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PubMed1993

The importance of strong evaluation standards and procedures in training residents.

A strong evaluation process in a residency offers faculty an opportunity to strengthen the educational program, to help residents know what is expected of them, and to remove with minimum difficulties those residents who are not progressing satisfactorily and do not appear to be salvageable. Despite these advantages, the evaluation of residents during their training is often done poorly or not at all. The author describes the kinds of standards and procedures that constitute a sound, strong evaluation process, proposes criteria for academic probation and due process when a resident is performing unacceptably, and describes the role that the medical school administration should play in the evaluation process, one that is flexible enough to allow each program to comply and still have program-specific procedures. The author closes with statistics on how few residents are dismissed for incompetency or unacceptable behaviors, and inquires how many more might be found if strong evaluation processes were more widely used. Even so, in the attempt to evaluate residents and to foster protection from legal problems, residency program directors must keep in mind the importance of letting residents make mistakes and learn from them; a good evaluation system strikes a balance that fosters the learning process and benefits the residents, the medical school, and the community.

Clinical Competence↗
PubMed1994

The Sophie Davis School of Biomedical Education: the first 20 years of a unique BS-MD program.

BACKGROUND: Since 1973 the Sophie Davis School of Biomedical Education, City University of New York Medical School, has integrated baccalaureate education with preclinical medical education; its graduates earn BS degrees in five years and are then eligible for entry into the traditional third year of medical school at one of seven participating medical schools in New York State. The school has a twofold mission: (1) to expand access to medical careers among inner-city youths, particularly among underrepresented minorities, and (2) to encourage the pursuit of primary care specialties among its graduates. METHOD: To assess the extent to which the two goals of the school have been met, the authors collected and analyzed information on the 1,402 students who entered Sophie Davis between 1973 and 1992, especially the 1,068 students from the 15 classes that entered the school from 1973-74 through 1987-88. In particular, the analysis focused on data on academic achievement and on choice of practice specialty. Where possible, state and national data were used for comparison. RESULTS: The results suggest that the school has achieved varying degrees of success: (1) The program has expanded access to medical careers among underrepresented-minority students at success rates well above national averages for college freshmen entering traditional premedical curricula. (2) Graduates have chosen primary care specialties at a somewhat higher rate than the national average, despite the school's lack of official involvement with students once they began clinical training in medical school. CONCLUSION: The aggregate data show that the school has achieved success in expanding access to medical careers for inner-city youth (especially among underrepresented minorities) and has been at least partially successful in nurturing primary care physicians. The latter goal may be realized more fully if the school becomes more involved in the clinical education of its graduates.

Career Choice↗
PubMed1998

Attrition rates of underrepresented minority students at the University of Illinois at Chicago College of Medicine, 1993-1997.

PURPOSE: To examine the attrition rates of underrepresented minority (URM) students and non-URM students at the University of Illinois at Chicago's College of Medicine (UIC-COM). METHOD: The study used 11 categories of information about URM and non-URM students at UIC-COM for the five academic years 1993-1997 to determine how many students withdrew and why. RESULTS: Of 895 graduates during these five years, 166 (18.5%) were URM students. The attrition rates were 6.5% for all graduates, 16.2% for URM students, and 4.0% for non-URM students. Students who withdrew because of academic difficulties comprised 75% of URM withdrawals and 57% of non-URM withdrawals. CONCLUSION: Many URM students need special academic attention after matriculation. Existing academic support programs should be assessed regularly to ascertain whether they may be improved to minimize attrition.

Chicago↗
PubMed1999

Why students drop out of the pipeline to health professions careers: a follow-up of gifted minority high school students.

PURPOSE: To track gifted underrepresented minority (URM) students who entered the pipeline to health professional school when they were in high school and to determine whether and why students left the pipeline to enter other professions. METHOD: A questionnaire was mailed to 162 students who had participated in the Student Educational Enrichment Program (SEEP) in health sciences at the Medical College of Georgia between 1984 and 1991; 123 (75%) responded. RESULTS: Students in the study population had higher graduation rates than the average state or national student. Fifty-nine (48%) of the students had entered health care careers; 98% had stated that intention when they were in high school. Although some of the students stated trouble with course work and GPA as reasons for their decisions to change career tracks, many students said that their interests in non-medical careers had been fostered by mentors or by opportunities to serve internships. CONCLUSION: Early intervention is important to retaining students in a pipeline that leads to a health care career. Summer programs are successful, but may not be enough to help students with difficult science courses in college, especially chemistry. However, another important conclusion is that much more needs to be done to help students find mentors with whom they can develop relationships and to give them opportunities to work in health care settings.

Career Choice↗
PubMedDate not supplied

Language disorders and learning disabilities in school-refusing adolescents.

OBJECTIVE: We undertook this study to test the hypothesis that school-refusing adolescents hospitalized on an inpatient psychiatric unit have more language and learning disabilities than diagnosis-, age-, and sex-matched psychiatric controls. METHOD: The Woodcock-Johnson Tests of Achievement-Revised (WJTA-R), the WISC-R, the Adolescent Language Screening Test, the Clinical Evaluation of Language Fundamentals-Revised, and the Test of Language Competence (TLC) were given to a group of well-characterized, primarily depressed school refusers and matched psychiatric controls. RESULTS: We found that school-refusing adolescents had significantly lower WISC-R verbal intelligence scores, lower Math and Written Language subscale scores on the WJTA-R, and lower scores on the TLC than nonrefusers. School refusers were found to have a significantly higher incidence of both language impairments and learning disabilities than controls. CONCLUSIONS: We infer that academic and communicative frustration and the adolescent's resulting inability to meet the academic and social demands in the school environment may play a role in the etiology of school refusal.

Adolescent↗
PubMed1999

ADHD boys in young adulthood: psychosocial adjustment.

OBJECTIVE: To prospectively examine psychosocial functioning in young adulthood in children with attention-deficit/hyperactivity disorder (ADHD). METHOD: This 10-year prospective study compared psychosocial functioning in 18 young adult men in whom ADHD had been diagnosed in childhood and 18 male controls who had never been psychiatrically ill. Subjects' average age was 21 years at follow-up. Interviews assessed subjects' educational, occupational, residential, and marital status; utilization of mental health services; and psychological status. RESULTS: Young adults with ADHD were significantly more likely than controls to be using mental health services, to report psychological problems, and to have fathered children. In addition, a trend indicated that young men with ADHD were more likely to have dropped out of high school but subsequently attained a graduate equivalency diploma. There was also a trend for young adults with ADHD to report a greater history of trouble with the law; however, the groups did not differ on current legal problems. CONCLUSIONS: Overall, these young adults with ADHD appear to have overcome educational and legal difficulties experienced during high school. However, continued problems in psychological functioning appear to persist into young adulthood.

Adult↗
PubMed2000

School consultation: a review of research on issues unique to the school environment.

OBJECTIVE: To provide clinicians with current information to assist in their consultations to schools on 4 major topics that are unique to the school environment and of serious concern to educators: absenteeism, disciplinary referrals, retention (non-promotion), and dropping out. METHOD: Computer literature searches and the major journals of the various school disciplines were used to identify empirically based articles with sound methodology. Information on each of the 4 issues is presented as general characteristics, characteristics of psychopathology, prevention and treatment, and implications for consultation. RESULTS: Findings are largely general, with little specific information on level of intelligence, learning disorders, psychopathology, or family stressors. Students under each topic have varied presentations. However, many pupils with absenteeism, disciplinary referrals, or retention appear to be characterized by chronic and serious academic and/or behavior problems, all of which can predate dropping out. CONCLUSIONS: Considerable research is still needed on all 4 school issues, especially psychopathology. Nevertheless, consultants can reasonably first help schools to identify students at risk for the 4 outcomes, followed by appropriate screening/evaluation to indicate more clearly their true intervention needs. The ongoing process can further educate school staff about psychiatric disorders in their most problematic students.

Absenteeism↗
PubMed2001

School refusal in children and adolescents: a review of the past 10 years.

OBJECTIVE: To critically review the past 10 years of research on school refusal in children and adolescents. METHOD: Literature on school refusal published from 1990 onward was reviewed following a systematic search of PsycINFO. The review focuses on definitional issues, epidemiology and school refusal identification, diagnostic considerations, family functioning, assessment, treatment, and follow-up studies. RESULTS: While definitional and conceptual issues are still evident, promising developments have occurred in relation to assessment and treatment practices and understanding of the family context of school refusal. CONCLUSIONS: From a clinical viewpoint, school refusal cases require comprehensive assessment and treatment. Advances have been made in the treatment of school refusal. However, additional controlled studies evaluating interventions for school refusal are needed.

Adolescent↗
PubMed2001

Treatment of school refusal: one-year follow-up.

OBJECTIVE: To conduct a 1-year follow-up of anxious-depressed school-refusing adolescents who participated in an 8-week study of imipramine versus placebo, each in combination with cognitive-behavioral therapy. METHOD: Sixty-five percent (41 of 63) of the randomly assigned subjects returned for follow-up evaluation, which consisted of diagnostic interviews, clinician rating scales for anxiety and depression, family functioning measure, and a questionnaire regarding interim treatments and school programs. RESULTS: From the adolescent and/or parent perspective, 64.1% met criteria for an anxiety disorder and 33.3% met criteria for a depressive disorder. Remission rates and acquisition rates for specific anxiety and depressive disorders were determined. In the follow-up period, 67.5% received at least one psychotropic medication trial and 77.5% had outpatient therapy. Higher level of somatic complaints on the Anxiety Rating for Children-Revised Physiological subscale at baseline predicted more severe depression on the Children's Depression Rating Scale-Revised at follow-up (p = .029). CONCLUSIONS: In this naturalistic follow-up study, there was high utilization of mental health interventions. In addition, a substantial number of subjects met criteria for anxiety and/or depressive disorders 1 year after treatment. Investigation of duration of acute treatments and evaluation of maintenance treatments for school refusal is needed.

Adolescent↗
PubMed2003

Predictors of treatment response in anxious-depressed adolescents with school refusal.

OBJECTIVE: To identify predictors of treatment response to 8 weeks of cognitive-behavioral therapy (CBT) among anxious-depressed adolescents with school refusal, half of whom received imipramine plus CBT and half of whom received placebo plus CBT. METHOD: A hierarchical multiple regression analysis was used to evaluate the following variables as potential predictors of treatment response as measured by school attendance at the end of treatment: baseline severity (school attendance at baseline), drug group (imipramine versus placebo), presence of separation anxiety disorder (SAD), and presence of avoidant disorder (AD). RESULTS: Baseline attendance, CBT plus imipramine, SAD, and AD were significant predictors of treatment response and accounted for 51% of the variance in outcome. Specifically, a higher rate of attendance at baseline and receiving imipramine predicted a better response to treatment whereas the presence of SAD and AD predicted a poorer response to treatment. The relationship between sociodemographic variables and treatment outcome was also evaluated. Age and socioeconomic status were unrelated to school attendance after treatment. Males had significantly higher rates of attendance after treatment than females. CONCLUSIONS: Adolescents with school refusal are a heterogeneous population and require individualized treatment planning. Variables such as diagnosis and severity at the start of treatment should be taken into consideration when planning treatment.

Adolescent↗
PubMedDate not supplied

Antecedents of nursing school attrition: attitudinal dimensions.

In an attempt to identify attitudinal orientations that might be used as indicators of attrition, demographic, academic performance, and attitudinal data on 261 students enrolled in the Woodruff School of Nursing at Emory University, Atlanta, between 1968 and 1972, were studied. Traditional measures of scholastic aptitude were not found to be good indicators. The higher the father's educational attainment, the more likely attrition was to occur. The higher the mother's occupational status, the less likely attrition was to occur. Attitudinal measures used in the study seemed to have little direct impact on attrition.

Attitude↗
PubMedDate not supplied

The faculty advisor role: an imperative for student retention.

The decline in applicants to schools of nursing emphasizes the importance of retaining those students who do enroll. The authors review factors affecting student attrition and retention in academic settings. They then present an ideal model for enhancing student retention through effective, individualized, and consistent student advising.

Education, Nursing, Baccalaureate↗