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PubMed1997

Leadership and organizational skills in academic medicine.

BACKGROUND AND OBJECTIVES: The complex and unique challenge of academic medicine requires that faculty possess both organizational and leadership skills. This article presents a framework of leadership and organizational skills in family medicine. METHODS: We conducted a focused review of the literature, of presentations at national primary care meetings, and of the curricula of several national faculty development fellowship programs to identify the current emphases, strategies, and outcomes regarding organizational and leadership development activities for academic physicians. RESULTS: We identified three types of organizational and leadership development strategies and programs, including isolated faculty development workshops at national meetings, longitudinal faculty development fellowship programs, and organizational change efforts within an academic department or residency training program. Indicators that these efforts are successful have primarily been reported in the context of career satisfaction, retention in academic medicine, and attainment of administrative roles or higher academic rank among faculty who have participated. CONCLUSIONS: Organizational and leadership development is occurring in the context of both individual and organizational initiatives. We propose a cycle-of-learning framework that provides one model for development of these essential skills.

Curriculum↗

PubMed1983

[Extension work and rendering services in the schools of veterinary medicine].

This article reviews the extension work in the schools of veterinary medicine and says that it performs a multiple function: it supports instruction and research, performs intra- and interinstitutional and promotional services, and acts as a link between the academic establishment and the community serves. After citing a variety of recommendations made by international expert groups in veterinary medicine connected mainly with instruction and training programs, the author explains the content of the intra- and extramural services provided by universities and schools through extension programs. In connection with the former, he describes in detail the organization of libraries, audiovisual resources, methodology units, planning, etc. As to extramural services, he gives an equally detailed account of the features and functions of clinics, dispensaries, diagnostic services, experiment stations, and so forth. Finally, the point is made that extension programs should be linked to national development plans, and that they have a series of institutional barriers and negative attitudes to overcome in order to accomplish a true integration of the veterinarian's academic training with the real needs of the community.

Animal Feed↗

PubMed1999

Athletic training education programs: to rank or not to rank?

OBJECTIVE: To discuss the literature regarding educational program ranking and to provide insights concerning undergraduate and graduate athletic training education ranking systems. BACKGROUND: The demand for accountability and the need to evaluate the quality of educational programs have led to program ranking in many academic disciplines. As athletic training becomes more recognized within the medical community, determining a program's quality will become increasingly important. DESCRIPTION: We describe program rankings used in other disciplines for determining quality and providing measures of accountability. We discuss the strengths and weaknesses of both subjective and objective ranking systems, as well as the arguments for using program rankings in athletic training. Future directions for program ranking and potential research questions are suggested. APPLICATIONS: Ranking systems on the basis of levels of perceived quality and academic productivity of programs that prepare future professionals will help potential undergraduate and graduate students make informed decisions when selecting an educational program.

Journal Article↗

PubMed2001

Manpower in Canadian academic rheumatology units: current status and future trends. Canadian Council of Academic Rheumatologists.

OBJECTIVE: To examine manpower and activity profiles of attending staff, and enrollment in training programs over 3 years in academic rheumatology units in Canada. METHODS: In 1998, the Canadian Council of Academic Rheumatologists (CCAR) established a database to annually monitor trends in manpower, activity profiles, and recruitment in 15 academic rheumatology units in Canada. Information was also collected on residents pursuing subspecialty training in rheumatology. RESULTS: Between 1998 and 2000, the total number of rheumatologists increased from 157 (137 adult; 20 pediatric) to 162 (139 adult; 23 pediatric). Male to female ratio was about 2:1 and mean age increased from 48 to 49 years. About 60% of rheumatologists held fulltime positions within their academic units. In the year 2000, 57% of individuals had a substantial commitment (> or = 50% time) to clinical care activities compared to 17% for research and 3% for teaching. There were 21 unfilled positions, mainly full-time in adult rheumatology, across 12 centers. A substantial commitment (> or = 50% time) for research was identified in 11 of the unfilled positions, for clinical care activities in 6, and for teaching in one. Significant barriers to recruitment as identified by 11 centers were lack of suitable applicants (9), financial resources (5), and physical resources (3). From 1998 to 2000 the number of trainees in pediatric and adult rheumatology fell from 38 to 29 and the number of active training programs from 12 to 11. The mean age of trainees was 30-32 years, with equal representation for males and females. Over the 3 years studied, funding of trainees was provided by government (range 41-51% of trainees), The Arthritis Society (21-26%), and alternative sources (23-38%). Based on current recruitment, anticipated changes in population growth, and increased prevalence of rheumatic diseases, there will be a 64% shortfall in rheumatologists required in Canada by 2026. CONCLUSION: Rheumatology manpower in Canadian academic units needed to fulfill responsibilities in delivery of clinical services and academic programs is inadequate. Enrollment in rheumatology training programs is falling and is insufficient to meet the present and future manpower needs for patients with rheumatic diseases in Canada.

Academic Medical Centers↗

PubMed1980

Family therapist--technician or clinician.

The proliferation of family therapy training programs outside of academic institutions has led to an emphasis on technique and too little emphasis on human growth and development. Therapists are superficially trained and often cannot recognize serious abnormality. They have learned one approach and often apply it indiscriminately to every case. Strategies and techniques have superseded understanding. The challenge of the 80's in Family Therapy is to develop greater discrimination about when and how to use it. Developing criteria for what kind of family therapy is most appropriate for what type of family is the task at hand.

Adolescent↗

PubMed2005

Visual training: current status in ophthalmology.

PURPOSE: To inform ophthalmologists of the current status of visual training. DESIGN: Personal perspective. METHOD: A perspective and analysis of current practices that include a review of the literature and personal experiences of the author. RESULTS: Visual training of some sort has been used for centuries. In the first half of the twentieth century, in cooperation with ophthalmologists, orthoptists introduced a wide variety of training techniques that were designed primarily to improve binocular function. In the second half of the twentieth century, visual training activities were taken up by optometrists and paramedical personnel to treat conditions that ranged from uncomfortable vision to poor reading or academic performance. Other visual training has been aimed at the elimination of a wide variety of systemic symptoms and for the specific improvement of sight and even for the improvement of athletic performance. At present, ophthalmologists and orthoptists use visual training to a very limited degree. Most visual training is now done by optometrists and others who say it works. Based on an assessment of claims and a study of published data, the consensus of ophthalmologists regarding visual training is that, except for near point of convergence exercises, visual training lacks documented evidence of effectiveness. CONCLUSION: Although visual training has been used for several centuries, it plays a minor and actually decreasing role in eye therapy used by the ophthalmologist. At the beginning of the twenty-first century, most visual training is carried out by non-ophthalmologists and is neither practiced nor endorsed in its broadest sense by ophthalmology.

Amblyopia↗

PubMed2005

Surfing for scoliosis: the quality of information available on the Internet.

STUDY DESIGN: A cross section of Web sites accessible to the general public was surveyed. OBJECTIVE: To evaluate the quality and accuracy of information on scoliosis that a patient might access on the Internet. SUMMARY OF BACKGROUND DATA: The Internet is a rapidly expanding communications network with an estimated 765 million users worldwide by the year 2005. Medical information is one of the most common sources of inquires on the Web. More than 100 million Americans accessed the Internet for medical information in the year 2000. Undoubtedly, the use of the Internet for patient information needs will continue to expand as Internet access becomes more readily available. This expansion combined with the Internet's poorly regulated format can lead to problems in the quality of information available. Since the Internet operates on a global scale, implementing and enforcing standards have been difficult. The largely uncontrolled information can potentially negatively influence consumer health outcomes. METHODS: To identify potential sites, five search engines were selected and the word "scoliosis" was entered into each search engine. A total of 50 Web sites were chosen for review. Each Web site was evaluated according to the type of Web site, quality content, and informational accuracy by three board-certified academic orthopedic surgeons, fellowship trained in spinal surgery, who each has been in practice for a minimum of 8 years. Each Web site was categorized as academic, commercial, physician, nonphysician health professional, and unidentified. In addition, each Web site was evaluated according to scoliosis-specific content using a point value system of 32 disease-specific key words pertinent to the care of scoliosis on an ordinal scale. A list of these words is given. Point values were given for the use of key words related to disease summary, classifications, treatment options, and complications. The accuracy of the individual Web site was evaluated by each spine surgeon using a scale of 1 to 4. A score of 1 represents that the examiner agreed with less than 25% of the information while a score of 4 represents greater than 75% agreement. RESULTS: Of the total 50 Web sites evaluated, 44% were academic, 18% were physician based, 16% were commercial, 12% were unidentified, and 10% were nonphysician health professionals. The quality content score (maximum, 32 points) for academic sites was 12.6 +/- 3.8, physician sites 11.3 +/- 4.0, commercial sites 11 +/- 4.2, unidentified 7.6 +/- 3.9, and nonphysician health professional site 7.0 +/- 1.8. The accuracy score (maximum, 12 points) was 6.6 +/- 2.4 for academic sites, 6.3 +/- 3.0 for physician-professional sites, 6.0 +/- 2.7 for unidentified sites, 5.5 +/- 3.8 for nonphysician professional sites, and 5.0 +/- 1.5 for commercial Web sites. The academic Web sites had the highest mean scores in both quality and accuracy content scores. CONCLUSION: The information about scoliosis on the Internet is of limited quality and poor information value. Although the majority of the Web sites were academic, the content quality and accuracy scores were still poor. The lowest scoring Web sites were the nonphysician professionals and the unidentified sites, which were often message boards. Overall, the highest scoring Web site related to both quality and accuracy of information was www.srs.org. This Web site was designed by the Scoliosis Research Society. The public and the medical communities need to be aware of these existing limitations of the Internet. Based on our review, the physician must assume primary responsibility of educating and counseling their patients.

Cross-Sectional Studies↗

PubMed2002

Exploring the academic context for quality improvement: a scientific discipline in need of a career path.

Physician training typically occurs in an academic context. We examine whether improvement should be a central element in academe--specifically medical school. We observe that quality improvement meets the criteria for a discipline, but that there are many obstacles to career development in this field. Whether the research agenda of quality improvement can be accomplished within centers or institutes or whether this discipline needs its own department to ensure the nurturing of new faculty is still an open question. What is not open is the necessity for a career path in this discipline to exist and flourish.

Career Choice↗

PubMedDate not supplied

Developing physician leaders in academic medical centers. Part 1: Their changing role.

While physicians have historically held positions of leadership in academic medical centers, there is an increasing trend that physicians will not only guide the clinical, curriculum and scientific direction of the institution, but its business direction as well. Physicians are assuming a greater role in business decision making and are found at the negotiating table with leaders from business, insurance and other integrated health care delivery systems. Physicians who lead "strategic business units" within the academic medical center are expected to acquire and demonstrate enhanced business acumen. There is an increasing demand for formal and informal training programs for physicians in academic medical centers in order to better prepare them for their evolving roles and responsibilities. These may include the pursuit of a second degree in business or health care management, intramurally conducted courses in leadership skill development; management, business and finance; or involvement in extramurally prepared and delivered training programs specifically geared toward physicians as conducted at major universities, often in their schools of business or public health. This article article was prepared by the author from research into and presentation of a thesis entitled. "The Importance of Leadership Training And Development For Physicians In Academic Medical Centers In An Increasingly Complex Healthcare Environment, " prepared for the Credentials Committee of the American College of Healthcare Executives in partial fulfillment of the requirements for Fellowship in the College (ACHE). Part 2 will appear in the next issue of the Journal.

Academic Medical Centers↗

PubMed1995

The current status of academic-mental health linkages in Rhode Island.

The purpose of this study is to describe the current status of academic-public mental health linkages in the State of Rhode Island by querying key informants concerning their opinions in the following areas: clinical orientation and preferred clinical interventions, specific approaches to academic-mental health linkages, training and educational opportunities, obstacles to a career working with persons who have persistent and severe mental illness, and recommendations to improve academic-mental health linkages. Forty-eight of sixty key informants, among them academics, mental health administrators, clinical practitioners and consumer advocates, responded to the mailed survey. More than half the respondents rated affective disorders, schizophrenia and substance abuse to be their highest concern as professionals; most subscribed to biological models of mental illness as well as a variety of prevailing treatment strategies employed in the care of persons with severe mental illness; generally they rated the current status of academic-mental health linkages to be low, but recommended a range of remedies to improve and increase collaborative efforts.

Community Mental Health Services↗

PubMed1977

A self-instructional approach to imagery training for medical students.

At the University of North Carolina School of Medicine, 110 first-year medical students were randomly assigned to experimental and control groups. Before the experimental group began the academic year, they were trained in visual imagery by means of 4 self-instructional units. Subsequently, both groups were given a criterion test to assess their ability to process and retrieve information. The investigators concluded that visual imagery can be taught and that it may help some medical students.

Association Learning↗

PubMed2000

University education of medicinal chemists: comparison of eight countries.

Medicinal chemists are mainly taught in faculties or schools of pharmacy and are available for employment. Yet major pharmaceutical research companies seek organic chemists, rather than medicinal chemists, for new drug discovery. This apparent contradiction led the Medicinal Chemistry Section of IUPAC to send a questionnaire regarding postgraduate academic education for medicinal chemists to the faculties or schools of pharmacy in eight countries, namely, France, Germany, Italy, Japan, Spain, Switzerland, UK and USA. The questionnaire aimed to elicit information about postgraduate medicinal chemistry students, their courses and training, and the occupations taken up after graduation. The replies representing 109 medicinal chemistry departments or sections have been analysed and the results are presented to provide a data base on modern medicinal chemistry curricula for comparative purposes. The information should help guide discussion of the optimum paths to be followed by students in preparation for their careers. The evidence suggests that academic training of medicinal chemists equips them to enter a wide range of occupations, many of which are in industry.

Chemistry, Organic↗

PubMed1996

Care of patients with upper gastrointestinal hemorrhage in academic medical centers: a community-based comparison.

BACKGROUND & AIMS: A common perception among purchasers is that academic medical centers are inefficient and overutilize technology; however, little empirical information exists. The aim of this study was to compare treatment and outcomes of patients with upper gastrointestinal hemorrhage admitted to major teaching hospitals and other hospitals in a large metropolitan area. METHODS: Data on 3801 consecutive eligible patients admitted to five major teaching hospitals and 25 other hospitals from 1991 to 1993 were obtained by review of medical records. Admission severity of illness was measured using validated multivariable models. RESULTS: Rates of upper endoscopy were somewhat lower among the 1004 patients discharged from fellowship hospitals, compared with the other 2797 patients (82.9% vs. 85.6%; P < 0.05), and the use of other procedures was similar. Although patients admitted to fellowship hospitals tended to have a higher severity of illness, both unadjusted (6.3 +/- 9.0 vs. 7.1 +/- 7.5 days; P < 0.01) and risk-adjusted length of stay were somewhat shorter. Mortality rates were similar between hospitals, and patients admitted to fellowship hospitals were somewhat less likely to be transfused. CONCLUSIONS: In patients with upper gastrointestinal hemorrhage, teaching hospitals do not appear to provide inefficient care or overutilize expensive treatments when compared with community facilities. These findings are noteworthy at a time when viability of academic centers and fellowship training is threatened.

Academic Medical Centers↗

PubMed1978

A premedical summer program for disadvantaged students.

In this paper five years of summer program experience with minority and disadvantaged students are examined and an attempt is made to provide an overview of the impact of summer programming on medical school admission and academic performance in the first year of medical training. A well-organized correlated academic curriculum of anatomy, biochemistry, and physiology, coupled with an intensive counseling program, has proved to be the basis of a sound reinforcement program for minority and disadvantaged students who are preparing for medical school.

Humans↗

PubMed1993

The perspectives of current trainees in combined internal medicine-pediatrics. Results of a national survey.

OBJECTIVE: To gather information from combined internal medicine-pediatric residents about their application process for residency, their perceptions of the stressors during residency, and their future plans. DESIGN: Survey of all combined internal medicine-pediatric residents-in-training in the 1989-1990 academic year. PARTICIPANTS: Fifty-four percent of residents-in-training responded to the survey, representing 70% of the programs. RESULTS: Combined residents often investigate and rank other generalist residences. However, internal medicine is significantly (P < .005) considered more often than pediatrics or family medicine. Sixty percent of combined residents do not anticipate further training beyond the 4 years and expect to practice both specialties. The majority of those interested in a subspecialty expect to continue to combine internal medicine and pediatrics in their subspecialty practice. Switching services during the residency engenders stress. Factors that decrease stress include more frequent switches and increasing seniority. Switching from pediatrics to internal medicine is more stressful (P < .0001) than switching to pediatrics from internal medicine. The residents considered ambulatory training sites and a specific coordinator for the program to be the most important features of the residency. CONCLUSIONS: Combined internal medicine-pediatric programs continue to attract a small cohort of well-qualified US medical school graduates, the majority of whom intend to practice as generalists in both pediatrics and internal medicine.

Adult↗

PubMed2001

The stepped-care approach in anorexia nervosa and bulimia nervosa: progress and problems.

The stepped-care approach is based on the assumption that treatment should be less intensive and hence less expensive and intrusive at the start. Current data suggest that cognitive behaviour therapy (CBT) should be the preferred first treatment for bulimia nervosa (BN) patients. By comparison with the numerous trials supporting its efficacy, in fact, the evidence sustaining similar therapies, e.g. interpersonal psychotherapy (IPT) or pharmacological therapy, is weaker. There are now sufficient data to justify the use of less intensive and shorter treatment (i.e. psychoeducational groups and self-help) in less serious cases. If CBT fails, IPT, pharmacological treatment, alternative psychotherapies, modified CBT, day-hospital and inpatient treatments are available, though it is not clear which is the most efficacious second step. The lower level of stepped-care models seems inapplicable in anorexia nervosa (AN). Current data do not suggest first-choice therapies. Management of this disorder is very expensive and requires a very high level of professional treatment and the highest level of the service hierarchy (intensive outpatient treatment, day-hospital, or inpatient treatment). One of the major obstacles to the employment of the stepped-care approach in eating disorders is that few therapists are trained in CBT and IPT. Academic structures and the scientific societies of eating disorders should promote training and dissemination of these effective forms of treatment.

Algorithms↗

PubMedDate not supplied

Fellowship training in physical medicine and rehabilitation. Developed by the Association of Academic Physiatrists.

The AAP supports the development of fellowships, especially those that enhance research in areas relevant to PM&R. If possible, research training within fellowship programs should be acknowledged. As accredited fellowships develop, the AAP acknowledges potential risks to residency training and supports accreditation standards that consider the importance of coexisting fellowships and residency programs.

Fellowships and Scholarships↗

PubMed1992

The 10-year experience of an academically affiliated occupational and environmental medicine clinic.

Occupational and environmental diseases are underrecognized. Among the barriers to the successful diagnosis, treatment, and prevention of these conditions are inadequate consultative and information resources. We describe the 10-year clinical and training experiences of an academically affiliated referral center that has as its primary goal the identification of work-related and other environmental diseases. The University of Washington Occupational and Environmental Medicine Program has evaluated 6,048 patients in its diagnostic and screening clinics. Among the 2,841 seen in the diagnostic clinics, 1,553 (55%) had a work-related condition. The most prevalent diagnoses included asbestos-related lung disease (n = 603), toxic encephalopathy (n = 160), asthma (n = 119), other specific respiratory conditions (n = 197), carpal tunnel syndrome (n = 86), and dermatitis (n = 82). The clinics serve as a training site for fellows in the specialty training program, primary care internal medicine residents, residents from other medical specialties, and students in industrial hygiene, toxicology, and occupational health nursing. The program serves two additional important functions: providing consultative services to community physicians and training specialists and other physicians in this underserved area of medicine.

Adolescent↗