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A 1976 AHA survey has determined that the extent of hospital-based training programs for the allied professions has increased since 1973, when the previous survey was conducted. Both surveys depict the wide range of types of such programs offered by hospitals.
OBJECTIVES: To estimate the impact of Rx for Change, an 8-h tobacco cessation training program on pharmacy students' perceived counseling skills, confidence for counseling, and future counseling of patients for tobacco cessation. METHODS: Unlinked, pre- and post-training surveys were administered to 142 pharmacy students enrolled at Texas Southern University, a primarily minority and historically black educational institution. RESULTS: Post-training counseling abilities were significantly improved over pretraining values for each of the five key components of tobacco cessation counseling (Ask, Advise, Assess, Assist, and Arrange), overall counseling abilities, and confidence for counseling (P < 0.001). Racial/ethnic differences in self-reported overall counseling was observed (P = 0.01). Ninety-one percent of participants believed that the training would increase the number of patients whom they counsel for cessation, and 95% believed that it would improve the quality of counseling that they provide. At least 95% of participants believed that the pharmacy profession should be more active in preventing patients from starting smoking and helping patients to stop smoking. CONCLUSIONS: The Rx for Change program had a positive impact on perceived abilities and confidence for providing tobacco cessation counseling to patients. While it is important that all current and future health care providers receive specialized tobacco cessation training, it is particularly important for clinicians of racial/ethnic minority backgrounds, who are more likely to practice in geographic areas with a high density of population subgroups at an elevated risk for tobacco-related mortality. In particular, pharmacists, who are uniquely positioned within the community to provide care to all patients, including the medically underserved, must be equipped with the necessary skills to assist patients with quitting.
The use of ionizing radiation and radioactive materials continues to increase worldwide in industry, medicine, agriculture, research, electrical power generation, and nuclear weaponry. The risk of terrorism using weapons of mass destruction or simple radiological devices also has increased, leading to heightened concerns. Radiation accidents occur as a consequence of errors in transportation of radionuclides, use of radiation in medical diagnosis and therapy, industrial monitoring and sterilization procedures, and rarely, nuclear power generation. Compared to other industries, a small number of serious radiation accidents have occurred over the last six decades with recent cases in the Republic of Georgia, Peru, Japan, and Thailand. The medical, psychological, and political consequences of such accidents can be considerable. A number of programs designed to train medical responders in the techniques of radiation accident management have been developed and delivered in many countries. The low frequency of serious radiation accidents requires constant re-training, as skills are lost and medical staff turnover occurs. Not all of the training involves drills or exercises in which responders demonstrate learning or communication over the broad spectrum of medical response capabilities. Medical preparedness within the context of a total emergency response program is lacking in many parts of the world, particularly in Central and Eastern Europe and the Newly Independent States. This paper describes an effort to enhance medical preparedness in the context of a total program of international cooperation and conventions facilitated by the International Atomic Energy Agency. The paper concludes that novel application of telecommunications technology as part of a training activity in radiation accident preparedness can help address gaps in training in this field in which preparedness is essential but experience and practical field exercises are lacking.
PURPOSE: Most general surgery residents obtain scant exposure to anorectal disease during training. The aim of this study was to determine whether adding a colon and rectal surgeon to the faculty of a general surgery training program improves the amount or quality of the anorectal surgical experience. METHODS: The surgical experience of all graduating residents from our university teaching program was reviewed during a ten-year period. Complete case data were obtained from the Residency Review Committee for surgery. The total small-intestine, colon and anorectal caseload was analyzed during the five-year period preceding the arrival of the colon and rectal surgeon and compared with the subsequent five-year period after the surgeon's arrival. RESULTS: There was a substantial increase in small-intestine (470 vs. 306) and anorectal cases (462 vs. 338). There was a particularly dramatic increase in anorectal cases performed during the chief resident year (159 vs. 36), which held true for all categories of anorectal cases. CONCLUSIONS: The addition of a full-time colon and rectal surgeon to a university general surgery residency program was associated with an increase in small-intestine and especially anorectal cases. However, most striking was the greater than fourfold increase in the number of anorectal cases performed during the chief resident year. This seems to reflect an increase in complexity of anorectal cases and an increased interest in anorectal surgery among general surgery residents.
A microcomputer-based biofeedback training program is presented that can be used (with minor modifications) under different hardware configurations. The program interacts friendly with the user, providing access and recording of up to eight different channels at the same time (although only four can be visualized). Within each channel, the user has control upon eight different variables (protocol), independently of each other. Different displays, sounds, sampling speeds, schedules of reinforcement, graphical presentation of the data and statistical analysis are provided to accommodate the feedback properties to various clinical and experimental applications.
We describe the changes in medical training program offered at the G. D'Annunzio University Medical School in Chieti-Pescara, Italy, which took place over the last decade. The new curriculum differs from the previous one in several important aspects, including limited number of students admitted to school depending on the estimated needs for physicians, obligatory class attendance, student attendance in preclinical laboratories, formative credits as a measure of student activity, and elective subjects. Furthermore, all medical graduates are allowed to take the State exam to obtain the licence to practice, which was not the case previously. As a result of these major changes, a higher number of students graduates in due time. The changes made in the medical education curriculum in Italy have enabled Italian medical graduates to work in European Community Hospitals, because their medical degree is recognized in other EU countries. The main motif that drives the Medical School in Chieti-Pescara is the achievement of high quality in medical education and biomedical research by creating as strong a relationship between education and research as possible.
The American Board of Internal Medicine and the American Board of Pediatrics agreed in 1967 to create combined medicine/pediatrics residency training programs. These programs span four years and provide 24 months of training in each discipline, leading to Board eligibility in both. Little is known about their curricula because there is no separate residency review committee to critique the current programs. The directors of the 65 current programs were surveyed by mail. Fifty-seven (88%) responded to questions about: lengths of time programs had been in operation, attitudes toward quality of residents, program structures and curricula, and performances of graduates taking the Boards. More than half of the programs were established after 1980. Forty of the programs' graduates have passed the Medicine Boards, and 48 have passed the Pediatrics written Boards. Most programs were structured to have residents switch specialties every six months. Program Directors, both in Medicine and in Pediatrics, rated the quality of combined program residents the same as or slightly better than that of residents in non-combined programs. Medicine/pediatrics residencies have become a successful and important source of training for generalists' careers in and outside of academe, and in both primary and specialty care.
BACKGROUND AND OBJECTIVES: This study determined the perceived characteristics of family practice residency training programs that produce a high percentage of graduates who provide maternity care. METHODS: We surveyed a Delphi panel of 28 family practice maternity care experts. RESULTS: Consensus was reached after the third survey. The characteristics of the family medicine faculty and teaching service were rated as most important. Other essential characteristics were an adequate obstetrical training volume; mutual respect between obstetric and family medicine faculty and residents; support for family practice maternity care from obstetricians, administration, and nursing staff; and family physicians being accepted in the community as maternity care providers. CONCLUSIONS: Family practice residency programs that produce a high percentage of graduates who provide maternity care have a unique, family practice maternity care-friendly environment. Residency programs wishing to increase the percentage of their graduates who provide maternity care should ensure that their faculty support family practice maternity care, are competent in maternity care, and model maternity care in their own practices. They should strive to ensure an adequate volume of obstetrical cases for resident education and work toward educating patients and local obstetricians, nursing staff, and hospital administration regarding family practice maternity care.
A prospective, randomized study of 365 women undergoing interval laparoscopic tubal sterilization in a residency training program was undertaken to compare method failures. Two occlusive techniques were compared, the spring-loaded clip (Hulka-Clemens) and the tubal ring (Falope Ring). Patients were randomized to either Falope Rings or Hulka-Clemens clips as the primary method. Demographic characteristics, educational level and operator experience were similar in the two groups. Follow-up at an average of 16 months (range, 6-24) revealed eight pregnancies (4.5%) in 176 women in the clip group and five pregnancies (2.6%) in the ring group. The Hulka-Clemens clip and the Falope Ring have similar incidences of method failure when employed by inexperienced operators. We question the usefulness of chromopertubation utilizing methylene blue dye to ensure proper placement of the occlusive device.
Current trends in pediatric residency training have shown that a growing number of programs have been unable to fill their available positions through the National Resident Matching Program, Evanston, Ill. This has caused a competitive climate among programs to attract medical students as potential residents. The purpose of this study was to learn what factors are important to all students in determining the rank order of the residency training programs to which they have applied. Analysis of data obtained from 600 survey respondents (40%) showed that program curriculum was most important. Factors, such as night call and benefits, took on much less importance. Differences did exist between students who applied for pediatric vs other residencies. The balance between primary and tertiary care and a university setting are examples of variables that had a greater influence on aspiring pediatricians. This information has important implications for training program directors.
BACKGROUND: Critical illness is a crisis for the total person, not just for the physical body. Patients and their loved ones often reflect on spiritual, religious, and existential questions when seriously ill. Surveys have demonstrated that most patients wish physicians would concern themselves with their patients' spiritual and religious needs, thus indicating that this part of their care has been neglected or avoided. With the well-documented desire of patients to have their caregivers include the patient's spiritual values in their health care, and the well-documented reality that caregivers are often hesitant to do so because of lack of training and comfort in this realm, clinical pastoral education for health care providers fills a significant gap in continuing education for caregivers. OBJECTIVES: To report on the first 6 yrs of a unique training program in clinical pastoral education adapted for clinicians and its effect on the experience of the health care worker in the intensive care unit. We describe the didactic and reflective process whereby skills of relating to the ultimate concerns of patients and families are acquired and refined. DESIGN AND SETTING: Clinical pastoral education designed for clergy was adapted for the health care worker committed to developing skills in the diagnosis and management of spiritual distress. Clinician participants (approximately 10-12) meet weekly for 5 months (400 hrs of supervised clinical pastoral care training). The program is designed to incorporate essential elements of pastoral care training, namely experience, reflection, insight, action, and integration. RESULTS: This accredited program has been in continuous operation training clinicians for the past 6 yrs. Fifty-three clinicians have since graduated from the program. Graduates have incorporated clinical pastoral education training into clinical medical practice, research, and/or further training in clinical pastoral education. Outcomes reported by graduates include the following: Clinical practice became infused with new awareness, sensitivity, and language; graduates learned to relate more meaningfully to patients/families of patients and discover a richer relationship with them; spiritual distress was (newly) recognizable in patients, caregivers, and self. CONCLUSIONS: This unique clinical pastoral education program provides the clinician with knowledge, language, and understanding to explore and support spiritual and religious issues confronting critically ill patients and their families. We propose that incorporating spiritual care of the patient and family into clinical practice is an important step in addressing the goal of caring for the whole person.
This study assessed the effectiveness of a model for diffusing the Life Skills Training (LST) Program into middle schools, examined implementation fidelity, and explored factors associated with involvement in training and program implementation. A convenience sample of master trainers (n = 44) and teachers (n = 45) from 16 Kentucky counties participated. Teachers were observed for content and process fidelity, and trainers and teachers completed questionnaires to assess factors related to training and program implementation. More than one-fourth (27%) of master trainers conducted training sessions, and 60% of teachers taught the curriculum. While implementation fidelity was relatively high, teachers were less likely to use the more innovative elements of the program. Trainers and teachers who conducted training and/or taught the LST Program were more enthusiastic toward the program than those who did nothing beyond being trained.
PURPOSE: Despite tremendous growth in the number of combined-training residency programs, little is known about their directorships, financing, recruitment, curricula, and attrition rates, and the practice patterns of graduates. The authors surveyed residency program directors from combined internal medicine-psychiatry (IM/PSY) and family medicine-psychiatry (FP/PSY) programs to provide initial descriptive information. METHOD: Programs' directors were determined from the American Medical Association's Graduate Medical Education Directory and FREIDA online database. Three mailings of a pretested questionnaire were sent to the 40 identified combined IM/PSY and FP/PSY residency programs. RESULTS: A total of 32 directors from 29 programs responded. Most programs were under the dual directorship of representatives from both the psychiatry department and either the internal medicine or the family medicine program. Although most directors responded that the residency program was based in psychiatry, both departments shared in administrative, recruiting, and financial responsibilities. Curricula varied widely, with limited focus on combined training experiences. Graduates (n = 41) tended to practice in academic settings (37%), where both aspects of training could be used. Others practiced in either community mental health centers or traditional private practice settings. The estimated attrition rate from combined residencies was 11%. CONCLUSIONS: Combined-training programs are directed by a diverse group of individuals, including dual-boarded physicians. Curricula vary widely, but most programs are within recommended guidelines. Further prospective studies are warranted to determine predictors of attrition and future practice plans.
The American Board of Internal Medicine (ABIM) has asked that directors of medical oncology training programs establish systems to evaluate, document, and substantiate the clinical competence of subspecialty trainees who seek certification. The Board defines the certificable medical oncologist at the completion of training as being competent to provide comprehensive and specialized medical care based on a high standard of demonstrated component skills. These skills clearly exceed those demonstrated by the certified internist. The goal of this expanded evaluation program is to ensure that the public and the profession can identify, through certification, physicians capable of providing a high standard of medical care.
Physicians in residency training will be the referring physicians of tomorrow. We sought to determine the current surgical and medical trainees' perception of vascular surgery's endovascular qualifications and capabilities. An anonymous survey was sent to all general surgery and internal medicine residents at a single academic institution. Respondents answered the question "Which specialty is the most qualified to perform (1) inferior vena cava (IVC) filter insertion; (2) angiograms, angioplasty, and stenting of the carotid arteries; (3) renal arteries; (4) aorta; and (5) lower extremity arteries?" For each question, respondents chose one response, either vascular surgery, interventional radiology, interventional cardiology, or do not know. One hundred respondents completed the survey (general surgery, n=50; internal medicine, n=50). There was a significant difference in the attitudes of surgery and medicine residents when choosing the most qualified endovascular specialist (p<0.05). Surgery residents chose vascular surgery as the most qualified specialty for each listed procedure: carotid (80%, n=40), IVC (56%, n=28), aorta (100%, n=50), extremity (86%, n=43), renal (78%, n=39). Medicine residents chose vascular surgery as the most qualified specialty less frequently: carotid (66%, n=33), IVC (6%, n=3), aorta (88%, n=44), extremity (72%, n=36), renal (16%, n=8). There was no significant difference in specialty selection based on postgraduate year. There is a large discrepancy between surgical and medical trainees' perception of vascular surgery's endovascular abilities, particularly regarding IVC placement and renal artery interventions. If our own institution mirrors the nation, each passing year a significant portion of the 21,722 graduating internal medicine residents go into practice viewing vascular surgeons as second-tier endovascular providers. A concerted campaign should be undertaken to educate medical residents regarding the skills and capabilities of vascular surgeons.
Surveys of current training show that many areas of pediatric emergency medicine are not taught in emergency medicine residencies. Furthermore, published recommendations for minimum pediatric core content in emergency medicine are scant and conflicting. To address this issue we have compiled from a variety of sources a detailed pediatric emergencies curriculum for emergency residency training. This curriculum is complete, and yet may be carried out with currently available resources.
The position of training director is perhaps the most difficult job in a department of psychiatry. The training director must implement the values, culture, and philosophy of the department; nurture residents, faculty, and support staff; maintain collaborative ties with the hospital and medical school-allied specialties and administration; and monitor the integrity and quality of clinical and academic training. All this must be accomplished in a role that has considerable authority but no real power. The director needs to understand the context in which training occurs and take into account the limited resources of the health care delivery system and the constraints imposed by the current era of managed care. This article provides an overview of the requirements for successfully achieving these complex goals and objectives.
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