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PubMed2005

Continuing medical education, quality improvement, and organizational change: implications of recent theories for twenty-first-century CME.

Healthcare providers and systems are being asked to measure and improve the quality of care delivered to their patients. Additionally, the American Board of Medical Specialties now requires physicians to participate in systems-based practice and practice-based learning and improvement activities as part of maintenance of specialty board certification. These changing paradigms provide opportunities for continuing medical education to become more aligned with health system goals and help prepare clinicians to practice in this new environment. Organizational change and quality improvement principles have much in common with continuing medical education planning processes. Medical education can play a role in helping organizations improve. Continuing medical education must move beyond delivering content to individual clinicians towards becoming a facilitator of organizational improvement. Research is needed to determine the effect of integrating continuing medical education with organizational change approaches on professional competence, organizational processes and patient outcomes.

Clinical Competence↗

PubMed2001

Midwifery across the generations: a modernizing midwife in Guatemala.

This article examines change and continuity in midwifery knowledge and practice by comparing a mother and daughter, both of whom are local midwives, or comadronas, on a Guatemalan plantation. The daughter apprenticed with the mother, who died in 1997. Like her mother, she received a government midwifery license after attending an official training course. I discuss the applicability of the concept of "postmodern midwifery" as I trace how both mother and daughter adapted to the pressures of medicalization and modernization. The daughter negotiates with biomedical personnel and copes with increasing government regulations, and she tends to accept biomedical authority more readily than did her mother. Unlike her mother, she sometimes uses this authority to enhance her own status. Nevertheless, her acceptance of the biomedical model is not complete, for she recognizes the practical constraints of poverty, under which both she and her clients live, and she also insists upon the superiority of such practices as massage. Furthermore, biomedicalization is countered by a process of sacralization, which, I suggest, enables midwives both to contest biomedical authority and to deliver meaningful care.

Attitude of Health Personnel↗

PubMed2001

Changing roles and identities of midwives in rural Costa Rica.

The roles and social identities of rural midwives in Costa Rica reflect the changing history of local birth practices vis-à-vis pragmatic local needs as well as the changing relation of the nation-state to the production of birth. This article explores how midwifery practices changed over time in relation to Costa Rican state policy and why prenatal massage (an important element of prenatal care historically) retains its importance despite the massive hospitalization of birth. Home birth's history as a heterogeneous, flexible model for care, combined with the pragmatic needs of women, make midwives and prenatal massage central in the production of hospital birth. Costa Rican midwives survive in the interstices of the biomedical model of care, providing interventions demanded by women (although demeaned by biomedicine) and serving as a safety net for pregnancy crises in hinterland communities. While acknowledging the potential for maternal or child death during pregnancy crises in isolated regions, midwives generate acute critiques of the biomedical model of birth and clearly articulate the practical need for (and continuing importance of) their practices in rural areas. This case study illustrates the obstacles to international awareness faced by midwives in so-called Third World countries like Costa Rica-midwives who must overcome not only geographic and socioeconomic marginalization, but also overwhelming opposition from the state and multilateral "reproductive development" policies.

Attitude of Health Personnel↗

PubMedDate not supplied

The acupuncture wars: the professionalizing of American acupuncture--a view from Massachusetts.

Since the 1970s acupuncturists in the United States have confronted the dilemma of how to define themselves not only as practitioners in relation to an evolving Americanized version of Chinese medicine but also with respect to definitions of biomedical professional identity, which are currently in flux. The central issue is that of professionalization. This study traces the process of professionalization through the initial reception of the modality; the first steps toward specialized training; and the further steps through professional associations, credentialing, and licensing. This process takes place within the broader social frame of fluctuating definitions of biomedical professionalism. It is within this context that acupuncturists are assessing role definition, status, and compensation. Part of the process also involves the renewed use of the clinical trial and the potential co-opting of acupuncture. The potential for resistance is tied in with alliances with holistic physicians and with acupuncturists' own defense of pluralism.

Acupuncture↗

PubMedDate not supplied

Career development: a life span issue.

One of the challenges for individuals pursuing a career throughout their life span is how to maintain a high level of professional competence. As the composition of the workforce changes, and new technologies are developed, workers are faced with changing job demands and pressures. A major issue for the 1990s is how long a worker's skills will remain current. With rapid technological changes, workers may find it necessary to update continually their knowledge, skills, and abilities or risk becoming obsolete. Factors such as individuals' motivation and attitudes and organizational climate can contribute to choices regarding career development. Current research on the factors that contribute to career development activities is reviewed, along with the impact of multiple career transitions throughout the life span. Interventions such as retraining and outplacement, which allow individuals in later life to continue work, change jobs, and further develop their careers, are also discussed.

Age Factors↗

PubMed1995

Somatic care wanted by HIV-infected intravenous drug abusers: the patients' opinions and experiences.

The somatic care of HIV-infected intravenous drug abusers (IVDUs) is often combined with many problems. The addict is often an unpopular patient, but society must assume responsibility for him or her and it is important to solve care problems in an appropriate way. This study was undertaken in order to investigate what kind of care addicts want when they become somatically ill. A questionnaire was given to patients who acquired HIV infection due to intravenous drug abuse, who visited an outpatient clinic for HIV-infected patients at the Department of Infectious Disease, Huddinge Hospital, Stockholm, Sweden. A total of 72 of the original 78 questionnaires could be evaluated. Thirty respondents took part in the Stockholm Methadone Programme. The patients were asked to rank the importance of professional competence among the staff. The patients ranked competence in pain treatment highest followed by competence in somatic medical care. Lower ranked, but still perceived as important, was competence in psychiatric medical care and social welfare work. Experience in treatment of addiction was ranked as less important. It can be concluded that it is fruitful to ask IVDUs about their preferences concerning care.

AIDS-Related Opportunistic Infections↗

PubMed1998

Effective regulatory approval process for food ingredient technologies.

Most sciences and technologies related to food safety have advanced exponentially over the 40 years since passage in the U.S. of the Food Additive Amendment of 1958 to the Federal Food, Drug and Cosmetic (FD&C) Act. Effective regulatory decision making places a high premium on competent professional and administrative judgement applied to sound scientific data. This review discusses changes and lessons learned in the food safety sciences over the last 4 decades. Other segments of the safety and compliance infrastructure necessary to assure that the public receives safe and wholesome foods have not kept pace with the new scientific knowledge. The quality of foods in our marketplace can be improved only after the regulatory and legislative segments of the infrastructure, discussed in a companion symposium paper, are brought into better synchrony with the sciences.

Agriculture↗

PubMedDate not supplied

The state of EMS education research project: characteristics of EMS educators.

OBJECTIVES: The preparation of emergency medicine practitioners occurs at a variety of levels, via individuals with various levels of experience and training, and through a variety of oversight organizations. The purpose of this study was to quantify the characteristics of those recognized as prehospital emergency medical services (EMS) educators, the type and amount of infrastructure available to facilitate the learning process, and what attributes and common practices the profession values. METHODS: The respondents (n = 1,691) were generated randomly from a nationwide systematic sample of all known EMS instructors. The sample was adequate to generalize to the 15,000 EMS educators. Face validity and content validity were assured through use of a 24-member focus group of EMS educators, practitioners, and administrators, who reviewed the questionnaire. Reliability estimates were generated via Cronbach's alpha and Kuder-Richardson 20 and 21 and ranged from 0.59 to 0.83, with a grand mean for the seven study constructs of 0.70. Factor analysis with varimax rotation explained 40% to 66% of the respective construct variance, with a grand mean of 56% of the response variance explained. RESULTS: The respondents were satisfied with their teaching experience (98%), expected to continue (80%), and taught because of a perceived dearth of qualified instructors. Only half of the respondents utilized federally generated curricular materials, and approximately 20% were uncomfortable in assessing psychomotor skills. The relationship of testing to assessment and skill performance appeared to be the most significant pedagogic challenge. CONCLUSIONS: The respondents were a senior group of educators committed to the training of new providers who will comprise the foundation of future EMS educational efforts at the national level.

Adult↗

PubMed2005

School staff members' and occupational health nurses' evaluation of the promotion of occupational well-being - with good planning to better practice.

This paper describes occupational health nurses' and school staff members' experiences of work ability maintenance carried out at schools and the development of ideas to promote the collaboration between occupational health care and school community and to enhance work ability maintenance. The data were collected in a baseline situation of an action research project to further plan and develop activities. The data were analysed by inductive content analysis. According to the results, school community staff members' work ability maintenance focused on the employee, the school community, school work and the working conditions as well as professional competence. The practical actions involved some individual and school-specific variation, focusing on actions to maintain individual and physical work ability. It seems that the collaboration between the school community and occupational health service for work ability maintenance took place at the individual level, but an obvious need for more structural collaboration emerged by several suggestions made by the participants (e.g. better information exchange between the school and occupational health care, improved collaboration between the school staff and the co-operative partners). The progress in collaboration may lead towards spontaneous collaboration, in which case both actors have the same target and work in a planned, continuous and natural way to ensure work ability maintenance in the school community.

Cooperative Behavior↗

PubMedDate not supplied

Auditory brainstem response threshold estimation: subjective threshold estimation by experienced clinicians in a computer simulation of the clinical test.

Little research has been undertaken into the extent to which auditory brainstem response (ABR) threshold estimation varies between experienced professionals. In this paper, results are presented for 16 professionals who estimated ABR threshold for 12 sets of data in a computer simulation of the clinical test. The design differs from previous research in this area in that subjects had control over the creation of the set of traces from which they would estimate threshold, much as they would in the clinical situation. No agreement for threshold was found for any of the 12 sets of test data across the 16 subjects, and for nine of the sets, the difference between highest and lowest estimated threshold was 40 dB or greater. The maximum difference between highest and lowest estimated threshold was 60 dB. It is argued that the variability is not accounted for by experimental design. The implications for clinical practice are discussed.

Adult↗

PubMedDate not supplied

Observations of ethical misconduct among industrial hygienists in England.

Industrial hygienists are uniquely situated to help solve problems in the working environment, and failure to behave ethically might have serious and possibly fatal consequences. A survey was conducted to estimate the prevalence and nature of ethical misconduct within the UK occupational hygiene profession during the past 5 years. A postal questionnaire was sent to 50 professional industrial/occupational hygienists. Of the 43 respondents, 33 (77%) had witnessed activities of potential ethical misconduct in at least one of nine questionnaire categories. Additionally, greater than 20% of the hygienists had witnessed at least one incident of data fabrication, failure to share credit on work, failure to protect confidentiality, criticizing the integrity of another hygienist for one's own gain, and plagiarism. The investigation also asked hygienists for their opinions on the reasons for breaches as well as potential methods of improvement.

Confidentiality↗

PubMed1996