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In the past it was assumed that medical students would be able to perform an adequate pelvic examination by the end of the third-year clinical clerkship. At the University of Virginia, students completing the clinical clerkship were evaluated by trained gynecology teaching associates (GTAs), acting as patients and chaperones, who systematically evaluated students' examination and interpersonal skills using both an objective scale including 86 specific items and two 12-point subjective rating scales. Interrater reliability was demonstrated, as was the correlation between the subjective scores and objective ratings. Thirty-two percent of the students were evaluated as having either inadequate or marginal examination skills, and 29% were rated as having interpersonal skills that fell into the same unsatisfactory category. GTAs can be used as evaluators of skills in a competency-based clerkship.
With the advent of DRGs, quality and cost have become the chief considerations of care providers and institutional managers; as a result, persons who can perform competently in crossover fields may be more employable and valuable than their single-credentialed counterparts. In academic health centers with more than one health-related school, opportunities exist to combine degree programs that result in educating multicompetent health care providers (MCHCP). In lieu of thinking about interdisciplinary education in the traditional sense, the training of MCHCPs can be achieved by simply combining one or more aspects of their respective curricula. Three methods--intra-, across-, and extra-field combinations--of melding two historically separate fields are described. An example of an across-field combination--the Baylor College of Medicine Physician Assistant/Perfusion Technology Program--is given.
A nationally representative sample of youth with disabilities who recently exited high school was studied to determine the participation of the youth in postsecondary educational programs. The results show that youth with disabilities participate in postsecondary programs at only one-quarter the rate attained by their counterparts without disabilities and at only one-third the rate attained by economically disadvantaged youth. The relationship of postsecondary education for youth with disabilities to long-term success in employment is yet to be determined.
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All trainee anaesthetists on the Northern Ireland training scheme were surveyed about the techniques they use when anaesthetising elective paediatric cases. We compared the practice of doctors with specialist paediatric training to that of others and discovered that trainees with specialist training were more likely (p less than 0.05) to admit parents during induction, but were less likely (p less than 0.05) to visit their patients pre-operatively and routinely to use suxamethonium. Other general findings were confusion over the re-use of halothane and extensive involvement of trainee anaesthetists in neonatal resuscitation.
OBJECTIVES: To examine the content of hospital obstetric vocational training for general practice, the beliefs of general practitioner trainees about this training, and their perceived competence at practical obstetric procedures and the effect of training. DESIGN: Confidential postal questionnaire. SUBJECTS: A random one in four sample of all general practitioner trainees in the United Kingdom on vocational training schemes or in training practices in Autumn 1990. MAIN OUTCOME MEASURES: Trainees' competence and beliefs on Likert scale, numbers of procedures witnessed and performed, type of maternity care trainees intended to provide. RESULTS: Of 1019 trainees sent questionnaires, 765 (75.1%) replied; 517 had done some hospital obstetric training. After six months as a senior house officer 232/367 (63%) believed they were competent to perform a normal delivery unaided, 228 (62%) to manage a severe postpartum haemorrhage, and 227 (62%) to resuscitate a newborn infant. 272 (35.6%) trainees intended to provide intrapartum care and 56 (7.5%) to book home deliveries in the future. Hospital training increased confidence in performing most obstetric procedures in all trainees. However, a greater proportion of trainees who intended to provide full care than shared care felt competent at performing a normal vaginal delivery (63% (170/272) full v 45% (215/473) shared), low forceps delivery (38% (103) v 17% (79)), manual removal of placenta (24% (65) v 17% (82)), and intubating a neonate (42% (114) v 34% (161)). Trainees who had done any obstetric training were less likely to think that training encouraged future provision of intrapartum care (113/509 (22%) training v 65/213 (31%) no training). CONCLUSION: Hospital vocational obstetric training increases the perceived competence of trainees but fails to encourage them to use obstetric skills.
The adequate preparation of health care assistants is a matter which is causing nurses great concern. Neil Headford outlines the initiative developed by Barnsley Health Authority which is designed to comply with the recommendations of statutory educational bodies. The meticulously designed course offers health care assistants broad and challenging opportunities and is based on the principles of adult and open learning. Assessment of performance is achieved through a competency model which draws on the ideas of established researchers.
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The Omnibus Reconciliation Act of 1987 set forth new provisions for Medicare and Medicaid sections related to new standards for care in the nursing home setting. One major provision was for nurse aide training. Within that provision there are four specified requirements: (1) nurse aide training for 75 hours, (2) competency evaluation of newly trained nurse aides, (3) competency evaluation of nurse aides already providing care, and (4) a registry for nurse aides. The primary implications of the these requirements center on the responsibility of the individual nurse or nurse community in ensuring appropriate implementation of the new requirement. Without appropriate implementation, some of the provisions increase the liability of the nurse and the risk to the public. The reality of OBRA 1987 and its intent of bringing a measure of quality assurance to the nursing home industry should only serve as an impetus for the nursing community to better translate the nurse role and its contribution in the nursing home setting to policy makers at local, state, and federal levels.
A primary method of cost control in health care facilities is the utilization of one employee in more than one capacity. The need for multicompetency education is readily apparent in radiologic technology, a field that consists of a wide variety of closely related specialty areas. The curriculum in the Division of Radiological Health Sciences at the University of Texas School of Allied Health Sciences at Galveston, has been specifically structured to accommodate this need. The division offers associate degree programs in radiography, nuclear medicine technology, and radiation therapy technology, and makes use of a core curriculum. The division also offers advanced skills training in subspecialty areas at the postassociate level in computed tomography, magnetic resonance imaging, angiography, and dosimetry. An evaluation of this system of multicompetent education is provided, based on a survey of graduates from the program. Multicompetent graduates were found to receive significantly higher salaries, enjoy an expanded job market, and have consistently better outlooks toward their future careers than single-skilled graduates.
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Primary dental health care has emerged as an important concept, particularly in the poor countries of the world, where dentistry as currently practised has not proved capable of controlling oral disease. Training for primary dental health care provision must be shaped to meet the specific needs of countries and communities. It demands a reorientation of those objectives which are conventional in dental teaching and the development of new attitudes on the part of teachers. Training must aim at self-development in which the ability to achieve simple goals is to the fore. The formulation of plans, the activities which result from them and the evaluation of their effects must be central to the teaching philosophy. Training must aim to develop competency in individual workers. This can best be generated by the use of field exercises. Teachers must not just deliver packages of information but they should develop a climate favourable to self-learning and use resources in a manner which allow students to recognise their own growth and development. Appropriate methods for achieving these goals are reviewed.
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A structured training program based on behavioral objectives was developed for interns in a hospital pharmacy department. In an 831-bed hospital that employs eight pharmacy interns, each for an average of less than or equal to 20 hours per week, a program was developed to ensure (1) that interns have experience working in all service areas and (2) that staff pharmacists are consistent in the tasks they assign to interns. Interns worked with area supervisors and the internship coordinator to develop 23 learning objectives that covered 10 pharmaceutical service areas. A manual listing the objectives is used by interns to document their progress and by pharmacists to ensure uniform experience for all interns. All staff pharmacists work with interns and participate in their evaluations. This program using behavioral objectives provides interns with basic experience in all areas of hospital pharmacy operations.