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An evaluation of a communications training program within a self-help group for sexually abusive families.

Remediating the dysfunctional communications patterns of sexually abusive families is an important step in treating them. No communications training program for such families has been evaluated, however. This paper describes an evaluation of a communications training program carried out within the context of a self-help group for sexually abusive families. Group members were randomly assigned to receive an eight-week communications training program or to continue participating at self-help meetings. No group differences were apparent on a preintervention communications questionnaire, but the posttraining scores of experimental subjects were higher than controls. Experimental subjects maintained these scores upon follow-up and the scores of controls increased when the program was administered to them by a student therapist. It is suggested that the procedures and findings of this study contribute to the community mental health field by a) underscoring communications concepts that are helpful to abusive families; b) modeling a novel design for evaluating interventions that includes self-help participation as a nonspecific treatment; and c) illustrating the value of collaborative efforts between self-help groups and human services providers when they serve their mutual interests.

Adult

Evaluation of a training program in breast cancer nursing.

A training program in breast cancer nursing was evaluated in terms of its effects on 55 nurse participants and 18 breast cancer patients who were assigned to a control or to a program group. The quasi-experimental evaluation design employed both standard and investigator-developed instruments. Pre- and posttests were used to measure nurse participants' knowledge and attitudes and appraisal of usefulness and satisfaction with the program. Effect on patient outcomes was measured by means of a Perception of Care Questionnaire, a Breast Cancer Knowledge Quiz, and the Multiple Affect Adjective Checklist. In the cognitive and attitude domains, nurse participants improved significantly and appraised the program as highly useful and satisfactory. Program group patients scored significantly higher scores on the Perception of Care and Breast Cancer Knowledge Questionnaires and exhibited significantly less anxiety than control group patients. Results support the use of evaluation as a part of systematic program development. The evaluation of patient outcomes is a challenging but essential component of program evaluation.

Breast Neoplasms

A survey of child and adolescent psychiatry residents: perceptions of the ideal training program.

A survey instrument was developed to examine several issues relevant to training in child and adolescent psychiatry. Forty percent of the residents representing 56% of the training programs in the United States completed the questionnaires. A descriptive profile of the typical training experiences of child and adolescent psychiatry residents is presented, as is a report of their satisfaction with each component of their program and their expectations of an ideal training program. In general, satisfaction with residency training experiences was found to be highly related to the amount of emphasis reportedly placed on the various training experiences. The implications of the findings for training directors are discussed.

Adolescent Psychiatry

Teaching models in an ambulatory training program.

Ambulatory care training is increasingly important in internal medicine. Such training centers on the practice where residents and faculty see their patients; thus, features of the practice model influence what residents learn. A resident-faculty group practice affiliated with a division of general internal medicine has many advantages. In such a practice, learning centers on resident-patient interactions, around which a comprehensive teaching program must be built. Major features of such a program include the mentoring of residents by faculty who work with them longitudinally and the presence of a well-balanced structured curriculum addressing clinical and nonclinical topics related to patient care. Teaching residents to interact and communicate with patients is crucial; approaches include role-modeling by faculty, use of videotaping, and role-playing and other innovative methods. Feedback is integral to learning and helps shape the attitudes and values that permeate residents' practices.

Ambulatory Care

A driver training program for the disabled.

This is a report of results of a driver training program for a selected group of disabled individuals at the Long Beach Veterans Administration Medical Center. A total of 167 eligible candidates elected to enter our driver training program, of whom 154 (92%) were successful. Dropouts were the result of educational deficiencies, physical inability, and/or stress in performance ability.

Automobile Driver Examination

Traditional obstetrics; a Nigerian experience of a traditional birth attendant training program.

A survey was conducted of 150 Traditional Birth Attendants (TBA) living in the peri-urban slum area of Ibadan, Oyo State, Nigeria. The purpose was to determine demographic characteristics as well as knowledge about midwifery practices prior to introducing a training program. The participants in the survey had volunteered for a free, 3-week training program in modern obstetrics. Information was collected by questionnaire which was read to the participants. The findings show that: (1) useful service is being rendered by the TBAs; (2) there are areas where the introduction of simple methods of aseptic technique, changes in some nutritional practices and increased knowledge on the benefits of immunization may improve the outcome for mothers and infants living in traditional societies in Nigeria. The findings serve as a guide for the development of content of TBA training programs.

Delivery, Obstetric

A survey of Cleveland Clinic training-program alumni. Implications for evaluation of graduate medical education.

The graduate of a medical training program is in a unique position to evaluate that program in comparison with the realities of medical practice. A survey of alumni of the Cleveland Clinic's graduate training programs was conducted in September 1986. The alumni's perceptions of the quality of their programs and the educational services provided by the Division of Education are discussed in relation to the educational administrative structure and evaluation process at The Cleveland Clinic Foundation. The need for such evaluation methods, as well as additional techniques to provide a comprehensive evaluation system in graduate medical education, is emphasized.

Attitude of Health Personnel

A model curriculum for substance abuse education in child and adolescent psychiatry training programs.

Child psychiatry training recognizes substance abuse as a problem requiring an educational effort to provide fellows with adequate clinical skills to manage these patients. The components of a substance abuse educational module which may be integrated into existing child psychiatry fellowships are presented, with a discussion of practical problems raised by the expansion of child psychiatry into this neglected area.

Adolescent

Treadmill training program for a bilateral below-knee amputee patient with cardiopulmonary disease.

This study was undertaken to determine the degree of progress an elderly bilateral below-knee amputee with cardiopulmonary disease could achieve by endurance training on a treadmill. Aspects of medications, orthotic/prosthetic evaluation, and energy expenditure are discussed. The subject was a 63-year-old Class IV cardiac patient with combined restrictive-obstructive pulmonary disease of moderate severity. He had undergone a coronary artery bypass graft (two-vessel) followed by a bilateral below-knee amputation for an ascending dry gangrene. The initial ambulatory aerobic evaluation showed the patient achieving only 50% of predicted maximal heart rate and 20% of maximal oxygen consumption. An individualized daily training program started the patient walking at .5 mph, 0% elevation, for five repetitions at two minutes each. By the end of the six-month training program the workload reached 1.4 mph at 2.5% elevation, for 30 minutes of total external work. The final exercise test evaluation showed an overall increase in age-predicted maximal heart rate (90%) and oxygen consumption (55%). The patient improved from cardiac Class IV to Class II, and therapeutically from Class E (bed rest) to Class C (moderate exercise restriction). These findings suggest a need for endurance training programs for patients with cardiopulmonary disease hindered by additional physical disabilities. The program enabled the participant to engage in significantly higher levels of activity for daily living within the community.

Activities of Daily Living

Frequency and duration of interval training programs and changes in aerobic power.

This study was designed to ascertain whether 7- and 13-wk interval training programs with training frequencies of 2 days/wk would produce improvement in maximal aerobic power (VO2max) comparable to that obtained from 7- and 13-wk programs of the same intensity consisting of 4 training days/wk. Sixty-nine young healthy college males were used as subjects. After training, there was a significant increase in VO2max (bicycle ergometer, open-circuit spirometry) that was independent of both training frequency and duration. However, there was a trend for greater gains after 13 wk. Maximal heart rate (direct lead ECG) was significantly decreased following training, being independent of both training frequency and duration. Submaximal VO2 did not change with training but submaximal heart rate decreased significantly with greater decreases the more frequent and longer the training. Within the limitations of this study, these results indicate that: 1) maximal stroke volume and/or maximal avO2 difference, principle determinants of VO2max, are not dependent on training frequency nor training duration, and 2) one benefit of more frequent and longer duration interval training is less circulatory stress as evidenced by decreased heart rate, during submaximal exercise.

Adult

The use of goal attainment scaling to evaluate a cancer research training program for high school and college students.

Goal attainment scaling has been used frequently in the evaluation of mental health services. The purpose of this study was to assess the usefulness of the goal attainment scaling methodology in the evaluation of a cancer research training program. Subjects were 62 high school and college students participating in a summer research program. Prior to the program, all students were asked to predict the specific outcomes they expected to attain in relation to eight independent dimensions of the research training program. At the close of the program students were asked to indicate the outcome they attained for each dimension. Students also ranked the importance of each dimension. The analyses indicated that participants entered the program with accurate expectations of their ultimate achievement and satisfaction with the program. Significant differences were found for expected outcomes on a number of program dimensions for the high school and college students at the preprogram assessment. Significant differences were also found for the high school and college students' importance rankings at both the pre-program and post-program period. Goal attainment scaling proved to be a valuable and flexible technique for the evaluation of a cancer research training program.

Adolescent

A report of a 1972 survey of physician's assistant training programs.

This article presents select results of a 1972 survey of all physician's assistant training programs in the United States and its territories. The survey gathered a broad range of information useful to federal health manpower policymakers, physician assistant training program administrators, guidance counselors, and prospective students. Responses were received from 75 operational programs and 13 programs still in planning for an estimated response rate of 81 per cent from the estimated 108 programs in existence.

Accreditation

Audiology training in Nigeria--II: A cost-effective approach to training programs.

The purpose of this article is to provide some ways and means so that an audiology training program can be implemented in a developing country (Nigeria). Specific problems facing students, faculty and the training process itself are examined. Suggestions are provided to reduce these problems. In addition to mobilization of local resources, it is suggested that international cooperation be sought in the development, establishment and implementation of audiology training programs in developing countries. While the present approach may not be unique, it may provide some cost-effective means for meeting the shortage of hearing health care professionals in many developing countries.

Audiology

Ambulatory neurology in residency training programs: a perspective.

Inpatient care and teaching have been the central theme in academic medicine, including neurology, for the last several decades. However, pressures from within and outside of medicine are building to create a renewed commitment to ambulatory care and education. Most neurology training programs have not yet made that commitment. They should do so for the benefit of both the patients and residents served by the programs. Effective outpatient clinic training programs should include full-time staff devoted to ambulatory care, teaching, and research. The practicing clinical neurology staff could be used more effectively. Regular chart review, case management conferences, and other teaching strategies, and the reorganization of the clinic to include private patients, as well as group practice and interdisciplinary team concepts, could improve both the patient care and resident training in the neurology clinic.

Ambulatory Care

What is the legal 'standard of medical care' when there is no standard medical care? A survey of the use of home apnea monitoring by neonatology fellowship training programs in the United States.

In treating a patient, a doctor is obliged to use the skill and care that is ordinarily used by reasonably well-qualified doctors in similar cases. In addition, the only way in which a juror may decide whether the defendant used the skill and care which the law required of him or her is from evidence presented by doctors called as expert witnesses (cf Illinois Pattern Jury Instructions). However, what should be done if expert opinions differ concerning the care that is "ordinarily used"? Home apnea monitoring (HAM) is prescribed at times for graduates of neonatal intensive care units despite the fact that indications for its use are not well established and efficacy is completely unknown. The authors attempted to determine standards for HAM as it is currently practiced in neonatology training programs. The primary teaching hospital for each of the 99 neonatology training programs in the United States was identified. Both the medical director (MD) and a neonatal intensive care unit nurse manager (RN) were asked about the use of HAM in their own nursery for four clinical vignettes. Each vignette depicted a 1000-g birth weight infant, currently 7 weeks old and ready for discharge. In three vignettes, the infant had demonstrated no apnea, mild apnea (resolved by 2 weeks of age), or moderate apnea (requiring theophylline therapy at discharge) during the hospital course. In the fourth vignette, the infant had no apnea but was to be discharged home with supplemental oxygen. For 67 of 99 training programs, paired responses of RN managers and MD directors were obtained.(ABSTRACT TRUNCATED AT 250 WORDS)

Aftercare

Governmental peer review of training programs in child psychiatry.

The authors present the results of a review of grant applications from 84 child psychiatry training programs that was conducted by the Psychiatry Education Branch of NIMH during fiscal year 1975. They found that training programs whose applications were approved were (among other things) university based and successful in filling training positions; they provided experiences in two or more treatment modalities in varied settings and with diverse types of patients, had active liaison with community organizations and with departments of pediatrics, and provided research opportunities for trainees.

Child Psychiatry