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Training is a dynamic process to assure that personnel are capable of performing their assigned functions. CGMP regulations contain only general expectations, and no FDA guideline regarding training has been issued. Training programs are generally in place in pharmaceutical firms. However, training quality and effectiveness may be inadequate in a number of firms. A pharmaceutical firm should be able to show that its training program consistently meets its training goals as purported, and that each trainee completing an instructional module has acquired the competencies as purported. The proper application of sound principles of instructional design should help firms overcome GMP deficiencies regarding training and personnel qualification. For example, principles of mastery learning, competency-based instruction, performance objectives, a systems approach to instructional design, and the evaluation of instruction as well as the instructional program should help ensure meaningful, relevant training and appropriate, effective instruction. Review of training should be included in the firm's program for managing change. Firms should also ensure adequate training documentation, a positive attitude toward training, and that training is not used inappropriately to remedy performance deviations not resulting from skills deficiencies.
A demonstration program was conducted in which 54 innercity children classified as educable mentally retarded were selected on the basis of age, IQ, family income, race, and achievement scores. They were then placed into self-contained classrooms with two classes being taught by precision-teaching procedures and two classes being taught by the methods particular to their teachers. Tesults showed that a high percentage (60 percent) of the children taught by precision-teaching procedured were capable of acquiring the basic skills necessary for regular-class placement.
The potential effectiveness of microcomputer-assisted instruction is based on the availability of quality instructional programs. The following article outlines important characteristics of high quality instructional software. If health educators are discriminating consumers of instructional software they will serve as a significant market force promoting the development of high quality educational programs.
The development of chronic inflammatory periodontal diseases is strongly correlated with the growth and maturation of subgingival bacterial colonies. Consequently a major preventive goal should be the control of plaque formation. We conducted a randomized, controlled trial to examine the short-term effect of an intensive instructional program without professional prophylaxis on the gingival health of 240, 11-14 year old school children. Plaque index (PlI), gingival index (GI), bleeding index (BI) and probing pocket depth (PD) were examined 4 x by 1 examiner blinded to the instruction. During the period of instruction, subjects in the experimental groups were involved in a plaque and gingivitis prevention program provided in separate educational sessions. One of the experimental groups (E-1; n = 80) was provided with a new toothbrush, toothpaste and instruction while the second experimental group (E-2; n = 80) was provided with toothbrush, toothpaste, dental floss and instruction. In the control group (C; n = 80) only dental examinations were provided: no preventive program or oral health measures were conducted. Examinations were conducted every 3 months during the instructional period and at 6 months following the completion of the active preventive programme. During the experimental period there was a significant decrease (p < 0.001) in the mean PlI, GI and BI of the experimental groups following the program while in controls there was a slight but not significant increase of mean values (p > 0.05). During the preventive program experimental groups exhibited small but not significant (p > 0.05) reductions of PD. Experimental group 1 showed similar PlI, GI, BI and PD scores as experimental group 2 during the study. After the instructional program was completed and a period of 6 months had passed, there was a large and significant (p < 0.001) increase of mean PlI, GI and BI scores in both experimental groups back to the baseline levels. We conclude that a short-term preventative program without professional instrumentation induces a transient improvement of gingival health of schoolchildren but only during the instructional period. The maintenance of improved gingival health over longer time periods requires prolonged, repeated instruction by professionals. These measures may be difficult to institute and are of questionable cost-effectiveness.
The use of computers in nursing education has evolved from elementary drill and practice tutorials to challenging presentations. Hypermedia technology has emerged as a powerful method of instruction that allows the user to experience new concepts, gain cognitive skill, and encounter realistic clinical situations in a no-harm environment. Hypermedia incorporates sound, video, graphics, text, and interaction. This article describes the process used to develop a CD-ROM for adult cardiovascular nursing that can be used as an interactive instructional program. A description of the use of Gagne's instructional design theory is incorporated as a framework to guide the project. Educators possess knowledge expertise and must become involved in the design of new teaching methodologies. If instructional design principles are followed when using authoring software, learners are motivated with real, challenging, life-like, nonthreatening scenarios to expand their critical-thinking and decision-making skills.
This article describes a successful developmental program specifically designed for academically "high risk" students entering a two-year community college career program in allied health. The program consisted of providing an intensive three-week instructional program to students before they entered the allied health career program, and subsequently providing an ongoing support system of tutoring, counseling and career development activities. Participants attained higher levels of academic performance and retention than nonparticipants.
Although practicing pediatricians spend a major portion of each day in the management of acute illness via telephone, information concerning instructional programs in telephone management is scanty. A 34-item questionnaire was mailed to the 242 program directors of US training programs to obtain information on how telephone calls are handled in pediatric training programs and how pediatric house officers are trained in telephone management. Fifty-five percent of programs have a formalized system for handling telephone calls. One half of programs have a policy on who can answer telephone calls; 11% stated that only physicians are permitted to handle calls. Residents handle an average of 19 calls per day (39% of the total calls received). Only 51% of programs document any telephone calls and only 19% document all calls. Despite the volume of calls handled by pediatric residents, only 45% of training programs offer specific training in telephone management. The most common instructional method is lecturing. Less than one third of programs have a review system or periodically audit telephone calls. Programs that offer resident training in telephone management are significantly more likely to have a system for handling calls, to document calls, and to have a review system.
Traditional library instruction programs teach scientists how to find and manage information, but not how to report their research findings effectively. Since 1990, the William H. Welch Medical Library has sponsored classes on scientific writing and, since 1991, has offered a fee-based editing service for affiliates of the Johns Hopkins Medical Institutions. These programs were designed to fill an educational gap: Although formal instruction was offered to support other phases of the scientific communication process, the medical institutions had no central resource designed to help scientists develop and improve their writing skills. The establishment of such a resource at Welch has been well received by the community. Attendance at classes has grown steadily, and in 1993 a credit course on biomedical writing was added to the curriculum. The editing service, introduced in late 1991, has generated more requests for assistance than can be handled by the library's editor. This service not only extends the library's educational outreach but also generates a revenue stream. The Welch program in scientific writing and editing, or elements of it, could provide a model for other academic medical libraries interested in moving in this new direction.
Probabilistic incremental program evolution (PIPE) is a novel technique for automatic program synthesis. We combine probability vector coding of program instructions, population-based incremental learning, and tree-coded programs like those used in some variants of genetic programming (GP). PIPE iteratively generates successive populations of functional programs according to an adaptive probability distribution over all possible programs. Each iteration, it uses the best program to refine the distribution. Thus, it stochastically generates better and better programs. Since distribution refinements depend only on the best program of the current population, PIPE can evaluate program populations efficiently when the goal is to discover a program with minimal runtime. We compare PIPE to GP on a function regression problem and the 6-bit parity problem. We also use PIPE to solve tasks in partially observable mazes, where the best programs have minimal runtime.
School health education is generally regarded as instructional programs for students. Such programs have limited impact, especially when the social environment is inconsistent with instructional messages. A study of Oregon school districts reveals that some school personnel have gone beyond curricula in their school education programs. Exemplary districts addressed noninstructional issues, most notably staff development programs and food service offerings. In doing so, they have changed not only the social context of the schools, but their ability to directly influence a greater number of Health Objectives for the Nation.
In recent years, undergraduate medical education has benefited from the use of computer-based instructional programs. However, in the case of clinical and postgraduate medical education there is a scarcity of such programs, particularly those with access to high-resolution images. Having a fundamental knowledge base of disease-associated images is crucial for the physicians during the diagnostic process. To fill this gap in clinical instruction in the rheumatic diseases, Images in Rheumatology was developed. By using a hypertext format, one may select representative color images of a clinical disease or view x-ray changes typical for one of the rheumatic disorders. In addition, for each displayed image there is an associated sound-bite which explains in detail what abnormalities are present and how the user may differentiate the disease being viewed from other illnesses. An extensive review element is also included so that one can assess their fundamental knowledge of rheumatologic images. The Images in Rheumatology program has been implemented in the DOS (IBM Microchannel). and Windows environments.
This study investigated the effects of cognitive and metacognitive strategy instruction on the mathematical problem solving of six middle school students with learning disabilities. Conditions of the multiple baseline, across-subjects design included baseline, two levels of treatment, setting and temporal generalization, and retraining. For Treatment 1, subjects received either cognitive or metacognitive strategy instruction. Treatment 2 consisted of instruction in the complementary component of the instructional program so that all subjects eventually received both cognitive and metacognitive strategy instruction. This design allowed a componential analysis of the content as well as sequence of instruction. Generally, subjects improved their mathematical problem solving as measured by performance on one-, two-, and three-step word problems. Discussion focused on effectiveness of treatment, acquisition and application of strategic knowledge, error pattern analysis, and the need to tailor instruction to the learner's individual characteristics.
Instructional systems design is a process for assessing learning needs, creating instructional programs, and evaluating effectiveness of learning. We discuss the benefits of including instructional systems design theory and practice in the curriculum, with an emphasis on making the process relevant for student nurse anesthetists.
Welch Medical Library has explored new roles for librarians in knowledge management instruction programs throughout the Johns Hopkins University School of Nursing curricula. These programs have created roles for library staff as both instructors and knowledge management experts. By fostering strong communication and attention to quality instruction, librarians achieved their vision of a program in knowledge management integrated into the curriculum, where they are partners working with nursing faculty to define the students' knowledge management needs and decide how these needs can be met.
BACKGROUND: Opportunities to acquire knowledge and skills in new technology are limited for cardiothoracic surgeons after completion of residency. In 2000 The Society of Thoracic Surgeons/American Association for Thoracic Surgery Joint Committee for New Technology Assessment accepted an educational grant from the Foundation for Advanced Medical Education to implement and test an instructional program for practicing cardiothoracic surgeons in off-pump coronary bypass surgery. METHODS: Twenty-four surgeons were selected for participation. Instruction was provided in three phases: (1) a preliminary video illustrating the techniques; (2) 2-day training sessions at two separate locations linked by videoconference; and (3) visits by trainees to observe preceptor surgeons at their institutions, followed by visits of preceptor surgeons to the institutions of the trainees. Evaluation of the program was made by review of trainee case lists in the year after completion of the program and by written surveys completed by trainees and preceptors. RESULTS: Seventeen surgeons completed all phases of the program. Most of them reported frequently utilizing off-pump bypass surgery in practice with good results. Two surgeons dropped out of the program before the first phase, and 5 surgeons did not complete all preceptor visits. Most survey respondents commented that the program met or exceeded their expectations. CONCLUSIONS: Some trainees were unable to complete proctor visits because of professional responsibilities at home or because of difficulty in advanced scheduling of procedures. More rigorous selection and stronger administrative controls might have reduced program dropouts. The instructional model worked extremely well for properly selected and motivated surgeons.
Computerized oral brush biopsy became commercially available in 1999. The objectives of this study were to provide senior dental students with the clinical competency to perform oral brush biopsy and to evaluate the extent to which students used this technique and the outcomes of their biopsy techniques. During the 2004-05 academic year, 114 senior dental students at The Ohio State University College of Dentistry participated in a brush biopsy instructional program. Brush biopsy training was part of their outreach and engagement experience. Technique instruction included 1) completion of thirteen interactive online educational modules, 2) discussion of a written protocol including clinical photographs and an oral pathology position paper, and 3) performance of a trial demonstration brush biopsy on each other. Eighty-one students submitted brush biopsies on clinical patients. Lesions were found in approximately one out of every twenty patients. Seventy-four biopsy results (91 percent) were diagnostic although seventeen (21 percent) were limited by suboptimal cellular representation and seven (9 percent) were inadequate. The high percentage (71 percent) of students who actually applied their training in a true clinical setting indicates that the program was successful in providing dental students the information necessary to perform this procedure on their own. However, the number of incomplete specimens suggests the need for technique refinement and additional clinical experience.
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