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PubMed2006

Perspectives of recent trainees on career choices in neonatology.

A major goal for neonatology training programs is to produce neonatologists who will pursue careers that combine clinical and research responsibilities. However, there appears to be a continuing decline in the number of trainees who choose academic, as opposed to private sector, jobs. The reason for this decline is perhaps best addressed by the people making career choices now, the recent trainees. Although many factors influence any individual's career choice, information from recent fellows indicates that several major factors play a strong role: finances; time demands; adequacy of research training; and academic institutions' attitudes toward recent trainees. Whereas the first two factors have been addressed by prior studies, the latter two factors have been less explored. The responses of a few recent trainees to an informal survey will be used to guide a discussion that focuses on the factors of research training and academic status. Ways to improve the success of training programs in producing academic neonatologists will be suggested, including the proposal of a research training curriculum, changes in the structure of post-fellowship academic status and increased encouragement of collaborative research efforts. A future survey of a broad group of recent trainees about their career choices and about proposals for training changes, such as those considered here, is needed to evaluate programs aimed at increasing the number of neonatologists engaged in research. Journal of Perinatology (2006) 26, S53-S56. doi:10.1038/sj.jp.7211527.

Biomedical Research↗

PubMed2006

Influence of resident and attending surgeon seniority on operative performance in laparoscopic cholecystectomy.

BACKGROUND: Resident participation in laparoscopic cholecystectomy (LC) is important for education but increases the time of operation. This time cost in training programs is not well-defined, and available data show no decrease in operative time as residents progress in training. We undertook this study to determine the effect of the resident and attending surgeon seniority on the operative performance of LC. PATIENTS AND METHODS: We undertook a retrospective review of LCs performed for all indications over two academic years in our training program. Operations were performed by junior (PGY 1-3) or senior (PGY 4-5) residents, assisted by junior (trained after 1994) or senior attending surgeons, none of whom had fellowship training in advanced laparoscopy. Demographics, surgeon, assistant, operative time, and operative complications were recorded. Operative diagnoses were defined as noninflammatory (biliary colic, dyskinesia, or polyps) or inflammatory (cholecystitis, pancreatitis). The primary outcome was time in minutes from skin incision to closure; secondary outcomes were complications and conversions to laparotomy. ANOVA, Student's t-test, and chi2 tests were used as appropriate with statistical significance attributed to P < 0.05. RESULTS: Three hundred fifteen LCs were performed. Two hundred seventy were without conversion to laparotomy or intraoperative cholangiography and were included in time and complication analysis. Junior attendings averaged 4 and senior attendings averaged 21 postresidency years. No differences were found on univariate analysis between groups in demographics or diagnosis category. Operative times were longer for junior residents irrespective of attending seniority: Jr Res/Jr Staff (n = 65): 86 +/- 32 min; Jr/Sr (n = 78): 88 +/- 38 min; Sr/Jr (n = 52): 73 +/- 27 min; Sr/Sr (n = 75): 67 +/- 24 min (P < 0.05). The overall rate of operative complications was higher in junior than senior resident cases (5.6% versus 0.78%, P < 0.05). The most common complication was cystic duct leak, of which 4/5 occurred in junior resident cases. Senior attendings had a trend toward increased conversions (8.4% versus 3.7%, P = 0.09). CONCLUSION: Resident, but not attending surgeon, seniority influences operative time and complication rate in LC. This information may help surgical educators maximize both resident learning and operative efficiency and safety.

Adult↗

PubMed2006

The future of academic surgery--a consensus conference held at the Royal College of Surgeons of England, 2 September 2005.

A consensus conference organised by the Association of Surgeons of Great Britain and Ireland (ASGBI) and the Association of Surgeons of Training (ASIT) was held at the Royal College of Surgeons of England on 2 September 2005. All Specialist Advisory Committees and specialist associations were represented, except for orthopaedic surgery. The future of both academic surgery and training were discussed. We concluded that the European Working Time Directive, and Modernising Medical Careers are likely to have an adverse effect on future of research in oral and maxillofacial surgery. Most surgeons were concerned about the future of training and the development of surgery in general.

Academic Medical Centers↗

PubMed1986

Educating medical academicians: a follow-up of the Vanderbilt Orthopaedic Training Grant.

This study is the retrospective review of an orthopedic surgery training grant (USPHS Training Grant No. AM 05494) at Vanderbilt University that was funded from 1965 through 1969. This training grant was directed toward the production of academic orthopedic surgeons. The director of the training grant, J. William Hillman, MD, was an educator of acute insight who realized the need for highly motivated orthopedic educators. This need is still present. An examination of the rationale of career choices of those who participated in the grant reveals how little has changed over the years. At the same time, a large number of students who participated in the program now hold academic positions in their chosen specialties.

Attitude of Health Personnel↗

PubMed1999

[The historical significance of the Polish medical faculty in Edinburgh].

The Polish Medical Faculty at the University of Edinburgh was a unique phenomenon in the history of universities. Established during the Second World War in 1941 as an entirely autonomous Polish academic institution, the Faculty trained 228 doctors and awarded 19 PhD degrees during its nine years of formal existence (1941-1949). In reviewing its almost 60-year old history, seen in the context of the involvement of the elite of both the political and academic establishments, the splendour of various celebrations and its graduates devotion in keeping the "Edinburgh experiment" alive, the author makes a case for the long-term historical and psychological significance of events well outlasting the period of formal activity of the Faculty. The history of the Faculty is well documented, but the long term outcome in terms of its lasting historical importance is gradually emerging with the passage of time. It has become an indisputable testimony to the generosity and hospitality of the Scottish (political and) academic establishment and a lasting proof of the special liaison between the Scots and the Poles. The Faculty's importance and psychological significance to the rich historical heritage of Polish medicine and the notion of patriotism and loyalty to Polishness have become apparent in the ensuing decades of its carefully maintained tradition. The existence of the Polish Medical Faculty has become an extraordinary asset in the history of Scottish universities, but for the Polish tradition both in Poland and throughout its rich diaspora it constitutes an increasingly valuable historical event which deserves to be cultivated and passed on to younger generations so that it may continue bringing further dividends, so important to national identity, achievement, dignity and pride.

Faculty, Medical↗

PubMed1976

Alumni of the Massachusetts mental health center residency training.

In a preliminary survey, 484 alumni of the Massachusetts Mental Health Residency Training Program from 1912 to 1967 were surveyed. Approximately 80% were found to have devoted half or more of their professional time to the nonprivate practice of psychiatry for at least one year. These data suggest that a training program with strong academic traditions might produce a preponderance of publicity of oriented psychiatrists. Since previous surveys have indicated a greater proportion of psychiatric time spent in private practice, we suggest that future surveys of psychiatric manpower need to consider the orientation of residency training programs in order to accurately assess the need for future psychiatric manpower.

Internship and Residency↗

PubMedDate not supplied

What is next for pharmacoeconomics and outcomes research in Asia?

OBJECTIVES: Pharmacoeconomics and outcomes research have the potential for rapid adoption in the Asia Pacific region. Nevertheless, the region is characterized by great diversity in social and economic development, ethnicity, population size, health-care system, culture, language, and religion. Thus, the rate of adoption is also quite diverse across the region. METHODS: Among the countries reviewed in this article, governments take varying levels of interest in applying this research in health policy decisions. For example, some countries have already implemented systems that require pharmacoeconomic studies as one component of a new pharmaceutical product's approval for reimbursement, whereas others recommend such data but do not require it in policy and medical decision making. The literature in the countries reviewed is actually quite robust given the early stages of development of this field in most countries. The academic community has members trained in this field of research in all the countries reviewed and some universities have established departments whereas others have just introduced a few classes in the area. RESULTS: At the moment, pharmacoeconomics and outcomes research are being conducted mainly by academics. In addition, some pharmaceutical researchers are active and pharmaceutical companies are currently preparing to conduct more of this research as part of their strategy for Asian drug development. CONCLUSIONS: Prospects for future growth and development in this field are quite good in Asia as rapid healthcare inflation, increasing rates of chronic conditions and aging population, and increasing technology diffusion will underpin the need for greater awareness of the need to incorporate economic efficiency into the health-care systems.

Aged↗

PubMed2001

[Residents training in gynecologic operative endoscopy: a review of Israeli and world experience].

Two decades ago, Gynecologic procedures performed by endoscopy were basically limited to diagnostic procedures. Since 1990, operative endoscopy is increasingly used to treat a growing variety of gynecologic conditions, resulting in shorter hospital stay and smaller, less painful incisions. One of the greatest tasks facing today's academic gynecologic surgeons is training residents and attendant physicians to perform endoscopic surgery adequately and safely. Clearly, there is a need to provide basic knowledge of endosurgical principles, and understanding of equipment and technologies used in operative endoscopy. Also, information on minimization, early recognition and treatment of endoscopic complications is of great importance as well as hands-on experience in these new procedures. We have reviewed the world as well as the Israeli experience in the field and out of this growing base of knowledge we have tried to delineate and forge guidelines for adequate teaching, training and accreditation.

Education, Medical, Graduate↗

PubMed1986

Initial clinical judgments by internists, family physicians, and psychiatrists in response to patient vignettes: I. Assessment of problems and diagnostic possibilities.

A sample of 146 physicians from internal medicine, family medicine, and psychiatry responded to two written clinical vignettes describing patients with combinations of commonly seen somatic and psychologic complaints. The physicians included housestaff of all levels of training, full-time academic faculty, and community-based clinical faculty. Enormous variation was seen in all specialties in the numbers and types of problems and diagnoses suggested by the physicians. Aside from one or two areas, there were few differences among the specialties or by level of training with regard to the numbers or types of problems identified and tentative diagnoses recorded. The variability within specialty groups was greater than among the groups. Physician behavior in response to one vignette was highly correlated with responses to the second vignette.

Adult↗

PubMed1996

Residents' experiences of abuse, discrimination and sexual harassment during residency training. McMaster University Residency Training Programs.

OBJECTIVE: To assess the prevalence of psychological abuse, physical assault, and discrimination on the basis of gender and sexual orientation, and to examine the prevalence and impact of sexual harassment in residency training programs. DESIGN: Self-administered questionnaire. SETTING: McMaster University, Hamilton, Ont. PARTICIPANTS: Residents in seven residency training programs during the academic year from July 1993 to June 1994. Of 225 residents 186 (82.7%) returned a completed questionnaire, and 50% of the respondents were women. OUTCOME MEASURES: Prevalence of psychological abuse, physical assault and discrimination on the basis of gender and sexual orientation experienced by residents during medical training, prevalence and residents' perceived frequency of sexual harassment. RESULTS: Psychological abuse was reported by 50% of the residents. Some of the respondents reported physical assault, mostly by patients and their family members (14.7% reported assaults by male patients and family members, 9.8% reported assaults by female patients and family members), 5.4% of the female respondents reported assault by male supervising physicians. Discrimination on the basis of gender was reported to be common and was experienced significantly more often by female residents than by male residents (p < 0.01). Ten respondents, all female, reported having experienced discrimination on the basis of their sexual orientation. Most of the respondents experienced sexual harassment, especially in the form of sexist jokes, flirtation and unwanted compliments on their dress or figure. On average, 40% of the respondents, especially women (p < 0.01), reported experiencing offensive body language and receiving sexist teaching material and unwanted compliments on their dress. Significantly more female respondents than male respondents stated that they had reported events of sexual harassment to someone (p < 0.001). The most frequent emotional reactions to sexual harassment were embarassment (reported by 24.0%), anger (by 23.4%) and frustration (20.8%). CONCLUSION: Psychological abuse, discrimination on the basis of gender and sexual harassment are commonly experienced by residents in training programs. A direct, progressive, multidisciplinary approach is needed to label and address these problems.

Adult↗

PubMed1987

Is there gender bias in the evaluation of surgical residents?

Although it might be assumed that the performance of surgical residents is assessed by faculty without regard to gender, no study to date has been undertaken to evaluate this. for 19 years, the Department of Surgery in our institution has had female faculty members to evaluate residents and, with the exception of 1969, female residents to be evaluated. All residents are evaluated by supervisory faculty after each clinical rotation. The same evaluation process has been used throughout this time, assessing residents on a five-point scale (1 = best) in each of six attributes: ethics, judgment, technical skills, knowledge, interpersonal skills, and work habits. The faculty evaluations of general surgery residents from academic years 1967 to 1985 were reviewed. A total of 2356 evaluations of 144 residents (22% female) by 69 faculty members (22% female) was available. For valid comparison, a subset of 702 evaluations was selected. Included were only those evaluations in which residents at the same level of training during the same academic year were evaluated by the same faculty members and in which both the resident and faculty groups had both male and female members. The average scores for male and female residents were nearly identical as determined by male and female faculty members, and no differences were statistically significant. In our program, with more than 20% women residents and faculty members over a 19-year period, no bias related to gender was demonstrated.

Clinical Competence↗

PubMed1984

Significance of the in-training examination in a surgical residency program.

The exact role that the American Board of Surgery In-Training Examination plays in resident evaluation remains poorly defined. We have required that all residents take the In-Training Examination annually. An analysis was performed of the results of the In-Training Examination and the Qualifying Examination of the American Board of Surgery for 16 residents who completed their residencies between July 1976 and July 1981. Twelve graduates passed their initial Qualifying Examinations with a mean +/- 1 SEM score of 81 +/- 2. Four graduates failed with a score of 70 +/- 0.3. Corresponding scores on their final In-Training Examinations were 42 +/- 9 and 11 +/- 6 (p less than 0.001). Each year the In-Training Examination Scores obtained by the residents who passed the Qualifying Examination were significantly higher than were those scores obtained by the graduates who failed. Linear regression analysis identified a significant correlation between the graduates' initial (r = 0.676) and final (r = 0.760) In-Training Examination scores and the Qualifying Examination score. In our resident training program, In-Training Examination results correlated well with Qualifying Examination results and may be used as an objective determinant for remedial measures and resident retentions. These data should be developed on a national level. While Board certification was or likely will be accomplished by all our residents, our goal is to strengthen the academic characteristics of the training program to produce uniform success on the initial Qualifying Examination.

Educational Measurement↗

PubMed2004

Trends in urology graduate medical education: a brief update from the Urology Residency Review Committee.

PURPOSE: This communication clarifies recent trends with regard to the number and configuration of urology training programs, and more precisely describes recent variations in the number of urology residents in training. MATERIALS AND METHODS: We reviewed and analyzed longitudinal data from the Accreditation Council for Graduate Medical Education regarding the number of urology resident positions as well as the number and format of urology training programs in the United States. Several publications related to general and urological graduate medical education were also reviewed. RESULTS: In response to various accreditation and demographic forces the total number of urology residency training programs has decreased by more than 20% since 1982. Coincident with this decrease was a transition in urology resident education away from smaller preceptor based programs and toward the current model of larger, broad based training programs anchored by academic medical centers. The educational format of most residency programs has also evolved, such that in 2003 all except 1 accredited program required 4 years of education in the clinical and basic urological sciences. For most programs this shift coincided with a decrease in the duration of pre-urological general surgical training. The number of first year urology residents decreased progressively between 1994 and 1998 before stabilizing at the current level of approximately 250 first year positions. In 2003 the total number of urologists in training was actually higher than it had been for most of the last decade. CONCLUSIONS: We describe recent trends in urological graduate medical education. The observations reported suggest that our specialty has maintained its focus on training a consistent number of high quality urological surgeons.

Education, Medical, Graduate↗

PubMed1984

Is group progressive relaxation training as effective with hyperactive children as individual EMG biofeedback treatment?

This study examined whether group progressive relaxation training was as effective as individual EMG biofeedback training in facilitating the academic achievement and self-control of 45 hyperactive elementary school children. Academic achievement was assessed with the Gates-MacGinities Reading Tests, and self-control was measured with the Nowicki-Strickland and the Teacher Rating scales. Eight sessions were scheduled at weekly intervals. Progressive relaxation was conducted in groups of seven or eight and was induced with a commercial audiocassette program. EMG training augmented frontalis biofeedback with those taped exercises. A placebo group listened to taped children's stories. Multivariate analysis of variance indicated no significant differences among the three contrast groups when all dependent variables were considered together. However, univariate F values and discriminant analysis disclosed locus of control to be significantly more internal for the progressive relaxation condition. Also, differences between the two relaxation and the placebo groups, though not statistically significant, were all in the expected direction. While the relative efficacy of group progressive relaxation could not be established conclusively, the data appeared sufficiently positive to warrant further investigation of this cost-effective prospective intervention.

Achievement↗

PubMed2005

Predictors of surgery resident satisfaction with teaching by attendings: a national survey.

OBJECTIVE: To identify factors that predict fourth- and fifth-year surgical resident satisfaction of attending teaching quality. SUMMARY BACKGROUND DATA: With the training of surgical residents undergoing major changes, a key issue facing surgical educators is whether high-quality surgeons can still be produced. Innovative techniques (eg, computer simulation surgery) are being developed to substitute partially for conventional teaching methods. However, an aspect of training that cannot be so easily replaced is the faculty-resident interaction. This study investigates resident perceptions of attending teaching quality and the factors associated with this faculty-resident interaction to identify predictors of resident educational satisfaction. METHODS: A national survey of clinical fourth- and fifth-year surgery residents in 125 academically affiliated general surgery training programs was performed. The survey contained 67 questions and addressed demographics, hospital, and service characteristics, as well as surgery, education, and clinical care-related factors. Univariate analyses were performed to describe the characteristics of the sample; multivariate analyses were performed to evaluate the factors associated with resident educational satisfaction. RESULTS: The response rate was 61.5% (n = 756). Average age was 32 years; most were male (79%), white (72%), and married (69%); 42% had children. Ninety-five percent of respondents graduated from U.S. medical schools, and the average debt was $80,307. Of 20 potentially mutable factors, 6 variables had positive associations with resident education satisfaction and 7 had negative associations. Positive factors included the resident being the operating surgeon in major surgeries, substantial citing of evidence-based literature by the attending, attending physicians giving spontaneous or unplanned presentations, increasing the continuity of care, clinical teaching aimed at the chief resident level, and having clinical decisions made together by both the attending and resident. There were 7 negative factors such as overly supervising in surgery, being interrupted so much that teaching was ineffective, and attending physicians being rushed and/or eager to finish rounds. CONCLUSION: This study identifies several factors that were associated with resident educational satisfaction. It offers the perspective of the learners (ie, residents) and, importantly, highlights mutable factors that surgery faculty (and departments) may consider changing to improve surgery resident education and satisfaction. Improving such satisfaction may help to produce a better product.

Adult↗

PubMed2006

Residency training as technology matures a survey of radiology residents' training experiences.

RATIONALE AND OBJECTIVES: The aim of the study is to assess radiology resident training experience in cardiac magnetic resonance imaging (MRI), positron emission tomography (PET), obstetrical (OB) ultrasound (US), carotid US, and barium esophagram. MATERIALS AND METHODS: One hundred eighteen radiology residents completed surveys. Surveys assessed resident year of residency training, hospital size, program affiliation with an academic institution, state, performance of the examinations listed, number of examinations performed per week, and number of weeks spent on rotations for each modality. The study was approved by the institutional review board and was Health Insurance Portability and Accountability Act (HIPAA) compliant. t-Test and chi-square test were performed, and results were analyzed for statistical significance. RESULTS: Most (94 respondents; 80%) respondents were third-year residents, 101 residents (86%) stated their program was affiliated with an academic institution, 92 residents (78%) performed cardiac MRI, 104 (88%) performed PET, 84 (71%) performed OB US, 71 (60%) performed carotid US (one did not respond), and all performed esophagrams (although one did not respond). Only performance of cardiac MRI and PET correlated positively with a larger average hospital size (P < .01). Residents at an academically affiliated program were significantly more likely to perform cardiac MRI (P < .05). Geographic region significantly affected likelihood of performance of cardiac MRI only. CONCLUSION: Such factors as hospital size, academic institution affiliation, and geography affect radiology resident training, particularly for such maturing applications as cardiac MRI and PET. This information may be useful in attempts to standardize radiology residency training.

Diagnostic Imaging↗

PubMedDate not supplied

Telemedicine: experience at SGPGIMS, Lucknow.

Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGIMS) located in Lucknow, capital of Uttar Pradesh, a state in Northern India, is a tertiary level referral academic medical center involved in teaching and training of super specialist medical professionals with 22 academic departments. It is the first tertiary care hospital in public healthcare sector in India to adopt Information Technology (IT) for healthcare delivery. The Hospital Information System (HIS) was implemented in 1998 to record, store, process and retrieve health data of all the patients. This software was developed in-house in collaboration with Center for Development of Advanced Computing (C- DAC), Pune. Later in the year 1999, telemedicine activities were initiated in the form of testing the concept and technology. The first research grant was availed of in the year 2001, which helped in creating an infrastructure for telemedicine. Regular tele-healthcare and tele-educational services were introduced for the postgraduate students of medical colleges of Orissa. These services have now been extended to educate the doctors of other medical colleges and community centers in other states. Besides, the Institute is associated with organizational activities and in policy initiatives of the government. All the activities are in project mode and are being financially supported by government agencies such as Indian Space Research Organisation (ISRO) and Department of Information Technology. Looking at the need of skilled manpower in the field of telemedicine and e-health, a school of telemedicine is coming up in the campus, which will also provide core infrastructure for research and development.

Academic Medical Centers↗

PubMed2002

Effects on depression pharmacotherapy of a Dutch general practitioner training program.

BACKGROUND: General practitioners' (GPs) ability to recognize, diagnose and treat depression improved significantly after a comprehensive, 20-h training programme. This study aims to evaluate in more detail the effects of the training on GPs' pharmacotherapy of depression and related issues. METHODS: A pretest-posttest design was used. Both in the pre- and post-training phase, a sample was drawn from consecutive patients of the 17 participating GPs. In the pre-training phase we identified a sample of 31 cases with an ICD-10 depression who received an antidepressant from their GP. The sample was followed for 1 year. Outcome measures were: type of antidepressant, dosage, duration and number of target instructions given by the GP. Then we trained the GPs. In the post-training phase, we identified a new sample (n = 47) from their practices and measured the same outcomes. RESULTS: Improvements were seen in choice for modern antidepressant, adequate dosage, adequate duration, and number of target instructions given. LIMITATIONS: Observed changes can be due to a period effect, inherent in a pre-post design. CONCLUSIONS: A post-academic hands-on training of GPs can improve depression pharmacotherapy according to clinical guidelines with respect to choice of a modern antidepressant, adequate dosage, adequate duration and psychoeducation.

Adolescent↗