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PubMed1994

Training in upper gastrointestinal endoscopy.

Training in upper gastrointestinal endoscopy is a vital portion of the education received by gastroenterology trainees. Proper training involves the acquisition of adequate technical, cognitive, and interpretive skills necessary for good patient care. With the continued technological advancement in endoscopy, advanced training in the form of an additional year of fellowship or hands-on workshops and courses will become essential.

Clinical Competence↗
PubMed2006

User and carer involvement in the training and education of health professionals: a review of the literature.

BACKGROUND: Health policy requires consumer involvement in services, research and education but little is known about how consumers are being involved in healthcare education, the effect on learning and practice, nor how involvement initiatives are being evaluated. OBJECTIVES: To describe methods of involving consumers in healthcare education, discuss ways in which initiatives have been evaluated, and identify areas for development in education, practice and research. DESIGN: All papers reporting specific initiatives involving consumers in health care worker training and education were included. Viewpoint articles and studies of consumers training consumers were excluded. DATA SOURCES: Cinahl, Medline, Assia, PsycINFO, British Nursing Index, Social Science Citation Index, citations from reference lists, relevant websites and personal communication with key people known to be working in this area. REVIEW METHODS: A narrative approach was taken with categorisation of data to reflect objectives of selected studies; method of involvement; process issues and evaluation. RESULTS: Thirty-eight papers were included; most provide small-scale qualitative studies of mental health service users and focus on process rather than outcome. Various methods of involvement are described and consumers consistently prioritise the need for training in interpersonal skills over 'technical' skills. There is little research into organisational strategies and no studies investigate the effect of consumer involvement on practice. Two studies indicated that students exposed to consumer involvement demonstrate more empathic understanding and better communication skills. CONCLUSIONS: There is tentative evidence that consumer involvement in training enhances workers' skills in the manner prioritised by consumers. However, if consumer involvement in training and education is to facilitate services that reflect the priorities of the people using them, it must be developed in partnership with service providers; further research is needed to explore the impact of consumer involvement and to track the development of organisational consumer involvement strategies, also systems for supporting consumers need to be established, including training for both consumers and staff.

Attitude of Health Personnel↗
PubMed2005

Prerandomization Surgical Training for the National Surgical Adjuvant Breast and Bowel Project (NSABP) B-32 trial: a randomized phase III clinical trial to compare sentinel node resection to conventional axillary dissection in clinically node-negative breast cancer.

OBJECTIVE: To train surgeons in a standardized technique of sentinel lymph node biopsy and to prepare them for the requirements of a prospective randomized surgical trial. SUMMARY BACKGROUND DATA: The NSABP B32 trial opened to accrual in May 1999. A significant component of this trial was a prerandomization training phase of surgeons performed by a group of core surgical trainers. The goals of this training phase were to expeditiously instruct surgeons in a standardized technique of sentinel lymph node biopsy and to educate those same surgeons in complete and accurate data collection and source documentation for the trial. METHODS: This study is a description of the training data collected in a prospective fashion for the training component for surgeon entry into the B32 trial, evaluating the effectiveness of the training program in regards to surgical outcomes and protocol compliance. RESULTS: Two hundred twenty-six registered surgeons underwent site visit training by a core surgical trainer and 187 completed training and were approved to randomize patients on the trial. The results of 815 training (nontrial) cases demonstrated a technical success rate for identifying sentinel nodes at 96.2% with a false negative rate of 6.7%. A protocol compliance analysis, which included the evaluation of 94 separate fields, showed mean protocol compliance of 98.6% for procedural fields, 95.5% for source documentation fields and 95.0% for data entry fields. CONCLUSIONS: This training and quality control program has resulted in a large number of surgeons capable of performing sentinel lymph node biopsy in a standardized fashion with a high degree of protocol compliance and pathologic accuracy. This will ensure optimal results for procedures performed on the randomized phase of the trial.

Axilla↗
PubMed1993

Sugar and spice and everything nice: health effects of the sexual division of labor among train cleaners.

Attempts have been made to justify the sexual division of labor by referring to women's relative physical weakness, lack of technical competence, and dislike for dirty work. An analysis of the work activity of train cleaners in France showed a rigid sexual division of labor, in which the task of toilet cleaning was exclusively assigned to women. Interviews and observations revealed a number of physical constraints associated with the work, and particularly with toilet cleaning. Women employees suffered from many musculoskeletal problems and were frequently absent from work. Toilet cleaning involved traveling distances of over 20 kilometers per day and maintaining uncomfortable postures. Twenty-five percent of time during the actual cleaning was spent in a crouched position. The work was complex, involving a number of choices and decisions, as well as requiring a variety of techniques adapted to the differences in the nature and location of soil. This "women's job" was dirty and physically demanding, and required technical skill. Among train cleaners, the inability to rotate jobs due to sex-typed job assignment may be associated with specific health and safety risks for both sexes.

Absenteeism↗
PubMed1982

[Vocational schools and the development of the human resources for water and sanitation institutions].

On the basis of his experience in occupational training in Panama, the author regards the vocational, professional and technical school as endowed with the requisites for the provision of adequate training of personnel for water supply and sanitation institutions. In his view, the programs of those schools, with their substantial content in technical, cultural and scientific subjects as well as practical activities, provide training that will enable the student to function successfully in the field in which he will be employed, and to pursue high-level careers. Despite the difficulties of various kinds to be surmounted, the author feels that, with the collaboration of the institutions in the sector, programs could be designed with any occupational profile that were regarded as necessary, as an accurate response for producing the technicians that the institutions need. The study plans of the professional and technical schools of Panama are added in an appendix.

Curriculum↗
PubMed1996

Application of TQM to mental health: lessons from ten mental health centers.

BACKGROUND: The principles and techniques of total quality management (TQM) have only recently been applied to the field of mental health. This article reviews issues and offers some preliminary observations, based on the author's consultation and training work with ten state-operated mental health organizations in Missouri (Jul 1, 1994-Jun 30, 1995). CULTURAL DIMENSION: Since many mental health organizations have operated in the public sector as part of large, hierarchical state agencies, the legacy of bureaucratic structures and a command and control leadership style may pose additional challenges. TECHNICAL DIMENSION: Two types of training have proven helpful in the Missouri project: general overview or awareness training for all staff and specialized training for team leaders and facilitators. STRATEGIC DIMENSION: To be successful with TQM, mental health organizations should clearly delineate their governing ideas, continuously reinforce them with all staff, and use the ideas as a measuring stick for progress. Some of the organizations in the Missouri project link their governing ideas and strategic planning efforts with critical success factors and the measurement methodology to track them. STRUCTURAL DIMENSION: This dimension, which may include a quality council, a quality department, and quality improvement (QI) teams, also extends to the way in which facilities are organized and function. The structure evolving from a team-oriented, time-limited, data-based, and problem-solving approach can facilitate the functioning of the entire organization. CONCLUSIONS: The philosophy and techniques of TQM are as applicable to mental health as to health care in general--the question is one more of motivation than of fit.

Adult↗
PubMed2005

Families' experiences of caring for technology-dependent children: a temporal perspective.

In the present study, families' experiences of caring for a technology-dependent child were examined from a temporal perspective. This involved exploring the multiple 'technological', 'social' and 'natural' rhythms and routines around which the families' lives were variously structured. A purposive sample of 36 families with technology-dependent children who used one or more medical devices on a daily basis was recruited. Devices included feeding pumps, suction machines, dialysis machines and ventilators. Using mainly qualitative methods, children, parents and siblings were interviewed to establish what the care routines involved and how these impacted on family members. The authors found that the rhythms and routines of care varied across the sample, depending on the type and number of devices used, the individual child's needs, and who provided technical care during the day and/or at night at home and in other settings. While the children's health and quality of life benefited from the technology, the time demands of the care routines and lack of compatibility with other social and institutional timeframes had some negative implications for the children and their families, limiting their participation in school, employment and social life in general. The need to use and oversee the use of some medical technologies at night also meant that many parents suffered regular disruption to their sleep. In conclusion, the authors argue that the care of technology-dependent children at home places considerable time demands on families. Families have little or no access to suitably trained carers who can provide technical care required in the home or away from the home to give parents and the whole family a break from caring where required. More trained carers and short-term care provision, better coordination of services and improvements in the design of devices would all help to reduce the negative effects of the care routines on families.

Adolescent↗
PubMed1991

The MAClinical Workstation Project at Georgetown University.

The intent of the MAClinical Workstation Project is to develop computer workstations for medical students of the sort they will use in future medical practice. The idea is to instill information query habits in the daily clinical activities of these young physicians-in-training. The Georgetown University Medical Center Library spearheads the project in conjunction with the School of Medicine. The library handles technical support, including software development, user training, equipment maintenance, and network installations. The project began in 1988 with nine Macintosh computers; today thirty machines are distributed throughout the Georgetown University Hospital conference rooms, faculty and resident offices, and at four affliated hospitals. The Macintosh computers are connected to the medical center's local area network (LAN) with access to the Integrated Academic Information Management System (IAIMS) and Library Information System (LIS) databases. The MAClinical workstations serve multiple educational purposes in the clinical setting. Primarily, students gain experience in medical informatics by using a variety of software systems installed at the stations: the H&P Writer, a history and physical system written in the C programming language, can be used by students to prepare the admission record on patients they examine; also, students can keep patient records, check findings against a diagnostic system, look up drugs and treatment protocols, develop medical sketches, and find additional information when needed in the medical literature.

Computer Systems↗
PubMed1996

[Prof. Dr. Richard Völker and the School for Veterinary Medicine Technical Assistants in Hannover].

The first assistant professions in medicine technical field were established in the last third of the 19th century. Basic units primarily were private institutions which aimed to set up training facilities and money-making opportunities for unmarried women of the middle and upper classes. In correlation with the progress in microbiology and X-ray technics from about 1900 in veterinary medicine the demand for technical assistants raised up too. Since 1929 in some institutes and clinics of the Hannover Veterinary School unpaid trainees were instructed. Accordingly to this the "School for the Training of Technical Assistants in Veterinary Institutes" was founded on the initiative and under control of Richard Völker in summer 1937. In this paper a preliminary report is given which deals with the main aspects of the development of the profession, the school's foundation history and the special role of its founder Völker. A doctoral thesis to this subject is submitted to the veterinary authorities.

Animal Technicians↗
PubMed2003

[A method increasing G-tolerance of fighters' pilots with symptoms of the partial cardiovascular deficiency].

Training on the static ergometer was shown to increase tolerance of fighters' pilots for radial accelerations. Proposed is a program of training on the static ergometer consisting of two incremental loads in the interval between 120 and 240 kgf. In persons with cardiac pathologies this training program noticeably improved parameters of the cardiovascular adaptive reaction to static loads. Effectiveness, technical simplicity and low cost of the training are the attributes that can insure it a proper place in the rehabilitative treatment of pilots prior to or during the institutional examination as a part of the medical flight certification.

Adult↗
PubMedDate not supplied

[Bases for the development of teaching, research and maternal and infant care in the rural area. The Temascalcingo plan].

The Instituto de Ensenanza e Investigaciones Rurales (Institute for Rural Training and Research) has been established in Solís, Municipality of Temascalcingo, State of Mexico. The institute is part of the Institucion Mexicana de Asistencia a la Ninez, IMAN (Mexican Institution for the Assistance of Childhood). The institute will study a system of healthy delivery in its (rural) zone of activity, based principally in programes with a strong content in the preventive and promotional aspects. For this purpose it will use in a preferential way, auxiliary and technical personnel which is being trained by the institute and that is original from the community where it will serve. At the professional level, the institute will mainly employ pediatricians, nurses and social workers that are completing their residency at the Hospital del Nino IMAN in Mexico City. These professional will obtain important supplementary training through their participation in the rural community health programes that the institute will develop.

Adolescent↗
PubMedDate not supplied

Training outcome in future professional voice users after 18 months of voice training.

The goal of this study is to define the long-term influence of vocal hygiene education and the effectiveness of voice training in 46 students. Half of the subjects, called the trained group (n = 23), received vocal hygiene education during 1 school year and voice training during 2 school years (18 months). The other half, also 23 subjects, received neither vocal hygiene education nor voice training as such (called the untrained group). The voice training is made up of technical workshops (30 h a year in groups of 5-8 subjects) and vocal coaching in the radio and drama projects (30 h whole class). In the lectures (30 h) a theoretical background on breathing, articulation, voicing and vocal hygiene was discussed. A multidimensional test battery containing the GRBAS scale, videolaryngostroboscopy, maximum phonation time, jitter, lowest intensity, highest frequency, Dysphonia Severity Index (DSI) and Voice Handicap Index (VHI) was applied before and after 18 months to evaluate the effect of voice training over time. A questionnaire on daily habits was presented before the lectures, and after 18 months to detect the long-term effect of the lectures. The objectively measured voice quality (DSI) of the trained group improved significantly over time (p < 0.001) due to training (p = 0.008), which was not the case in the untrained group. The self-assessed VHI, on the other hand, changed over time (p < 0.001) in both groups. For the trained group the VHI changed from 18.4 to 14.4 and in the untrained group from 20.1 to 15.3. It is important to note that the VHI scores of both groups remained high. The interpretation of the results of the daily habit questionnaire is disturbing: the initial high degree of smoking, vocal abuse, stress and late meals was not influenced by the lectures or training and remained high. This study proves the positive outcome and emphasizes the need for a well-organized voice training program in future professional voice users. However, the lectures and training on vocal hygiene failed to improve voice-conserving habits.

Adult↗
PubMed1996

Training and privileging for new procedures.

Hands-on training for advanced laparoscopic procedures is more difficult to obtain than for basic laparoscopy, but because morbidity and mortality rates for these technically demanding procedures are higher, adequate training is essential and obtained, ideally, through a formal fellowship in advanced laparoscopy. Shorter preceptorships can provide adequate training but are more difficult to find. Few advanced laparoscopic procedures are experimental, but the safety of each must be ensured before a hospital awards privileges for their performance. Vigilance regarding local and national outcomes of these new procedures is essential in this rapidly evolving field.

Fellowships and Scholarships↗
PubMed1996

Early experience with transfemoral endovascular aneurysm management (TEAM) in the treatment of aortic aneurysms.

OBJECTIVES: To evaluate the early experience with transfemoral endovascular aortic aneurysm management using the Endovascular Grafting System. DESIGN: Multi-centre prospective evaluation of the implantation procedure and early results (median follow-up 153 days). SETTING: Department of Surgery, University Hospital Utrecht, The Netherlands; Department of Surgery, University of Sydney, Australia; University of Leicester School of Medicine, Leicester, U.K., Department of Surgery, Karolinska Hospital, Stockholm, Sweden and Nuffield Department of Surgery, University of Oxford, John Radcliffe Hospital; Oxford, U.K. MATERIALS: 31 consecutive patients treated in 13 months. CHIEF OUTCOME MEASUREMENTS: Peri and postoperative morbidity and mortality in accordance with the recommendations of the Ad Hoc Committee on Reporting Standards. MAIN RESULTS: Graft placement was initially successful in all 31 patients. In one patient the endograft had to be replaced by a standard aortic tube graft because of extra graft flow in the aneurysm sac, and complaints of back pain. One patient died from multiple organ failure, 11 days after the operation. In three patients five severe adverse events were recorded. Breaks of the attachment system were encountered in two patients. These failures did not have severe clinical consequences for individual patients. CONCLUSIONS: Transfemoral Endovascular Aneurysm Management is a technically demanding procedure that requires special training in both catheter and surgical techniques. The potential for less operative morbidity when compared to conventional surgery and the prospect of technical improvements in graft and introduction system design will make TEAM an important tool in aneurysm management in the near future.

Aged↗
PubMed2006

Evolution of surgical skills training.

Surgical training is changing: one hundred years of tradition is being challenged by legal and ethical concerns for patient safety, work hours restrictions, the cost of operating room time, and complications. Surgical simulation and skills training offers an opportunity to teach and practice advanced skills outside of the operating room environment before attempting them on living patients. Simulation training can be as straight forward as using real instruments and video equipment to manipulate simulated "tissue" in a box trainer. More advanced, virtual reality simulators are now available and ready for widespread use. Early systems have demonstrated their effectiveness and discriminative ability. Newer systems enable the development of comprehensive curricula and full procedural simulations. The Accreditation Council of Graduate Medical Education's (ACGME) has mandated the development of novel methods of training and evaluation. Surgical organizations are calling for methods to ensure the maintenance of skills, advance surgical training, and to credential surgeons as technically competent. Simulators in their current form have been demonstrated to improve the operating room performance of surgical residents. Development of standardized training curricula remains an urgent and important agenda, particularly for minimal invasive surgery. An innovative and progressive approach, borrowing experiences from the field of aviation, can provide the foundation for the next century of surgical training, ensuring the quality of the product. As the technology develops, the way we practice will continue to evolve, to the benefit of physicians and patients.

Clinical Competence↗
PubMed1994

Midwives in Niger: an uncomfortable position between social behaviours and health care constraints.

Maternal mortality rates are very high in developing countries. In Niamey, the capital of Niger, maternal mortality rate is 280/100,000, in spite of a high concentration of health services and of health personnel. Several studies demonstrated that the efficiency of maternal health services was low, both because the quality and the quantity of work were insufficient. The usual response to the poor performances of health services in developing countries is mainly technical. If improvement of the training of health personnel and re-organization of health services are necessary, they are not sufficient. A good effectiveness of care cannot be achieved without a mutual confident relationship between providers and patients. Focus group discussions were held in Niamey with women users of maternal health services, with student midwives and experienced midwives. Sources of complaints between providers and patients appeared to be numerous. However, they are centered around two themes, delivery techniques and cultural requirements, which correspond to two types of constraints: technical constraints and social representations and practices of the population. A description of traditional practices and beliefs related to delivery were obtained through discussion groups with old women and traditional birth attendants (TBAs). Both women and midwives are tied up by the same social rules (e.g. linguistic taboos, respect and shame) but technical constraints force midwives to violate those rules, making the application of their technical skills very difficult. Thus, the mutual relationship between users and providers is source of dissatisfaction, which often degenerates into an open confrontation. Midwives must learn how to implement obstetrical techniques within specific cultural environments.

Cultural Characteristics↗
PubMed2001

Developing a District Health Information System in South Africa: a social process or technical solution?

South Africa initiated a national District Health Information System rollout strategy in the latter half of 1999. Experience has demonstrated that the implementation of an information system as a vehicle for the delivery of accountability in the management of health services, demands organisational change within a framework of human resource development and technical support. The aim of training, to empower facility and district staff to use locally generated information to improve coverage and quality of primary health care services, can only be realized if training and innovation for change are appropriately marketed and supported. The appeal of HISP software, a locally developed application system lies in its user acceptance. While computers form a vital tool in providing easily accessible information for decision-making, their use must not be seen as a panacea for all information problems in primary health care services. Strategies for promoting sustainability of DHIS implementation lie in the social processes of human resource development, changing organisational infrastructure and the use of ongoing evaluation rather than those of technical infrastructure. South Africa has developed a variety of mechanisms to facilitate this process.

Community Networks↗
PubMed1990

Training in critical care medicine: a personal perspective.

Over the past several years, there has been growth in the number of training programs in the new subspecialty of critical care medicine. The adoption of subspecialty certifying examinations in critical care medicine has added momentum to the growth of the subspecialty. A personal experience in a critical care medicine fellowship training program is detailed and contrasted with a year of clinical pulmonary fellowship training. The clinical training programs differed primarily in scope. Technical expertise in intensive care unit procedures and therapy was stressed during the critical care medicine fellowship, whereas the year of clinical pulmonary training was of greater scope, encompassing comprehension of pulmonary pathophysiology, diagnostic procedures, and therapy. "Hands-on" intensive care unit training was limited during the pulmonary fellowship, though didactic instruction and the conceptual approach to critical illness was stronger. Research training opportunities were largely equivalent. From this experience, I present suggestions for selecting fellowship training in critical care medicine.

Critical Care↗