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Enhancing the clinical research pipeline: training approaches for a new century.

There is growing concern that the numbers of physician-scientists being trained in U.S. academic health centers will not be sufficient to continue the rate of current progress in biomedical research. The authors believe that the needs of current trainees and junior faculty must be addressed immediately, and that programs to train the next generation of patient-oriented researchers must be established without delay. The authors describe a two-pronged approach to this looming crisis. First is a description of innovative educational programs implemented at one academic health center from the K-12 level through the medical-school curriculum. Second, programs are discussed that have been developed to facilitate the recruitment, training, and retention of physician-scientists in the early parts of their professional careers. Four models of training "translational" investigators are presented, along with case studies of how these models have been implemented in real-life productive and professionally satisfying collaborations within one academic health center. The authors conclude by stating that to be prepared for the effects of future knowledge on human disease and preventive health, academic health centers must enhance training opportunities for physician-scientists.

Humans↗

Clinical research career development: the individual perspective.

The process of integrating medical scientific breakthroughs into improved clinical practice requires talented and dedicated clinical investigators. Unfortunately, substantial impediments deter gifted physicians from clinical research. The experience of "Dr. Ross," an aspiring (fictional) clinical investigator, is presented in this report. The factors that ultimately contribute to Dr. Ross' choice to abandon an academic clinical research career are explored. Issues relating to research training, mentoring, funding, and academic promotion standards are analyzed from his individual perspective. Special emphasis is given to the intense financial pressure trainees face. Finally, potential solutions are presented. These include a description of the National Institutes of Health K23, K24, and K30 programs and its new extramural Loan Repayment Program for clinical researchers. These important advances provide much-needed support, but additional work must be done. In the absence of further reform, academic medicine's mission to train tomorrow's clinical investigators will erode further.

Adult↗

Scholarly Productivity of Athletic Training Faculty Members.

OBJECTIVE: To compare the scholarly productivity index (SPI) among the levels of academic appointment, degree type, and percentage of academic appointment of athletic training faculty members. DESIGN AND SETTING: We used a 5 x 6 x 4 factorial design for this study. A survey instrument was used to determine the number of publications and the number of years in their current appointment. SUBJECTS: Subjects were faculty members in Commission on Accreditation of Allied Health Education Programs-accredited athletic training education programs. MEASUREMENTS: The SPI was calculated by dividing the total number of publications (peer-reviewed and non-peer-reviewed journal articles, peer-reviewed abstracts, books written or edited, book chapters, platform presentations, published book reviews, and external funding) by the number of years in the productivity period. RESULTS: The SPIs were different for the levels of academic rank. Full professors had a higher SPI than all other groups (Tukey honestly significant difference, P </=.05). Associate professors had higher SPIs than instructors or lecturers and clinical specialists, equivalent SPIs to assistant professors, and lower SPIs than full professors. Assistant professors had lower SPIs than full professors but were equivalent to all other groups. There were no differences among the levels of degree type or percentage of academic appointment. CONCLUSIONS: The scholarly productivity of athletic training educators was affected by their academic rank but not by the percentage of time they were assigned to academics or their academic degree type.

Journal Article↗

Repaving the road to academic success: the IMeRGE approach to peer mentoring.

In recent years, academic health centers have made a considerable effort to encourage medical students and physicians-in-training to consider academic medicine as a career choice. For physicians, selecting a career in academic medicine may be the first hurdle, but the challenge of successfully maintaining an academic career is perhaps a more formidable task. Mentoring is a much-needed response to this challenge. But the success of traditional mentoring programs at academic institutions is often limited by, among other things, the availability of senior faculty who can serve as mentors. The authors describe the formation and organization of the Internal Medicine Research Group at Emory (IMeRGE), an innovative peer mentoring group within the Division of General Medicine at Emory University. This group, born partially out of the mentoring needs of our women and minority faculty, shared the primary goal of fostering a collaborative atmosphere among junior faculty, while simultaneously acquiring experience through advanced faculty development. The authors present our methods of garnering division support for designated time and financial resources, defining member responsibilities, developing a curriculum, providing peer support, and seeking advisors with expertise in the areas on which we wished to focus. In addition to the development of IMeRGE, the authors provide an overview of the pros and cons of traditional mentoring versus peer mentoring; discuss the challenges faced by IMeRGE and strategies for addressing these issues; and present the paradigm of IMeRGE as a template for alternative forms of academic mentorship.

Academic Medical Centers↗

Educational outreach (academic detailing) regarding osteoporosis in primary care.

BACKGROUND: Academic detailing utilizes educators trained in social marketing to conduct one-on-one visits with physicians using evidence-based data. Academic detailing programs have improved physician's prescribing behaviors; however, the feasibility of large-scale programs across a large, geographically disperse state is unclear. METHODS: The study team collaborated with a state-run pharmacy benefits program for low-income elderly in a trial to improve osteoporosis management. Community-practicing physicians who saw a minimum of 25 patients enrolled in the benefits program were randomized to receive academic detailing or not. Fourteen educators were trained in the principles of academic detailing as well as osteoporosis epidemiology, diagnosis, and treatment. From September 2003 to January 2004, they attempted to meet with physicians or an allied health professional to discuss osteoporosis and fracture prevention. RESULTS: The physician population was 356 and 148 (41.6%) visits were completed-100 with physicians, 38 with allied health professionals, and 10 with both the physician and an allied health professional. In mixed multivariable models, there were no physician characteristics associated with completed encounters, including gender, training, geographic location, years since medical school, and number of study patients (all p-values > 0.11). The detailer's gender, professional training, and professional experience were not statistically significant correlates of completed encounters (all p-values > 0.28). Number of years since a detailer's professional training was a predictor of a completed encounter, OR = 1.43 per 5 years (95%CI 1.05, 1.96). CONCLUSIONS: A moderate rate of completed encounters was achieved. There was only one predictor of completed encounters.

Allied Health Personnel↗

Development of a clinical forensic medicine curriculum for emergency physicians in the USA.

To address the forensic needs of living patients, the Department of Emergency Medicine at the University of Louisville School of Medicine in Louisville, Kentucky, USA initiated the first clinical forensic medicine training programme in the USA. In July 1991, formal training in clinical forensic medicine was incorporated into the core curriculum of the USA's second oldest academic emergency medicine training programme. The University of Louisville, in cooperation with the Kentucky Medical Examiner's Office, developed the curriculum to provide the emergency physician with the knowledge base and technical skills to perform forensic evaluations of living patients. Forensic lectures are given monthly by local and regional forensic experts including: forensic pathologists, prosecuting attorneys, firearm and ballistics examiners, law enforcement officers, forensic chemists and forensic odontologists. Topics which are presented include: forensic pathology, forensic photography, ballistics and firearms analysis, paediatric physical and sexual assault, crime scene investigation, forensic odontology, courtroom and expert testimony and the forensic evaluation of penetrating trauma. As a result of the introduction of clinical forensic medicine into the core curriculum of an emergency medicine training programme the residents are now actively addressing the forensic issues encountered in the Emergency department. Key, often short-lived forensic evidence, which was frequently overlooked or discarded while delivering patient care is now recognized, documented and preserved. The development and introduction of a clinical forensic medicine curriculum into emergency medicine training has greatly enhanced the emergency physician's ability to recognize, document and address the forensic needs of their patients who are victims of violent and non-fatal trauma.

Journal Article↗

The affirmation of the scientist-practitioner. A look back at Boulder.

In the aftermath of World War II, several influences were paramount in forcing academic psychology to recognize, albeit reluctantly, the coming professionalization of psychology. The federal government, wishing to avoid a repeat of blunders following World War I that led to significant dissatisfaction among veterans, took proactive steps to ensure that mental health needs of the new veterans would be met. The USPHS and the VA were mandated to expand significantly the pool of mental health practitioners, a direction that led not only to the funding of the Boulder conference but also to the development of APA's accreditation program, funded practical and internship arrangements with the VA, and the USPHS grants to academic departments for clinical training. The GI Bill, amended to include payment for graduate education, created tremendous interest in graduate programs in psychology. As a result, psychology programs were inundated with funded applicants, most of whom were interested in the application of psychology to clinical and other applied fields. Graduate psychology departments were mixed in their views of this "blessing." The reality of a separate curriculum for professional training in psychology was a bitter pill for some academic psychologists to swallow. Graduate departments feared that control of their programs would be taken over by external forces and that they would lose their right to determine their own curriculum. Further, they feared the domination of clinical training within their own departments and the effects of such educational emphasis on their traditional experimental programs. The Boulder conference brought together these disparate needs and concerns, although one can argue about how well some points of view were represented with respect to others. It was a time of high anticipation and fear. The conference could easily have ended in failure, with such diverse interests being unable to reach any consensus. There are many letters in the correspondence of committee members that suggest disagreements serious enough to prevent the development of any single model of training. Instead, by most yardsticks that one could apply, the conference succeeded, perhaps beyond the dreams of many of those in attendance who were most invested in a model for professional training. In evaluating the legacy of Boulder, several points are apparent. First, the conference succeeded because 73 individuals were able to agree to some 70 resolutions in 15 days, creating the scientist-practitioner model of professional training. Such consensus was arguably a remarkable achievement. The endorsement of the model by academic units followed with little evident resistance, although it is clear that some Boulder-model programs were developed that bore little resemblance to the model's insistence on significant training in both research and practice. Second, as a response to social and political needs, the conference was clearly a success. The cooperation of the APA, the USPHS, and the VA benefited all three entities. Clinical psychology was given the financial support and backing to advance it as a profession, and the federal government was able to begin the process of securing the personnel needed to address the mental health needs of the nation. The architects of Boulder were clear that their vision of training for professional psychology should be viewed as dynamic and experimental rather than fixed and prescribed. Certainly there are several variants of professional training extant today, yet the overwhelming majority of currently accredited programs in psychology label themselves as "Boulder-model" programs or "scientist-practitioner" programs. Still, new national conferences on professional training in psychology occur with some regularity as participants seek to resolve many of the same concerns debated by those at Boulder. The grand experiment goes on.

Colorado↗

[Clinical gastroenterology--luxury or standard of service in gastroenterology?].

Gastroenterology is one of the important specialities in internal medicine. The reform of the training curriculum for internal medicine and the reimbursement for inpatient and outpatient services in gastroenterology threatens the existence of internal medicine and gastroenterology in Germany, too. The capacity for training in internal medicine and gastroenterology is reduced by a decrease in the number of hospital beds in academic and community training centres. The concentration on gastrointestinal endoscopy in outpatient gastroenterology will be a result of an increasing demand for gastrointestinal endoscopy services and the decreasing number of gastroenterology clinics, respectively. Therefore, clinical gastroenterology as a core service in gastroenterology will be steadily eliminated. This development will diminish clinical gastroenterology to gastrointestinal endoscopy by eliminating the clinical services for chronic gastroenterological conditions such as, e.g., IBD, chronic hepatitis, reflux disease, IBS and functional dyspepsia. In this way gastroenterology looses its central role in health care services in specialised internal medicine. In 2003 the American Gastroenterological Association position paper: "Training the Gastroenterologist of the Future: the Gastroenterology Core Curriculum" was published. It has emphasised the role of clinical gastroenterology in medical training and medical services, too. Clinical gastroenterology consists of an array of several disciplines, e.g., GI physiology, GI research, infectious diseases, hepatology, oncology and gastrointestinal endoscopy, which all contribute to the effectiveness and efficiency in health care service. Financial incentives and better prospects of leading positions for young gastroenterologists in clinical gastroenterology have to be accomplished in order to nourish clinical gastroenterology in Germany. The German Association of Gastroenterology should negotiate with the responsible authorities for the addition of clinical gastroenterological services to the reimbursement by the EBM2000plus. The section of Gastroenterology of the German Association of Internists will provide sustained support to the achievement of this goal.

Delivery of Health Care↗

A blueprint for linking academic oncology and the community.

The processes by which academic medicine will train the next generation of physicians and develop new knowledge have brought to the forefront the relationship between academic medical centers and community hospitals and practitioners. Over the past thirteen years, the Harvard Medical School Joint Center for Radiation Therapy (JCRT) has developed an integrated radiation oncology program designed to serve simultaneously the needs of the community, teaching hospitals, medical schools, and faculty. The structure and function of this program are described here, as are the challenges posed by the highly competitive health care marketplace. We believe that long-term vision should guide short-term goals. The success of academic-community collaborative programs depends not only on the good will and vision of the participants but also on the medical administration, academic leadership, policy makers, and politicians who define the principles and rules by which cooperation within the health care industry occurs.

Academic Medical Centers↗

Biomaterials. New Chinese biochip center straddles business, academe.

Last month, U.S.-trained entrepreneur and researcher Cheng Jing was named head of a new, two-pronged biochip venture here that will be highly unusual even for China, which has been experimenting with academic-industrial arrangements in recent years. One part is a for-profit company backed by $48 million from a combination of national and academic partners and overseas venture capital. The second piece is a nonprofit national center with nearly $10 million in research funding from the Ministry of Science and Technology.

Biotechnology↗

Resident training in head and neck flap reconstruction in U.S. academic otolaryngology programmes.

The main objective of this study was to assess resident training in head and neck flap reconstruction, and to determine the confidence of graduating residents in performing these flaps independently. Questionnaires were distributed to otolaryngology residents graduating in 1997. Respondents recorded the number of pedicled and free flap procedures they performed, or assisted with, and indicated flaps they felt confident about performing independently. Pectoralis major myocutaneous (PMMC) (n = 560, mean 6.59) and radial forearm (RF) (66, 0.78) were the most common pedicled and free flaps performed. There was a significant difference (p = 0.0002, Mann-Whitney U test) between median confidence for pedicled (44.5 per cent) and free flaps (two per cent). Ten of the 17 flaps showed a significant Pearson correlation (p < 0.05) between number of procedures performed and confidence in performing them independently. Of the pedicled flaps, latissimus dorsi (LD) showed good correlation (r = 0.67), PMMC showed low correlation (r = 0.19) and other pedicled flaps fair correlation. Of the free flaps, LD (r = 0.64) and fibula (r = 0.50) showed good correlation and rectus abdominis and RF fair correlation. There was a fair inverse correlation (r = -0.29) between numbers of pedicled and free flaps performed. Higher correlation in flaps uncommonly performed reflects greater operative training necessary to achieve the confidence for performing these flaps independently. As respondents performed greater numbers of free flaps, the number of pedicled flaps decreased. It might thus be important to train residents in all aspects of pedicled flaps. Most respondents were of the opinion that additional training in free flaps was necessary for those planning a career in head and neck reconstructive surgery.

Clinical Competence↗

Simulation based teamwork training for emergency department staff: does it improve clinical team performance when added to an existing didactic teamwork curriculum?

OBJECTIVE: To determine if high fidelity simulation based team training can improve clinical team performance when added to an existing didactic teamwork curriculum. SETTING: Level 1 trauma center and academic emergency medicine training program. PARTICIPANTS: Emergency department (ED) staff including nurses, technicians, emergency medicine residents, and attending physicians. INTERVENTION: ED staff who had recently received didactic training in the Emergency Team Coordination Course (ETCC) also received an 8 hour intensive experience in an ED simulator in which three scenarios of graduated difficulty were encountered. A comparison group, also ETCC trained, was assigned to work together in the ED for one 8 hour shift. Experimental and comparison teams were observed in the ED before and after the intervention. DESIGN: Single, crossover, prospective, blinded and controlled observational study. Teamwork ratings using previously validated behaviorally anchored rating scales (BARS) were completed by outside trained observers in the ED. Observers were blinded to the identification of the teams. RESULTS: There were no significant differences between experimental and comparison groups at baseline. The experimental team showed a trend towards improvement in the quality of team behavior (p = 0.07); the comparison group showed no change in team behavior during the two observation periods (p = 0.55). Members of the experimental team rated simulation based training as a useful educational method. CONCLUSION: High fidelity medical simulation appears to be a promising method for enhancing didactic teamwork training. This approach, using a number of patients, is more representative of clinical care and is therefore the proper paradigm in which to perform teamwork training. It is, however, unclear how much simulator based training must augment didactic teamwork training for clinically meaningful differences to become apparent.

Adult↗

Nurse Education Tomorrow Conference 1990. Reforming nurse education. 1--The reorganisation of nursing knowledge.

With the development of Project 2000, nurse education is being increasingly drawn into higher education with the expansion of diploma and degree courses. This paper explores the implications of these new relationships, drawing on the sociology of the curriculum and education in its analyses. It examines the impact of these changes on the professional standing of nurses and nursing and the reorganisation of the curricular codes that underpin nurse education. A movement towards higher education will introduce a new educational culture into nurse training and the wide multi-disciplinary base of nursing knowledge and practice will offer new challenges to nurse educators. The changes in nurse education add a new dynamic to the old tensions between academic and vocational training and raise new questions about the relationship of nurse education to the academic tribalism of higher education.

Curriculum↗

Outcomes of three part-time faculty development fellowship programs.

BACKGROUND AND OBJECTIVES: Part-time faculty development fellowship programs have trained large numbers of new physician faculty for family medicine education programs. This study reviews data from three part-time fellowship programs to determine how well the programs train new faculty and the academic success of fellowship graduates. METHODS: Part-time fellowship programs at Michigan State University, the University of North Carolina, and the Faculty Development Center in Waco, Tex, sent written surveys to graduates as part of routine follow-up studies. Graduates were asked to report their current status in academic medicine, how they spend their time, measures of academic productivity, and assessments of how well their training prepared them for their current academic positions. Data were complied at each institution and sent to Michigan State University for analysis. RESULTS: The majority of graduates (76%) have remained in their academic positions, and half (49%) teach in medically underserved settings. Graduates report high levels of satisfaction with the training they received. Thirty-two percent of graduates have published peer-reviewed articles, and almost 50% have presented at peer-reviewed meetings. CONCLUSIONS: Part-time fellowship programs have been successful at training and retaining large numbers of new faculty for family medicine.

Faculty, Medical↗

Uncovering frustrations. A qualitative needs assessment of academic general internists as geriatric care providers and teachers.

BACKGROUND: General internists commonly provide medical care for older adults and geriatric education to trainees, but lack the necessary knowledge and skills to fulfill these tasks. OBJECTIVE: Assess the geriatric training needs of academic general internists in 3 hospital systems in Portland, OR. DESIGN: Ten focus groups and 1 semi-structured interview. Interview transcripts were analyzed using thematic analysis, a well-recognized qualitative technique. PARTICIPANTS: A convenience sample of 22 academic general internists and 8 geriatricians from 3 different teaching hospitals. MEASUREMENTS: We elicited stories of frustration and success in caring for elderly patients and in teaching about their care. We asked geriatricians to recount their experiences as consultants to general internists and to comment on the training of Internists in geriatrics. RESULTS: In addition to deficits in their medical knowledge and skills, our Internists reported frustration with the process of delivering care to older adults. In particular, they felt ill prepared to guide care transitions for patients, use multidisciplinary teams effectively, and were frustrated with health care system issues. Additionally, general internists' approach to medical care, which largely relies on the medical model, is different from that of geriatricians, which focuses more on social and functional issues. CONCLUSIONS: Although our findings may not be broadly representative, improving our general internists' abilities to care for the elderly and to teach learners how to do the same should address deficits in medical knowledge and skills, barriers to the processes of delivering care, and philosophical approaches to care. Prioritizing and quantifying these needs and measuring the effectiveness of curricula to address them are areas for future research.

Academic Medical Centers↗

Diploma in addiction behaviour: update.

The Diploma in Addiction Behaviour, offered by the Institute of Psychiatry of the University of London, began in 1986. We are now recruiting for the fourth year, 1989/90. Although its primary objective remains to 'train the trainers', this 'experiment in action' has in itself catalysed changes in the structure and goals of the programme. These include balancing the academic and clinical training, in which placements will be both hospital-based and community-orientated. Student participation will be maximised, and the experience of their own country emphasised. Training for leadership emerges as an important module, as does the process of learning about research skills.

Adult↗

Autogenic training to reduce anxiety in nursing students: randomized controlled trial.

AIM: This paper reports a study to determine the effectiveness of autogenic training in reducing anxiety in nursing students. BACKGROUND: Nursing is stressful, and nursing students also have the additional pressures and uncertainties shared with all academic students. Autogenic training is a relaxation technique consisting of six mental exercises and is aimed at relieving tension, anger and stress. Meta-analysis has found large effect sizes for autogenic trainings intervention comparisons, medium effect sizes against control groups, and no effects when compared with other psychological therapies. A controlled trial with 50 nursing students found that the number of certified days off sick was reduced by autogenic training compared with no treatment, and a second trial with only 18 students reported greater improvement in Trait Anxiety, but not State Anxiety, compared with untreated controls. METHODS: A randomized controlled trial with three parallel arms was completed in 1998 with 93 nursing students aged 19-49 years. The setting was a university college in the United Kingdom. The treatment group received eight weekly sessions of autogenic training, the attention control group received eight weekly sessions of laughter therapy, and the time control group received no intervention. The outcome measures were the State-Trait Anxiety Inventory, the Maslach Burnout Inventory, blood pressure and pulse rate completed at baseline, 2 months (end of treatment), and 5, 8, and 11 months from randomization. RESULTS: There was a statistically significantly greater reduction of State (P<0.001) and Trait (P<0.001) Anxiety in the autogenic training group than in both other groups immediately after treatment. There were no differences between the groups for the Maslach Burnout Inventory. The autogenic training group also showed statistically significantly greater reduction immediately after treatment in systolic (P<0.01) and diastolic (P<0.05) blood pressure, and pulse rate (P<0.002), than the other two groups. CONCLUSION. Autogenic training has at least a short-term effect in alleviating stress in nursing students.

Adult↗

Development of certified health education specialists (CHES) in the United States: focusing on the CHES responsibilities and competencies.

Health education is an important profession. The certification of health education specialists (CHES) has evolved in the United States (U.S.) over the past 50 years. This article briefly focuses on the CHES system in the U.S. and research studies related to this topic, including coverage of the CHES responsibilities and competencies by professional school programs in the U.S., as well as other CHES issues. The CHES credentialing system in the U.S. was successfully developed over a long period of time, and its history in the U.S. is unique. Japan has now started to develop a similar certification process and is concerned about academic programs for training Japanese health educators. Awareness of the CHES system and the U.S. health education certification process and framework may help Japanese health educators and academics to tailor their health education certification processes more effectively.

Certification↗