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At least 811 records · Page 45Linked to original sources
PubMedDate not supplied

Esophagogastroduodenoscopy by family physicians: a national multisite study of 717 procedures.

This is the first multisite report of esophagogastroduodenoscopies (EGDs) performed by family physicians. The first 717 EGDs performed by family physicians from 8 separate office practices provide a practical and safe rationale for selected cognitive and psychomotor aspects of continuing medical education after residency training. Although primarily in private practice, these physicians were affiliated with 6 academic institutions. This group of family physicians received training in short courses. The average amount of hands-on training before independent EGD was 8 supervised cases. Cumulatively, these data represent 227 months (18.9 years) of office practice. All cases were collected sequentially from the beginning of each physician's experience, and 454 cases were collected prospectively. Physicians reported excellent patient tolerance. Diagnostic yields were high, and biopsies were performed where appropriate. Pathologists reviewed biopsy specimens from 213 sites. The family physician endoscopic diagnosis agreed with the tissue diagnosis in 188 cases (88 percent). Physicians believed that EGD enhanced management or changed the diagnosis in more than 89 percent of cases. One bleeding complication requiring overnight hospitalization was noted. This complication rate 0.0014 (1/717) compares favorably with published subspecialty complication rates 0.0013 (1.3/1000). These data confirm the ability of some family physicians to perform EGD and suggest that continuation is safe. Biopsy analysis indicates diagnostic accuracy is high. Further study on the cognitive aspects and the defragmentation of care is needed.

Adolescent↗
PubMed2002

Global veterinary leadership.

The public needs no reminder that deadly infectious diseases such as FMD could emerge in any country at any moment, or that national food security could be compromised by Salmonella or Listeria infections. Protections against these risks include the knowledge that appropriate and equivalent veterinary education will enable detection and characterization of emerging disease agents, as well as an appropriate response, wherever they occur. Global veterinary leadership is needed to reduce the global threat of infectious diseases of major food animal and public health importance. We believe that the co-curriculum is an excellent way to prepare and train veterinarians and future leaders who understand and can deal with global issues. The key to the success of the program is the veterinarian's understanding that there is a cultural basis to the practice of veterinary medicine in any country. The result will be a cadre of veterinarians, faculty, and other professionals who are better able (language and culture) to understand the effects of change brought about by free trade and the importance of interdisciplinary and institutional relationships to deal effectively with national and regional issues of food safety and security. New global veterinary leadership programs will build on interests, experience, ideas, and ambitions. A college that wishes to take advantage of this diversity must offer opportunities that interest veterinarians throughout their careers and that preferably connect academic study with intensive experiential training in another country. At its best, the global veterinary leadership program would include a partnership between veterinarians and several international learning centers, a responsiveness to the identified international outreach needs of the profession, and attention to critical thinking and reflection. The global veterinary leadership program we have described is intended to be a set of ideas meant to promote collaboration, coalitions, and discussion among veterinarians and veterinary educators who may be intrigued by the concept. The impact of the program can be summarized as follows: Outreach Programs: The global veterinary leadership program will establish new partnerships between veterinarians and veterinary college faculty as they supervise the international internships and see a relationship between their goals and the value of food safety to this country. Strategic Opportunity: The program will build on the critical role that US veterinarians and veterinary colleges already play in strengthening the safety of free trade in this hemisphere. Diversity in an Age of Specialization: The program will combine a global orientation, language ability, and access to comprehensive, research- and economic-related work/study opportunities to expose veterinarians to the expanding world market for veterinary expertise. New Linkages Through Corporate Partners: Through the success and high visibility of current research and education programs, most veterinary colleges are well positioned to engage industry, government, and university leaders in ways to use the proposed program to increase the flow of new ideas and talent into the world food enterprise. International Funding: A new partnership among veterinarians, industry, government, and university leaders can coordinate strong multilateral requests for funding from national and international sources. An Interdisciplinary Strategy that Benefits Veterinary Medicine: The program will combine the diverse veterinary research and education system with our strong national and international network of collaborators to provide globally competent veterinarians who will be needed for the corporate and public opportunities of the future.

Animal Diseases↗
PubMed2001

Preparedness for clinical practice: reports of graduating residents at academic health centers.

CONTEXT: Medical educators are seeking improved measures to assess the clinical competency of residents as they complete their graduate medical education. OBJECTIVE: To assess residents' perceptions of their preparedness to provide common clinical services during their last year of graduate medical education. DESIGN, SETTING, AND PARTICIPANTS: A 1998 national survey of residents completing their training in 8 specialties (internal medicine, pediatrics, family practice, obstetrics/gynecology, general surgery, orthopedic surgery, psychiatry, and anesthesiology) at academic health centers in the United States. A total of 2626 residents responded (response rate, 65%). MAIN OUTCOME MEASURES: Residents' reports of their preparedness to perform clinical and nonclinical tasks relevant to their specialties. RESULTS: Residents in all specialties rated themselves as prepared to manage most of the common conditions they would encounter in their clinical career. However, more than 10% of residents in each specialty reported that they felt unprepared to undertake 1 or more tasks relevant to their disciplines, such as caring for patients with human immunodeficiency virus/acquired immunodeficiency syndrome or substance abuse (family practice) or nursing home patients (internal medicine); performance of spinal surgery (orthopedic surgery) or abdominal aortic aneurysm repair (general surgery); and management of chronic pain (anesthesiology). CONCLUSIONS: Overall, residents in their last year of training at academic health centers rate their clinical preparedness as high. However, opportunities for improvement exist in preparing residents for clinical practice.

Academic Medical Centers↗
PubMedDate not supplied

The ethical commitments of academic faculty in psychiatric education.

OBJECTIVE: This article explores the commitment of faculty to ethics training in psychiatric education. Although psychiatry has insufficiently addressed the profession's need for ethics training in education, program directors acknowledge its critical importance, and its positive impact has been demonstrated. Additionally, residents often seek ethics training as part of their instruction. METHOD: The author suggests that academic faculty could respond to the profession's inadequate treatment of ethics training by helping trainees develop moral agency--the ability to recognize, assess, and respond to ethical dilemmas; decide what constitutes right or wrong care; and act accordingly. The author also describes how this objective could be met by promoting professionalism and offering didactic instruction that address substantive and process issues regarding psychiatric care. CONCLUSION: Specific recommendations are provided.

Attitude↗
PubMed2002

Attitudes toward working on interdisciplinary healthcare teams: a comparison by discipline.

Interdisciplinary teams are important in providing care for older patients, but interdisciplinary teamwork is rarely a teaching focus, and little is known about trainees' attitudes towards it. To determine the attitudes of second-year post-graduate (PGY-2) internal medicine or family practice residents, advanced practice nursing (NP), and masters-level social work (MSW) students toward the value and efficiency of interdisciplinary teamwork and the physician's role on the team, a baseline survey was administered to 591 Geriatrics Interdisciplinary Team Training participants at eight U.S. academic medical centers from January 1997 to July 1999. Most students in each profession agreed that the interdisciplinary team approach benefits patients and is a productive use of time, but PGY-2s consistently rated their agreement lower than NP or MSW students. Interprofessional differences were greatest for beliefs about the physician's role; 73% of PGY-2s but only 44% to 47% of MSW and NP trainees agreed that a team's primary purpose was to assist physicians in achieving treatment goals for patients. Approximately 80% of PGY-2s but only 35% to 40% of MSW or NP trainees agreed that physicians have the right to alter patient care plans developed by the team. Although students from all three disciplines were positively inclined toward medical interdisciplinary teamwork, medical residents were the least so. Exposure to interdisciplinary teamwork may need to occur at an earlier point in medical training than residency. The question of who is ultimately responsible for the decisions of the team may be an "Achilles heel," interfering with shared decision-making.

Attitude of Health Personnel↗
PubMed1996

Abortion training in family practice residency programs.

BACKGROUND: Despite a relatively fixed demand for services, access to abortion services has become increasingly limited, in part due to fewer training opportunities for OB-GYN residents. The recommended core educational guidelines for family practice residents include voluntary interruption of pregnancy up to 10 weeks gestation, but the availability of and interest in such training have not been reported. METHODS: A survey questionnaire assessing availability of abortion training, percentage of residents participating, program demographics, and resident interest in training was sent to all US family practice residency program directors and randomly selected third-year residents during the 1993-1994 academic year: A total of 301 of 399 (75%) program directors and 253 of 399 (63%) third-year residents completed the questionnaire. RESULTS: Twelve percent of programs nationwide offered abortion training during 1993-1994. Western programs were more likely to offer training (18 of 50 or 36%) than Northeastern (7 of 55 or 12%), Midwestern (6 of 98 or 6%), or Southern programs (4 of 98 or 4%). When available, 45% of trainees chose to participate. Training was primarily in suction curettage up to 12 weeks gestational age. The median duration of training was 4 weeks. Training was provided in both freestanding clinics and hospitals. Religious hospitals were less likely to offer training. CONCLUSIONS: About one of eight family practice residency programs nationwide offer training in abortion. When offered, nearly half of family practice residents choose to participate in this training. Interested family practice residents could be trained to fill an increasing need for physicians willing and able to perform first-trimester abortions.

Abortion, Induced↗
PubMed1990

Education on breast disease in an obstetrics and gynecology training program: a multidisciplinary approach.

Breast cancer affects one in ten women during their lifetime. Recognizing the importance of early detection in the prognosis of this condition, the American Board of Obstetrics and Gynecology has stated guidelines encouraging breast disease education in obstetrics and gynecology training programs. To fulfill this academic responsibility, we have organized a multidisciplinary Breast Disease Detection and Treatment Clinic where patients with abnormal mammograms or any breast-related complaints are evaluated and managed. In cooperation with the radiology department and general surgery service, a mammogram review conference has been instituted. Abnormal mammograms are reviewed with a radiologist. Our activities have been coordinated such that a general surgery staff member and resident are present during the breast clinic hours to review mammograms and to examine the patients with the gynecologist, providing immediate consultation. Needle aspiration of breast cysts, repeat imaging studies, and general surgery referrals for breast biopsies are performed as indicated. The patient receives integrated care of her breast problem in one visit, and our residents gain the experience of diagnosing and managing breast problems which, before establishment of this clinic, were referred to the general surgery department. This multidisciplinary approach developed in our institution helps us provide the most efficient care to our patients, while providing our residents with integrated teaching and training concerning the diagnosis and management of breast disease.

Ambulatory Care Facilities↗
PubMedDate not supplied

Strengthening local health care management in Bolivian districts through participatory operational research.

The purpose of this article is to demonstrate how the use of a participatory health care management and problem-related research methodology may help strengthen health service management and the capacities of local health care personnel. The text refers to five studies carried out in three Bolivian health districts from 1993-1995, in an Operational Research Project, conducted by an Italian N.G.O. (Cooperazione Internazionale) in agreement with the local Ministry of Health and P.A.H.O./W.H.O. The object of these studies was to assess the main problems in health care delivery and to define and implement appropriate solutions. The studies utilized a methodology based on the principles of operational research and continuous quality improvement. During the process some positive aspects and difficulties were met. The positive aspects were: the applied character of the research focused on the solution of a problem; the study of a problem related to health service management; the use of modern and simple techniques adapted to local knowledge; on-the-job training of health care personnel during the research process. Lack of a generic 'culture of research' and poor health personnel training were the main difficulties encountered. National health authorities should take these points into account to define or readjust policies on health service research, health workers' academic education and in-service training. Insisting on developing human resources and allowing them to achieve and expand their potential is the key factor for getting developing countries out of their current crisis and toward reaching a truly human and sustainable development.

Bolivia↗
PubMed2007

Evaluation of an intelligent tutoring system in pathology: effects of external representation on performance gains, metacognition, and acceptance.

OBJECTIVE: Determine effects of computer-based tutoring on diagnostic performance gains, meta-cognition, and acceptance using two different problem representations. Describe impact of tutoring on spectrum of diagnostic skills required for task performance. Identify key features of student-tutor interaction contributing to learning gains. DESIGN: Prospective, between-subjects study, controlled for participant level of training. Resident physicians in two academic pathology programs spent four hours using one of two interfaces which differed mainly in external problem representation. The case-focused representation provided an open-learning environment in which students were free to explore evidence-hypothesis relationships within a case, but could not visualize the entire diagnostic space. The knowledge-focused representation provided an interactive representation of the entire diagnostic space, which more tightly constrained student actions. MEASUREMENTS: Metrics included results of pretest, post-test and retention-test for multiple choice and case diagnosis tests, ratios of performance to student reported certainty, results of participant survey, learning curves, and interaction behaviors during tutoring. RESULTS: Students had highly significant learning gains after one tutoring session. Learning was retained at one week. There were no differences between the two interfaces in learning gains on post-test or retention test. Only students in the knowledge-focused interface exhibited significant metacognitive gains from pretest to post-test and pretest to retention test. Students rated the knowledge-focused interface significantly higher than the case-focused interface. CONCLUSIONS: Cognitive tutoring is associated with improved diagnostic performance in a complex medical domain. The effect is retained at one-week post-training. Knowledge-focused external problem representation shows an advantage over case-focused representation for metacognitive effects and user acceptance.

Attitude to Computers↗
PubMed2005

Factors that influence successful training and faculty career development in hematology/oncology patient-oriented clinical research.

BACKGROUND: We wanted to identify what factors promote career development in patient-oriented clinical research (POCR). METHODS: We used a survey questionnaire covering areas relevant to the training of subspecialty fellows and the career development of POCR faculty. RESULTS: Pursuit of an academic career after fellowship correlated with completion of a clinical project, availability of a clinical research training program, opportunity to earn academic credit, faculty mentorship, and obtaining independent career development funding. Successful faculty career development in POCR was closely correlated with excellent morale and adequate protected time for academic pursuits. CONCLUSIONS: Specific academic environmental factors positively influence success in POCR hematology/oncology fellowship training and faculty career development.

Biomedical Research↗
PubMed2003

[The forms of postgraduate education of physicians in Poland in years (1918-1939)].

Postgraduate studies of the Polish physicians between World Wars was not obligatory, except the doctors, who occupied positions in Health Services Administration. They were trained in The State School of Hygiene, in which were performed systematically courses regarding social diseases (tuberculosis, trachoma), organization of health protection. This studies were founded by Department of Health in Ministry of Public Care. The other forms of training were courses of several weeks, regarding general practice or particularly specializations, organized by medical departments of Universities. The aim of this education was completion of the theoretical academic knowledge wish practical skills. The trainings were also organized by medical associations, departments, institutes, hospital wards and other public societies. The postgraduate studies were continued during the domain and foreign medical meetings, by reading medical journals and publications and by practicing in hospital wards. Until the II World War the postgraduate training was not obligatory and the idea of the state institution coordinating this area was not realized.

Education, Medical, Graduate↗
PubMed1992

Factors influencing research productivity among health sciences librarians.

Secondary analysis was performed of data collected in 1989 from a random sample of members of the Medical Library Association. Results show that about half the sample had at least one publication; academic health sciences librarians were much more likely than hospital librarians to have published. Almost half the sample had taken formal courses in research, but only a small percentage had taken continuing education (CE) courses in research. Institutional support services for research were most available in academic settings. The combination of institutional support, CE training, and research courses explained 31.1% of the variation in research productivity among academic librarians; these factors were less important in hospitals and other institutional settings. The authors suggest that health sciences librarians working outside academia should seek support for research from sources outside the employing institution.

Humans↗