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PubMed2006

Occupational well-being of school staff members: a structural equation model.

This study aimed to develop a theoretical basis for the promotion of school staff's occupational well-being. The 'Content Model for the Promotion of School Community Staff's Occupational Well-being' describes the four aspects of the promotion of occupational well-being ('working conditions', 'worker and work', 'working community' and 'professional competence') as well as the functionality and structure of the model. The content model was examined empirically by means of a structural equation model. The project was developed with school staff and occupational health nurses and implemented in 2001-2004. The target group consisted of the staff of 12 comprehensive schools in Eastern Finland in 2002 (n = 211) and 2004 (n = 266). The data were collected using a 'well-being at your work index' questionnaire at both times. A structural equation model for the school staff's occupational well-being, i.e. the 'Occupational Well-being of School Staff Model' (baseline OWSS Model: Study I in the year 2002), was produced. The model was tested with the 2004 data. Based on this, the model was further developed into the final OWSS Model (Study II). The theoretical Content Model for the Promotion of School Community Staff's Occupational Well-being can be used as a framework for planning, implementing and evaluating school staff's occupational well-being.

Adult↗
PubMed2000

Qualitative analysis of a BSW field placement with a hospital-owned physician practice in a skilled nursing facility.

Health services and medical social work are being reshaped in the wake of managed care and the movement toward community-based delivery systems. In this article, a bachelor's of social work student is assigned to a field placement to work with a hospital-owned physician practice in a skilled nursing facility. Structured interviews are conducted with the field placement student, the physician, a resident (client), the field placement instructor, two social work designees, and the facility administrator to ascertain the student's practice activities. Findings indicate a wide range of duties at both micro- and macro practice levels. Value issues and potential considerations for practitioners entertaining professional associations with physicians are examined.

Employment↗
PubMed1983

The doctor-patient relationship.

This essay focuses on the doctor-patient relationship as a measure of ethical behavior by the physician. The perspective is derived from commitment as a religious humanist to the Judaic heritage, and experience in hospitals. The ethical responsibility to be competent professionally is presupposed. Emphasis is placed on the need of the physician to respect the autonomy of the patient as person, thus to limit the paternalism inherent in the physician's position, and to re-enforce this with compassion. Judaic sources supporting such conduct are cited. Exception is taken to decisions by civil and rabbinic judges which disregard the intimacy of the doctor-patient relationship.

Abortion, Therapeutic↗
PubMedDate not supplied

Regulation of tattooing in Minneapolis and St. Paul, Minnesota: tattooists' attitudes and relationship between regulation and practice.

OBJECTIVE: This study investigated tattooists' attitudes regarding government regulation and the relationship between existing tattooing regulation and tattooists' knowledge and practice of infection control. METHODS: Self-reported and observational data were collected in a cross-sectional study of professional tattooists. A written survey was used to investigate knowledge and practice of infection control and attitudes toward government regulation. Infection control practice was also examined through direct observation of tattooing. Rating scales were used to compare tattoo artists subject to local tattooing ordinances with those in areas without ordinances. RESULTS: Sixty-one tattooists (45 regulated, 16 unregulated) completed surveys and 25 (17 regulated, 8 unregulated) were observed. Attitudes toward regulation were generally positive. Most participants supported health department inspections and training requirements. The presence of local tattooing ordinances was not associated with tattooists' knowledge (p=0.53), but was associated with self-reported practices (p=0.05). A more positive attitude toward regulation was associated with the use of more self-reported infection control procedures (p<0.01). CONCLUSION: Tattoo artists in areas with local tattooing ordinances may implement more bloodborne pathogen precautions than those in areas without ordinances, despite working from a similar knowledge base. Tattooists most in need of improvement may be difficult to reach due to opposition to government intrusion. Federal guidelines, clarification of OSHA rules applying to tattooists, and statewide regulation are needed. Tattooists should be involved in the development of regulations.

Attitude to Health↗
PubMed1983

Clinical teaching in physical therapy education. An ethnographic study.

The purpose of this ethnographic study was to examine the process of clinical education from the viewpoint of clinical teachers. A three-month field study based on a grounded theory approach and involving simultaneous collection and codification of data led to the discovery and explication of two major components of the clinical education process. One component, the clinical teaching situation, identified the organizational and human factors that influence the type, quality, and quantity of the student learning. The second component, teaching tools used by the clinical teachers, identified the strategies used to pace the student to professional competence. The authors view the findings as a beginning understanding of how and why clinical education is fundamentally different from academic education.

Humans↗
PubMed1990

Relationship of professional involvement to clinical behaviors of physical therapists.

This study was designed to measure the level of professional involvement of respondents and to examine the relationship between a high level of professional involvement (eg, membership in the American Physical Therapy Association, attendance at Association conferences, participation in continuing education programs) and the frequency of use of high-complexity procedures. A questionnaire survey of 165 Alabama physical therapists was conducted to establish 1) the ranking of 24 physical therapy procedures according to the perceived level of complexity and 2) the relationship of a procedure's rank to delegation of that procedure to support personnel. The ranking and a cluster analysis of the 24 procedures correlated with similar ranking in other studies (Pearson r = .92). The level of complexity of a procedure influenced delegation to support personnel, with high-complexity procedures being delegated less frequently and requiring greater supervision than moderate- and low-complexity procedures. There was variation in the frequency of use of procedures, but a clear relationship was not found between a high level of professional involvement and use of high-complexity procedures. A relationship existed between professional involvement and both job title and types of referrals received. Those physical therapists with a higher level of professional involvement tended to be directors and supervisors (chi 2 = 28.29, df = 2, p less than .001), and they received autonomous referrals with greater frequency than those physical therapists with a lower level of involvement (chi 2 = 16.25, df = 3, p less than .001). The findings have implications for the continued professionalization of physical therapy and for the role that physical therapy educators and administrators play in this process.

Administrative Personnel↗
PubMed2003

Finding meaning in medical necessity.

Managed care organizations have become partners in patient care through their representatives/liaisons---care managers. This article uses personal experiences and relevant literature to highlight the professional conflicts care managers face in the struggle to fulfill two main clinical functions: applying criteria to determine medical necessity and educating practitioners and patients about effective and efficient treatments. Many care managers struggle to maintain cordial relationships with colleagues, while determining which requests for treatment are necessary versus discretionary, and insuring treatment excellence.

Case Management↗
PubMed2005

Social work in Jewish community centers: a question of compatibility.

This article focuses on the Jewish community center JCC) as a host setting for social work practice. Findings of a national study of JCC professional staff designed to explore the degree of congruence between social work values and JCC practice are presented. The findings have implications for other sectarian and nonsectarian host settings providing similar types of services. The survey was sent to practitioners at 191 of 200 JCCs. The sample was drawn from a population of MSW and non-MSW personnel. Respondents were asked to indicate the extent to which they fulfilled particular social work responsibilities. One-way analysis of variance (ANOVA) and the independent t tests were used to analyze the data. The study findings demonstrate that social workers actively call on their knowledge, values, and skills, deal with the social welfare concerns of constituents, and use the agencies' Jewish function as a guide for their practice.

Analysis of Variance↗
PubMed1979

Development of departmental promotion guidelines.

In making optimum use of its faculty, a medical school department should ensure that each faculty member has a clear understanding of what is expected of him and what will be evaluated when he is considered for reappointment or promotion. A set of departmental promotion guidelines which are available to all faculty can serve both these ends. In addition to defining the nature of the work which will be evaluated and stressing that performance quality is important, such guidelines should make explicit the various ways in which the work will benefit the department, the medical school, and the discipline. The guidelines can be used at the time of promotion, but they should also contribute to an ongoing evaluation of faculty work by the administration and by the faculty themselves.

Achievement↗
PubMed1988

Student evaluation of accelerated program at the University of Miami.

The University of Miami School of Medicine has an accelerated, six-year B.S.-M.D. program called the Honors Program in Medicine (HPM). In 1985 the HPM and traditional program students were surveyed at the end of their first year in medical school regarding their opinions about accelerated medical education. Eighty-seven percent of the traditional students felt that HPM students had ability equal to that of the average medical student (that is, neither more nor less ability), but 41 percent felt that the HPM students were less mature than the average class member. The traditional students felt the HPM students were required to follow a rigid collegiate curriculum (76 percent) and had an inadequate nonscience background (68 percent) and that the HPM would negatively affect both the future professional competence of HPM participants (59 percent) and the medical profession (34 percent). A larger percentage of the HPM than the traditional students (63 versus 48 percent) reported earning more than a minor in nonscience subjects, and fewer HPM than traditional students (9 versus 36 percent) felt that pressure to maintain a high grade-point average limited their selection of college courses. The HPM students felt that they were well prepared for medical school academically (82 percent) and emotionally (91 percent). The HPM students excelled academically in college and in the preclinical curriculum.

Attitude↗
PubMed1991

A review of the validity and accuracy of self-assessments in health professions training.

Valid self-assessment is fundamental to continuing professional competence but is seldom explicitly taught in health professions training. This review analyzed 18 scholarly articles published between January 1970 and February 1990 (14 articles regarding health professions trainees, and four concerning college students or graduate trainees) in which it was possible to compare performance as self-assessed by trainees with performance as assessed by experts or objective tests. The validity of self-assessed performance was found to be low to moderate and did not improve with time in conventional health professions training programs. Self-assessed performance seemed closely related to generalized self-attributions and was minimally influenced by external feedback in the form of test scores, grades, or faculty assessments. In five programs emphasizing explicit self-assessment goals and training strategies, moderate-to-high validity outcomes or improvements over time were demonstrated. Much of what passes for self-assessment in training seems the exercise of an underdeveloped skill, but effective training to improve validity and accuracy is available and feasible.

Health Personnel↗
PubMed1998

Responsive medical professionalism: integrating education, practice, and community in a market-driven era.

Revolutionary changes in the nature and form of medical practice institutions are likely to reverberate backward into medical education as leaders of the new practice organizations demand that the educational mission be responsive to their needs, and as these demands are increasingly backed by market power. In the face of this pressure, medical education's traditional response--that it should have autonomy in defining its mission--is no longer viable. Instead, more explicit, formal, and systemic linkages between practice and educational institutions are inevitable. The crucial question is whether these linkages will reflect the values of the market, oriented by economic self-interest, or the values of medical professionalism, oriented by the obligation to sacrifice economic self-interest in the service of patients. The authors maintain that the realization of the normative ideal of professionalism in medical education within the emerging market environment requires that a vision be articulated that is distinct from that of either autonomy or the market, and that combined lay-professional institutions be established to integrate--and perhaps merge--education and practice, and to foster responsiveness to lay values and community needs. The authors conclude by briefly describing examples of current efforts in this direction.

Academic Medical Centers↗
PubMed2002

The anatomy of the professional lapse: bridging the gap between traditional frameworks and students' perceptions.

PURPOSE: To support students' developing professionalism, it is necessary to understand the professional challenges and dilemmas they perceive in the clinical setting. This study systematically documented and catalogued students' reports of professional lapses. METHOD: Six focus groups were conducted with senior medical students (n = 29) at three universities. Using a grounded-theory approach, three researchers analyzed the students' reports of specific lapses in professionalism for recurrent themes. The resulting coding structure was applied using NVivo qualitative data analysis software. RESULTS: A total of 120 pages of text yielded 48 specific incidents of professional lapses, which were analyzed by three researchers using grounded theory. Most incidents were witnessed (n = 34) or known about (n = 4), as opposed to self-reported (n = 10). Six critical "issues" emerged: communicative violations (to or about patients or other health care professionals); role resistance (individuals chafing against constraints or expectations of their perceived roles); objectification of patients (ignoring patients or treating patients as vehicles for learning); accountability (to colleagues or patients, including avoiding patients, failing to disclose information, or failing to treat appropriately); physical harm (to patients or others); and crossfire (being put in the middle of a struggle between superiors). CONCLUSIONS: This study explored how students experienced and operationalized professionalism in clinical settings at a variety of universities. Interestingly, the critical issues they reported as salient did not map easily onto standard, abstract definitions of professionalism. This incongruence suggested that the development of effective curricula in this domain must bridge the gap between traditional taxonomies and students' perceptions of professionalism.

Canada↗
PubMed2002

Using the American Board of Internal Medicine's "Elements of Professionalism" for undergraduate ethics education.

PURPOSE: To examine the feasibility of using the taxonomy of professional and unprofessional behaviors presented in the American Board of Internal Medicine's (ABIM's) Project Professionalism to categorize ethical issues that undergraduate medical students perceive to be salient. METHOD: Beginning second-year medical students at the University of Washington School of Medicine (n = 120) were asked to respond to three open-ended questions about professional standards of conduct and peer evaluation. Two of the authors read and coded the students' responses according to the ABIM's elements of professionalism (altruism, accountability, excellence, duty, honor and integrity, and respect for others) and the challenges to those elements (abuse of power, arrogance, greed, misrepresentation, impairment, lack of conscientiousness, and conflict of interest). Coding disagreements were solved using review and revision of the category definitions. New categories were created for students' responses that described behaviors or issues that were not captured in the ABIM's categories. RESULTS: A total of 114 students responded. The ABIM's professional code was adapted for students and teachers, making it context- and learning-stage-specific. One new category of challenges, conflicts of conscience, was added, and one category (abuse of power) was expanded to include abuse of power/negotiating power asymmetries. CONCLUSIONS: Using the ABIM's taxonomy to name professional and unprofessional behaviors was particularly useful for examining undergraduate medical students' perceptions of the ethical climate for learning during the first year of medical school, and it holds promise for research into changes in students' perceptions as they move into clinical experiences. Using the framework, students can build a unified professional knowledge-and-skills base.

Behavior↗