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PubMed2006

What we don't know we are teaching: unveiling the hidden curriculum.

In addition to the intentional teaching of knowledge and skills by surgeons to their trainees and protégés is the unintended, often unrealized transmission of implicit beliefs, attitudes, and behaviors through a process called the hidden curriculum. The hidden curriculum is a function of implicit values held by the institution as a whole, and the individual surgical educators and allied health professionals working in the trainee's learning environment. It has been argued the hidden curriculum plays a central role in the development of professionalism, but it may also play an important role in inadvertently deterring good candidates from considering orthopaedic surgery as a career. We review the importance of attending to the messages we transmit to our trainees, protégés, and junior colleagues as we strive to develop professional competency and recruit the best into the field.

Attitude of Health Personnel↗
PubMed2003

Survivors of intimate partner violence speak out: trust in the patient-provider relationship.

OBJECTIVE: To identify characteristics that facilitate trust in the patient-provider relationship among survivors of intimate partner violence (IPV). DESIGN: Semistructured, open-ended interviews were conducted to elicit participants' beliefs and attitudes about trust in interactions with health care providers. Using grounded theory methods, the transcripts were analyzed for common themes. A community advisory group, composed of advocates, counselors and IPV survivors, helped interpret themes and interview excerpts. Together, key components of trust were identified. SETTING: Eastern Massachusetts. PARTICIPANTS: Twenty-seven female survivors of IPV recruited from community-based IPV organizations. MAIN RESULTS: Participants' ages ranged from 18 to 56 years, 36% were African American, 32% Hispanic, and 18% white. We identified 5 dimensions of provider behavior that were uniquely important to the development of trust for these IPV survivors: 1) communication about abuse: provider was willing to openly discuss abuse; 2) professional competency: provider asked about abuse when appropriate and was familiar with medical and social histories; 3) practice style: provider was consistently accessible, respected confidentiality, and shared decision making; 4) caring: provider demonstrated personal concern beyond biomedical role through nonjudgmental and compassionate gestures, empowering statements, and persistent, committed behaviors; 5) emotional equality: provider shared personal information and feelings and was perceived by the participant as a friend. CONCLUSIONS: These IPV survivors identified dimensions of provider behavior that facilitate trust in their clinical relationship. Strengthening these provider behaviors may increase trust with patients and thus improve disclosure of and referral for IPV.

Adolescent↗
PubMed2005

Summative assessment of medical students' communication skills and professional attitudes through observation in clinical practice.

UNLABELLED: To establish medical students' professional competence for the medical profession, we designed a standardized observation procedure and the Amsterdam Attitude and Communication Scale (AACS) with nine five-point scale items, for summative assessment of their communication skills and professional attitudes. This study examines the reliability of the AACS assessment in clinical practice. In the Academic Medical Centre, Amsterdam, The Netherlands, the performance of 442 fifth year clinical students was judged six times in two settings: behaviour in clinical practice was judged independently twice by a doctor and a nurse; one videotaped patient interview was judged independently by a doctor and by a psychologist. The final mark was obtained by averaging ratings across all six assessments. Raters were 88 doctors, 29 nurses, and three psychologists. MAIN OUTCOME MEASURES: Standard errors (SEs) for absolute judgements indicate measurement precision. Precision of AACS scores is considered sufficient with SEs smaller than 0.25. Multi-disciplinary assessment of students' clinical performance using the AACS is feasible and sufficiently precise (with an overall mean of 3.97 and standard deviation of 0.55, the absolute SE is 0.21). Judgements of behaviour in the clinic were more precise (SEs range from 0.11 to 0.16) than judgements of videotaped interviews (SEs are 0.25 and 0.29). The procedure is sufficiently precise if five or six assessments are combined.

Attitude of Health Personnel↗
PubMed2002

[Accidents in radiotherapy: historical account].

Radiotherapy accidents are exceedingly rare. However, they may have major negative consequences: for health (and sometimes life) of victims as well as for the trust that patients put in radiotherapy and radiation oncologists. Each accident must be pointed out, analysed and reported, in order to allow preventive actions, avoiding repetitive accidents. Through examples of majors accidents occurred all over the world in the last decades, affecting professionals, public or patients themselves, the necessity of transparency is demonstrated. The International Commission of Radiobiological Protection has drawn positive lessons from such accidents and insists on following recommendations: necessity of sufficient number and competent professionals, importance of continuous and initial education, information of professionals and, in general, a strict Quality Assurance program. It is clear that each radiotherapy center remains at risk for errors. It is essential to develop preventive procedures to avoid transformation of errors into accidents. In that context, complete and detailed description and reports of each anomaly or incident must be encouraged as it is done for sectors of aviation or nuclear industry. Radiation oncology must develop such a culture of transparency and of systematic report of all incidents.

Accidents, Occupational↗
PubMed1999

Some important limitations of competency-based education with respect to nurse education: an Australian perspective.

Issues concerning competency-based education (CBE) have recently promoted much discussion and debate throughout most developed countries. This paper provides an Australian perspective and adds to the wider debate about CBE by deliberating on the part professional competency standards should play in a university curriculum, specifically the undergraduate nurse education curriculum. A position is developed by addressing the following thesis statement: the competency-based approach to nursing education is an indisputable reality but nursing competencies must not be allowed to control the curriculum. Some background material is briefly reviewed in order to situate CBE, nurse education, and nursing competencies in their Australian economic and sociopolitical context. The position is then explicated through an examination of some intersections between nursing competencies and aspects of undergraduate nurse curriculum making.

Australia↗
PubMed2005

Assessment of personal qualities in selection of medical radiation science students.

UNLABELLED: It is increasingly acknowledged that, in addition to prior academic achievement, there is a need to seek evidence for the abilities and personal qualities of applicants to health professional programs at a university. The aim of this study was to determine the specific abilities and personal qualities required for excellence in practice in the relevant professional domains of medical radiation science (MRS). METHODS: A focus group, consisting of MRS academic staff, developed a questionnaire. The questionnaire was sent to senior MRS practitioners throughout Australia and 213 were returned for analysis. Respondents were asked to rate 40 specific abilities and qualities (referred to as "elements") on a 5-point scale. RESULTS: Two hundred thirteen completed questionnaires were returned, a 53% response rate. One hundred twelve respondents (52%) indicated they currently worked in diagnostic radiography (DR), 57 (27%) worked in radiation therapy (RT), and 44 (21%) worked in nuclear medicine (NM). The duration (mean +/- SD) of the respondents' professional practice in MRS was 14.5 +/- 10 y, with durations ranging from 1 to 43 y. Raw scores and mean scores were examined for any influence of the variable "Number of Years in Practice." DISCUSSION: No major differences were found between the ratings provided by the practitioners from the 3 different MRS professional domains of NM, RT, and DR. Factor analysis indicated the existence of 3 orthogonal factors in the questionnaire data: (a) treat others professionally and ethically, (b) engage with and be open to others, and (c) problem-solving ability. Qualitative analysis of the respondents' comments provided similar themes: (a) the need for professional competence (knowledge and abilities), (b) ethical behavior, (c) the need for a technology and a people orientation, and (d) MRS should be the first choice of MRS students and not a second choice to other professional degrees. CONCLUSION: Senior medical radiation scientists identified professionalism, ethical behavior, engagement with and openness to others, intrinsic specific motivation, and an orientation to people and technology as nonacademic qualities required for excellence in the practice of the professions embraced by MRS.

Attitude of Health Personnel↗
PubMed2006

Institutional conditions and individual experiences in the career-entry period of Swiss medical residents--a qualitative study.

BACKGROUND AND OBJECTIVES: The study investigated first-year residents' career entry experiences according to gender, clinical field and type of training hospital. In addition to quantitatively assessed workplace experiences, this paper reports qualitative data on institutional conditions as well as interpersonal and individual experiences encountered by junior physicians during their first year of residency. METHODS: The present study is part of the longitudinal Swiss physicians' career development study. After their first year of residency, participants were interviewed for the second time. The qualitative data of this second assessment are reported in this paper. A total of 1861 terms were given by 342 junior physicians working in the two main clinical fields (internal medicine and surgical fields) with regard to positive and negative experiences in the career entry period. The answers were assigned to 12 categories (according to Mayring's content analysis). These categories were then allocated to three superordinate subject areas: Institutional conditions, Interpersonal experiences, and Individual experiences. RESULTS: Institutional conditions accounted for 17% of all entries, with negative experiences in particular, high workload - predominating. Within Interpersonal workplace experiences (41% of all responses), relationship experiences accounted for the largest proportion of all statements (25.7%), which were mainly positive. Individual experiences (42%) were assessed both positively (professional competence, learning, responsibility, and pleasure) and negatively (working under pressure and curtailment of one's private life). Female and male residents reported similar workplace experiences. Residents in surgical fields more often complained of a lack of professional support than those in internal medicine. Physicians working in university or big county hospitals had more negative experiences with regard to teaching than residents at smaller hospitals. CONCLUSION: The junior physicians' career-entry experiences indicated that a genuine concept of education and training would greatly improve their workplace experiences. Furthermore, senior physicians should bear in mind that they are important role models for the junior staff.

Adult↗
PubMed1975

A competency-based curriculum for training middle-level community--clinical psychologists.

The focus of this paper is to delineate the basic skills that might be appropriate for a community--clinical psychologist.. The need for competent professionals to deliver mental health services has exceeded the capacity of existing training programs. Current training emphasis is aimed at providing a community--clinical psychologist on the middle level who would have a set of skills or competencies that would easily identify him as a psychologist

Community Mental Health Services↗
PubMed1983

Student-instructor relationships in nursing education.

The nursing instructor who assumes a colleagial or facilitator role in the student-instructor helping relationship assists students to learn and develop both personal and professional competence. In an attempt to attain power, female faculty members may exert power over students, causing students to feel threatened, powerless, and incompetent. Research studies indicate that there is a direct correlation between a student's self-concept and academic performance. When an instructor manifests open communication with students and demonstrates an interest in their learning, the instructor may facilitate a positive self-concept in students and enhance their cognitive abilities. Nursing practice is based on utilizing therapeutic communication, which is authentic, open, and personal. Students may acquire these skills and simultaneously increase their competence in nursing practice more readily when faculty members serve as role models in a helping relationship through sharing and developing trust. By applying the principles of the helping relationship, nursing instructors may facilitate students' personal and professional growth.

Education, Nursing, Baccalaureate↗
PubMed1998

[Personalization concepts of medical ethics in the teachings of John Paul II].

According to John Paul's teaching, the medicine cannot be purely technological, but needs to have some human character. The medicine doctors should consider patients as a whole, not only their problems bound with the treating them as patients, and to cure them from their illnesses, but together considering their feelings, and their intellectual and spiritual life. John Paul's teaching in relation to "the personalizing of medicine" means such a consideration of the human being that is leading to the respect about the body, spirit and their culture. Therefore the knowledge about the biological properties of human life, should be accompanied together with the look onto their dignity. Nobody could be a doctor who cures only one organ of the human's body, but must see the whole human person together with the relations to other persons connected with that patient, because they have very often much of influence on to the health of a patient. That "personalizing of the medicine" should be done on such a way, when it is seen the total ill person. The doctor should be having friendly and even heartily personal relationship to the patient, which should lead to a dialog between them, full of respect and confidence. Nobody is allowed to consider an ill person as a clinical case, but should see a person who is expecting not only professional, competent medical attention, but also the understanding of the patient's spirit, which is being bound with that illness. In this way, John Paul II is telling us, that the health service should not be based entirely on the professional knowledge and skill. The doctor should see in the ill person his own dearest brother or sister, whom we are to love very much, and should be taking part in the illnesses of them.

Attitude of Health Personnel↗
PubMed1989

Attributes conducive to learning in psychotherapy supervision.

Characteristics of future physicians and psychiatrists that are conductive to superior professional competency are possibly comparable to attributes that facilitate the learning of psychotherapy skills. For supervisors and supervisees, this article considers the usefulness of a list of ideal supervisee characteristics developed from a sampling of supervisor responses. Characteristics important in negotiating professional development stages are also discussed.

Curriculum↗
PubMed2007

[Expert opinion aspects of thrombosis prophylaxis].

The boom in medical liability shows no sign of easing even for thrombosis prophylaxis, so that it is becoming increasingly more common that experts must decide whether this has been correctly carried out. From this point of view they are legally only "assistants" to the judge, but practically they make the decision in liability disputes. It is therefore of great importance that the experts fulfil their key role in an unbiased and professionally competent manner and limit their opinions to their own field of expertise. They must also be fully aware of the different prerequisites for liability in both civil and criminal proceedings and the legal definitions of, for example the terms "standard medical professional practice", "grossly" negligent treatment, "a probability bordering on certainty", "obligation to the evidential value" and be familiar with the facts in question. Without this necessary knowledge in the legal field, regrettable judicial errors will always reoccur.

Anticoagulants↗
PubMed1988

Psychological aspects of hypohidrotic ectodermal dysplasia.

There is little information on the psychologic aspects of HED. In particular, there is insufficient evidence to support or dispute the claim that the intelligence of persons with HED is dissimilar to that of the general population. Impressions of frequent mental retardation may arise from patients suffering brain damage following high fever and from our biases against the physically unattractive. A small number of adults with HED have been reported to hold a relatively wide range of jobs, and an even smaller number have been reported with educational and occupational achievement that is predictive of bright average to superior intellectual functioning, but even less evidence is available here. Chronic illness and handicaps exert a toll on the patient and the family. There appears to be greater maladjustment among the families of chronically ill children, but this differs according to the type of illness, and we do not know how this affects the HED child and his/her family. Still, the HED family is exposed to some unique stresses: having always to take into account the ambient temperature regardless of their planned activity; responding to cruel stares and remarks when out in public; and dealing with the problem of broken, lost, or merely publicly discovered dentures. On the other hand, some children apparently benefit from having a sib with a disability. Families react in a variety of ways to a disability, and their reaction may interact with the child's temperament to affect emotional development for better or worse. However, the existence of HED does not insure either normal or inadequate emotional adjustment, and parents should be advised of this. As difficult as it may be, this may also be the time for the pediatrician to say "I don't know." Parents can be told that each child, not just those with HED, should be provided a warm and supportive environment congruent with his/her unique style, in order to facilitate emotional development. They should also be advised of the probable emotional benefits of early prosthetic care with wigs and dentures. When this is either not possible or not sufficient, professional guidance should be sought. Psychotherapy or counseling can be obtained for the child, a parent, or for the entire family. While some familiarity with HED may be helpful, it is not essential, and is far less important than finding a competent professional with whom the family is comfortable. As far as obtaining the information we need, a series of systematic investigations appears to be called for.(ABSTRACT TRUNCATED AT 400 WORDS)

Adaptation, Psychological↗
PubMed2006

Risks and concerns about supplementary prescribing: survey of primary and secondary care pharmacists.

UNLABELLED: OBJECTIVE (OF THE STUDY): To provide data on the views of chief pharmacists (CPs) and primary care trust pharmacists (PCTPs) on the risks and concerns surrounding supplementary prescribing. SETTING: Secondary and primary care within England. METHOD: Postal questionnaire surveys of chief pharmacists and primary care trust pharmacists. MAIN OUTCOME MEASURE: Significance of the association between the extracted factors. RESULTS: The response rate was 68% for both the primary care (183/271) and secondary care surveys (97/143). The survey tool was subjected to factor analysis and reliability testing. For both sectors, the three factors that were extracted described concerns over the training model for supplementary prescribing, concerns about the professional competency/responsibility of the supplementary prescribers once trained, and positivity about the implementation of supplementary prescribing. For both sectors, as trusts have more experience of supplementary prescribing by nurses, the respondents had less concerns about the supplementary prescribing training model. For secondary care, as the total number of pharmacists employed within the trust increases, the respondents had less concerns over the limitations of the supplementary prescribing training model. CONCLUSION: Although both sectors have concerns over the training model for supplementary prescribing and also professional competence and responsibility once trainees qualify, there is overall a positive attitude towards supplementary prescribing and there is a belief that pharmacists wish to take this role on.

Attitude of Health Personnel↗
PubMed1975

Socialization of health proffessionals in Israel: early sources of congruence and differentiation.

In the longitudinal study reported here a comparison was made of changes in basic professional orientations of students during the first three years of professional socialization four health fields in Israel: medicine, dentistry, pharmacy, and nursing. Data are analyzed from the same groups at three points: prior to entry, at the end of year one, and at the end of year three. The image of the "competent" professional is analyzed in terms of a set of underlying traits which in all four populations are shown to group themselves empirically into three dominant components: People, Science, and Status. The priorities accorded to these components are quite similar in all four professions, suggesting a common basic orientation among them. The analysis also points to different levels of absolute emphasis on the components and to changes in patterns of emphasis during the early stages of socilization.

Attitude of Health Personnel↗
PubMed1983

The future optometric office--from a consultant's view.

It's no secret the eye care field, which lay dormant for the most part in the gentle hands of the three Os, is being dressed up and marketed by big business who recognize the financial potential. You are in competition with this element in this 6 billion dollar vision care area, but you should be competing on a different level. Surveys still indicate price is the 7th reason patients choose their doctor on a scale of 1 to 10. To be financially successful in the future, fortunately or unfortunately, will require more of the O.D. than being professionally competent. It's going to take a combination of all the prerequisites that make for success in any business. Sound principles in planning, marketing, management, personnel, communications, education, public relations, and finance. Doctors must be willing to hire the support talent in areas they lack to accomplish their goal. It is not necessary for a practice to grow bigger, but it is necessary that it constantly grow better. Where to begin? The doctor and his staff must be able to answer the question, "Why should a patient come to this office for vision care, rather than the ophthalmologist three blocks away, or the optical chain in the Mail?" Don't answer, "quality." It's relative.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed2001

Continuing education: the British experience.

The methods used to assess proficiency in neurosurgical trainees and consultant staff are reviewed. Under the auspice of the Surgical Royal Colleges trainees undergo a formal assessment 6 monthly by their trainer, annually by a local training committee and in their 3rd year of training by the Specialist Advisory Committee (SAC) in Neurosurgery. This committee supervises all neurosurgical training in the UK and Ireland and recommends trainees for the Certificate of Completion of Training if their training assessments and operative experience are satisfactory and if they have passed the Intercollegiate Specialty Examination in Neurosurgery. Assessing proficiency of consultant staff in the UK poses greater difficulty. For several years neurosurgeons have registered Continuing Medical Education (CME) credits on a voluntary basis. Such action is insufficient to reassure the public of professional competence. The General Medical Council (GMC) have submitted proposals for revalidation based on- (i) the maintenance of a 'folder' including details of performance, CME and complaints, (ii) annual appraisals carried out internally, (iii) a 5 yearly external assessment which if satisfactory would lead to revalidation by the GMC. Team working will be encouraged and consultants made responsible for the quality of service of their professional colleagues. A national comparative audit of subarachnoid haemorrhage should permit comparison of outcomes between neurosurgical units.

Clinical Competence↗
PubMed2005

Contents of a core library in continuing medical education: a Delphi study.

INTRODUCTION: In developing their professional competence, those who are interested in the practice of continuing medical education (CME) should recognize the knowledge base that defines their field. This study systematically identifies and organizes a list of books and journals comprising a core library (100 books/15 journals) for CME professionals. METHODS: The Delphi method was applied to elicit and combine the judgments of a fifty member panel considered knowledgeable about the CME field. The panelists participated in three iterations of the survey to first identify and then rank order nominated works. Separate ranked lists were created for books and journals. RESULTS: Forty-four participants completed the study (88% response rate). 268 books and 34 journals were identified. Mean ratings ranged from 4.78 (high) to 1.50 (low). DISCUSSION: The results of the study reflect the panel's judgment. The list is not definitive; instead, it describes what a select group of individuals knowledgeable about the CME field considered important. The list should therefore be seen as a general guide and a resource to facilitate decision-making, not as a prescription for creating a library.

Delphi Technique↗