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PubMed1994

Homework and students with learning disabilities and behavior disorders: a practical, parent-based approach.

This article provides a limited review of the effects of homework on students with disabilities, the essentials of effective homework programs, and variables that affect home-school partnerships. The emphasis is on students with learning disabilities and behavior disorders who are at risk for academic failure and poor school adjustment. The authors introduce the University of Utah Homework Partners series, which highlights three homework packages: a cooperative learning teams-based approach for classrooms, a package to train parents to be positive academic tutors for their children, and a systematic program to train parents in effective homework practices. The latter package is the major focus of this article because it emphasizes home-school partnerships for students with disabilities. Sanity Savers for Parents: Tips for Tackling Homework is a training program that teaches parents how to assess, design, and troubleshoot an effective in-home homework program for their child. The overall emphasis of this program is on practical interventions that are positive and motivating and include a home-to-school link to maximize the generalization of effects for students with learning and behavior disabilities.

Achievement↗
PubMed2002

On-site screening sigmoidoscopy promotes long-term utilization but fails as a venue for training primary care endoscopists.

BACKGROUND & AIMS: "Academic detailing" is an effective strategy for promoting the use of screening sigmoidoscopy by primary care physicians. The primary objectives of this study were to determine whether the sustained presence of an "outside" university-based gastroenterologist performing on-site screening sigmoidoscopy promoted long-term utilization and whether the provision for on-site sigmoidoscopy was an effective venue for training primary care endoscopists. METHODS: Nine urban community health centers, including 4 intervention and 5 control sites, participated in a nonrandomized controlled trial conducted over 3 years. RESULTS: By the end of year 3, overall self-reported use of screening sigmoidoscopy increased by 61% for the intervention group vs. only 25% for the comparison group (P = 0.001). Ninety-seven percent of those reporting compliance referred 1 or more asymptomatic average-risk patients for screening examinations. Only 2 of 83 (2.4%) eligible providers completed on-site training and continued performing screening examinations independently. The major barriers to participation included lack of interest, lack of time to learn or perform sigmoidoscopy, concerns about technical competence, and lack of need because of on-site availability. CONCLUSIONS: Maintenance of on-site screening sigmoidoscopy services performed by an outside gastroenterologist promotes long-term utilization but fails as venue for training primary care endoscopists. Alternative strategies for expanding capacity are needed.

Adult↗
PubMed1996

Dissemination of the work of public health medicine trainees in peer-reviewed publications: an unfulfilled potential.

OBJECTIVE: To assess the extent to which work undertaken during training in public health medicine was formally disseminated in peer-reviewed publications. SETTING: An English Health Region. METHODS: A postal questionnaire survey of former and current senior trainees. RESULTS: The response rate was 75% (38/51). Thirty per cent (11/37) had no publications arising from any work undertaken during training and specifically 49% (18/37) had no publications arising from submissions made for the Part II examination for Membership of the Faculty of Public Health Medicine. Major perceived barriers to publication were: lack of priority accorded to publication by the training department; lack of time and lack of a supervisor or mentor to facilitate preparation of material. CONCLUSIONS: Overcoming these perceived barriers will require action at trainee, trainer and organisational level. Skills training in writing could be included in academic courses and publication could be identified as a training goal for appropriate pieces of work. Health authorities could be more active in encouraging publication of work undertaken by trainees on their behalf.

Authorship↗
PubMed2001

Combined internal medicine-psychiatry and family medicine-psychiatry training programs, 1999-2000: program directors' perspectives.

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.

Attitude of Health Personnel↗
PubMed1993

Area of Concentration programs in university-based family practice residency training.

To encourage pursuit of focused academic and clinical interest by family practice residents, we developed an Area of Concentration (AOC) program at a university-based residency program. The program uses resources available throughout the university and permits residents to focus on a variety of interest areas, including geriatrics, women's health, sports medicine, international health, behavioral medicine, and others. These AOCs are not fellowships but special longitudinal training experiences that occur throughout the duration of a standard residency program. Residents who have participated in our AOC program have become involved in research, published papers, and been invited to present their work at state and national meetings.

Curriculum↗
PubMed2001

Higher-education administrators: when the future does not make a difference.

The relationships between administrative actions and their long-term consequences were investigated in 14 people beginning training to become high-level college and university administrators, 19 people who had just finished that training, and 44 provosts (chief academic officers) at colleges and universities in the northeastern United States. The experienced administrators (those who had completed the training plus the provosts) were significantly more likely than the trainees to mention long-term consequences when describing their past and possible future administrative actions. However, in hypothetical choice situations, the experienced administrators were also significantly more likely than the trainees to choose smaller amounts offunds available immediately for their units versus larger amounts of promised future funds. With experience, administrators may both become more aware of their actions' long-term consequences and learn that they are unlikely to receive promised future funds. The contingencies in effect for higher-education administrators may lead them to make choices that do not result in their institutions meeting the highest standards.

Education↗
PubMed1978

Physician manpower needs and research training in infectious diseases.

As a result of recent and continuing studies of internal medicine manpower, data are now becoming available on training and manpower, data are now becoming available on training and manpower in infectious diseases. In 1976-1977, there were 121 training programs graduating a total of about 180 infectious disease specialists each year. Most funding for these fellowship programs comes from the federal government and hospital revenues. It is conservatively estimated that 2300 medical subspecialists in infectious diseases will be practicing in 1986-1987. About 55% of graduates of infectious diseases training programs plan careers in academic medicine. Information from manpower studies should be of value in the development of a national policy on the training of infectious disease specialists.

Education, Medical, Graduate↗
PubMed1991

The Psychology Student Stress Questionnaire.

Stressors of graduate psychology training remain relatively unexplored. The Psychology Student Stress Questionnaire (PSSQ) was developed to assess the impact of emotional, financial, and academic stressors of graduate psychology training on students. The PSSQ was administered, along with the Symptom Check List-90-R and the Health and Daily Living Form, to 133 graduate psychology students. Significant though limited correlations were obtained between the PSSQ and the two stress measures. Factor analysis of the PSSQ yielded seven underlying factors; time constraints accounted for the greatest variance in stress ratings. Female students had higher stress scores than males. These results suggest that the PSSQ could be useful in exploring student stress in graduate psychology training.

Achievement↗
PubMed1987

CMHC's: relationships with academia and the state.

We have surveyed all community mental health centers (CMHC's), state departments of mental health, and university departments of psychiatry in the country to ascertain the status of their relationships with one another. The response rate to a one page questionnaire was 33%. An overwhelming percentage, 88%, of CMHC's have relationships with state hospitals and/or academia. Most often they consist of a service relationship. The control for such relationships is most often shared or there is no one controlling organization. The benefits of such relationships include improved communication, improved access to state hospitals, and improved quality of inpatient and outpatient care. CMHC's who responded to our survey did not think that relationships with the state or academia resulted in improved recruitment of psychiatrists and improved residency training--but state and academic respondents did. All, however, agreed that research, long-term care, and recruitment of other staff are minimally improved by collaborative relationships.

Combined Modality Therapy↗
PubMedDate not supplied

Training for laparoscopic surgery.

Laparoscopic cholecystectomy has rapidly become the procedure of choice for most patients with symptomatic gallbladder disease. Laparoscopic surgery, however, has not been a required component of most general surgery training programs. The demonstrated efficacy of laparoscopic surgery dictates that this discipline be rapidly incorporated into residency programs. Laparoscopic cholecystectomy and other surgical endoscopic procedures have been an integral part of the training program at the University of Maryland since 1989. Currently, residents who are completing their training have performed on average 50 to 75 laparoscopic procedures as the primary surgeon and 25 to 30 as the first assistant. In addition to training future community and academic physicians, those surgeons currently in practice must receive appropriate instruction in laparoscopic surgery. Most practicing surgeons attend a 2- to 3-day intensive course offering both didactic and hands-on experience. Additional exposure to clinical cases is achieved by working with other surgeons with laparoscopic expertise. Full credentialing in laparoscopic cholecystectomy generally requires proctoring by a surgeon from the local community. Since 1990 faculty from the University of Maryland have been active in the local community serving as proctors to surgeons in 14 hospitals.

Credentialing↗
PubMed1994

Use of psychoactive substances in three medical specialties: anaesthesia, medicine and surgery.

In order to determine the prevalence of psychoactive substance use in three specialty groupings, 1,624 questionnaires were sent to physicians in medicine, surgery and anaesthesia; all had trained at the same academic institution. A response rate of 57.8% was achieved. Comparison of prevalence of impairment rates showed no differences between Surgery (14.4%), Medicine (19.9%) and Anaesthesia (16.8%). Substance abuse was clearly associated with a family history of abuse; 32.1% of the abusers had a family history of such abuse compared with 11.7% of the non-abusers. Increased stress at various career stages did not appear to increase substance abuse; problem areas during medical life times were similar for each specialty. Substances most frequently used were marijuana (54.7%), amphetamines (32.9%); and benzodiazepines (25.1%). Seventy-three used psychoactive drugs which were non-prescribed. Drug counselling programmes were judged inadequate by most. Use of alcohol and drugs by faculty members was reported by a number of respondents.

Adult↗
PubMed1996

Trauma care in China: challenge and development.

The People's Republic of China has significantly improved the general health of its people by a concerted effort in primary health care but trauma care and its prevention remains a problem. This paper provides an overview of the strengths and weaknesses of the trauma-care system in China and proposes a strategy for its future development. This includes public-health legislation, the integration of military and civilian practice to provide comprehensive care from the scene of the incident through to rehabilitation, medical audit, the introduction of postgraduate trauma-management training courses and international academic exchanges.

China↗
PubMed1995

Child neurology in Taiwan, ROC: past, present and future.

The status of child neurology in Taiwan is analysed as to three stages, i.e., past, present and future. The year of demarcation between the past and present is set arbitrarily at 1988, when the academic organization changed. Each stage is reviewed from four aspects--academic organization of subspecialty training and research, change in disease pattern, diagnostic procedure, and treatment.

Child↗
PubMed2005

South Asian participation in clinical trials: the views of lay people and health professionals.

There is little UK-based empirical research on South Asian participation in clinical trials. The predominantly US literature rarely engages with mainstream debates about ethnicity, diversity and difference. This study was prompted by a lack of knowledge about how South Asian people perceive trial involvement and the risks and benefits involved. Face to face interviews were conducted with 25 health professionals (consultants, GPs, nursing staff, academics, non-medically trained trial co-ordinators, LREC and MREC members) and 60 South Asian lay people (20 Indians, 20 Pakistanis and 20 Bangladeshis) who had not taken part in a trial. The study took place in the Leeds and Bradford areas of England. It was found that lay South Asian attitudes towards clinical trial participation focused on similarities rather than differences with the general UK population, suggesting that the relevance of ethnicity should be kept in perspective. There was no evidence of antipathy amongst South Asians to the concept of clinical trials, and awareness was a correlate of social class, education and younger age. Lay factors that might affect South Asian participation in clinical trials included: age; language, social class; feeling of not belonging/mistrust; culture and religion. Approachable patients (of the same gender, social class and fluent in English) tended to be 'cherry picked' to clinical trials. This practice was justified because of a lack of time, resources and inadequate support. South Asian patients might be systematically excluded from trials due to the increased cost and time associated with their inclusion, particularly in relation to the language barrier. Under-representation might also be due to passive exclusion associated with cultural stereotypes. The paper concludes by applying the theoretical framework of institutional racism as a means of making sense of policy and practice. At the same time, caution is advocated against using ethnicity as the only form of discrimination facing minority ethnic populations.

Adult↗
PubMed2005

Determinants of physician use of an ambulatory prescription expert system.

PURPOSE: To determine whether physician experience with and attitude towards computers is associated with adoption of a voluntary ambulatory prescription writing expert system. METHODS: A prescription expert system was implemented in an academic internal medicine residency training clinic and physician utilization was tracked electronically. A physician attitude and behavior survey (response rate=89%) was conducted six months after implementation. RESULTS: There was wide variability in system adoption and degree of usage, though 72% of physicians reported predominant usage (> or =50% of prescriptions) of the expert system six months after implementation. Self-reported and measured technology usage were strongly correlated (r=0.70, p<0.0001). Variation in use was strongly associated with physician attitude toward issues of system efficiency and effect on quality, but not with prior computer experience, level of training, or satisfaction with their primary care practice. Non-adopters felt that electronic prescribing was more time consuming and also more likely to believe that their patients preferred hand-written prescriptions. CONCLUSION: A voluntary electronic prescription system was readily adopted by a majority of physicians who believed it would have a positive impact on the quality and efficiency of care. However, dissatisfaction with system capabilities among both adopters and non-adopters suggests the importance of user education and expectation management following system selection.

Ambulatory Care Information Systems↗
PubMed2006

A qualitative study of the implementation of a bioinformatics tool in a biological research laboratory.

OBJECTIVE: To explore how the implementation of a comprehensive new bioinformatics analysis system would affect workflow, collaboration and information management in a small genetic research lab. DESIGN: This was a longitudinal qualitative study of seven individuals involved in genomic and proteomic research. The study data were gathered using the illuminative/responsive approach of immersion in the environment. Additional qualitative data were gathered using informal semi-structured interviews, participant observation in lab meetings, and direct observation of lab researchers engaged in specific tasks. MEASUREMENTS: Interview, observation and field note data were coded and analyzed based on three analysis perspectives. A subset of the data was independently evaluated by an external researcher to enhance the trustworthiness of results. RESULTS: Three reoccurring themes were observed in the study. (1) Satisfaction and acceptance of software tools tended to be role and goal specific. (2) The system was seen primarily as a measurement system rather than a "total laboratory analysis system". (3) Lab meetings deemphasized the system, preferring more traditional data analysis techniques. These themes support the observations that the system was not used to its full potential in the lab. CONCLUSION: Themes identified in this study suggest that sophisticated genetic researchers face similar problems of technology implementation as do professionals in other fields. We recommend that leadership support and on-going training and evolution of academic curricula can improve chances of bioinformatics analysis systems becoming used more effectively.

Computational Biology↗
PubMed2005

Ultrasound guidance during central venous catheterization: a survey of use by house staff physicians.

PURPOSE: The objective of this study is to explore the attitudes, knowledge, and behavior of house staff physicians regarding the use of ultrasound guidance (UG) during central venous catheter placement (CP). MATERIALS AND METHODS: A questionnaire-based study was used to survey house staff in multiple training programs at an academic tertiary care center. RESULTS: Fifteen percent of the respondents reported using UG on at least 60% of CP attempts. Those house staff physicians who agreed that UG is faster, easier, and more convenient than the landmark method reported more frequent use. Agreement that UG reduces the number of mechanical complications and placement failures was also associated with increased use. Respondents reporting the most CP experience were least likely to use UG. Most agreed that UG is useful in patients without good landmarks or when the landmark method failed, but these attitudes were not associated with the frequency of UG use. Most respondents were not aware of controlled trials demonstrating the benefits of UG. CONCLUSIONS: The use of UG during CP is infrequent despite the demonstrated benefits of this technology. Multiple knowledge and attitudinal barriers to the greater use of UG during CP must be addressed in the design of an effective UG implementation strategy.

Attitude of Health Personnel↗
PubMed1997

Intraoperative brain mapping in a community setting--technical considerations.

Intraoperative brain mapping is a surgical adjunct used during lesionectomy or epilepsy surgery in functional cortex. This procedure is typically performed at academic institutions by fellowship trained neurosurgeons. However, most of the technology is straightforward and adaptable to the private practice setting. This paper outlines our intraoperative methodology for brain mapping during lesion resection in eloquent cortex.

Brain Mapping↗