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PubMed1984

[Seminar on reciprocal physical examination for structuring personal experience within the scope of medical education].

During medical training, two aspects are usually neglected: practical exercise of technical skills, and the psychological and emotional aspects of the physician's action. A training model is described which is designed to assist in remedying this situation. In a theme-centered sensitivity training group, preclinical medical students of both sexes become acquainted with the basic techniques of physical examination and practice them under mutual guidance. These aspects of technical skill are also compared with the inseparably linked emotional angle. By changing repeatedly from the physician to the patient role and vice versa, role-specific tasks and their implications for practical medical action can be rendered transparent and discussed. The basic setting, exercises developed by the author, and experience with six groups (n = 72 participants) over a period of 2 years are described and briefly discussed.

Education, Medical↗

PubMed1999

Effectiveness of a hands-on training course for laparoscopic spine surgery in a porcine model.

BACKGROUND: Although it is widely proposed that surgeons, before introducing a novel laparoscopic technique in man, should practice in an appropriate animal model for acquisition of the necessary technical skills, the effectiveness of those hands-on training courses are rarely documented. METHODS: In 1995 we have organized eight hands-on training courses for laparoscopic anterior interbody spine fusion in an in vivo porcine model. A total of 72 colleagues from 50 different centers of 12 countries participated, including orthopedic, trauma, visceral, neuro-, and vascular surgeons. Quality and effectiveness of the course were evaluated by a questionnaire after a 1.5- to 2.5-year period. RESULTS: During this time, 42.2% of the participating centers had applied the new technique successfully in man. Centers which participated in the course with a team that included a skilled laparoscopic surgeon and an orthopedic or trauma surgeon introduced the technique more frequently to clinical practice (57.9%) than those represented by only one participant (30. 8%). Moreover, there was a tendency toward a more frequent introduction of the technique to clinical practice in centers associated with university hospitals (57.1% vs. 29.2%), indicating the requirement of a particular infrastructure for this complex interdisciplinary procedure. Almost all participants (98.3%) agreed that for novel surgical techniques requiring advanced technical skills, there should first be training in a large animal model before the technique is applied in man. CONCLUSIONS: Complex laparoscopic procedures (i.e., laparoscopic spine surgery) can be successfully learned by in vivo hands-on training courses. We propose that for refinements and modifications of the technique (e.g. , the lumboscopic approach), there should also first be training in a large animal model before these are applied in man.

Animals↗

PubMed2001

Training, job demands and mental health of pre-registration house officers.

OBJECTIVES: This study aims to explore pre-registration house officer (PRHO) perceptions of work role, job requirements and mental health, in order to enhance work role preparation by means of identifying potential areas for curriculum development. DESIGN: Phase 1 took place 6 weeks before completion of the pre-registration year. A total of 56 PRHOs completed questionnaires which included a diary of activities, recorded daily over a 2-week period (ward rounds, on-call, audit, administration, continuing medical education, etc.), items relating to perceived occupational control, and the Maslach Burnout Inventory. In phase 2, in the final 2 weeks of the preregistration year, 36% (n=18) of phase 1 participants were randomly selected for interview. SETTING: Three hospitals in the North-west of England. RESULTS: The average working week was 56 h, with 10% working in excess of this figure. The average weekly proportion of time spent on organized continuing medical education was 5%. Routine administrative tasks took up one-fifth of PRHO time and were perceived as lacking in training or educational elements. Of the PRHOs, 52% (n=29) desired further advice/training on the technical and management aspects of the job. Additional training was required on topics such as chest drains, delegation and time management. PRHOs felt this should be given prior to commencement of the pre-registration year. In terms of mental health, 25% (n=14) were experiencing burnout. Occupational control was external; many individuals perceived events as often occurring outside individual control. CONCLUSIONS: These findings have implications for the undergraduate curriculum and support General Medical Council recommendations for curriculum reform. It is suggested that organizational skills such as managing responsibility/delegation and additional training in practical procedures should be an integral part of the medical undergraduate curriculum.

Adaptation, Psychological↗

PubMed1991

The national leprosy eradication programme in India.

India has the largest leprosy problem in the world, with an estimated 4 million patients. The number of registered cases in the country was 2.4 million by June 1990, and the number of new cases detected during 1989-1990, 0.47 million. The disease prevalence varies widely from state to state and even among districts within states--8 of the 26 states contribute to 90% of all the registered cases. The country has a high priority for leprosy and the National Leprosy Eradication Programme (NLEP) aims to arrest the disease among all known cases in the country by the turn of the century through a strategy which includes multidrug therapy (MDT), early case detection, health education and rehabilitation. The specialized leprosy infrastructure in the country has a total of about 8,500 establishments including 719 leprosy control units, 244 district leprosy units and 49 training centres. By June 1990, 130 districts with 2.15 million patients had come under MDT. It is planned to cover 196 districts by 1992, ensuring coverage for 90% of the patients in the country. The country spends approximately 600 million rupees (US$ 33.3 million) per year on NLEP. In addition, a number of bilateral and international agencies including nongovernmental organizations participate in the programme. WHO supports the NLEP through technical inputs, monitoring and evaluation, and training. Plans to integrate leprosy control within primary health care, particularly after completion of the intensive phase of MDT, are being developed. Operational and technical constraints are constantly reviewed in order to find optimal solutions.

Communicable Disease Control↗

PubMedDate not supplied

Neonatal circumcisions performed by pediatric residents: implementation of a training program.

OBJECTIVE: To implement a pilot training program on neonatal circumcisions for pediatric residents in a residency training program, and to evaluate the effectiveness of the program in improving knowledge and skills in performing circumcisions. DESIGN: Educational curriculum. SETTING: The mother-baby unit of a tertiary care university medical center. PARTICIPANTS: Nineteen pediatric residents in training. INTERVENTION: A 1-month circumcision-training program. OUTCOME MEASURES: Successful completion of the training program, change in mean knowledge scores, and change in attitudes regarding circumcision. RESULTS: All 19 residents successfully completed the pilot program. Residents were enthusiastic about the opportunity to train in performing circumcisions. The mean test scores on the content items increased significantly from 5.0 (SD, 1.8) before training to 8.3 (SD, 1.0) after training (P <.003). After training, there were significant changes in residents' attitudes regarding giving anesthesia for the procedure and the medical indications for performing routine circumcisions. CONCLUSIONS: Given a structured curriculum, pediatric residents can be taught to safely and successfully perform neonatal circumcisions with adequate technical competency and pain relief skills. Training results in increased knowledge and increased level of comfort in performing this routine procedure.

Adult↗

PubMed2003

[Evaluation of radiological teaching programs in the Internet].

PURPOSE: Evaluation of web based training programs, which can be contacted from the homepages of radiological departments of German universities. MATERIAL AND METHOD: From June 2000 to January 2002 the 75 web based training programs of 57 providers,which can be contacted from the web pages of the radiological departments of German universities were evaluated in a prospective study. A medical student experienced in using the world wide web examined each training program three times in an interval of six months using the following criteria: availability of the web sites, target group, kind of training program, contents and structure and the technical solution. RESULTS: 51 of the 57 the homepages were fully available at each visit. 64 of the 75 web based training programs which could be connected from these sites were available at all three visits.One program was only partially available at one spot check. 8 of the 75 programs were designed for physicians and medically trained personal, 23 were made for medical students and 44 addressed both target groups (partially more than once mentioned). The number of the presented cases ranged between one single and 3700. In 31 of 75 training programs links to other teaching files were found. A complete presentation of cases was presented by 48 of the 75 web sites.5 of the 75 web sites offered physiological images for comparison. In 20 training programs the pathological changes were optically marked in the x-ray images. A logical and didactical structure was found in 24 teaching files, 14 gave the possibility to check the learning results. No provider made use of the possibility to pass credits to the students or physicians account with regard to official training programs. Multimedia techniques were used in 15 training programs.43 sites used data reduced preview images (thumbnails). The latest update of the site is mentioned in 55 of the 75 web sites. 19 of 57 providers had either no possibility of contact or did not answer to an e-mail. CONCLUSION: From the homepages of the departments of diagnostic radiology of German universities 75 teaching files can be contacted. There is a great variety in quantity and quality. Most sites offer collections of cases. A web based training program which is comparable in quality to a CD-ROM teaching program could not be found. No program used the possibility to give credits to the users with regard to official training programs.

Computer-Assisted Instruction↗

PubMed1992

Stapedectomy techniques in residency training.

The KTP-532 laser has decreased the technical difficulty involved in teaching and performing a stapedectomy in our residency program. Use of this laser has resulted in improved hearing and a decreased number of major and minor complications compared to an equal number of large fenestra stapedectomies performed with hand-held instruments. The major disadvantages of the KTP-532 laser are its cost and limited availability, and the inconvenience of a micromanipulator. The laser should not be relied upon entirely in performing a stapedotomy on a thick footplate. The University of Texas Medical Branch experience in training residents in both large and small fenestra stapedectomy is reported.

Adolescent↗

PubMedDate not supplied

[Bioethics and scientific training of physicians].

Bioethics is becoming a major current in modern medical thought and action. Given the youth of this field of enquiry, there are still important debates and controversies on its proper role in medicine and in medical education, but the need to foster its integral incorporation into the formative process of the physician is unreservedly accepted, on an equal footing with the scientific, technical, and humanistic components of medical training.

Bioethics↗

PubMed1998

Virtual environments for training critical skills in laparoscopic surgery.

Surgical training simulations must incorporate not only advanced technical features, such as detailed geometric organ models and physically-based modeling techniques, but also a thorough understanding of the major training issues relating to a particular procedure. We have developed a prototype environment for training laparoscopic cholecystectomy, or gallbladder removal surgery, which focuses a student's attention on the critical steps performed during the procedure and provides feedback as to the common errors committed during a session. The current version of our system runs in real-time on a mid-range graphics workstation. The simulation also provides a platform for research into a variety of different areas, including tissue modeling, finite element methods, and generalized simulation authoring.

Algorithms↗

PubMed1999

Extrication of entrapped victims from motor vehicle accidents: the crew concept.

During the extrication process the trauma victim is at high risk for additional injuries or aggravation of existing lesions. Improper handling during extrication with poor concern and knowledge of the ongoing resuscitation process may increase the time spent at the scene and expose the patient to unnecessary risks. Earlier studies report a significant number of neurological injuries that appear to be a result of the extrication process, or of inadequate immobilization during transport. Recent work also underlines the need for appropriate and situation adapted Advanced Life Support (ALS) procedures to improve outcome after prehospital trauma resuscitation. In this paper we present a method for training advanced extrication of trauma victims and the results obtained after five consecutive courses. The training focuses on enhanced liaison between medical and technical team members to optimize synchronization of operations. The course consists of both theoretical lectures and practical training in different crash scenarios. The complexity of the scenarios increases throughout the course and different extrication techniques and strategies are practised. Both the times to extrication and on-scene times were reduced during the 3-day course. Therapeutic interventions and handling of the patient were also improved, in terms of early recognition of medical and technical risks and reduction of the time of no therapy.

Accidents, Traffic↗

PubMed2004

Simulation and airway-management training.

PURPOSE OF REVIEW: Simulators can be used to teach simple technical skills or used in more realistic settings to teach or assess various cognitive/affective skills. Although simulators have become widespread, their use and efficacy in these various areas have not been delineated and are still being explored. This review will discuss the present state of using medical simulation for airway-management training. RECENT FINDINGS: Airway management includes both specialized technical skills and higher-order cognitive skills and behaviors. Since no one simulator is capable of covering all the functions necessary to teach these varied skills, medical specialists will need to train on a couple of different simulators. Now widely accepted in medical education, simulator training is being mandated in certain situations at some institutions because of a belief that it alters the physician. In this article its efficacy in teaching the specific psychomotor skills of bronchoscopy were validated but its use in teaching higher cognitive skills remained inconclusive. SUMMARY: Simulators are here to stay. Presently their usage in teaching psychomotor skills has scientific validity in specific tasks but their efficacy for teaching higher-order cognitive skills is still evolving. Future studies will continue to delineate the usage in different areas by studying the outcome in skills training and retention.

Journal Article↗

PubMed2006

Standards for data collection and monitoring in a telemedicine research network.

While a networked, nationwide health information system is financially and logistically impractical, the development of independent, regional systems is realistic and feasible. A Telemedicine Research Network (TRN) could connect a number of geographically disparate health systems. This would require the reconciliation of policies and practices in five principal areas: partner agreement on project scope; privacy, security and confidentiality; technical standards; telecommunications and computer infrastructure; change management and training. Initial establishment of a first-stage TRN would require very little technical development and would, instead, rely on trust among the partners. The development of standards-based TRNs will greatly increase the quality and quantity of telemedicine research.

Confidentiality↗

PubMed1997

A pilot study of the theoretical and technical competence and appropriate education for the use of nine physical agent modalities in occupational therapy practice.

OBJECTIVE: This study described occupational therapy practitioners' perceptions about the content and method of training or education necessary for gaining theoretical and technical competence in the use of nine physical agent modalities (PAMs). METHOD: A survey was developed and sent to 543 members of the Physical Disabilities Special Interest Section of the American Occupational Therapy Association who had identified their primary area of practice as hand therapy. One hundred and fifty-one completed surveys (28% response rate) were returned. RESULTS: The respondents indicated that theoretical and technical expertise necessary for competent use of PAMs varied according to the type of modality being considered. Continuing education courses were identified as the best method for gaining theoretical and technical competence for the use of deep thermal agents, such as ultrasound and electrical stimulation agents, whereas entry-level professional education and one-the-job training were identified as most appropriate for superficial thermal agents, such as paraffin bath and hot and cold packs. CONCLUSION: The results suggest that considerations regarding the type and amount of education necessary for gaining theoretical and technical competence in the use of PAMs depend on the type of modality being addressed. These differences should be considered in the future development of competency objectives for the use of PAMs.

Adult↗

PubMed2004

Family caregivers of older adults on home enteral nutrition have multiple unmet task-related training needs and low overall preparedness for caregiving.

OBJECTIVES: We used stress process theory to identify family caregiving variables that are salient to the experience of managing older adults' home enteral nutrition. In this article, we describe the specific tasks family caregivers performed and their unique training needs in the context of caregiver preparedness, competence, effectiveness, and health care use. DESIGN: Hospital billing lists from two university-affiliated institutions in Miami, FL, were used to identify older adults who had enteral tubes placed over a 6-month period. Consent was obtained from those older adults discharged for the first time on home enteral nutrition and their family caregivers at the first scheduled outpatient visit. SUBJECTS/SETTING: In-home interviews were conducted with a diverse sample of 30 family caregivers (14 white, 8 Hispanic, 7 African-American, 1 Asian) during their first 3 months (mean=1.83+/-0.69 months) of home enteral nutrition caregiving. STATISTICAL ANALYSES PERFORMED: Descriptive statistics were used to summarize data for all variables; chi(2) analysis was conducted to analyze differences in categorical variables. One-way analysis of variance was used to analyze mean differences among caregivers grouped by ethnicity for total number of hours and tasks performed. Post hoc comparisons were conducted using the Tukey HSD test. The Spearman rho correlations were calculated to assess bivariate associations between quantitative variables. RESULTS: Caregivers reported providing from 6 to 168 hours of care weekly (mean=61.87+/-49.67 hours), in which they performed an average of 19.73+/-8.09 caregiving tasks daily. Training needs identified were greatest for technical and nutrition-related tasks. Preparedness for caregiving scores were low (mean=1.72, maximum=4.0) and positively correlated with caregiver competence (P<.001) and self-rated caregiver effectiveness (P=.004). Preparedness negatively correlated with health care use (P=.03). CONCLUSIONS: Caregivers of older adults on home enteral nutrition need training for multiple nutrition-related and caregiving tasks. Multidisciplinary interventions, involving dietitian expertise, are needed to better prepare caregivers to improve both caregiver effectiveness and enteral nutrition outcomes.

Adult↗

PubMed2006

Challenges to the development of complex virtual reality surgical simulations.

Virtual reality simulation in surgical training has become more widely used and intensely investigated in an effort to develop safer, more efficient, measurable training processes. The development of virtual reality simulation of surgical procedures has begun, but well-described technical obstacles must be overcome to permit varied training in a clinically realistic computer-generated environment. These challenges include development of realistic surgical interfaces and physical objects within the computer-generated environment, modeling of realistic interactions between objects, rendering of the surgical field, and development of signal processing for complex events associated with surgery. Of these, the realistic modeling of tissue objects that are fully responsive to surgical manipulations is the most challenging. Threats to early success include relatively limited resources for development and procurement, as well as smaller potential for return on investment than in other simulation industries that face similar problems. Despite these difficulties, steady progress continues to be made in these areas. If executed properly, virtual reality offers inherent advantages over other training systems in creating a realistic surgical environment and facilitating measurement of surgeon performance. Once developed, complex new virtual reality training devices must be validated for their usefulness in formative training and assessment of skill to be established.

Computer Simulation↗

PubMedDate not supplied

Training program for new ophthalmic assistants.

1. A certified technician supervises the training of new ophthalmic assistants, but the entire technical staff is involved in the instruction. 2. The program lasts for 10 weeks: 8 weeks of training with ophthalmic procedures and 2 weeks of observation. 3. The essential elements of a well-rounded training program include knowledgeable trainers, role playing, and hand-on experience.

Educational Measurement↗

PubMed2006

Effects of resistance training on the physical capacities of adolescent soccer players.

This study examined the effects of a progressive resistance training program in addition to soccer training on the physical capacities of male adolescents. Eighteen soccer players (age: 12-15 years) were separated in a soccer (SOC; n = 9) and a strength-soccer (STR; n = 9) training group and 8 subjects of similar age constituted a control group. All players followed a soccer training program 5 times a week for the development of technical and tactical skills. In addition, the STR group followed a strength training program twice a week for 16 weeks. The program included 10 exercises, and at each exercise, 2-3 sets of 8-15 repetitions with a load 55-80% of 1 repetition maximum (1RM). Maximum strength ([1RM] leg press, bench-press), jumping ability (squat jump [SJ], countermovement jump [CMJ], repeated jumps for 30 seconds) running speed (30 m, 10 x 5-m shuttle run), flexibility (seat and reach), and soccer technique were measured at the beginning, after 8 weeks, and at the end of the training period. After 16 weeks of training, 1RM leg press, 10 x 5-m shuttle run speed, and performance in soccer technique were higher (p < 0.05) for the STR and the SOC groups than for the control group. One repetition maximum bench press and leg press, SJ and CMJ height, and 30-m speed were higher (p < 0.05) for the STR group compared with SOC and control groups. The above data show that soccer training alone improves more than normal growth maximum strength of the lower limps and agility. The addition of resistance training, however, improves more maximal strength of the upper and the lower body, vertical jump height, and 30-m speed. Thus, the combination of soccer and resistance training could be used for an overall development of the physical capacities of young boys.

Adolescent↗

PubMed1977

Temporary transvenous cardiac pacemaking in rural family practice.

Interested family physicians with proper training and minimal extra equipment can now employ transvenous pacemaking. Some cardiac centers have developed training programs for general internists and family physicians. We believe that this valuable procedure can, with proper physician training, be offered to patients in rural areas as well as in cardiac centers. While the number of patients in this rural family practice who require this procedure has not been great (ten patients in four years), the need is often urgent when it does occur. Use of this treatment modality with consultation in a 44-bed hospital was found to be safe and practical, although sometimes technically difficult. This paper describes the training, techniques used, results, and complications in a rural community in southeastern Nebraska. It is suggested that every hospital caring for seriously ill cardiac patients should have at least one physician trained to perform this emergency procedure.

Aged↗