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PubMed1983

The cultural meanings and social uses of illness. A role for medical anthropology and clinically oriented social science in the development of primary care theory and research.

Basic research that is conceptually and methodologically innovative and that fosters long-term research programs should play a role in the academic development of primary care, alongside more practical applied studies of specific clinical problems. A creative tension between the two has been a distinctive attribute of academic medicine and should be fostered in family medicine and other primary care disciplines. The biopsychosocial model offers a paradigm for the incorporation of clinically oriented social science research as one basic science approach in which primary care researchers can receive advanced training and pursue an academic career. The author briefly illustrates such a career with reference to studies (his own included) on the social uses and psychocultural meanings of illness. Somatization, a major problem in primary care, is illuminated by such a clinically applied social science research framework. Developing the scientific basis of an academic discipline involves intellectual education in systematic scholarship to create and critique concepts as much as it requires training in the application of rigorous research design and powerful statistical techniques.

Anthropology, Cultural↗
PubMed1995

The community general surgeon: a time for renaissance.

The practice of general surgery in smaller Canadian communities requires a broad scope of training, and recently the Royal College of Physicians and Surgeons of Canada introduced training requirements to meet the needs of these communities. The traditional role of physicians and surgeons in relation to the hospital boards is changing, with the development of regional health boards. Surgeons must be adaptable to these changes while striving to preserve the standards of surgical care in the new environment. The 1990 Canadian Medical Association manpower studies indicated that there will soon be a major shortage of general surgeons in Canada. In 1990, 48% of general surgeons in Canada were over 55 years of age. In communities with a population of 10,000 or less, there were relatively more general surgeons than other specialists, but, again, they were proportionately older. Recruitment to general surgery is a concern. A survey of 205 residents obtaining the Royal College fellowship in surgery between 1991 and 1993 revealed that 107 took post-fellowship training; of these, 46 developed academic careers, 17 became community surgeons and 44 were lost to surgical practice (they went into cardiac surgery or emigrated). Ninety-eight did not take further training; of these, 5 developed academic careers, 87 chose community practice and 6 emigrated. The role of the general practitioner in providing surgical services in remote areas was the topic of discussion between the Canadian Association of General Surgeons (CAGS), the Royal College and the College of Family Physicians of Canada. Guidelines were developed and approved by the CAGS.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed2000

Fellowship training in medical toxicology: characteristics, perceptions, and career impact.

STUDY OBJECTIVE: To determine the number of physicians who have received fellowship training in medical toxicology and to describe fellowship-trained medical toxicologists' perceptions of fellowship training and its career impact. METHODS: All current medical toxicology fellowship directors were contacted by mail for information on who had trained at their program. Subsequently, a written survey was mailed to all current American College of Medical Toxicology members regarding work force and educational issues pertaining to medical toxicology. Fellowship-trained toxicologists were asked about their clinical and research experiences during fellowship, and career impact of toxicology fellowship training. RESULTS: Fellowship directors from 21 programs reported that 147 physicians had completed a toxicology fellowship since 1970. Of the 236 current American College of Medical Toxicology members surveyed, 160 (68%) responded. Ninety-four of the 160 (59%) are fellowship trained. Sixty-four of the 94 (68%) fellowship-trained toxicologists are emergency medicine board certified. About half the respondents believed they did not have enough inpatient and outpatient experiences during fellowship, but poison center time was more than adequate. After fellowship, 91% remain in medical toxicology although 78% spend less than 3/4 time in toxicology-related activities. More than 50% of respondents believed that fellowship training impacted their career by choosing an academic career, developing a toxicology clinical program, and altering clinical responsibilities. CONCLUSIONS: Most fellowship-trained toxicologists only work part-time in medical toxicology, but fellowship training has significant impact on choice of academic career and altering clinical responsibilities. Training concerns include limited bedside experiences, particularly outpatient, and uncertain job prospects.

Career Mobility↗
PubMed1977

The need for comparative pharmacologists in industrial and academic research.

Comparative pharmacologists solidly trained in the principles of modern pharmacology, comparative biology, and comparative medicine are needed in various facets of drug research. Although this type of training would ideally be obtained in the professional medical environment of a veterinary college, the discipline of pharmacology has been neglected in these schools and must be upgraded by staffing and funding before quality training programs can be established. An interim solution would be to offer postgraduate training in comparative pharmacology and medicine at selected veterinary schools. Trainees would be recruited from pharmacology centers of excellence in medical or pharmacy schools. We assume that some of these trainees wound join veterinary school faculties and eventually establish quality Ph.DTRAINING PROGRAMS IN COMPARATIVE PHARMACOLOGY AT THEIR INSTITUTIONS. Comparative pharmacologists trained in these pre- or postdoctoral programs would be valuable additions to any team responsible for evaluating the safety and efficacy of drugs or chemicals in man or animals.

Animals↗
PubMedDate not supplied

[Medical graduate and continuing education in gerontopsychiatry and psychotherapy].

Continuous medical training in psychogeriatrics and in psychotherapy with the elderly is in need of improvement in many respects. There are, however, manyfold efforts to theoretically and practically mediate the state of the art in the course of medical further training. We present a model of psychiatric and psychotherapeutic care for the elderly in continuous medical training which is already a basic component in many psychiatric training facilities, aimed at providing each and every board certified psychiatrist and neurologist with adequate psychogeriatric competency. Growing knowledge in this field doubtlessly requires the development of a respective academic sub-specialty. Training facilities not only for psychiatrists, psychotherapists, and neurologists, but also for various other medical disciplines, in particular for general practitioners, as well as for nonmedical professionals in the field of care for the elderly have increased in recent years. As an example we point to the Gerontological Forum.

Aged↗
PubMed2001

Small group learning in the final year of a medical degree: a quantitative and qualitative evaluation.

The new undergraduate medical curriculum in Manchester uses problem-based learning (PBL) throughout the course. However, the major difference from other PBL schools is that in years 3 & 4 (phase 2) the students can use clinical experience when discussing the paper cases. The process is then developed further in year 5 (phase 3), in which there are no set PBL 'triggers' and students bring their own cases to the groups for discussion. In this study, we have explored what happens in the phase 3 (year 5) group sessions and how the students view them. A questionnaire and focus groups were used to generate data, from which a model was developed of what happens in a 'good' group session. The data suggest that most groups run on a case-presentation and discussion format, most commonly about clinical management and diagnosis. Students want tutors to act as an expert resource and to be flexible in allowing students to direct the discussions. University guidance about the group sessions was not generally used.

Journal Article↗
PubMedDate not supplied

A developmental model for enhancing research training during psychiatry residency.

OBJECTIVE: The authors describe a developmental model for enhancing residency research training for careers in academic psychiatry. Over the past 10 years, the University of Pittsburgh Department of Psychiatry has developed a research track (RT) for its residents. While the Department's plan has been to address the critical need of training physician-scientists in psychiatry, the RT continues to evolve as a structured extension of the University's residency-training program. Recently, the University's departmental leadership has taken several steps that address regulatory, institutional, and personal barriers to residency research training put forth by the 2003 Institute of Medicine (IOM) report. METHODS: The authors outline a model of residency research training, elements of which should be exportable to the majority of U.S. psychiatry residency programs. RESULTS: For residents in the RT, up to 50% of time in PGY-3 and up to 75% of time in PGY-4 can be devoted to research-related activities. The authors currently have 13 residents and fellows in their track. Over the past 10 years, 15 of 33 RT residents have become research postdocs or full-time grant-funded researchers in academic positions. CONCLUSION: The authors' experience suggests that it is possible to organize and implement an RT during psychiatry residency within the parameters presented by the Psychiatry Residency Review Committee (RRC).

Education, Medical↗
PubMed2002

The administration of programs for infants and toddlers.

In this article, models for providing training in infant and toddler mental health are described. The goal has been to outline programs in enough detail that they may serve as models for persons who wish to develop infant psychiatry training and services within their academic division or their clinical program. From an administrative and fiscal perspective, developing training experiences in infant mental health has many advantages. Consultation experience and clinical experience with infants and young children are training requirements of the psychiatry Residency Review Committee. There is also a workforce shortage of child and adolescent psychiatrists and clinicians who can work with children, and there is an even greater shortage of child psychiatrists and psychologists who can work with very young children. This shortage allows a division chief or program director a particular opportunity to earmark core training funding for this underserved area and to partner with affiliated institutions and programs that can help fund these training efforts. The author's program was helped immensely by a private foundation grant, but for the first 20 years it was able to be self-sufficient through a commitment to training and reimbursement for clinical services. Currently, there seems to be an awareness on the part of community and public sector programs that they not only need to pay for trainee time but also must include administrative and faculty time. Finally, experience has defined major important principles of this work with infants, toddlers, and their families. First, training and clinical service must be provided within a context of knowledge and experience in child development. Second, the principles and knowledge of infant mental health must be used. Third, an understanding of relationship-based interventions provided within the context of reflective supervision and mentorship must be provided.

Academic Medical Centers↗
PubMed1997

Why training is the key to successful guideline implementation.

The market for pharmacoeconomic analysis is rapidly expanding. Demand for experienced investigators seems to have outpaced the capacity of both the academic community and industry to train qualified practitioners. The result is that many professionals charged with producing and using cost-effectiveness and other drug-related economic evaluation studies may lack the basic skills required to carry out their duties. This, in turn, raises concerns regarding the credibility and integrity of the field as a whole. In our opinion, the adoption of self-imposed practice guidelines is a necessary first step in confronting these issues. However, the power of guidelines to promote responsible practice will be limited by the technical preparation of the analysts charged with adhering to them. A long term solution requires a collaborative commitment, on the part of both the academic community and the private sector, to targeted graduate training in pharmacoeconomic methods, and to the provision of ample opportunities for continuing professional education.

Economics, Pharmaceutical↗
PubMedDate not supplied

Developing physician leaders in academic medical centers.

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. While part one of this series, which appeared in Volume 43, No. 6 of Medical Group Management Journal addressed, "The changing role of physician leaders at academic medical centers," part 2 will examine as a case study the faculty leadership development program at the University of Texas M.D. Anderson Cancer Center. These two articles were prepared by the author from his research into, and the presentation of a thesis entitled. "The importance of leadership training and development for physicians in academic medical centers in an increasingly complex health care environment," prepared for the Credentials Committee of the American College of Healthcare Executives in partial fulfillment of the requirements for Fellowship in this College.*

Academic Medical Centers↗
PubMed2006

The role of research training during higher medical education in the promotion of academic medicine in the UK.

OBJECTIVES: To examine the research activities and perceived barriers to research among higher specialist trainees in geriatric medicine and to show how trainees active in research might have a role in assisting their peers in getting started in research. DESIGN: Cross-sectional questionnaire survey on research activities, attitudes to doing research and perceived difficulties in doing research. SETTING AND PARTICIPANTS: Trainee members of the British Geriatrics Society (BGS) in the UK. RESULTS: A total of 122 responses (30% response rate) were received after a single mailing and a follow-up questionnaire to trainees attending the BGS national conference. Although 64% (67/104) of respondents would like to undertake a period of research, many perceived barriers preventing them from planning, funding and executing a research project. Among those who had not undertaken research, the majority (70%, 42/60) indicated that they have no clear idea of a topic to research, 64% (39/61) did not know how to develop an idea and 62% (38/61) indicated that they did not know how to get funding. Trainees motivated to do research were faced with particular difficulties with regards to funding and selection of a project topic. CONCLUSIONS: One useful method would be systematically to provide basic information to trainees on how to enter into the early stages of research. This would help to overcome some of the unnecessary uncertainty that many trainees keen to do research seem to have.

Attitude of Health Personnel↗
PubMed2003

Slow progress: predoctoral education in family medicine in four Latin American countries.

BACKGROUND: Many countries in Latin America are seeking to expand primary care services provided through their health care systems. Family physicians are an essential component of an effective primary care workforce, but we know little about the status of family practice training in Latin America. This study examines predoctoral training in family practice in four Latin American countries and identifies factors affecting its incorporation into medical training institutions. METHODS: A Spanish language survey was mailed to the heads of all medical schools in Argentina, Colombia, Mexico, and Panama (n=100), asking about the status of family practice training at the school and factors perceived as facilitating or impeding its acceptance by the institution. Quantitative data were analyzed for frequency, and qualitative data were analyzed for content and theme. RESULTS: Sixty-five of the 100 schools responded to the survey. Of these, only 34 (52%) provide training in family practice at the predoctoral level, and only nine (14%) have established departments of family medicine. Barriers to inclusion of family medicine include lack of financial and human resources, definition of family practice as a subject rather than a specialty, and a perceived lack of interest among students. DISCUSSION: Inclusion of family medicine into medical education in Latin America has been slow. Unless strategies can be developed to increase training for family physicians in Latin American countries, governments in the region will have difficulty expanding primary health care services in their systems. Support is needed from governments, public health officials, funding agencies and organizations, and the academic community to increase training of family physicians in Latin America.

Argentina↗