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[Appeal of French specialized training programs for foreign medical students].

Despite a good reputation abroad, specialized medical training programs in France fail to attract a sufficient number of high-level foreign students. This report examines ways of improving the situation. If French universities are to increase their international renown, they must always be referred to by the same name in scientific papers. Students following channels of excellence must be distinguished from other students. They must have a level of medical knowledge equivalent to that of a 6th-year French medical student, together with a good knowledge of French and a letter from their dean stating that their training in France is compatible with their career in their country of origin. For full medical specialist training (up to five years) the only access requirement should be the equivalent of entrance examinations for French residents. Thereafter, the theoretical and practical training should be similar to that received by French residents. Complementary specialist training courses (one year) should take place in selected university hospitals. Intensive training courses (six months) should be open to physicians who have already specialized. Diplomas should be delivered after testing knowledge and skills.

College Admission Test↗

Intraosseous infusion: success of a standardized regional training program for prehospital advanced life support providers.

STUDY OBJECTIVE: To evaluate a standardized training program in intraosseous (IO) infusion for prehospital providers. DESIGN: Prospective multicenter 24-month study. SETTING: IO infusions were performed by prehospital providers from eight advanced life support units serving 14 hospitals within nine counties. PARTICIPANTS: Field advanced life support providers (paramedics and registered nurses). INTERVENTIONS: All providers participated in a one-hour standardized training session and supervised hands-on simulation. Providers completed a data sheet on all IO infusions performed. Data sheets were collected and summarized. RESULTS: One hundred thirty-four prehospital providers completed the training session and were approved to perform the procedure. Fifteen patients requiring IO infusion were encountered during the study period. Thirteen (87%) had IO infusion completed successfully. Clinical indications included 11 patients in cardiac arrest, two trauma resuscitations, one seizure, and one toxic ingestion. Patient ages ranged from 1 to 24 months. Seven patients were initially resuscitated. Four survived to hospital discharge. Procedural complications included one incidence of local fluid extravasation and one IO line that became dislodged en route. There were no complications at time of discharge in the four survivors. All procedures were performed in less than two minutes. CONCLUSION: A one-hour standardized training session was successfully used to train prehospital providers in the procedure of IO infusion. IO infusion then was implemented into their clinical practice with a satisfactory success rate and few complications.

Child, Preschool↗

Results of a survey to assess curriculum needs for academic training programs in hazardous substances.

With the advent of new industrial hygiene academic training programs in hazardous substances, located at nine United States universities, a curriculum needs assessment survey was developed at the University of Minnesota and completed by members of the joint American Industrial Hygiene Association/American Conference of Governmental Industrial Hygienists Hazardous Waste Committee and members of the Health and Safety Subcommittee of the Hazardous Waste Action Coalition. The survey asked respondents to indicate whether 27 course subjects (1) should be required, (2) may be required or elective, (3) should be elective, or (4) should not be offered. Respondents were also asked to recommend additional course subjects, research needs in the hazardous materials and waste field, and certifications to be pursued. Results from 50 completed surveys (50% response rate) showed that about half of the respondents work for consulting companies and have more than 15 years of experience in the hazardous material or waste field. The courses receiving the most "required" responses included (1) the relevant regulations, (2) worker training in health and safety, (3) waste management technology, (4) pollution prevention, and (5) treatment technology. Of elective subjects, respondents recommended education in communications, public affairs, negotiations and conflict resolution, property inspection, government relations, and air pollution modeling. Respondents indicated the strongest research needs were in the areas of direct reading instruments (improved versions and their use for personal exposure monitoring) and heat stress management of personnel wearing protective clothing. Respondents felt that the best qualifications to pursue after graduation were the Certified Industrial Hygienist designation alone, or in combination with the Certified Safety Professional designation.

Curriculum↗

Current positions of graduates of internal medicine-pediatrics training programs.

OBJECTIVE: To determine what positions graduates of internal medicine-pediatrics programs currently hold. DESIGN: A survey of the program directors of residencies in internal medicine-pediatrics. PARTICIPANTS: Program directors of the 85 internal medicine-pediatrics training programs listed in the 1993-1994 Graduate Medical Education Directory. MAIN OUTCOME MEASURES: A 1-page survey that described the current positions of trainees graduating between 1987 and 1993. RESULTS: Seventy-four (87%) of the 85 program directors completed the survey. Of the 708 graduates reported on, 68% were practicing as generalists. The generalists of this cohort (n = 480) were primarily in private practice settings (n = 390, 81%) and most were practicing internal medicine-pediatrics (n = 416, 85%). Only 12% of the generalists had chosen to practice either pediatrics or internal medicine. Twenty-one percent of the total graduates had entered subspecialty training. CONCLUSIONS: To our knowledge, the sample of 708 graduates is the largest survey of graduates of internal medicine-pediatrics programs to date and shows that 68% of graduates are practicing in primary care fields. Graduates of internal medicine-pediatrics programs should be considered as an important source of primary care physicians.

Education↗

Gynecologic operative laparoscopy: new training programs are needed.

The revolution in laparoscopic surgery demands implementation of adequate training programs preferably in an academic setting. The most dramatic progress over the last decade in the field of gynecology was undoubtedly the development of advanced operative laparoscopy. This has been initiated by an unprecedented technological revolution.

Journal Article↗

Basic Training Program in Medical Pedagogy: a 1-year program for medical faculty.

In 1979 université de Montréal developed the Basic Training Program in Medical Pedagogy; the program has since been offered at two other Canadian medical schools. The learning activities are spread over an academic year so that the teachers are able to continue their clinical or research duties. The program, which follows a model of systematic instruction, comprises 17 self-instructional modules on basic educational topics adapted to medical teaching. The topics are related to four components of an integrated system: student needs and learning objectives, instructional methods, student evaluation and program evaluation. The instructional format is aimed at three levels--understanding, analysis and application--to which assignments and assessments are related. In addition to the modules, the program offers 15 half-day sessions for small groups (five participants and one instructor) to discuss aspects of the program, especially home assignments and the application of personal educational projects. A minimum of 100 hours of personal time is requested. The program's main goal is that students be placed at the centre of the educational process. Of 215 participants since 1979, 171 (80%) have completed the program and reported high satisfaction. Issues related to any faculty development program are discussed.

Attitude of Health Personnel↗

An internal review of a residency training program.

Six residency units at the University of Minnesota Affiliated Hospitals Residency Training Program in Family Practice and Community Health participated in an internal evaluation which resulted in changes both in the program and in the program's standards. The evaluation model used, a modified Provus approach, is suggested for other programs along with a discussion of the difficulties and positive affects found in the Minnesota study.

Community Medicine↗

Effect of training program based on anaerobic threshold in the early phase after acute myocardial infarction.

We devised a new physical training program on the basis of anaerobic threshold for rehabilitation in the early phase of acute myocardial infarction. Forty-four patients were divided into two groups, control and training. We measured the left ventricular ejection fraction using nuclear stethoscopy during the treadmill test and calculating radioactive cardiac output. In the training group, anaerobic threshold and exercise time to the anaerobic threshold point were significantly increased, and stroke volume at rest measured by the dye dilution method increased significantly. Radioactive cardiac output during exercise also increased after the exercise therapy. These results indicate that the rehabilitation program consisting of physical training based on the anaerobic threshold is effective.

Adult↗

Effectiveness of a nutrition education and physical fitness training program in lowering lipid levels in the black elderly.

A multidisciplinary nutrition education and fitness training program was tested for its effectiveness in lowering lipid profiles of elderly clients through dietary modification and exercise. The program served 31 free-living, predominantly female, black elderly aged 56-88 years. Dietary, anthropometric, biochemical, and fitness assessments were performed before and after the 10-week, biweekly program. Significant decreases (p < 0.05) were seen in waist circumference, total cholesterol (TC), low-density lipoproteins (LDL-C), and TC/HDL-C ratio. These findings suggest a 10-week, biweekly program can be effective in producing both significant, as well as favorable changes, in atherogenic lipids in elderly black subjects.

Black or African American↗

[On line self-assessment system for psychiatry training program].

A radical reform in Japan had been done on the postgraduate clinical training system since April 2004. The subject point of the change was that in the past, mainly in the University hospitals, where the postgraduate clinical training system was made by the Department of a resident's planned medical staff, to enter in the future; in the new system, resident is incorporated in a 2-year training program with contents of internal medicine, surgery and emergency, not just bounded to particular field, in order to master basic and general clinical abilities. This new system included psychiatry rotation for 1 to 3 months. The new postgraduate clinical training system is also expected for the hospital's side to become activated by remaining the clinical training system. As a matter of course, the System has given a great effort to the curriculums of medical education. This super rotation system will be evaluated in 5-year after the introduction. The problem is whether psychiatry rotation is effective or not in a new system. If not so, psychiatry rotation might be omitted in this system. Therefore, we psychiatrists will prepare for the evidence of the effectiveness of psychiatry rotation. I developed on line self-assessment system with reference to Accreditation Council for Graduate Medical Education (ACGME) in the United States. I have introduced this system in the paper.

Accreditation↗

[The medical-dental specialty regulation and the training program for "Orthodontic specialist"].

The Central Professional Committee for Orthodontics provides the instructors and the dentists specializing in orthodontics with an interpretation of the regulations for the diploma of specialist physician/specialist dentist of May 23, 1974, and of the educational program. Advice and recommendations are given for the fulfillment of the training program and also for the course and methods of the training for a dental speciality.

Education, Dental, Continuing↗

[Towards the establishment of a postgraduate training program of neurology--in the case of Tokyo Medical and Dental University].

The training as neurologist in Department of Neurology and Neurological Science, Tokyo Medical and Dental University has mainly been performed through 3rd to 5th year after the graduation. It includes training for neurophysiology, neuroradiology and neuropathology as well as clinical neurology. Neurophysiology training has the separate 3 months course where trainee residents study exclusively neurophysiology but neuroradiology and neuropathology were learned during training for clinical neurology in general. The major problem of our training program is that the quota is so small to prepare enough trainee's positions. This appears also true in many institutes in Japan according to a questionnaire survey by this workshop. The number of neurology staff should be increased to accomplish better training for Neurology in each institute. The Japanese Society of Neurology should support this effort in each institute.

Education, Medical, Graduate↗

Housekeeping: customized training program keyed to hospital's procedures, staff.

Thoughtfully developed, conscientiously applied housekeeping employee training programs are all too scarce. The program described was customized to fit an individual hospital's standard procedures, and it used volunteer models from among the workers to illustrate the video portion of the program. Recognition of employee merit and effective supervision and follow-up were two other key elements.

Hospital Bed Capacity, 500 and over↗

A randomized controlled trial of an enhanced balance training program to improve mobility and reduce falls in elderly patients.

OBJECTIVES: To evaluate the effectiveness of an enhanced balance training program in improving mobility and well-being of elderly people with balance problems. DESIGN: Prospective, single-blind, randomized, controlled trial. SETTING: District general hospital. PARTICIPANTS: One hundred ninety-nine patients aged 60 and older with a Berg Balance Scale (BBS) score of less than 45. INTERVENTIONS: Six weeks enhanced balance training consisting of a series of repetitive tasks of increasing difficulty specific to functional balance. The control group received physiotherapy conforming to existing practice in elderly patients with mobility problems. MEASUREMENTS: Ten-meter timed walk test (TWT), BBS, Frenchay Activities Index (FAI), Falls Handicap Inventory (FHI), and European Quality of Life questionnaire (Euroqol) measured at 6, 12, and 24 weeks after intervention. RESULTS: The mean age +/- standard deviation of subjects was 82.7 +/- 5.6, and baseline characteristics were comparable between the groups. Both groups showed improvements in TWT (intervention: 22.5-16.5 seconds, P =.001; control: 20.5-15.8 seconds, P =.054), BBS (intervention: 33.3-42.7, P =.001; control: 33.4-42.0, P <.0001), FAI (18-21, P =.02 in both groups), FHI score (intervention: 31-17, P =.0001; control: 33-17, P =.0001) and Euroqol score (intervention: 58-65, P =.04; control: 60-65, P =.07). There were no intergroup differences at any time. More patients reported increased confidence in walking indoors (36% vs 28%; P =.04) and outdoors (27% vs 18%; P =.02) in the enhanced balance-training group. CONCLUSION: Exercise programs significantly improve balance and mobility in patients with balance problems, independent of strategy. Enhanced balance training may, in addition, improve confidence and quality of life but needs further investigation.

Accidental Falls↗

Veterans administration biomedical engineer training program.

The Veterans administration's Department of Medical and Surgery includes in its Graduate Engineer Training Program a special program for Biomedical Engineers. The program is intended for recent graduates in biomedical engineering and provides for the VA a means of recruiting and training biomedical engineers for employment in its medical centers nationwide. This paper discusses the structure and objectives of the program, the opportunities that exist for the trainee within the program and the results of the program since its inception in 1973, and provides an outlook on the future of the program.

Biomedical Engineering↗

Rehabilitative rheumatology content in current rehabilitation medicine training programs.

The Council on Rehabilitative Rheumatology of the American Rheumatism Association, through the Education Subcommittee, surveyed directors of 69 approved rehabilitation medicine residency training programs to assess the nature of training in rehabilitative-rheumatology and whether the directors believed this training to be adequate. Sixty-one directors responded, with 84% of the respondents reporting a rheumatology department in their hospitals and 43% reporting a formal rotation for their residents in rheumatology. Fifty-nine (97%) reported their residents received lectures in rheumatology. Fifty-five (90%) reported lectures given by a physiatrist in the rehabilitative management of rheumatic diseases. Only 21 (34%) reported a physiatrist-attended rheumatology outpatient clinic. Fifty-one (82%) desired a closer liaison with the rheumatology department. Thirty-seven (61%) indicated their residents received adequate training on the diagnosis of rheumatic diseases, and 46 (75%) adequate training in rehabilitative management, while 59 (97%) desired a concise handbook which emphasizes the rehabilitative management of rheumatic diseases. A previous survey of 100 arthritis fellowship programs approved by the American Medical Association brought 81 responses, of which only 43% considered that their Fellows had adequate training in rehabilitative rheumatology. Physiatrists attended clinics 21% of the time and patient care rounds 19%. Ninety-four percent desired a syllabus. Both surveys indicated limited interaction between the two specialties and leads us to conclude that a rehabilitative-rheumatology handbook would be desirable, closer liaison of rehabilitation faculty with rheumatology faculty is needed to respond to individual training needs, more active participation by a physiatrist in patient care conferences may be necessary for adequate education in rehabilitative-rheumatology.

Education, Medical, Graduate↗

Losses, maintenance and recruitment of patients in a peritoneal dialysis home training program.

The St. Peter Hospital Kidney Dialysis Center began a peritoneal dialysis home training program in 1988, and demonstrated steady growth until the end of its sixth year at which time the census plummeted. Peritoneal dialysis staff sought to determine a cause for the reduction in census by evaluating the reasons for drop-out. They concluded that drop-out rates were not unexpected or unusual and that maintenance and referrals are influenced by: (a) patient predialysis education and (b) continual conversation and collaboration between the nephrologists and peritoneal dialysis home training staff.

Home Care Services↗