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PubMed1987

[Experiences in the training of personnel in homes for the aged].

This paper concerns a proposal in an area of increasing importance to social psychiatry: improving personnel training. A survey in 1980 of old age and nursing homes in the psychiatric region of the Zurich Oberland showed that a quarter of the residents suffer from psychiatric disturbances. As only 12% of the personnel have completed any nursing training, the signs of overwork and the changes in personnel are many. Therefore we have developed 2 successful methods for personnel improvement: A) Patient-centered, ongoing training sessions, and B) Periodic intensive seminars. The goal of both is to increase the professional competence of those working in these homes; to give them skills and confidence to deal with sometimes difficult patients, and to increase the likelihood of their "job loyalty". The evaluation shows a trend that such an approach helps to achieve these goals, to avoid unnecessary psychiatric hospitalizations as well as reduces the turnover of personnel.

Aged↗
PubMed2005

Two models of ethics committees.

A distinction is made between two models of ethics committees. According to the Mirror Model, ethics committees ought to reflect the values of society. The Critical Model says committees are to critically examine these standards rather than merely reflect them. It is argued that the Critical Model should be accepted because a society's ethical standards can be mistaken and a society that has Critical rather than merely Mirror ethics committees is more likely to have such mistakes revealed. Some implications of the Critical Model are discussed.

Animal Care Committees↗
PubMed2005

[Expert evidence. General prerequisites and procedural characteristics for expert opinions].

In view of the boom in medical liability suits, which centre around medical malpractice, the decision of the medical expert is the pivot in the conflict between doctor and patient. Therefore, from a legal point of view it is extremely important that the expert is well prepared for a courtroom appearance. Beginning from a systematic and logical structure of the expert opinion, the most important demands on quality are dealt with: professional competence, objectivity and impartiality, intellectual integrity and intelligibility of speech, duty to give a strictly personal delivery of the opinion, limitation to the medical specialty, no legal comments, no insinuation and strict adherence to the theme. As an aid to the Judge, the expert must have a certain degree of background legal knowledge. This includes the peculiarities of civil and criminal procedures with respect to the burden of proof, the causality of medical or organisational errors in treatment leading to injury or even death of the patient, the significance of the term "a probability bordering on certainty", the meaning of "gross" errors in treatment, the guidelines and the medical standards. The obligation of the medical expert in questions of medical malpractice is not only an extremely responsible and difficult one, but also not without risk for the expert himself. Since August 2002 gross negligent errors by the expert are also liable for compensation in law under [section sign] 839a of the German Civil Code Book.

Expert Testimony↗
PubMed2006

Broadening perspectives on clinical performance assessment: rethinking the nature of in-training assessment.

CONTEXT: In-training assessment (ITA), defined as multiple assessments of performance in the setting of day-to-day practice, is an invaluable tool in assessment programmes which aim to assess professional competence in a comprehensive and valid way. Research on clinical performance ratings, however, consistently shows weaknesses concerning accuracy, reliability and validity. Attempts to improve the psychometric characteristics of ITA focusing on standardisation and objectivity of measurement thus far result in limited improvement of ITA-practices. PURPOSE: The aim of the paper is to demonstrate that the psychometric framework may limit more meaningful educational approaches to performance assessment, because it does not take into account key issues in the mechanics of the assessment process. Based on insights from other disciplines, we propose an approach to ITA that takes a constructivist, social-psychological perspective and integrates elements of theories of cognition, motivation and decision making. A central assumption in the proposed framework is that performance assessment is a judgment and decision making process, in which rating outcomes are influenced by interactions between individuals and the social context in which assessment occurs. DISCUSSION: The issues raised in the article and the proposed assessment framework bring forward a number of implications for current performance assessment practice. It is argued that focusing on the context of performance assessment may be more effective in improving ITA practices than focusing strictly on raters and rating instruments. Furthermore, the constructivist approach towards assessment has important implications for assessment procedures as well as the evaluation of assessment quality. Finally, it is argued that further research into performance assessment should contribute towards a better understanding of the factors that influence rating outcomes, such as rater motivation, assessment procedures and other contextual variables.

Clinical Competence↗
PubMed2006

Ethical considerations in CT angiography.

The rapid development and clinical deployment of CT angiography raises several important issues, including assurance of professional competence and technical quality, self-referral, the relative role of radiologists and cardiologists, appropriateness and proper indications, the detection and disposition of unexpected or incidental findings and the concern for the rapidly increasing costs of health care and imaging. These questions are properly addressed within the framework of medical ethics, including principles of beneficence, autonomy and justice.

Advertising↗
PubMed2006

Games in clinical genetic counseling supervision.

Games are defined as ongoing series of complementary ulterior transactions that are superficially plausible but have a concealed motivation to maximize pay-offs and minimize penalties for the initiator. While some games are harmless and part of socialization, others are destructive. Destructive game-playing in clinical supervision, in which game-playing (initiated by either supervisors or students) interferes with a student's realization of internship goals, has been documented in some allied healthcare professions but has not yet been studied in genetic counseling. Genetic counselors and clinical supervisors of genetic counseling students were anonymously surveyed regarding their experiences with destructive game-playing. Results show that such games do occur in genetic counseling clinical supervision. Some games are the same or similar to ones previously described in other health-care professions; others may be unique to genetic counseling. The purpose of this paper is to document these games as a first step to facilitating dialogue, understanding and awareness of them.

Defense Mechanisms↗
PubMed1976

Satisfaction with medical care during pregnancy and delivery.

Societal attitudes toward the medical profession are apparently undergoing a change from awe and total respect to a more critical assessing of accountability and credibility. Based on mass media reports and the increasing number of malpractice suits, it would appear that a rational, unbiased review of medical doctors, hospital personnel, and care received is in order. This review should be concerned with technical aspects of medicine as determined by highly competent professionals and the consumer's view of the medical care he receives. The latter review should logically be taken directly to the consumers of medical care to determine their satisfaction with the care they received. Because of the varied areas of specialty within the medical profession, there are different types of relationships between doctors and their patients. The obstetrician, for instance, is usually associated with pregnancy as a joyful event, in contrast to a surgeon whose diagnosis may seldom be accompanied by joy. Satisfaction with medical care could thus be expected to vary according to the area of specialty and may be related to factors over which doctors have no control, factors which initially bring the patient to the doctor for care. The degree of anxiety related to the patient's condition could also be expected to contribute to the degree of satisfaction expressed by the patient.

Consumer Behavior↗
PubMed1985

Commentary: psychiatry and primary care.

The role of the psychiatrist in educating primary care physicians has evolved from one of leadership to that of weakened collaboration. Concurrently, other mental health professionals compete with the psychiatric physician for actual clinical referrals. The primary care physician's fear of loss of control, stigmatization from psychiatric labels, and issues of time and money are reasons cited for limiting psychiatric intervention. Although the consultation-liaison service has proved to be a useful vehicle for integrating psychiatric services in hospital settings, how best to integrate psychiatric education and service in the ambulatory-based practice is still a challenge. Issues of clinical uncertainty and medical responsibility that the primary care provider regularly experiences may offer solutions for reestablishing the psychiatric physician as the leader in such educational and clinical initiatives.

Humans↗
PubMed1994

Practicing oncology in provincial Mexico: a narrative analysis.

This paper examines the discourse of oncologists treating cancer in a provincial capital of southern Mexico. Based on an analysis of both formal interviews and observations of everyday clinical practice, it examines a set of narrative themes they used to maintain a sense of professionalism and possibility as they endeavored to apply a highly technologically dependent biomedical model in a resource-poor context. They moved between coexisting narrative frameworks as they addressed their formidable problems of translating between theory and practice. In a biomedical narrative frame, they drew on biomedical theory to produce a model of cellular dysfunction and of clinical intervention. However, limited availability of diagnostic and treatment techniques and patients inability or unwillingness to comply, presented serious constraints to the application of this model. They used a practical narrative frame to discuss the socio-economic issues they understood to be underlying these limitations to their clinical practice. They did not experience the incongruity between theory and practice as a continual challenge to their biomedical model, nor to their professional competency. Instead, through a reconciling narrative frame, they mediated this conflict. In this frame, they drew on culturally specific concepts of moral rightness and order to produce accounts that minimized the problem, exculpated themselves and cast blame for failed diagnosis and treatment. By invoking these multiple, coexisting narrative themes, the oncologists sustained an open vision of their work in which deficiencies and impotency were vindicated, and did not stand in the way of clinical practice.

Communication↗
PubMed2005

Training emergency medicine nurses and physicians in youth violence prevention.

Adolescents seen in an urban Emergency Department (ED) are more likely to die from violence than from any other illness or condition for which they seek care in the ED. Most injured patients presenting to our nation's EDs are treated and released, even after a firearm-related injury. These youth who are discharged from the ED will not interface with resources on the inpatient trauma unit. The current standard of care in the ED involves no referral for violence-related prevention services. Despite the fact that ED physicians and nurses frequently medically manage victims of violent assault, there are few courses on youth violence prevention (YVP) framed from the viewpoint of emergency healthcare providers, and ED staff remain relatively uneducated as a specialty on the identification, assessment, and referral resources available for early intervention and prevention. This article focuses on the development and in-depth description of a case-based, 1-hour continuing medical education presentation for ED physicians, residents, and nursing staff on YVP. This presentation is aimed to increase awareness of the role of ED personnel in YVP and to provide basic knowledge and skills needed to begin to incorporate YVP into routine clinical practice in an Emergency Department setting.

Adolescent↗
PubMed2004

[Assessment of teaching methods of anaesthesiology and intensive care medicine in France: opinions of teacher and residents].

OBJECTIVE: The objective of this study was to provide informations about French practice of anaesthesiology and intensive care graduation. STUDY DESIGN: Prospective study. MATERIAL AND METHODS: [corrected] Surveys relative to evaluation tools were sent to professors, and students in anaesthesiology and intensive care in France. RESULT: About 95% of French students in anaesthesiology and intensive care want to be evaluated all over their cursus, by using "Carnet de stage", tutor-student agreement or written examinations. Pedagogical evaluation is hardly wished by students and professors despite that "Carnet de stage" and written examinations are frequently used before professional certification. In order to improve the professional competence, the patronage and use of simulator are frequently quoted by professors. CONCLUSION: Despite the fact that "Carnet de stage" and written examinations are frequently used, pedagogic dimension of evaluation need to be improved.

Anesthesiology↗