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PubMed1994

Is the public being protected? Prevention of suboptimal medical practice through training programs and credentialing examinations.

Governments have traditionally looked to the medical profession for leadership in health planning and have charged the profession with the responsibility of establishing and monitoring standards of medical practice. Training program accreditation and licensure/certification exams have been used as the primary methods of preventing unqualified individuals from entering medical practice. Despite the critical nature of the decision made at the time of licensure/certification, there is no information about the validity of these examinations for predicting subsequent practice and health outcome. In this article, the assumptions implicit in the current use of licensing/certifying examinations are identified, the relevant evidence is reviewed, and the implications of this evidence for current methods of measurement are discussed.

Canada↗
PubMed2001

Initial employment experiences of 1997 graduates of radiation oncology training programs.

PURPOSE: To inform the profession of current trends in the job market, the American College of Radiology (ACR) sought to detail the job-hunting experiences and outcomes of 1997 graduates of radiation oncology training programs. METHODS AND MATERIALS: In early 1998, questionnaires were mailed to all graduates; 67% responded. Results were compared with similar surveys of 1996 graduates. RESULTS: Similar to past years, immediately after graduation, 13% of residency graduates and 1 of 10 fellowship graduates encountered serious employment difficulties--that is, spent some time working locums, working outside radiation oncology, or unemployed. By 6-12 months after graduation, approximately 2% of all residency graduates were working outside the profession and approximately 3% were not working at all. Eighty-five percent of residency graduates and 7 of 8 fellowship graduates reported that their employment reasonably matched their training and individual goals. On average, graduates' actual salaries approximately corresponded to expected salaries. Eleven percent of all graduates were in nonownership-track jobs, a significant decline since 1996. For residents and fellows combined, 46% had a job with at least one characteristic some observers associate with a weak job market, but fewer than half of those with one of these characteristics actually disliked it. These percentages are similar to 1996. Women graduates were more likely than men to have spouse-related restrictions on job location but less likely to end up in a self-reportedly undesirable location. CONCLUSION: Unemployment remained low. Some other indicators of the employment market showed improvement, while others did not.

Employment↗
PubMed1997

Correction of protein-energy malnutrition in older adults: effects of a short-term aerobic training program.

Twenty malnourished subjects (average age 67 years old) treated by cyclic enteral nutrition were assigned to an active or control group according to whether they took part or not in a 3-week aerobic training program. Subjects underwent the following tests on d(0)-d(1) and d(20)-d(21): calculation of a global nutritional deficiency index (GND), bioelectrical impedance analysis, evaluation of daily energy expenditures using a 24 h heart rate (HR) recorder and a pedometer, maximal voluntary isometric strength assessment (MVIS), and symptoms limited maximal oxygen uptake ((.)VO(2 max. SL) estimation. Although energy intakes were similar in both groups, active subjects showed greater improvements (P < 0.05) than control subjects regarding GND (-9.8 vs -4.8%), serum albumin and prealbumin. Active subjects also showed a greater increase (P < 0.05) in pedometer readings compared to control subjects. Reduction of resting HR was observed in active (-5 beat/mn, P < 0.05) whereas no significant changes in average HR were noted in either group, reflecting increased metabolic activity. Compared to control, active subjects showed significant (P < 0.05) improvements in MVIS (0.8 vs 0.1 N/kg) and (.)VO(2 max. SL) (5.5 vs 1.4 mL/min/kg). Short-term aerobic training has positive effects on nutritional recovery and functional capacities in elderly malnourished subjects and should be recommended whenever possible.

Journal Article↗
PubMedDate not supplied

Evaluation of a training program for foster parents of infants with prenatal substance effects.

The lack of prepared and available foster parents for children with prenatal substance effects is of increasing concern to the child welfare field. The research study reported here evaluated a multimodal inservice training program designed to enhance the competency of foster parents caring for infants with prenatal substance effects, and to promote an intent to foster such infants. Findings suggest that future foster parent training efforts in this area should focus on knowledge and skill attainment.

Caregivers↗
PubMed2006

Preliminary evaluation of a coping skills training program for those with a pathological-gambling partner.

Individuals living with a pathological-gambling partner can experience significant psychological distress. In this report, we conduct a preliminary evaluation of a coping skills training program (CST) for this population. Twenty-three individuals experiencing stress from living with a pathological-gambling partner who was not in treatment were randomly assigned to either CST or a delayed treatment control (DTC) condition. CST consisted of ten, weekly individual sessions to teach more effective coping skills. At the end of the treatment/delay period, CST participants, relative to those in DTC, showed a large improvement in coping skillfulness that appeared to mediate a corresponding large significant reduction in depression and anxiety relative to DTC. Partner gambling during the period decreased in both conditions but did not differ between them, nor did partner help-seeking differ. CST shows promise as an effective treatment for individuals distressed as a result of a partner's gambling problem. Larger, longer-term evaluations of the intervention, and comparison with alternate treatment models are needed.

Adaptation, Psychological↗
PubMed2000

Inadequacy and indebtedness: no-fee psychotherapy in county training programs.

The nature of the fee arrangement has significant influence on the psychotherapeutic process even when there is no fee. Given the large number of psychiatrists who receive at least some part of their training in the public system, understanding the no-fee arrangement is vital to the psychodynamic training of future psychiatrists. Following a brief overview of the meaning of money and the fee arrangement, various scenarios are considered under the headings of "inadequacy" and "indebtedness. "Although similar dynamics may be present in other public and private settings, attention is given to the county training program, with the intent to assist psychiatry residents and supervisors in their awareness and understanding of the psychodynamics of psychotherapy without fee.

Fees and Charges↗
PubMed2004

Effect of different training programs on the velocity of overarm throwing: a brief review.

Throwing velocity in overarm throwing is of major importance in sports like baseball, team handball, javelin, and water polo. The purpose of this literature review was to give an overview of the effect of different training programs on the throwing velocity in overarm throwing, provide a theoretical framework that explains findings, and give some practical applications based on these findings. The training studies were divided into 4 categories: (a) specific resistance training with an overload of velocity, (b) specific resistance training with an overload of force, (c) specific resistance training with a combination of overload of force and velocity, and (d) general resistance training according to the overload of force. Each category is presented and discussed.

Adolescent↗
PubMed1992

A participatory workplace health and safety training program for ethylene oxide.

The Occupational Safety and Health Administration (OSHA) has regulated ethylene oxide (EtO) on the basis of its acute toxicity and its potential carcinogenic and reproductive effects since 1971. OSHA's 1984 EtO standard and its 1988 revisions focused new attention on health and safety training and other preventive measures. An EtO health and safety training program for hospital sterilization workers was developed by the staff of an independent occupational and environmental health clinic. Participatory and empowerment training methods were central to the approach. Also included were hands-on, demonstration, interactive presentation, and other methods. An EtO Health and Safety Training Manual was developed based on the training experiences. This paper presents the challenges, benefits, and limitations of incorporating participatory and empowerment approaches in the design, implementation, and evaluation of EtO health and safety training.

Central Supply, Hospital↗
PubMed1996

Cancer prevention and control investigators: the need for high quality training programs.

There are increasing numbers of cancer prevention and control investigator trainees. On the basis of experience as research proposal reviewers and on reviews of a large number of current trainees, we offer some perspectives on the discipline and important aspects of optimal training programs. The historical importance of public health activities, the significant differences between prevention and treatment, and the breadth and public interest in prevention all have significant implications for trainees. In training, the need to focus efforts and to have active mentoring are critical. More attention to data analysis and complete development of a specific research proposal are also key elements of high-quality training. Although the need for cancer prevention and control investigators is great, more attention to the quality of their training is warranted.

Data Interpretation, Statistical↗
PubMed2003

A survey of residents and faculty regarding work hour limitations in surgical training programs.

HYPOTHESIS: Surgical faculty and residents have significantly different attitudes regarding work hour restrictions. SETTING: All general surgery residencies approved by the Accreditation Council for Graduate Medical Education (ACGME). PARTICIPANTS: All voluntarily participating surgical faculty and residents. MAIN OUTCOME MEASURES: Current hours worked, days off per month, and attitudes and opinions regarding the current surgical-training environment. METHODS: A 17-question survey instrument was mailed to the program directors of all ACGME-approved surgical-training programs in the United States. They were requested to distribute the survey to all faculty and residents for completion and to return the forms for analysis. RESULTS: Responses (N = 1653) were received from 46% of surgical-training programs. A significant difference was noted between faculty and resident responses in most categories. Most residents (87%) reported more than 80 duty hours per week, whereas 45% reported working more than 100 hours per week. Only 30% of residents reported an average of 1 day per week free of clinical activities. Although a minority of residents (43%) felt that their workload was excessive, 57% felt that their cognitive abilities had been impaired by fatigue. A significant number of residents (64%) and faculty (39%) believe that duty hour restrictions should be adopted. A minority of residents (20%) and faculty (47%) believe that the duration of residency training should be increased to compensate for duty hour restrictions. One quarter of residents regret choosing a career in surgery. CONCLUSIONS: Current duty hours for most surgical residents exceed the proposed ACGME limits. Although most residents support duty hour limits; surgical faculty are less supportive. Significant alterations in the current design and structure of surgical-training programs will be required to meet the ACGME guidelines.

Adult↗
PubMed1999

Tuberculin skin testing among economically disadvantaged youth in a federally funded job training program.

Low income, medically underserved communities are at increased risk for tuberculosis. Limited population-based national data are available about tuberculous infection in young people from such backgrounds. To determine the prevalence of a positive tuberculin skin test among economically disadvantaged youth in a federally funded job training program during 1995 and 1996, the authors evaluated data from medical records of 22,565 randomly selected students from over 100 job training centers throughout the United States. An estimated 5.6% of students had a documented positive skin test or history of active tuberculosis. Rates were highest among those who were racial/ethnic minorities, foreign born, and (among foreign-born students) older in age (p < 0.001). Weighted rates (adjusting for sampling) were 1.3% for white, 2.2% for Native American, 4.0% for black, 9.6% for Hispanic, and 40.7% for Asian/Pacific Islander students; rates were 2.4% for US-born and 32.7% for foreign-born students. Differences by geographic region of residence were not significant after adjusting for other demographic factors. Tuberculin screening of socioeconomically disadvantaged youth such as evaluated in this study provides important sentinel surveillance data concerning groups at risk for tuberculous infection and allows recommended public health interventions to be offered.

Adolescent↗
PubMed2006

Needs assessment of neurosurgery trainees: a survey study of two large training programs in the developing and developed worlds.

BACKGROUND: There are challenges facing surgical education in both the developing and the developed worlds. Few studies have examined trainee perceptions of their educational needs in a systematic way. We undertook a study to examine this issue, focusing on two large training programs, one in the developed world and one in the developing world. METHODS: Neurosurgical trainees at the University of Toronto, Toronto, Canada, and at Hasan Sadikin Hospital in Bandung, Indonesia, were surveyed with a comprehensive questionnaire assessing both the content and the methods of their training. The questionnaire had 37 quantitative questions requesting responses on a 7-point Likert scale and three open-ended questions to give more qualitative data. RESULTS: Sixty-four percent of all trainees responded. A number of interesting findings about the strengths and weaknesses of training emerged. For example, Bandung trainees felt they had excellent training in trauma but not in specialty areas, especially spine and vascular, with ample opportunity to operate as the primary surgeon. Toronto trainees felt that the volume and the variety of cases were excellent but they did not have enough ambulatory experience, and that they had suboptimal experience as the primary surgeon. Trainees in both centers agree that they will feel competent to practice neurosurgery upon completion of their training. CONCLUSION: This study defined different educational needs for neurosurgical trainees in two centers that reflect both their individual training environments and the local culture of medicine. As such, trainees' perceptions of these needs represent an important adjunct to program evaluation.

Attitude of Health Personnel↗
PubMed1985

[Recent myocardial infarction: role of digitalis therapy in patients with left ventricular dysfunction during exercise who participated in a short-term physical training program].

In order to verify the usefulness of long-term digitalis therapy during physical rehabilitation in patients with recent myocardial infarction (MI) and left ventricular disfunction during exercise, 24 consecutive pts with PAedP greater than or equal to 25 mmHg (Swan-Ganz cath.) at maximal work load were selected. Pts with angina, ST depression (greater than or equal to 2 mm), complex ventricular arrhythmias (Lown 4-5), symptoms of left ventricular failure were excluded. At random 12 pts were assigned to group A (digoxin therapy) and 12 to group B (no therapy). Serum digoxin level was on average 1.48 ng/ml (range 1-2.85 ng/ml). Both groups performed over 4 weeks the same controlled training program. Before and soon after the end of the training period all pts underwent to an exercise test, standard chest x-ray films, 24 hour ambulatory ECG and two-dimensional echocardiography. No complication was observed during exercise test and training period. Age, myocardial infarction location, cardiac volume and hemodynamic behaviour during the first exercise test were similar in both groups. After training, maximal work capacity was increased in group A by 14% and in group B by 16% without significant changes in PAedP and Cl; at the same work load PAedP was lower in group B (-12%, p less than .02) while LVSWI was increased in both groups (14% and 17% respectively, p less than .05). No significant changes in cardiac volume, left ventricular asynergy, EF, and ventricular premature beats were observed. QT interval at rest decreased significantly only in group A 408 +/- 31 msec vs 371 +/- 34 msec (p less than .01).(ABSTRACT TRUNCATED AT 250 WORDS)

Digoxin↗
PubMed1994

Orientation of medical residents to the psychosocial aspects of primary care: influence of training program.

PURPOSE: To describe the attitudes of residents in general medicine to the psychosocial dimensions of primary care and to evaluate the influences of selected variables. METHOD: A cross-sectional analysis-of-variance design (two training programs involving residents in all three residency years) was used in the analysis of 21 psychosocial attitude items from a survey questionnaire completed by general medicine residents. In 1991-92, 77 general medicine residents in ambulatory care group practices associated with the Massachusetts General Hospital were surveyed. Eighteen of the residents were in a primary care program (PCP), and 59 were in a traditional medicine program (TMP). RESULTS: The overall response rate was 82% (63 of 77 residents), with slightly lower rates for four items. The residents' attitudes to the psychosocial role of the primary care physician were positive but with reservations: 55 (87%) endorsed asking psychosocial questions, while only 28 (44%) indicated that most internists felt competent to diagnose and treat. Most residents did not feel defensive about enacting the role (neither uncomfortable asking questions in ambulatory care settings, 58, 92%; nor nosey, 56, 89%; nor personally interfering, 47, 76%). Fifty-two residents (83%) perceived patients to be receptive to psychosocial questions, yet 31 (49%) indicated that patients were resistant to psychosocial attributions, and 48 (76%) indicated that patients need to be prompted to talk about life problems. The clearest and strongest influence on attitudes was setting: ambulatory care over inpatient (p < .0001). Overall, the responses of the residents from the PCP and TMP were more similar than different. CONCLUSION: The residents accepted the psychosocial role of the primary care physician, found it most appropriate in ambulatory care settings, felt ambivalent about their ability to carry it out, and assigned it a secondary priority in patient care. To interest residents in primary care, more training should be based in ambulatory care settings and more emphasis should be placed on improving residents' competency in psychosocial skills.

Attitude of Health Personnel↗
PubMed1990

Major hepatic resection in a residency training program.

Records of 30 major hepatic resections performed at David Grant USAF Medical Center and Wilford Hall USAF Medical Center were analyzed to assess the feasibility, safety, and resources required for such procedures in a general surgery residency training program. The mean intraoperative blood loss during surgery was 2022 mL and the mean intraoperative transfusion volume was 4.2 units of packed red blood cells. Patients spent an average of 2.7 days in the intensive care unit, with a mean overall postoperative stay of 15 days. One death occurred within 30 days of operation due to a postoperative myocardial infarction, and another death during the hospital stay was due to hepatic insufficiency and Candida endocarditis. Overall, five major postoperative complications occurred (17%), one requiring reoperation. All but one procedure was done by a closely supervised surgical resident. This experience compares favorably with others in the literature and supports the practice of hepatic resection as part of surgical training.

Adult↗
PubMed1988

Evaluation of clinical competence in rheumatology training programs.

To ensure that members of the public and the medical profession can identify physicians who have demonstrated excellence in the field of rheumatology, the American Board of Internal Medicine has called upon directors of rheumatology training programs to establish systems to evaluate, document, and substantiate those components of overall clinical competence that are considered essential for certification. Many of these abilities can be assessed only by repeated, direct observations.

Certification↗
PubMed1991

The nature of hypnotic performance following administration of the Carleton Skills Training program.

30 low hypnotizable Ss were administered the Carleton Skills Training (CST) program, while 8 were assigned to a practice group. Prior to treatment, an attempt was made to facilitate training by altering the ecological conditions of the laboratory. All Ss were tested immediately after treatment, and trained Ss were retested after 5-7 months. Immediate training gains were large and were comparable in magnitude to those routinely found at Carleton University. In addition, (a) trained Ss responded comparably whether screened once or twice, (b) practice alone did not enhance hypnotic performance, and (c) natural high hypnotizable Ss obtained significantly larger Field Inventory of Hypnotic Depth (Field, 1965) scores than created high hypnotizables. Follow-up scores fell between scores posted at screening and immediately after training. Current findings are interpreted in the context of existing evidence concerning the CST program.

Adolescent↗
PubMed2001

[Hypogastric artery ligation. Safety and efficacy of a training program].

Bilateral hypogastric artery ligation is a technique described in the antiquity to restrain the hemorrhage in the gynecological and obstetric surgery. There are few Gineco-obstetricians that dominate the technique, for what intended a training program, in which was to demonstrate their security and effectiveness. We carry out a program where were qualified 14 gineco-obstetricians, theoretical and surgically. Results were analyzed finding an acceptable security with 1.5% of complications and an effectiveness demonstrated when having to the program 92.9% of students that reached the competition. We intend to reply the course in other hospital units, in order to decrease the maternal mortality for hemorrhage obstetric or gynecological.

Clinical Competence↗