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PubMed1975

Career attainment - chance or choice. Survey of career experience of doctors graduating in Scottish medical schools in 1962.

A survey was carried out of the career experience of the doctors who graduated from Scottish medical schools in 1962. Few of those in general practice in the UK had undergone the minimum period of vocational training now considered necessary for new entrants to practice. Of those in the hospital and specialist services, 53% were consultants. There was a tendency for early career decisions to be made, leading to an increasing number of doctors obtaining postgraduate training almost exclusively in one specialty. Many married women doctors were underemployed. A quarter of the doctors were living overseas, including those of the nonBritish nationals who had returned to their country of origin.

Career Choice↗
PubMed1994

Determinants of career choices among women and men medical students and interns.

Women continue to be poorly represented in medical specialties other than general practice. A cross-sectional design was used to explore the development of career plans as medical training progressed; men and women students were compared in their first (n = 316), final (n = 295) and intern (n = 292) years. Women at each stage of training were significantly more likely to choose general practice as the field in which they were most likely to practise. There was little evidence that these differences were influenced by experience during training: women were as likely to choose general practice in first year as in the intern year. The most important determinant of career choice appeared to be the flexibility of training and of practice of medicine: variables such as the opportunity for part-time training, flexible working hours and part-time practice were important determinants of career choice and were of more importance to women than to men. The study also found high rates of discrimination or harassment reported by women medical students and interns. The results indicate the need for continued debate about these issues within medicine and the development of more flexible styles of medical training and practice.

Career Choice↗
PubMed1996

Portfolio-based learning and general practice vocational training.

This action research project developed a portfolio-based learning system, based around a 'log dairy,' with the trainers and general practitioner registrars of one training region in the UK. For those that found benefit from the system, the diary became an important way of holding all the events of a training year together; a way of looking back, in order to view the progress made, and looking forward, to view potential learning needs. Such portfolios were not found to be effective formal assessment mechanisms because the threat of assessment influenced the type of material collected. The enthusiasm of trainers was crucial in encouraging use of the model. The action research process was fundamental in stimulating explorations of ideas on reflective learning. There remains some resistance to the idea of reflective writing, and in this context, portfolios may be one educational tool for use by some, but which may not be universally applicable. Their development and implementation requires considerable local support through facilitation.

Family Practice↗
PubMed2004

Cost-effectiveness of post-transplantation quality of life intervention among kidney recipients.

BACKGROUND: The purpose was to demonstrate the cost-effectiveness of an experimental post-transplant care program designed to improve kidney transplant recipients' quality of life (QoL). The intervention program integrated a three-pronged interdisciplinary approach emphasizing: (i) proactive, patient-initiated care to prevent transplant-related morbidities, (ii) employment/vocational counseling, and (iii) enhancement of social support. METHODS: A cost-effectiveness analysis of a clinical trial was performed comparing QoL and costs in two groups: a retrospective cohort (n = 30) and those who received the experimental interventions (n = 150). Data were collected at baseline, 6 and 12 months. The number of quality-adjusted 'treatment-free days' was used as the primary outcome. The costs included those for direct intervention, direct inpatient and outpatient post-transplant health care, and indirect out-of-pocket expenses borne by patients. RESULTS: Patients in the intervention group had more quality-adjusted treatment-free days (289 vs. 272 and statistically significant) and lower cost per patient (although not statistically significant). Further, the superior outcome was delivered at an incremental cost of 29 US dollars per quality-adjusted treatment-free day. A one-way sensitivity analysis confirmed the robustness of the results. CONCLUSION: The experimental post-transplant care program is both effective and cost-effective; the superior results are attributed to improved QoL.

Adult↗
PubMed1996

Paddock to campus: rural high school and medical undergraduate programs in South Australia.

This paper outlines the programs that support country high school students with the potential to take tertiary health training, particularly in medicine and the details of mentor support and the transition into medical undergraduate training. Also, the establishment of rural clubs in Adelaide and Flinders Universities, together with their aims, objectives and activities are highlighted together with details of the evaluation process which has confirmed the success of rural clubs. The establishment of an effective database is described, with a summary of its objectives and scope.

Career Choice↗
PubMed1985

Vocational predictions compared with present vocational status of 60 young adults with cerebral palsy.

A group of 97 cerebral-palsied students between the ages of seven and 16 years were assessed in the 1960s and 1970s, and predictions were made as to their vocational status as adults. In 1983, 60 of the 76 over 18 years of age were contacted. 39 had been employed at some time since leaving high-school, but only 17 were employed at the time of the survey. Of those who had worked, over half had achieved or exceeded their vocational predictions. Those in competitive employment were more likely to be mildly disabled, to have higher IQs and to have been educated in integrated schools. Those who had never been employed were older and less independent in self-care and travel in the community. However, intelligence was not a major factor in distinguishing the employed from the never-employed. Recommendations are made for integrated education and job training in competitive settings, for community-based assessments and for family involvement in all aspects of planning to improve the vocational prospects of cerebral-palsied children.

Adult↗
PubMed2006

Background factors related to and/or influencing occupation in mentally disordered offenders.

OBJECTIVE: Knowledge of background and occupational related factors of mentally disordered offenders are missing. It is essential to understand these issues when planning discharge from forensic psychiatric hospital care to enable community dwelling. AIMS: One aim was to investigate mentally disordered offenders' background factors, confidence in and how they value occupations. Another aim was to investigate MDOs background factors' in relation to and the influences on Occupational Performance and Social Participation. METHOD: Data was collected with an explorative, correlative design after informed consent, from 74 mentally disordered offenders (mean age 34,2) cared for in forensic psychiatric hospitals. Assessments were Allen Cognitive Level Screen, Capability to Perform Daily Occupations, Interview Schedule of Social Interaction, Manchester Short Assessment of Quality of Life, Self-efficacy Scale and Importance scale. Eight background factors were assembled from the individual forensic psychiatric investigation. FINDINGS: Most of the investigated background factors relate to and half of them influence occupational performance, particular the cognitive aspect of occupational performance. The influences on occupation originate from adulthood, such as suffering from schizophrenia, psycho/social problems, and having performed violent crimes. These findings indicate that staff in forensic hospital care should initiate rehabilitation with knowledge about MDOs' complex daily occupations. For avoiding information bias, information gathering preceding treatment planning should be performed in collaboration between caring staff and mentally disordered offenders.

Adolescent↗
PubMed2006

Mentoring matters. Mentoring and career preparation in internal medicine residency training.

PURPOSE: Mentoring during the early stages of a career has been associated with high career satisfaction and may guide development of professional expertise. Little is known about mentoring experiences during residency training. Our purpose was to describe mentoring relationships among internal medicine residents, and to examine the relationship between mentoring and perceived career preparation. SUBJECTS AND METHODS: We designed and administered a mailed survey to all interns and residents enrolled in the five independent Internal Medicine Residency Training Programs affiliated with Harvard Medical School. We examined the development of mentoring relationships during residency training, and measured satisfaction with mentoring and with perceived career preparation. RESULTS: Of the 329 respondents (65% response rate), 93% reported that it is important to have a mentor during residency, but only half identified a current or past mentor. Interns [adjusted odds ratio (AOR) 0.3 (95% confidence interval (CI) 0.2, 0.5)] and underrepresented minority residents [0.3 (0.1, 0.7)] were significantly less likely to establish a mentoring relationship than their peers. Mentored residents were nearly twice as likely to describe excellent career preparation [1.8 (1.1, 3.1)]. CONCLUSION: Our findings demonstrate the importance of mentoring to medical residents, and identify a relationship between mentoring and perceived career preparation. We also identify a relative lack of mentoring among interns and underrepresented minority residents.

Boston↗
PubMed1983

Relationship of General Aptitude Test Battery scores to successful employment for epileptics in a rehabilitation setting.

The US Employment Service's (USES) General Aptitude Test Battery (GATB), when used with USES-developed cut-off scores, has been found to be an accurate predictor of successful job performance. In the present study, results of the GATB scores obtained by vocational rehabilitation clients (n = 15) who were successfully placed into permanent employment were evaluated with reference to published GATB norms and cut-off scores. The major finding of this study was that the scores were not accurate predictors of successful employment for this population. Subjects' subtest scores averaged between 1/2 and 2 SD below the published means, with scores on subtests measuring motor speed and dexterity producing the lowest values. Subtests measuring verbal and visual--spatial ability produced relatively higher values. In only 3 instances was successful employment predicted by the cut-off scores. For the entire sample, GATB scores were frequently low enough to indicate poor job performance in nearly all occupations covered by published cut-off scores. Based on the results from the present study, and considering the wide-spread use of the GATB in the United States, a more comprehensive research project is being implemented to adapt GATB material for use with the targeted population.

Adult↗