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PubMed1989

The professional socialisation of midwives: balancing art and science.

Mastery of esoteric knowledge is one of the central features assigned by sociologists to fully professionalised service occupations, together with an orientation towards public service. There are, nevertheless, different views about the best way in which this education and socialisation can be provided for new recruits for practitioner roles. Some maintain that the university provides an ideal training ground. Critics of this view, however, call for a rejection of "university diploma mills' and a return to the type of apprenticeship socialisation common during the premodern era. This paper tests the usefulness of these perspectives in understanding the occupational socialisation of Newfoundland and Labrador midwives. Three major styles of training - traditional apprenticeship, vocational schooling and university education - can be discerned. In comparison to both apprenticeship and academic styles of occupational socialisation, only vocational training nicely blended the art and science of midwifery to produce competent and committed professionals.

Clinical Competence↗
PubMed1988

Research skills and the research environment: a needs assessment of allied health faculty.

Allied health faculty are expected to successfully compete with other academic faculty in the research arena, yet many feel unprepared for this role. Most faculty have been trained as clinicians and, thus, bring to academe few skills in research design and methodology. A national study was conducted to assess the research skills and the research milieu of allied health faculty across eleven disciplines. Data are presented from 2,187 survey responses. Unmet needs included skills in obtaining funding, statistical analysis of the data, and publishing research results. Major barriers to research included the undervaluing of research relative to education and service, the lack of financial and administrative support, the absence of professional resources, and the generally low priority given research. Faculty with earned doctorates perceived their research environments more favorably and had fewer gaps in research skills than did faculty with a bachelor's or master's degree.

Allied Health Personnel↗
PubMed1996

Gender and interest in academic careers among first- and third-year residents.

BACKGROUND: While increasing proportions of medical students and residents are women, the proportion of women in the advanced ranks of medicine remains small. This study describes gender differences among residents concerning interest in academic medicine and related influences. METHOD: A survey instrument was mailed to all 308 first- and third-year residents at the University of Washington School of Medicine in the late summer of 1993. The survey assessed interest in academic careers, values, psychological traits, exposure to mentoring, and perceived role stress. Frequency analysis and chi-square analysis were performed to compare the distribution responses by gender within the entire respondent group and within the first-year and third-year subgroups. RESULTS: A total of 180 (58%) of all first- and third-year residents responded; 99 (55%) were men. Although the level of interest in academic careers was similar among first-year male and female residents, the level of interest was greater among third-year men than among third-year women. Women overall were less likely to consider it personally important to achieve national recognition. Women in the third (but not the first) year of residency were significantly less likely than men to agree that leading others was personally important to them. Women reported feeling less confident, were less likely to have identified a faculty member who had successfully balanced career and personal life, and were significantly more likely to feel under stress and to have interrupted their careers for childbearing. CONCLUSION: The interest in academic careers appeared to be lower among third-year female residents than among third-year male residents, despite the similar interests in academic medicine among male and female first-year residents. Increasing role stress among women in training may explain the reduced interest in leadership and academic careers among women at more advanced levels of training.

Attitude of Health Personnel↗
PubMed2002

The National Surgical Quality Improvement Program in non-veterans administration hospitals: initial demonstration of feasibility.

OBJECTIVE: To assess the feasibility of implementing the National Surgical Quality Improvement Program (NSQIP) methodology in non-VA hospitals. SUMMARY BACKGROUND DATA: Using data adjusted for patient preoperative risk, the NSQIP compares the performance of all VA hospitals performing major surgery and anonymously compares these hospitals using the ratio of observed to expected adverse events. These results are provided to each hospital and used to identify areas for improvement. Since the NSQIP's inception in 1994, the VA has reported consistent improvements in all surgery performance measures. Given the success of the NSQIP within the VA, as well as the lack of a comparable system in non-VA hospitals, this pilot study was undertaken to test the applicability of the NSQIP models and methodology in the nonfederal sector. METHODS: Beginning in 1999, three academic medical centers (Emory University, Atlanta, GA; University of Michigan, Ann Arbor, MI; University of Kentucky, Lexington, KY) volunteered the time of a dedicated surgical nurse reviewer who was trained in NSQIP methodology. At each academic center, these nurse reviewers used NSQIP protocols to abstract clinical data from general surgery and vascular surgery patients. Data were manually collected and then transmitted via the Internet to a secure web site developed by the NSQIP. These data were compared to the data for general and vascular surgery patients collected during a concurrent time period (10/99 to 9/00) within the VA by the NSQIP. Logistic regression models were developed for both non-VA and VA hospital data. To assess the models' predictive values, C-indices (0.5 = no prediction; 1.0 = perfect prediction) were calculated after applying the models to the non-VA as well as the VA databases. RESULTS: Data from 2,747 (general surgery 2,251; vascular surgery 496) non-VA hospital cases were compared to data from 41,360 (general surgery 31,393; vascular surgery 9,967) VA cases. The bivariate relationships between individual risk factors and 30-day mortality or morbidity were similar in the non-VA and VA patient populations for over 66% of the risk variables. C-indices of 0.942 (general surgery), 0.915 (vascular surgery), and 0.934 (general plus vascular surgery) were obtained following application of the VA NSQIP mortality model to the non-VA patient data. Lower C-indices (0.778, general surgery; 0.638, vascular surgery; 0.760, general plus vascular surgery) were obtained following application of the VA NSQIP morbidity model to the non-VA patient data. Although the non-VA sample size was smaller than the VA, preliminary analysis suggested no differences in risk-adjusted mortality between the non-VA and VA cohorts. CONCLUSIONS With some adjustments, the NSQIP methodology can be implemented and generates reasonable predictive models within non-VA hospitals.

Feasibility Studies↗
PubMed2006

The required research rotation in residency: the University of Pennsylvania experience, 1978-1993.

The University of Pennsylvania orthopaedic surgery residency program under the direction of Dr. Carl T. Brighton was uniquely structured to require a year of research as part of a 5-year program. This requirement was instituted to foster critical thinking, and not necessarily to produce academic orthopaedic surgeons. Nonetheless, measures of academic productivity of the 127 residents who trained under Dr. Brighton's leadership may be instructive. The purpose of this study was to assess metrics of academic productivity. In addition, the six current and former chairmen of orthopaedic surgery programs who performed research while residents at the University of Pennsylvania were surveyed for their impressions regarding required research rotations. Fifty-nine percent of the University of Pennsylvania residents took faculty positions after training; 75% published a peer-reviewed paper after residency; and 17% are current members of the American Orthopaedic Association. Overall, the chairmen surveyed found great value in their own resident research experience, but none have replicated the Brighton model of residency organization. Only two of the six programs have a research year: at both, this research rotation is in addition to the standard 5 years of clinical education and only at one are all residents required to participate.

Authorship↗
PubMed2001

Canadian research fellowship training programs in digestive sciences: achievements and challenges.

BACKGROUND: The Canadian Association of Gastroenterology (CAG) is committed to fostering the development of future Canadian investigators. Up to 1986, research fellowship support was obtained from the Medical Research Council (MRC) of Canada. Since that time, several peer-reviewed, industry-sponsored, CAG-supported research fellowships and a variety of independently funded awards have augmented this effort. In the same period, peer-reviewed operating grants (OGs) from the MRC and other agencies have been constrained. The aim of this study was to determine the success of CAG, MRC or any other Canadian research fellowships in the development of career investigators in digestive sciences and to identify factors influencing the outcomes of such training. METHODS: MRC records and the minutes of CAG annual meetings were reviewed to identify research fellowship support. Canadian program directors were requested to list research fellows affiliated with their groups between 1986 and 1997. Only fellowships providing at least 1 year of training were included. A 7-page questionnaire detailing biographic characteristics, the site and duration, and specific issues related to the quality of research training was sent to identified trainees. Significant associations between success in achieving an academic appointment or OG support and several variables of training were identified. RESULTS: Eighty-six research fellows were trained. Responses were obtained from 43 of them. The demographic characteristics of the whole group and the respondents were similar. Of the respondents, 81% of trainees obtained academic appointments. Fellowships longer than 1 year were associated with higher rates of academic posting, and MRC-funded fellows had greater success rates of academic appointments. Of eligible trainees 63% have obtained OG support. None of the other variables examined predicted success. Of the trainees responding, 85% valued the fellowship very highly. CONCLUSIONS: The establishment of the additional research fellowships has fostered the development of career investigators in digestive sciences. The high success rate of former trainees in obtaining academic appointments and OG support suggests that the fellowship programs are effective and appropriately oriented. The structure of the current programs does not require substantial revision. OG support for new investigators appears now to lag substantially.

Canada↗
PubMed2006

Publication rate of abstracts presented at the British Association of Urological Surgeons Annual Meeting.

OBJECTIVE: To determine the number of peer-reviewed publications arising from the abstracts presented at the annual meetings of the British Association of Urological Surgeons (BAUS), and to assess urological trainees' attitudes to research in relationship to the pursuit of Specialist Registrar (SpR) training numbers and their perception of academic urology in the UK. METHODS: Publications resulting from presentations at the annual meetings of the BAUS 2001 and 2002 were searched for using the PubMed database. Variables that might influence the subsequent publication of abstracts in peer-reviewed journals were analysed. Whether institutions from other countries had similar publication rates to those in the UK was also assessed. SpRs were interviewed about their motivation to convert presentations to publications before and after their appointment to SpR training. RESULTS: In July 2004, 142 of 449 abstracts presented at BAUS 2001 and 2002 were published, giving a publication rate of approximately 42% on Kaplan-Meier analysis. The rate of publication appeared to continue to the end of the period of searching for publications. The publication rate arising from UK presentations was lower than that from the non-UK presentations (hazard ratio 0.75, 95% confidence interval 0.49-1.15, P = 0.14). Publication rates from podium and poster presentations were similar. Urology journals accounted for 75% of the publications. Of the SpRs evaluated, 83% did research and presented papers to obtain a training number rather than because of an inherent interest to pursue an academic career. CONCLUSIONS: The conversion rate from BAUS presentation to peer-reviewed publication at 36 months was similar on Kaplan-Meier analysis to that of the American Urological Association (AUA, 38%). Interestingly, the rate of publication from the AUA seems to be faster than from BAUS. In addition, presentations from outside the UK appeared to be published faster than those from the UK. Delegates attending these conferences need to consider this when deciding whether a particular presentation will influence their practice. British urology requires academics who are interested in pursuing high-quality research, and which is presented at major conferences with an intention to publish it in peer-reviewed journals.

Peer Review, Research↗
PubMedDate not supplied

Recruit, screen, and hire: staff selection and the decision-making process.

This article focuses on the role of the clinician-manager in staff selection. The duties of the clinician-manager in a mental health center include those tasks described as "recruit, screen, and hire" but little or no guidance on the steps involved in this sequence of events is available. The "how" of hiring is transmitted by word of mouth, by following another's example, or by trial and error. This article examines the component parts of staff selection from the assimilation of procedures, rules, and regulation of the public authority under which a particular mental health center operates, to the compilation of a "short list" of those to be screened and finally the risk taking and decision-making process by the clinician-manager who makes the choice. Some speculation on the emotional impact it has on the clinician-manager is examined. The impact of personal value judgments of the selector are considered. Recommendations are made for the inclusion of training in staff selection by academic programs for mental health administrators.

Decision Making↗
PubMed1987

Anaesthesia training in Nepal.

The background, organization, problems, and successful implementation of an anaesthesia training program in Nepal are described. Nepali physicians had previously taken their postgraduate anaesthesia training in western countries, especially in Britain. The low pay of anaesthetists, poor maintenance of equipment, and irregular supplies of anaesthetic drugs in their own country has led many of them to stay abroad. In 1985 there were only seven Nepali anaesthetists in Nepal for a population of 16 million. An alternative approach to training is presented in which a series of Canadian anaesthetists, over a three-year period, are supporting the establishment of a one-year Diploma in Anaesthesiology program in Nepal. They are working with Nepali anaesthetists and the Institute of Medicine in Kathmandu, Nepal. The local anaesthetists supervise most of the clinical training while the Canadians give academic leadership and guidance.

Anesthesiology↗
PubMedDate not supplied

Surgical oncology: a specialty in evolution.

Surgical oncology has established its role in the multidisciplinary care of the cancer patient. Surgical oncology fellowships are organized to teach multimodality treatment. The typical fellow has completed 6 years of general surgery residency and 1 year in the laboratory with the resultant eight publications. Data compiled from the review of two Society of Surgical Oncology-approved fellowship programs, the Surgical Residency Review Committee and the American Board of Surgery, indicate that the majority of fellows join academic faculties and enhance the training of general surgeons, who, in turn, have the major responsibility for oncologic care of the population at large.

General Surgery↗
PubMed1994

Primary health care in Japan and the United States.

Japan has universal health insurance and its total health expenditure as a percentage of the gross domestic product is almost 50% less than that of the United States where 15% of persons under age 65 are uninsured. The health of the Japanese population as judged by neonatal, postnatal, and total infant mortality, percent of infants born with birth weights below 2500 g, and life expectancy at birth and ages 20 and 65 is superior to the health of Americans. Primary care, however, as an academic discipline and primary care training programs are absent in Japan. Physician training, incongruent with need, combined with government controlled low professional medical fees contribute to an extraordinarily high annual ambulatory patient contact rate (14 compared with 2.8 for Americans) and excessive use of diagnostic testing. Although primary care training is better developed in the U.S.A., interest in receiving, such training among medical school graduates is declining. Several factors that contribute to quality of care are examined. Comparisons between countries, however, must be viewed with caution because of the multitude of demographic, genetic, historical, economic and cultural variables that influence how health care is delivered and received. Both countries face major challenges. The projected rapid increase in the relative ratio of the elderly to total population in Japan will severely strain its ability to contain health care costs. Interest in primary care training in Japan dates back to 1978 but its implementation has been largely unsuccessful. The challenges in the U.S.A. are far more formidable.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed2004

Preparing the singing voice specialist revisited.

In review of singing voice specialist preparation, discussion can be chronicled prior to the establishment of Arts Medicine in 1987. Although discussion began in 1984 (and earlier), no formal academic program currently exists to train the singing voice specialist. The need now is greater than ever for a formal program of study to prepare a person who seeks to be a singing voice specialist. The question of adequate preparation continues to be in need of an appropriate answer because no formal training programs or fellowships are available. It is essential to first define the role of singing voice specialists and the populations that they will encounter. To meet the needs of a diverse population, care of the professional voice demands cross-disciplinary training. Knowledge from the fields of music, science, medicine and communication disorders and experience/observation, clinical preparation, and research would provide for optimal preparation. To meet this need, development of a Masters degree program seems highly desirable. The structure of such a program is proposed, along with specific requirements outlined from the music and singing voice pathology components for a Masters Degree in Arts Medicine with a concentration in voice.

Curriculum↗
PubMed2005

Re-engineering the process of medical imaging physics and technology education and training.

The extensive availability of digital technology provides an opportunity for enhancing both the effectiveness and efficiency of virtually all functions in the process of medical imaging physics and technology education and training. This includes degree granting academic programs within institutions and a wide spectrum of continuing education lifelong learning activities. Full achievement of the advantages of technology-enhanced education (e-learning, etc.) requires an analysis of specific educational activities with respect to desired outcomes and learning objectives. This is followed by the development of strategies and resources that are based on established educational principles. The impact of contemporary technology comes from its ability to place learners into enriched learning environments. The full advantage of a re-engineered and implemented educational process involves changing attitudes and functions of learning facilitators (teachers) and resource allocation and sharing both within and among institutions.

Biomedical Engineering↗
PubMed2001

Optimal teaching environment for laparoscopic splenectomy.

BACKGROUND: Traditional surgical teaching depends on graduated acquisition of skill learned in residency. The introduction of minimal access techniques after residency training has created a new paradigm dependent on animate course experiences and limited preceptor training. The outcome of performance of a new skill "learned" in these settings has not been assessed. The purpose of this study was to test the benefit of an animate course compared with a precepted operating room experience in learning to perform a laparoscopic splenectomy. METHODS: All attending surgeons who had taken a 1-day course to learn laparoscopic splenectomy (n = 37) and those who had undergone an intraoperative preceptorship (in their hospital) by the lead author (n = 15) were polled to ascertain their previous experience with laparoscopy and with laparoscopic splenectomy since the intervention. The course included lectures, operative videos, and an animal lab. Statistical differences were measured using a t test. RESULTS: Thirty-two of the 37 (86.5%) taking the course and all 15 of the precepted surgeons responded. There was no difference between the groups regarding prior laparoscopic experience (P = 0.73), laparoscopic training during residency (P = 0.74), academic or private practice (P = 0.48), or follow-up since the intervention (P = 0.36). The participants graded the courses (1 to 5, 5 = excellent) at an average of 4.72. Fourteen of 15 precepted surgeons have performed laparoscopic splenectomy as compared with 2 of 32 taking courses (nonprecepted surgeons; P <0.0001). The number of laparoscopic splenectomies performed totaled 112 for precepted surgeons and 4 for nonprecepted surgeons (P = 0.0003). The nonprecepted surgeons performed significantly more open splenectomies than laparoscopic (95 versus 13 respectively, P = 0.02). Reasons quoted not to proceed with laparoscopic splenectomy included waiting for the perfect patient, concern of hilar management, and splenic size. CONCLUSION: Surgeons precepted in their own operating room performed a laparoscopic splenectomy more readily than those gaining experience from a course only (93% versus 6%, respectively) despite no difference in their preintervention experience and having the opportunity to do so. The expectation of the eventual performance of advanced laparoscopic techniques depends on a precepted experience.

Education, Medical, Continuing↗
PubMed2001

What do master surgeons think of surgical competence and revalidation?

BACKGROUND: There has been on-going debate and public interest in surgical competence in recent years. METHODS: A Delphi reiterative opinion survey was conducted among master surgeons on selection of surgical trainees, methods of assessment of progress of surgical trainees, and revalidation of established consultant surgeons. RESULTS: Selection-the current methods of trainee selection were considered inadequate and in need of revision. The important attributes recognized by group are cognitive factors, innate dexterity, and personality. Important aspects of personality include decision-making ability, insight, team spirit, and emotional stability. Assessment during training-the majority view was that this should be based on clinical judgement/skills, operative skills, and cognitive ability. Assessment of technical ability should be based on standardized checklists. Research within training programs was encouraged but academic achievement does not reflect surgical competence. There was a majority verdict for an exit clinical examination. Revalidation-the group agreed on the need for competence checks during the professional career of surgeons. These should cover knowledge, clinical, operative, and humanistic skills; but expressed concern on the feasibility of a revalidation system that can reliably assess the range of skills needed for surgical competence. There was a majority vote against an internal appraisal system. External assessment by nationally appointed 'assessors' was considered preferable. CONCLUSIONS: Both selection and assessment of surgical trainees require changes and standardization. Although revalidation is necessary, concern was expressed on the reliability and validity of existing and proposed systems.

Clinical Competence↗
PubMed2003

Evaluation of the National Resident Matching Program (NRMP) radiation oncology data (1993-2003).

PURPOSE: Radiation oncology continues to evolve as a specialty. In the early 1990s, issues of manpower oversupply, resource allocation, development of academic radiation oncology, and residency training curricula were fervently considered and evaluated. Much of this effort continues. This communication endeavors to examine the National Residency Matching Program (NRMP) results as they pertain to radiation oncology to identify and document applicant trends over the last decade. METHODS AND MATERIALS: The NRMP database tables for inclusive dates 1993-2003 were evaluated. The database figures were supplied directly from the executive staff at the AAMC/NRMP. Data were reviewed for radiation oncology, and the following variables were evaluated for the study period (1993-2003): Training program participation, positions offered, applicant totals, proportion of US senior applicants, US seniors as a percentage of those who successfully matched, ratio of applicants to positions, and percentage of training program positions filled. Trends over the study period were analyzed. Data were also analyzed for all specialties collectively as a comparison group. RESULTS: The number of training programs has remained relatively stable between 1993 and 2003. In 2003, each radiation oncology program in the NRMP on average accepted two new candidates. The number of positions offered has fluctuated over time. There appeared to be a downward trend until 2003, during which 107 positions were offered. The number of applicants continues to rise with totals of 209 and 214 in 2003 and 2001, respectively. Percentage of US senior applicants compared with the total pool has remained relatively stable, but raw numbers are rising. The number of US seniors as a percentage of those who successfully matched escalated during 2001 compared with previous years. This value has been consistent over the past 3 years, at a level of approximately 94%. The ratio of applicants to positions, which is a broad indicator of level of competition for entrance, began to rise significantly in 2000 to a level of 1.9. It peaked at 2.6 in 2001, and the ratio for 2003 was approximately 2.0. For the first time, all positions offered were filled (100%) through the NRMP match process in 2003. Such positive trends have not been realized to the same degree for all specialties analyzed as a cohort. CONCLUSION: Acceptance into radiation oncology training programs through the NRMP has become very competitive. The explanation for this trend is likely complex with many variables. These data may be helpful in training program development and will certainly be of service to advisors of medical students seeking entrance into the field in the near future.

Career Choice↗
PubMed1997

The SMARTT (Sunnybrook Memory Assessment Research Treatment and Training) Program: planning for dementia care.

Dementia is being recognized as a major public health challenge. Caring for those with dementia poses a unique problem for family and health care providers in community and institutional settings. This article describes the development of the Sunnybrook Memory Assessment Research Treatment and Training (SMARTT) Program at an academic health science centre. This program serves as a model for an integrated health system to meet the needs of dementia patients and their families.

Academic Medical Centers↗
PubMed1996

Recruitment and retention of African American patients for clinical research: an exploration of response rates in an urban psychiatric hospital.

The issues related to recruiting African American psychiatric inpatients are discussed in the context of a study on the influence of ethnicity on psychiatric diagnosis. Ethnically diverse psychiatric residents interviewed 960 Black and White inpatients in 2 urban psychiatric hospitals. Despite the obstacles cited in the literature about recruiting and retaining African Americans into research, 78% of this sample were African American. In addition, interview completion and refusal rates did not differ by patient ethnicity. Results suggest that matching interviewer and patient ethnicity did not influence African Americans' likelihood of participating in or of refusing an interview. This article summarizes a number of guidelines that others may find useful in conducting clinical research with African Americans, ranging from the formation of academic-public liaisons to interviewer training.

Adult↗