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An examination of the relationships among interpersonal stress, morale and academic performance in male and female medical students.

Conflicts between medical students and persons involved in their clinical training are a common, yet little studied, source of stress for students. The study reported in this paper examined the relationships between interpersonal stress, specific to training, and measures of students' morale and academic performance during the clinical phase of medical education. The results show that although interpersonal stress was inversely related to morale in both male and female students, the relationship was stronger for females. Morale and interpersonal stress variables strongly predicted the academic performance of female students, as measured by the grades they received in clinical clerkships and their scores on the Part II examination of the National Board of Medical Examiners. The results for males were less clear-cut, as the predictor variables were significantly related to only one of the two performance measures. These findings are consistent with the view that non-cognitive factors have particular relevance for the performance of female medical students.

Achievement↗

The effect of oculomotor training on reading efficiency.

The purpose of this study was to record and measure, by means of a microcomputer, the reading eye movements and reading efficiency of a sample of "poor readers" from an adult, professional school population. A program of oculomotor skill enhancement training was given to 10 students who failed an academically appropriate reading test. Their pre- and post-training reading performance was compared to that of a group of students who also failed the reading test but received no such training. All subjects' eye movements were monitored and recorded individually while reading, using a Visagraph Eye-Movement Recording System. The subjects were split into an experimental group (receiving training) and a control group (receiving no training). Following a 12-hour program of "in office" and "home" training, the group receiving oculomotor training showed trends toward improved reading eye movement efficiency (number of regressions, number of fixations and span of recognition), compared to that of the untrained group.

Dyslexia↗

Where we've been, where we are, and where we're going: emergency medicine--past, present, and future.

The challenge to emergency medicine for the future is to maintain the intensity of attraction and appeal that the specialty currently enjoys through the next decade and beyond. This will only be accomplished by attracting some of this bright young talent into full-time academic emergency medicine for research and teaching activities. Currently there are unfilled academic positions in the department at LAC/USC Medical Center and across the country in emergency medicine. This is because the salaries are not competitive, and most physicians completing their residencies with indebtedness for their education have the need of high income for a period after residency training. However, few return to academic medicine after becoming accustomed to a higher standard of living. This trend must change if we are to maintain the cutting edge of clinical emergency medicine and become the academic equivalent of the other specialties. The 12 physicians who founded ABEM, and especially the remaining six founding members who will be leaving the Board in a few days, feel honored that you selected us to serve. I am deeply grateful that you selected me to give the Kennedy Lecture, though I must admit to moments of anxiety and panic these last few weeks and days. Also, I would like to thank all the candidates for Board certification whom it was my privilege to examine during a delicate and stressful moment of their professional lives. It is really they who make the job worthwhile. Hopefully, we have laid a good foundation so that we can legitimately say the "ball" is yours now, "run with it."

Career Choice↗

Academic preparation of athletic trainers as counselors.

Athletic trainers have assumed several roles and responsibilities over the years, but perhaps there is no more important role than that of a counselor. Are they prepared to do so? One hundred and thirty-two modified Revised Wylie Inventories were mailed to college/university athletic trainers to examine their educational preparation and experiences with counseling in various areas. Most athletic trainers surveyed reported that they were predominantly counseling in the areas of injury prevention, injury rehabilitation, and nutrition, and felt academically prepared to do so. However, it was reported that preparation to counsel in other less common areas (eg, family matters, financial matters, etc) was not adequately addressed in academic programs. The athletic trainers surveyed sought continuing education in order to meet the other counseling needs of student-athletes. Although they used several psychological referral services, it was apparent that most athletic trainers frequently served as counselors on many nonorthopedic topics. We suggest that athletic training educators consider incorporating both academic knowledge and clinical experience in a wider variety of counseling areas into their curricula.

Journal Article↗

Assessing research methodology training needs in emergency medicine.

OBJECTIVE: To determine the perceptions of emergency medicine (EM) academic faculty leaders and other academic emergency physicians regarding importance and knowledge of specific research methodology content areas and training priorities. METHODS: The authors conducted a confidential mail survey of 52 EM academic chairs, 112 residency directors, 116 research directors, and 400 randomly selected other members of the Society for Academic Emergency Medicine (SAEM). Respondents rated the importance of knowledge about each of 12 content areas for enhancing research productivity, rated their own knowledge of these areas, and identified training priorities. Standard descriptive statistics were used to characterize the study population; subgroup differences were examined by nonparametric statistics. RESULTS: 551 (81%) of those sampled returned surveys. Most (90%) respondents thought that knowledge about all selected content areas was important for enhancing research productivity; however, 7-37% (depending on the topic) reported little knowledge or experience in specific areas. Research directors reported highest overall knowledge levels (p < 0.001), followed by chairs, residency directors, and other SAEM members. Top training priorities (identified by all subgroups) included study planning (70%), problem identification/hypothesis construction (41%), and proposal writing (38%). CONCLUSIONS: These data support the continued need to offer broad training in research methodology, but suggest that greater emphasis be given to concepts involved in initiating and planning a study and to strengthening research proposal writing skills. These results should be of interest to academic departments who must address their own training needs, and help support the development of research methodology curricula on regional and national levels to advance the state of research in the specialty of EM.

Attitude of Health Personnel↗

Occupational medicine residency training programs. The role occupational health nurses play.

An experienced occupational health nurse with suitable academic qualifications is able to assist in providing a well-rounded education and teaching physicians to be effective members of occupational health teams. Nurses are involved in teaching occupational health to physicians in the academic and practicum phases of occupational medicine residency training programs. However, the involvement of nurses in training physicians is inconsistent among the accredited residencies. Most of the nurses involved in teaching occupational health to physicians are at least master's degree prepared. Nurses are involved in the didactic, clinical, and administrative components of the training programs. Though nurses are involved in residency training programs to an extent, the lack of consistent involvement limits the diversity of points of view and fosters an imbalance in the training of occupational medicine residents.

Curriculum↗

Simulation based medical education: an opportunity to learn from errors.

Medical professionals and educators recognize that Simulation Based Medical Education (SBME) can contribute considerably to improving medical care by boosting medical professionals' performance and enhancing patient safety. A central characteristic of SBME is its unique approach to making (and learning from) mistakes, which is regarded as a powerful educational experience and as an opportunity for professional improvement. The basic assumption underlying SBME is that increased practice in learning from mistakes and in error management in a simulated environment will reduce occurrences of errors in real life and will provide professionals with the correct attitude and skills to cope competently with those mistakes that could not be prevented. The main message of the present paper is that this assumption, which serves as the driving force of SBME, should also serve as a starting point for critical thinking and questioning regarding the multiple aspects and components of SBME. These questions, in turn, should lead to empirical research that will provide feedback concerning changes that may be necessary in order to attain the goal of improving medical professionals' performance. Based on such research, SBME will be held accountable for its outcomes, i.e. whether its educational techniques indeed result in decreased occurrence of errors or not, and whether the ability to cope with the errors that do occur is significantly improved. The first of three issues that were addressed concerns individuals' experience of performing mistakes. It is suggested that in order to benefit fully from the experience of performing mistakes in a simulated context, medical educators should create a balance between the emotional load associated with the experience and the professional lessons that can be learned. Furthermore, research should focus on the long-term effects of the experience in changing professionals' attitudes and behaviour. The second question concerned the contribution of the different components of the educational experience to creating the desired changes in professionals' performance. Analysis of the teaching and learning involved in each stage of the educational event should serve as the basis for research that aims at identifying the unique contribution and efficiency of each element, and defining the essential core activities of a simulated experience. Finally, the need to define a newly emerging profession-SBME educator-was addressed. The professional qualifications are, clearly, multidisciplinary and should be based on the growing experience of medical educators in training students and professionals. Defining the profession is essential in order to create academic environments in which professionals will be trained to develop and implement new programmes, accompanied by research and assessment.

Attitude of Health Personnel↗

Careers in academic general practice: problems, constraints, and opportunities.

Changing priorities in the NHS have underlined the crucial importance of academic general practice in providing quality training and research to underpin developments in general practice. Unfortunately, several problems and constraints mean that the full potential of general practitioners to make a contribution to teaching and research has not been realised. These issues are examined and recommendations for improvements are made. Obstacles to career development for academics in general practice should be removed. The funding of academic general practice should be the same as for other medical disciplines. Vocational training for general practice should be extended to include research and audit methods, particularly for doctors interested in an academic career. Above all, the long term objective should be to integrate undergraduate and post-graduate general practice to increase the overall effectiveness of teaching and research and hence the quality of service general practice.

Academic Medical Centers↗

Students' perceptions of educational environment: a comparison of academic achievers and under-achievers at kasturba medical college, India.

CONTEXT: No country, least of all poorly resourced countries such as India, can afford to lose too many medical students in their undergraduate years. It would be useful to have an instrument to identify those students who are vulnerable to academic failure at this level of training and to identify the features of the educational environment that they perceive differently from students who are succeeding academically in order to design intervention strategies. Gender differences in perceptions of the educational environment might well emerge in particular academic or cultural contexts, with particular curricula. The present study was motivated by this concern and focused on comparisons between academic achievers and under-achievers and male and female students of Kasturba Medical College, India. OBJECTIVES: (1) To compare the perceptions of the educational environment of academic achievers and under-achievers and to identify problem areas that should be remediated. (2) To identify whether there is any gender difference in the perceptions. METHODS: The Dundee Ready Educational Environment Measure (DREEM) was administered to 508 medical students studying in the clinical years at the Kasturba Medical College in India. Item as well as scale scores were compared between academic achievers and under-achievers. FINDINGS: Overall sample of the present study rated educational environment in this institution as average. The overall mean DREEM score was significantly higher for academic achievers. Compared to under-achievers, academic achievers scored significantly higher on perceptions regarding teachers, academic atmosphere and social self-perceptions. In addition to this, the overall rating (total DREEM score) of female students was significantly less compared to males in the academically vulnerable group. CONCLUSIONS: Perceptions of poor performers are significantly different from those of better performers in the same institution. More importance should be given to the perceptions of students to improve the educational environment, as perceptions are associated positively with learning outcome, learning approach and attitude toward studying. Use of the DREEM as a monitoring tool might permit timely interventions to remediate problematic educational environments.

Achievement↗

Hospitalists in medical education: coming to an academic medical center near you.

Hospitalists are physicians whose medical practice focuses on general medical inpatient care. In the past decade, the number of practicing hospitalists has soared, and hospitalist programs have been established at both community hospitals and academic medical centers. As hospitalists increasingly assume a greater share of inpatient care responsibilities, they will contribute to the training of medical students and house staff. This paper reviews current data on the impact of hospitalists on medical education and the future of hospitalist training.

Academic Medical Centers↗

[The creation of a national faculty development program in Israel for family physicians].

University Departments from many countries recruit their faculty members for academic duties without prior formal training (specific for their jobs). This has been the common approach in Israel. Other countries however, have created faculty development (FD) programs to help new faculty accomplish their new tasks. This article describes the creation of the first National Faculty Development Program in Israel for Family Physicians. The main goals of a comprehensive FD program are to improve vitality in education, promote academic excellence and develop professional and organizational leadership. In 1998, the Israeli Society of Teachers in Family Medicine decided to develop a National Program to deal with basic FD requirements. Family Physicians and educationalists worked together at its development and cooperated in co-teaching. The program was launched in 2001 and we are now in the process of evaluating the first year and the development of the second course. We chose a format similar to the program from the University of Toronto. Twenty-three family physicians enrolled in the course. Half of the participants were born and trained in medicine in Israel. After completing the first year of this program, both participants and teachers provided positive feedback and requests were received for a second course for new participants.

Education, Medical, Continuing↗

[Community health as a determinant of the nursing curriculum].

This paper summarizes the experience acquired under the first university-level program for the basic training of nurses in Peru. It describes the gradual refining of the academic curriculum, which was designed not only to train people as competent professionals, but also to acquaint them with the country's basic social problems. Four levels of teaching-learning were defined in wide-ranging discussions in which various academic and professional sectors connected with the health field participated. Establishing a process of steps of increasing complexity has considerably facilitated the integration of community health, the scientific method, and mental health into the structure of the curriculum. The practice of community nursing was heavily emphasized, and it was endeavored to strike a balance between hospital experience and work in communities themselves. The program includes specific studies community groups spanning such aspects as control of the more common disease, epidemiologic surveillance, and accident and disaster prevention. Practical work in community health care earns the same credit as hospital internship. The paper closes with a description of the experience of a specific program conducted in the self-managed city of Villa El Salvador under an agreement between the community and the university. The writer also notes that the intense campaign to publicize the program is having an effect because most nurse-training institutions in Peru are tending to add community nursing to their curricula.

Community Health Nursing↗

Views of new internal medicine faculty of their preparedness and competence in physician-patient communication.

BACKGROUND: We sought to assess self-rated importance of the medical interview to clinical practice and competence in physician-patient communication among new internal medicine faculty at an academic medical center. METHODS: Since 2001, new internal medicine faculty at the Mayo Clinic College of Medicine (Rochester, Minnesota) have completed a survey on physician-patient communication. The survey asks the new faculty to rate their overall competence in medical interviewing, the importance of the medical interview to their practice, their confidence and adequacy of previous training in handling eight frequently encountered challenging communication scenarios, and whether they would benefit from additional communication training. RESULTS: Between 2001 and 2004, 75 general internists and internal medicine subspecialists were appointed to the faculty, and of these, 58 (77%) completed the survey. The faculty rated (on a 10-point scale) the importance of the medical interview higher than their competence in interviewing; this difference was significant (average +/- SD, 9.4 +/- 1.0 vs 7.7 +/- 1.2, P < .001). Similar results were obtained by sex, age, specialty, years since residency or fellowship training, and perceived benefit of training. Experienced faculty rated their competence in medical interviewing and the importance of the medical interview higher than recent graduates (ie, less than one year since training). For each challenging communication scenario, the new faculty rated the adequacy of their previous training in handling the scenario relatively low. A majority (57%) said they would benefit from additional communication training. CONCLUSION: Although new internal medicine faculty rate high the importance of the medical interview, they rate their competence and adequacy of previous training in medical interviewing relatively low, and many indicate that they would benefit from additional communication training. These results should encourage academic medical centers to make curricula in physician-patient communication available to their faculty members because many of them not only care for patients, but also teach clinical skills, including communication skills, to trainees.

Academic Medical Centers↗

Industrial hygiene in the world arena of occupational health and safety.

The professional industrial hygienist is a "man (or woman) for all seasons," with the ability to cope with a wide variety of problems affecting the health and safety of workers. The development of this profession, for which we in the United States can take credit, had its beginnings about the time of WWI when our chemical industry was beginning to expand and munitions had to be produced for the war effort. Today this professional expertise that is industrial hygiene is in demand in every industrialized country, and even the developing countries are realizing its potential benefit in prevention of occupational disease. In the last decade, which some call the OSHA decade, we have seen several important trends in this profession. The industrial hygienist has become a manager. He must be able to supervise industrial hygiene technologists and technicians. He has become an allied health professional in that he is doing the biologic monitoring heretofore done exclusively by physicians and nurses. In many companies he has been given organization status equal to that of the corporate medical director, and in some instances he has even been given corporate responsibility for overall health and safety. Industrial hygiene is truly a rewarding field for young people with backgrounds in engineering or one of the chemical, physical, or biological sciences. Several hundred are currently in training at the graduate level, but still the demand far exceeds the supply. The decade of the 80's should see even further advances in the field of industrial hygiene, especially in the development of more sophisticated instrumentation and the increased use of the computer in managing environmental and biological data and programming epidemiologic studies. To the academic institutions responsible for postgraduate training in this field, these rapid and profound changes in the professional requirements pose a real challenge, and continuing education courses will assume an even more important role.

Occupational Medicine↗

Training of surgeons in Kenya at the University of Nairobi teaching hospital.

OBJECTIVE: To determine the number of surgeons trained by the Department of Surgery, Faculty of Medicine, College of Health Sciences, University of Nairobi, since its inception in 1967. DESIGN: This was a retrospective (1975-1987) and prospective study (1988-1999). SETTING: Kenyatta National Hospital, a National Referral Hospital and University of Nairobi Teaching Hospital. SUBJECTS: All surgeons trained by the Department of Surgery of the University of Nairobi for postgraduate MMed in general surgery, anaesthesia, ENT surgery and ophthalmology from 1975 to March 1999. RESULTS: Two hundred and eighty-five surgeons with Master of Medicine degree were trained by the Department of Surgery of the University of Nairobi between 1975 and March 1999. They included 181 (63.51%) general surgeons; 46 (16.14%) anaesthetists; 35 (12.28%) ophthalmologists and 23 (8.07% ear, nose and throat (ENT) surgeons. One hundred and seventy-six, (61.75%) were from retrospective studies; 94 (32.98%) were from prospective studies while 15 (5.26%) were from both retrospective and prospective studies. Two hundred and thirty-two (81.40%) surgeons were Kenyans while 53 (18.60%) were foreigners. The majority, 42 (79.24%) of the foreigners were from other African countries. Thirty one (58.50%) were from neighbouring Uganda, Sudan, Tanzania, Ethiopia and Zambia. There was also one PhD in anaesthesia and one MD in urology during the same period. CONCLUSION: The University of Nairobi, Department of Surgery based at Kenyatta National Hospital has played a very significant and leading role in the training of surgeons for Kenya and even other African and foreign countries since its inception. Of the forty surgeons who constitute the academic staff in the Departments of General Surgery, Orthopaedic Surgery and Ophthalmology of the University of Nairobi, thirty-five surgeons (87.50%) have been trained by the Faculty of Medicine at KNH.

Education, Medical, Graduate↗

The coming crisis in funding child psychiatry training.

Rapid changes in health care financing and delivery systems will adversely affect child psychiatry training. Reductions in teaching hospitals' patient revenues and in federal support for graduate medical education have made the development of strong academic and research programs more difficult. Training programs must search for innovative ways to fund clinical training if they are to survive and grow. The authors review major sources for funding, such as state governments, future employers of trainees, endowments, faculty practice plans, and residents paying for training, and discuss opportunities for increasing their contributions.

Child Psychiatry↗

Learning to work together: developing academic and community research partnerships.

BACKGROUND: Community-based participatory research (CBPR) has been promoted as an important collaborative methodology for addressing local health concerns. However, academic physicians and researchers usually are not trained to work with communities as partners. METHODS: Key characteristics of effective community-academic partnerships are examined based on experiences with 2 CBPR projects in Wisconsin. RESULTS: These 2 projects increasingly have involved the respective communities and researchers in a collaboration. The steps they have taken illustrate the qualities of successful CBPR partnerships: ongoing development of joint community and researcher analysis, communication, and mobilization to search for relevant solutions to important community health problems. To sustain this kind of partnership, it is critical for researchers using the CBPR approach to understand how their academic-scientific perspective differs as well as converges with the community members' practical-experiential perspective. CONCLUSIONS: Health care researchers can effectively make use of partnerships with communities by following defined CBPR steps for developing mutually agreed upon research agendas, timelines, and goals. This, in turn, builds the capacity of communities to initiate and engage in future collaborative research projects concerning health issues.

Academic Medical Centers↗