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PubMed2002

A conversation about the clinical scholars program: the training of nonbiomedical fellows inside the modern academic medical center. Interview by Joel R. Gardner, Julius Krevans, and Margaret Mahoney.

BACKGROUND: The Robert Wood Johnson Clinical Scholars Program is arguably the best example of "action research" in postgraduate medical education conducted in the second half of the twentieth century. Since its inception in the late 1960s, the program has sought to improve the sensitivity of medical care to its constituents by producing a new kind of physician-one with the skills to rigorously assess the societal forces that impact health care and effect useful change. METHODS: An oral history interview with Dr. Halsted Holman, one of the surviving founders, regarding his personal impressions of the program after 30 years of operation. RESULTS: The greatest success of the program is its scholars. Today, nearly 1,000 alumni are ubiquitous in health care, from the hallowed ranks of the Institute of Medicine to departments of medicine, as heads of hospitals and leaders of government, from federal and state agencies to statehouses throughout the United States, and even to the Surgeon General's office. However, as a revolutionary departure in academics, the program has to watch out that in its maturation and senescence it does not miss opportunities to embrace new disciplines, new methods, and new focuses of investigation. CONCLUSION: Philanthropy can come together with courageous leadership to successfully challenge educational orthodoxy.

Academic Medical Centers↗
PubMed2001

Preadmission Criteria as Predictors of Academic Success in Entry-Level Athletic Training and Other Allied Health Educational Programs.

OBJECTIVE: To investigate preadmission criteria, Scholastic Aptitude Test (SAT) scores, and high school grade point average (HSGPA) and to determine the ability of those criteria to predict the college grade point average (CGPA) of graduates from programs in athletic training and 5 other allied health disciplines. DESIGN AND SETTING: Descriptive data, including age, sex, year of graduation, HSGPA, CGPA, and SAT scores (SAT mathematics [SATM], SAT verbal [SATV], and SAT total) were gathered from the files of graduates (1992 to 1997) of allied health education programs. SUBJECTS: The complete records of 373 graduates (244 women and 129 men) of 6 allied health education programs in athletic training, health management systems, occupational therapy, perfusion technology, physician assistant, and physical therapy were used in this study. Subjects with incomplete files were excluded from this study. MEASUREMENTS: We collected data from official college transcripts, official high school transcripts, and SAT scores reported to the university. Descriptive statistics, analysis of variance, Pearson correlation, and stepwise forward regression analyses were used to determine the ability of SATV score, SATM score, and HSGPA to predict CGPA. RESULTS: Both SATV score and HSGPA were found to predict 14% of the variance in student success (CGPA) in all allied health programs; however, only HSGPA was predictive of student success in athletic training (P =.00). Both SATV score and HSGPA were predictive of CGPA in both physical (P =.02 and.03, respectively) and occupational (P =.02 and.00, respectively) therapy graduates; however, they predicted only 12% and 21%, respectively, of the variance in CGPA. The SATM score was predictive of CGPA in both perfusion technology (P =.05) and physician assistant (P =.00) graduates, accounting for 7% and 18% of the variance in outcomes. CONCLUSIONS: Overall, HSGPA and SATV score were predictive of student success (CGPA) in the allied health group as a whole and should continue to be used as part of the process of admission in higher education until such time that more predictive criteria are determined. The HSGPA was predictive of CGPA (r(2) = 0.38) in athletic training graduates, predicting more than one third of the professional program success. Athletic training educators should continue to use HSGPA as a predictor of success; however, they may wish to establish similar baseline comparisons between athletic training and other disciplines at their schools before determining the importance of standardized preadmission criteria for future students. This work should be considered a pilot study for the profession of athletic training and should be repeated at individual schools to determine the findings' applicability to other athletic training education programs.

Journal Article↗
PubMed1984

Influence of programmed textbook review on American Board of Surgery In-service Examination scores.

Documentation of academic achievement throughout training is an essential component to residency accreditation. Resident performance evaluations by attending staff provide good assessments of affective behavior and technical skills, but evaluation of surgical knowledge is often subjective in nature. The American Board of Surgery In-Service Examination has become the standard by which academic performance is measured. Numerous types of educational programs are used to increase the knowledge base of residents. Sporadic reading of a standard surgical text is a common part of many residency programs. In 1981, the Michigan State University/Butterworth Hospital General Surgery Residency opted to drop the surgical text reading in favor of a review of specific topics attuned to resident needs. Results of the 1982 American Board of Surgery (ABS) examination identified a significant decrease in percentile scores and average resident performance. A program requiring a systematic review of a standard surgical text was then initiated. This review involved assigned reading and administration of weekly examinations covering each assignment. Following institution of this program, a dramatic improvement in the total average scores for the entire resident group was noted. Similar improvement was noted in individual group scores (PG I, II, III, IV, and V). Results of this study indicate that reading of a standard surgical text should be a required part of each residency program.

Achievement↗
PubMed2006

[Initial training in obstetric anaesthesia].

Obstetric anaesthesia is a "young" discipline, with constant novelties from a clinical, scientific and academic standpoint. While there is still no official sub-specialty in obstetric anesthesia, this field has become more diversified because of the growing maternal request for labor analgesia, a constant and perhaps even increasing rate of caesarean deliveries of 20-30% depending on institutions and countries, and also due to the raise in "high risk" pregnancies in women carrying various medical conditions such as complex congenital cardiopathies. In their anesthesia training, most residents rotate in the delivery room for three months on average, which should allow them to acquire good practical skills when performing regional analgesia and anesthesia for labor and delivery. It has been shown that performing 75 epidurals in the obstetric context is sufficient to provide good technical expertise, when appropriate supervision is provided by a present and devoted staff. General anaesthesia remains the critical point, because this technique is less and less performed in pregnant women. It should be recommended to develop training programs to improve the technical skills for intubation in pregnant women, which is why anaesthesia simulators may have an important role in the future. In terms of the theoretical knowledge, good academic training programs are required. The physiology of pregnancy and the physiopathology of pregnancy-related disorders justify a thorough and rigorous teaching in order to reduce both maternal and neonatal morbidity and mortality.

Analgesia, Epidural↗
PubMed1995

Stress among student nurses: is it practical or academic?

Previous research into stress among student nurses has only concentrated on the practical aspects of nursing and has ignored stress caused by the academic side of training. In comparing Registered General Nurse (RGN) and Diploma of Higher Education in Nursing (Dip. HE Nursing) students using a modified nurses stress scale, the intensity of stress was investigated. It was hypothesized that there would be a difference in the total stress scores between the two pre-registration education courses as well as within the practical and academic elements. Dip. HE Nursing students were significantly more stressed than RGN students, but equally for practical and academic elements. RGN students were significantly more stressed on the practical elements. Factors analysis clearly identified two factors: (i) the practical elements, and (ii) the academic elements of nursing. A third factor was also identified and this was related to stress induced by issues concerning death and suffering in the patient. These results have implications for the development of the nurse education course (Dip. HE Nursing) which is still in its infancy.

Adult↗
PubMed1987

Observational studies of staff working with mentally retarded persons: a review.

Experimental or quasi-experimental studies of the behavior of staff working with retarded persons were reviewed and provided the following generalizations: (a) staff often have very low rates of interactions with clients, (b) a disproportionate number of interactions occur with a relatively small number of clients, (c) structured settings promote more interactions, (d) small teaching groups promote interactions, (e) staff involvement in relevant decisions promotes interactions, (f) larger, more global, and ecological assessments of both staff and clients provide important information on the effects of staff management and training, (g) lowering the reading difficulty of training materials increases staff comprehension, (h) lectures tend to improve academic skills while practicum training improves teaching skills, (i) some trained skills generalize while others do not, apparently unsystematically, (j) a system in which supervisors rather than researchers external to the facility do the training is feasible, (k) various low cost systems of public or private feedback can increase staff participation in their duties, (l) implementation of strict administrative policies can reduce tardiness and absenteeism, and (m) staff may be very reactive to announced observation by inspection agencies.

Environment↗
PubMed2000

The role of the new School of Public Health of the Chinese University of Hong Kong in public health education.

In recent years there have been several major outbreaks of infectious diseases in Hong Kong due to deteriorating environmental hygiene, food hygiene and environmental pollution. Aging of the population has resulted in a growing prevalence of chronic degenerative diseases. Changes in behaviour and socio-economic environment have also resulted in many diseases associated with lifestyle such as smoking, substance abuse and obesity. Hong Kong has a long history of medical education and well-established academic institutions for the training of doctors. However, there is still up to now no academic health institution specially designed and built dedicated solely and fully to public health education. A School of Public Health is therefore urgently needed in Hong Kong to provide training and education of public health professionals, to learn new approaches, to discover new solutions and develop new services through research and discovery.

Education, Medical↗
PubMed1995

Clinical management of the NIDDM patient. Impact of the American Diabetes Association practice guidelines, 1985-1993. Endocrine Fellows Foundation Study Group.

OBJECTIVE: To assess the impact of the American Diabetes Association's (ADA's) standards of care for patients with non-insulin-dependent diabetes mellitus (NIDDM) on practice patterns among university-based endocrine physicians and fellows. RESEARCH DESIGN AND METHODS: This study represents a retrospective chart-based review of 790 patients with NIDDM conducted by endocrine fellows in training at 42 academic institutions. By using an ADA guidelines-based questionnaire, patient management and adherence to the guidelines were assessed by reviewing charts dating > or = 3 years before, the year of, and 3 years after the guidelines' publication. All calculations were performed using the McNemar test, and all P values are two-sided. RESULTS: The ADA standards of care have not had the significant impact in the clinical training setting that was anticipated. Deficiencies were noted in all aspects of the diabetic patient encounter and did not improve significantly following publication of the guidelines, except in the areas of foot care, eye examination, and lipid screening. Major deficiencies exist in areas of quality assurance and chart documentation, and these did not improve over time. CONCLUSIONS: New strategies must be devised to increase awareness and implementation of these guidelines, both to enhance patient care and to improve the training of future diabetes caregivers.

Blood Glucose Self-Monitoring↗
PubMed1988

[Stroke. Status and general practice of conservative treatment and rehabilitation].

Adequate help for the apoplectic patient according to recent standards can be given only by simultaneous and equivalent orientation towards both acute therapy and rehabilitation, which should merge smoothly into each other. This can be achieved only by specialised hospitalisation. The idea of totally domestic treatment, as advocated in times past, has to be abandoned for good. In the foreground of acute therapy are treatment of edema, cardiac output and blood pressure, rheological factors: blood viscosity, thrombocyte aggregation, erythrocyte elasticity. In the foreground of rehabilitation efforts we place the principle of "totality and permanence" regardless of prognostic selectivity. The principle of permanence refers to rehabilitative efforts from the very beginning to long-term rehabilitation for months and years with the help of our special rehabilitation service and systematic training of relatives. At least, it has to be stressed that the rehabilitation patient is not a medical waste product and not a symbol of medical surrender either. It would be unfair and senseless to help him through the acute phase and leave him alone during his rehabilitation period. Permanent attention for the apoplectic patient is essential within a system of social medicine. Much is lacking in this respect, as far as academic institutions, advanced training, and information is concerned. We hope that we herewith demonstrate that not only the acute therapy, but also the rehabilitation of the apoplectic patient is a field of scientific fascination, still being in consequent further development. It is intended to give an additional stimulus for the optimal after-care of the apoplectic.

Cerebrovascular Disorders↗
PubMed2003

Complementary and alternative medicine in mainstream public health: a role for research in fostering integration.

In light of the increased utilization of complementary and alternative medicine (CAM) in recent years, there is an increased possibility that CAM approaches could prove to be important factors in public health, particularly if used within an integrative framework together with mainstream medicine. There exists a defined need for research to explore the integration of conventional health care and CAM approaches, as well as define mechanisms of CAM-based therapies to facilitate such integration. Essential to these goals is the accumulation of a database derived from outcomes-based clinical and basic science investigations. We posit that that CAM clinicians need to be more thoroughly trained as researchers, skilled in developing and recording results of pragmatic studies that could provide credible evidence for the use of CAM in the public sector health care. It is proposed that this may be best achieved through a three-tiered system in which (1) clinician-scientists of both mainstream and alternative disciplines recognize the value of research designed to foster such integration; (2) educational and health care institutions must develop academic and clinical training programs that examine and delineate each disciplines' respective strengths and weaknesses; and (3) such programs are attractive to, and receive continued extramural subsidy. In the broadest sense, such a paradigmatic approach to CAM integration could create a common basis for scientific dialogue, encourage exchanges between medical communities, and establish policies for the development of a true multidisciplinary health care cooperative that is consistent with the current public health model.

Complementary Therapies↗
PubMed1986

Career choices of 135 cardiology trainees at Duke University Medical Center from 1970 to 1984.

Alarm has been expressed at recently presented evidence showing that diminishing numbers of physicians are entering academic careers. The experience of the cardiology training program at a university medical center between 1970 and 1984 was reviewed to determine the career paths chosen by its trainees. During the study period, 135 physicians received training. Between 1970 and 1978 the percentage of trainees making academic medicine their initial career choice fluctuated considerably. Beginning in 1978, the percentage entering academic medicine steadily increased; in the most recent class, 8 of 9 trainees accepted academic faculty positions. Among 72 former trainees who joined an academic faculty after finishing training, approximately 7% per year left academic medicine for clinical practice. The median length of an academic career was 10 years. Individual institutions may be able to reverse the national trend of trainees making clinical practice their initial career choice. However, physicians who leave academic medicine for clinical practice may continue to deplete faculty ranks.

Academic Medical Centers↗
PubMed1999

Electronic medical record systems at academic health centers: advantages and implementation issues.

The growth of managed care has fueled expectations for a more coordinated delivery of clinical services and a reduction of unnecessary utilization. Among the most important issues that constrain these expectations is the transfer of medical information. Electronic medical record (EMR) systems appear to offer substantive advantages over paper records for both containing costs and improving the quality of care. However, incorporation of EMR systems into practice settings has languished. Among the barriers to implementation are software problems of codification and entry of data, security issues, a dearth of integrated delivery systems, reluctant providers, and prohibitive costs. The training programs of academic health centers (AHCs) are optimal environments for testing and implementing EMR systems. AHCs have the expertise to resolve remaining software issues, the components necessary for integrated delivery, a culture for innovation in clinical practice, and a generation of future providers that can be acclimated to the requisites for computerized records. The authors critically review these and other issues of implementing EMR systems at AHCs and propose four necessary steps for financing their implementation.

Academic Medical Centers↗