programs utilizing elastic tubing can serve as a practical and effective means of eliciting strength gains in adults over the age of 65.

Aged↗
PubMed1997

An interdisciplinary health team training program for school staff in Minnesota.

This paper describes an interdisciplinary health team training program for school-based clinic staff in Minnesota. The project sought to improve team functioning, level of practice, and health care services at the school sites. Participants were interdisciplinary staff members from clinics in senior high, middle, and elementary schools. The program consisted of further development in team training knowledge and skills and educational sessions on issues identified by participants. Evaluations indicated participants reported greater knowledge and improved team functioning experiences from the team training. Gains also were shown in knowledge and skills in specific school topic areas such as violence, resiliency, working with resistant families, and self-care. The program could serve as a model for other interdisciplinary school health team training.

Curriculum↗
PubMed1977

Metabolic responses to interval training programs of high and low power output.

The metabolic responses of 30 college-aged males were compared following high power (30-sec runs with 19 repetitions-Group HP) and low power (120-sec runs with 7 repetitions-Group LP) interval training programs (8-wk, 3 days/wk). Measurements included: maximal aerobic power (Vo2max, open circuit spirometry); maximal lactacid capacity (net-LAmax, blood LA accumulation following exhaustive exercise); net energy production (net Vo2 and netLA) following a 2-min run that was exhaustive before but not following training; and maximal muscular power (stair-climbing procedure). The results indicated: 1) significant but equal increases in Vo2 max in both groups; 2) no change in either group in netLAmax; 3) net Vo2 during the 2-min run was unchanged, however, netLA was significantly greater in Group LP; 4) no changes in either group in muscular power. It was concluded that low power and high power output interval training programs elicit similar changes in maximal aerobic and anaerobic metabolism, and that the physiological and or biochemical changes responsible for lowered lactic acid production during heavy, but submaximal exercise following training are produced to a greater extent by the low power program.

Adolescent↗
PubMed1993

Education in adult basic life support training programs.

The Panel on Educational Issues in Adult Basic Life Support Training Programs reviewed the characteristics of adult learners, aspects of educational theory, issues concerning barriers to learning and performing CPR, and issues concerning testing and evaluation. The panel made the following recommendations: a comprehensive evaluation of the basic life support program with the goal of improving the program design and educational tools must be initiated; adult programs must be designed to motivate laypersons to become trained in CPR, as well as to target relatives and friends of high-risk individuals; and emotional and attitudinal issues, including the student's reluctance to act in an emergency, must be addressed. Programs must incorporate information on the willingness of an individual to perform CPR; CPR programs must be simplified and focus on critical success factors; flexible educational approaches in programs are encouraged; flexible programming that addresses the needs of the allied health professional is encouraged; formal testing should be eliminated for layperson programs; and formal testing for health care providers and instructors should be continued.

Adult↗
PubMed1985

Self-evaluation by house officers in a primary care training program.

Expertise in ambulatory care requires a broad range of knowledge and skills. A modified Delphi survey technique was used to delineate diagnoses, management techniques, and procedural skills in seven subspecialty areas necessary for house officers in a primary care internal medicine training program. Self-evaluation instruments were developed, and residents were asked to rate their abilities in the seven areas. At entry, the house officers generally had more confidence in their diagnostic abilities than in their management techniques and procedural skills. Progression through the training program was accompanied by increases in confidence in all areas except the behavioral sciences. The self-evaluation approach provided a longitudinal assessment of changes in the confidence of house officers throughout their training and an indication of the effectiveness of the educational program.

Ambulatory Care↗