[Aquisition of basic knowledge and technics to enrich the clinical training].
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Education, Nursing↗
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Control of sleeping sickness due to Trypanosoma brucei gambiense.
Sleeping sickness due to Trypanosoma brucei gambiense is endemic in 23 African countries and an estimated 45 million people are exposed to infection. The relatively low incidence of the disease (about 10 000 new cases each year) is mainly a result of 50 years of regular medical surveillance and treatment in combination with tsetse control where indicated and possible. The present article considers the significant developments in research in the field and assesses the impact of these findings on techniques used in the control of the disease. The World Health Organization has recently established an action programme for sleeping sickness control to organize and coordinate medical surveillance, treatment of infected individuals, and vector control activities. Among its objectives, the programme aims to provide support for national control services in the form of technical expertise, training of staff, and provision of newly developed equipment for diagnosis and treatment. The programme is also closely associated with the research activities supported by the UNDP/World Bank/WHO Special Programme for Research and Training in Tropical Diseases.
Africa↗
[Proposal for a new type of medical education in Linkoping: Early clinical training and education in communication technics].
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Curriculum↗
Implementation of ORT: some problems encountered in training of health workers during an operational research programme.
During an operational research study on implementation of oral rehydration therapy in a block of West Bengal, India, amongst a population of 2, 16,805, a total of 171 Community Health Guides and 152 Anganwadi Workers were initially trained for one working day by lectures and slides about diarrhoea case management at the community level. The training was evaluated after two months and found to be inadequate. The workers were then retrained with modern approach using a module (prepared in local language) as suggested by World Health Organisation. The level of retention of the imparted knowledge of Health Workers for different items 2-3 months after training with lectures and slides ranged between 5-25% except preparation of ORS which was 80%. With the use of modules, 47-98% of health workers could retain the same knowledge 3 months after the training. The knowledge thus acquired were sustained even after 12 months of training to a level which was still much better than that retained 2 months after training with slides and lectures. However some of the items like indication of use of Home Available Fluids, dosage of ORS and when to refer a diarrhoea case to health facility were more difficult to recall after one year. This possibly indicates need for in-service training of grassroot level health workers at suiTable interval.
Community Health Workers↗
Metabolic and cardiorespiratory reactions in tennis-players in laboratory testing and under sport-specific conditions.
Metabolic and cardiorespiratory reactions were investigated during a sport-specific incremental field test (FT) for tennis and compared with a treadmill step test (TT) in a group of 13 trained male tennis players. In both the FT and the TT lactate acid (La), heart rate and oxygen uptake (VO2) were measured. VO2 was determined using a portable telemetric system (K2, Cosmed, Italy). Aerobic- (AT) and anaerobic threshold (ANT) at a blood lactate concentration of 2 mmol/l and at 4 mmol/l respectively was indicated to characterize the endurance capacity of the athletes. In both FT and TT, minimum value of lactate equivalent (LE(min)), measured in every exercise test, was also registered. At AT and ANT values for HR (AT: p < 0.001; ANT: p < 0.001) and VO2 (AT: p < 0.001; ANT: p < 0.001) were significantly higher in FT than in TT at submaximal loads. At LE(min) only higher values for HR (p < 0.05) were registered in FT. In contrast to maximum range significantly higher values for VO2 (p < 0.001) could be seen in TT (there were no significant differences for HR). Comparing maximum lactate (La(max)) subjects reached a higher lactate (p < 0.05) in TT. A particular aim of our investigation was to characterize the individual cardiopulmonal and metabolic adaptation of tennis players, considering sport-specific criteria. As a result, differences in cardiorespiratory and metabolic adaptations could be determined between laboratory TT and FT. This finding seems to point to the fact that, using field testing in addition to laboratory exercise testing, makes a better judgement of aerobic and anaerobic endurance under sport-specific conditions possible. Furthermore, it was important for us to put data, determined in the field test into practice, using the given pattern of the field test as an element of training. This kind of training has the advantage of combining an individually intensity-controlled specific endurance training for tennis with a training of technical skills.
Adult↗
An electronic consumer health library: NetWellness.
NetWellness is a community-based, consumer-defined grant program supporting the delivery of electronic health information to rural residents of southern Ohio and urban and suburban communities in the Greater Cincinnati tri-state region. NetWellness is a collaboratively developed and publicly and privately funded demonstration project. Information is delivered via ISDN, standard dial, dedicated network connections, and the Internet. TriState Online (Greater Cincinnati's Free-Net) and other southern Ohio Free-Nets are key access points in the larger project communities. The other access points are more than forty workstations distributed at public sites throughout the project's primary geographical area. Design strengths and limitations, training initiatives, technical issues, and the project's impact on medical librarianship are examined in this paper. Also discussed are ways of determining community needs and interest, building political alliances, finding and developing funding sources, and overcoming technical obstacles. NetWellness's Internet address is: http:@www.netwellness.org.
Community Participation↗
An evaluation of teaching methods utilized during an HIV miniresidency course for Thai physicians.
This study examines the efficacy of medical education methods in improving the knowledge base and clinical skills of participants attending a 2-day miniresidency course in HIV infection. Instructional methods included: a didactic lecture format, diagnostic algorithm presentation, color slide photographic demonstration, bedside teaching rounds, and "meet-the-professor" sessions. Questions to assess the various instructional formats were administered and teaching methods were evaluated. Fifty-seven Thai physicians, highly exposed to HIV patient care duties, completed both precourse and postcourse tests. Overall, significant improvement was noted in participant's final global test score. However, discrepancies existed among the efficacy of instructional methods. Recognizing physical signs of HIV infection, as taught by slide photographs, revealed a high baseline level of expertise. Statistically significant postcourse gains were made in physician's diagnostic decision-making ability and basic knowledge of HIV and AIDS taught respectively by the methods of a teaching algorithm and didactic lecture. Despite the latter, participation performed poorly regarding HIV case management. This observation may be related to test design and cultural differences but likely underscores the difficulty in imparting clinical HIV management skills to course participants over a short period of time. Future continuing medical education (CME) courses intended to enhance physician care for the HIV infected must strive to refine evaluation methods for assessing case management skills while exploring innovative instructional techniques when current methods are ineffective.
Adult↗
Managing the development of dialysis nursing: ten years experience.
Different authors have stressed the need for specialised knowledge to serve the needs of the renal patient. This is due especially to the great advances in renal function substitution techniques which require training and technical, scientific and specific expertise on the part of the nursing staff who perform their work in renal units (1,2,3).
Curriculum↗
[The relationships between the specialist in radiology, the competent physician, the licensed physician and the qualified expert].
PURPOSE: To define the juridical figures of the medical specialist (in radiodiagnostics, radiotherapy, nuclear medicine), of the qualified doctor, of the physician authorized to radioprotection controls, and of the qualified expert. To analyze the role of these professionals and their working integration in the light of the regulations in force. To review the regulations referrable to nonspecialist physicians in the activities with ionizing radiation risks. To stress how patient radioprotection remains one of the major concerns of the radiologist, not only with the precautions he/she must take directly but also with the radioprotection policy he/she must promote in the different application fields and with the other specialists. DISCUSSION: Only the specialist (in radiodiagnostics, radiotherapy, nuclear medicine) can practice the specific relevant profession. The physicians working in public institutions in radiodiagnostics, radiotherapy, or nuclear medicine departments without the relative specialization will have to acquire it by 2007, the deadline of a specific moratorium (not indemnity) measure. Also the other medical specialists and nonspecialists using ionizing radiations for complementary activities to clinics are responsible for the radioprotection measures they take; particularly, nonspecialists will be allowed to work only if they get the relative specialization diploma. The medical specialist can interact with the authorized physician at three different levels: as the object of the regulation, he/she being exposed for professional reasons; as the promoter of the radioprotection of patients and the general population; as the person in charge and thus the direct responsible, together with the head of department and the management for the application of the regulations. Thence the need of effective consulting and collaboration between the two professionals. The same should apply also in full for the qualified expert, who is responsible for the physical control of radioprotection. CONCLUSIONS: The medical specialists is both the subject and the object of radioprotection regulations. For optimal collaboration with the other two professionals and to make the needed protection effective for patients and the population (as well as for the involved workers), he/she must be qualified enough and have sufficient technical-professional training, as well as a radioprotection-oriented attitude. In this respect the Italian Society of Medical Radiology (Società Italiana di Radiologia Medica: SIRM) plays a fundamental role.
Clinical Competence↗
The surgeon for the future and implications for training.
Clinical and technical skill may not be sufficient to fulfil society's expectations of surgeons. Other skills, which have been well defined in the published literature, include those of the professional, communicator, collaborator, manager, scholar and health advocate. It is the purpose of this review to explore the current understanding of these different domains and make comment about ways to improve training that will ensure that the surgeon of the future has the opportunity to develop broader expertize.
Australia↗
[Applications in cardiovascular MRI and CT--clinical indications and training].
The recent technical advances in magnetic resonance imaging (MRI) and multislice computed tomography (MSCT) have led to a routine use of both methods in clinical cardiology. MRI is established for the diagnosis of complex congenital heart disease, aortic and pericardial disease as well as cardiac tumours. New indications include the diagnosis of myocardial infarction and inflammatory heart disease as well as myocardial perfusion measurements. CT is used for the diagnosis of coronary calcification for risk stratification. Moreover, stenoses of the coronary arteries and bypass grafts can be depicted using contrast enhanced multi-slice CT in selected patients. Training of cardiologists in the field of MRI has been defined by the Deutsche Arztetag in 2003 and demands 24 months of full-time training. At least 12 months must be spent in a department of radiology. Alternatively, the approach of the Landesärztekammer Baden-Württemberg is presented.
Aortic Diseases↗
Priorities in general surgical training.
PURPOSE: We wished to determine which area of surgical resident training receives the highest priority--surgical technique, surgical judgment, or "book knowledge." We were also interested in how the programs addressed each area, particularly the teaching of surgical technique. METHODS: A questionnaire was distributed to the program directors and chief residents of all 289 general surgery residency programs in the United States. RESULTS: Answers were received from 144 chief residents (50%) and 152 program directors (53%). Programs to teach surgical judgment and technique were offered by 55 (36%) and 68 (45%) of general surgical residencies. Most program directors (83%) and chief residents (72%) considered surgical judgment the most important aspect of surgical training. Sixty-four percent of chief residents felt they were receiving adequate training in the technical aspects of surgery. Approximately half of the program directors felt that residents needed better training in the technical aspects of surgery. One hundred thirty programs (86%) had specific curricula for teaching "book knowledge." CONCLUSIONS: With the advent of minimal access surgery and the constant introduction of new instruments and procedures, new demands are constantly being placed on practicing surgeons. In order to prevent the further fragmentation of general surgery, a more structured approach to the early teaching of surgical skills should be considered.
Attitude of Health Personnel↗
Communication skills and psychological training in oncology.
Preserving the best possible quality of life for cancer patients and their families has become a major goal in cancer care. However, the cumulative effect of stressors related to cancer care, many of which involve communicating with patients and relatives, may lead to the development of burnout in staff. Many health care professionals lack the psychosocial knowledge and communications skills needed to identify patients' problems because general professional training focuses on technical care. Teaching strategies known as psychological training programs (PTP) are therefore being developed to help improve health care professionals' sensitivity to communication problems with patients and relatives. Cognitive (e.g. theoretical information), experiential (e.g. case-history discussions), behavioural (e.g. role-playing exercise) and supportive (e.g. stressor identification) training techniques are used to teach the essential skills of good communication, i.e. listening, empathy, response to cues and appropriate use of reassurance. PTP range from one-day courses and residential workshops to full-time 1- or 2-year curricula. However, one of the main obstacles to implementing PTP is scepticism among health care professionals about its usefulness. Research on training effectiveness should therefore be developed to assess the impact of communication skills on quality of care and patients' quality of life.
Communication↗
Training and assessment of laparoscopic skills.
Laparoscopic surgery is gaining popularity among the surgical community. While its prevalence expands, the need for reliable training and assessment tools is becoming increasingly important. Laparoscopic skills are not an innate behavior, nor can they be easily mimicked, and can only be acquired through hands-on training. A consensus exists among physicians that establishment and evaluation of technical skill in surgical training programs are inadequate and in need of improvement. A validated, reliable bench model that could train and assess could be standardized and provide numerous benefits including determination of which medical students should consider a career in surgery, valuable feedback to residents, a tracking mechanism of resident performance, a possible certification and recertification tool, and to allow for interinstitutional comparison. To this end, several potentially successful bench models testing dexterity, hand-eye coordination, and depth perception have been developed. A few models have been proven to be both valid and reliable indicators of technical skill. Although the future remains uncertain, enough groundwork has been laid to begin incorporating technical skill training and assessment into surgical training programs.
Clinical Competence↗
Assessing pediatric senior residents' training in resuscitation: fund of knowledge, technical skills, and perception of confidence.
OBJECTIVE: To describe pediatric housestaff knowledge, experience, confidence in pediatric resuscitations and their ability to perform important resuscitation procedures during the usual training experience. DESIGN AND PARTICIPANTS: Cohort study of PGY-3 level residents in a ACGME accredited pediatric residency training program at a large, tertiary care children's hospital. METHODS: Fund of knowledge was assessed by administering the standardized test from the Pediatric Advanced Life Support (PALS) Course in addition to a supplemental short answer test requiring clinical problem-solving skills. Procedural skills were evaluated through observation of the resident performing four procedures during a skills workshop using a weighted step-wise grading sheet. Resident experience and confidence was quantified using an anonymous survey. RESULTS: Ninety-seven percent of residents participated. Residents achieved high scores on the standardized PALS test (93.2%+/-5.5), but performed less well when answering more complicated questions (60.0%+/-9.9) on the short answer test. No resident was able to successfully perform both basic and advanced airway skills, and only 11% successfully completed both vascular skills. Although residents were overall confident in their resuscitation skills, performance in the skill workshop revealed significant deficits. For example, only 18% performed ancillary airway maneuvers properly. None of the residents performed all four skills correctly. Experience in both real and mock resuscitations was infrequent. Residents reported receiving feedback on their performance less than half of the time. Over 89% of them felt that resuscitation knowledge and skill were important for their future chosen career. CONCLUSION: Pediatric residents infrequently lead or participate in real or mock resuscitations. Although confident in performing many of the necessary resuscitation skills, few residents performed critical components of these skills correctly. Current pediatric residency training may not provide sufficient experience to develop adequate skills, fund of knowledge, or confidence needed for resuscitation.
Attitude of Health Personnel↗
Training with the compactEASIE biologic endoscopy simulator significantly improves hemostatic technical skill of gastroenterology fellows: a randomized controlled comparison with clinical endoscopy training alone.
BACKGROUND: The Erlangen Active Simulator for Interventional Endoscopy (EASIE) was introduced in 1997 for interventional endoscopy training. compactEASIE developed in 1998 is a modified, light-weight version of the original model. Objective evidence of the benefits of training with these models is limited. A randomized controlled study, therefore, was conducted to compare the effects of intensive 7-month, hands-on training in hemostatic techniques by using the compactEASIE model (in addition to clinical endoscopic training) vs. pure clinical training in endoscopic hemostatic methods. METHODS: Thirty-seven fellows in gastroenterology in New York City area training programs were enrolled. Baseline skills were assessed on the simulator for the following techniques: manual skills, injection and electrocoagulation, hemoclip application, and variceal ligation. Twenty-eight fellows were then randomized into two comparable groups. Those randomized to Group A received purely clinical training in endoscopic hemostatic techniques at their hospitals. Those in Group B, in addition, were trained by experienced tutors in 3 full-day hemostasis workshops over 7 months. Both groups underwent a final evaluation on the compactEASIE simulator conducted by their tutors and additional evaluators who were blinded to the method of training. Initial and final evaluation scores were compared for each group and between groups. Outcomes of actual clinical hemostatic procedures performed during the study period also were analyzed. RESULTS: Ten of 14 fellows randomized to Group A (standard training) and 13 of 14 in Group B (intensive training) returned for the final evaluation. For Group B, scores for all techniques were significantly improved. In Group A, a significant improvement was noted for variceal ligation alone. CONCLUSIONS: compactEASIE simulator training (3 sessions over 7 months), together with clinical endoscopic training resulted in objective improvement in the performance by fellows of all 4 endoscopic hemostatic techniques, whereas significant improvement was noted for variceal ligation alone for fellows who had standard clinical training. In clinical practice, fellows who had intensive simulator/clinical training had a significantly higher success rate and a nonsignificant reduction in the frequency of occurrence of complications.
Animals↗
[Stepwise training and evaluation of clinical training in obstetrical nursing in a classroom: acquisition of nursing technics and its application to the object--the second stage in clinical training (the 1st half of the 2d year)].
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Clinical Competence↗
Technology for independence: a community-based resource center.
Despite the prominence of the disability civil rights model--with its values of inclusion and empowerment--the majority of social and policy research conducted to date has not sufficiently included the perspective of persons with disabilities in the research process and as uniquely qualified researchers themselves. This article describes a new project, "Technology for Independence: A Community-Based Resource Center" (CBRC). Over a five-year period, the CBRC will attempt to enhance community and consumer-directed disability organizations to design, implement, and disseminate research that promotes access to and use of assistive technology (AT). The CBRC will use strategies such as leadership training, participatory action research, technical assistance, web-assisted training, and annual symposia. A primary goal of the CBRC is to increase the capacity of community organizations to conduct research on AT that is scientifically rigorous and relevant to disability services, policy, and law.
Activities of Daily Living↗