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PubMed2006

Simulation training in video-assisted urologic surgery.

The current system of surgical education is facing many challenges in terms of time efficiency, costs, and patient safety. Training using simulation is an emerging area, mostly based on the experience of other high-risk professions like aviation. The goal of simulation-based training in surgery is to develop not only technical but team skills. This learning environment is stress-free and safe, allows standardization and tailoring of training, and also objectively evaluate performances. The development of simulation training is straightforward in endourology, since these procedures are video-assisted and the low degree of freedom of the instruments is easily replicated. On the other hand, these interventions necessitate a long learning curve, training in the operative room is especially costly and risky. Many models are already in use or under development in all fields of video-assisted urologic surgery: ureteroscopy, percutaneous surgery, transurethral resection of the prostate, and laparoscopy. Although bench models are essential, simulation increasingly benefits from the achievements and development of computer technology. Still in its infancy, virtual reality simulation will certainly belong to tomorrow's teaching tools.

Clinical Competence↗
PubMedDate not supplied

Communication disorders: investigator training and support needs.

There are very few "simple problems" left in the area of communication disorders, but that does not mean that there are unsolvable problems. However, in pursuit of these, present day research often requires extensive technical procedures which require teams of investigators trained in different areas. Among these should be the otolaryngologist, but, in this country, there are few involved and there is a paucity of disease-oriented research. In the 1950s and 1960s the NIH training grant provided funds for bringing doctor of philosophy researchers into clinical departments to set up laboratories and work intimately with the medical doctor. Basic research training is still essential during residency and the number of postresidency fellowships ought to be increased. The familiarity with clinical problems introduced into the research effort should improve the possibility for the conduction of disease-oriented research in addition to the present day emphasis on basic research.

Animals↗
PubMed1996

Performance-based assessment in continuing medical education for general practitioners: construct validity.

The use of performance-based assessment has been extended to postgraduate education and practising doctors, despite criticism of validity. While differences in expertise at this level are easily reflected in scores on a written test, these differences are relatively small on performance-based tests. However, scores on written tests and performance-based tests of clinical competence generally show moderate correlations. A study was designed to evaluate construct validity of a performance-based test for technical clinical skills in continuing medical education for general practitioners, and to explore the correlation between performance and knowledge of specific skills. A 1-day skills training was given to 71 general practitioners, covering four different technical clinical skills. The effect of the training on performance was measured with a performance-based test using a randomized controlled trial design, while the effect on knowledge was measured with a written test administered 1 month before and directly after the training. A training effect could be shown by the performance-based test for all four clinical skills. The written test also demonstrated a training effect for all but one skill. However, correlations between scores on the written test and on the performance-based test were low for all skills. It is concluded that construct validity of a performance-based test for technical clinical skills of general practitioners was demonstrated, while the knowledge test score was shown to be a poor predictor of competence for specific technical skills.

Adult↗
PubMed2005

[The reference nurse--position on the practice of training and supervision].

This qualitative research discusses the nurse known as the reference nurse who is more specifically in charge of the training and supervision, and evaluation of the student nurse who has in-service training in care unit. The research notably describes the practice and position of the Reference Nurse (hereafter RN) in this role. As the aim is to know better the practice of the RN for the training and supervision of student nurses, this is an approach of mutual understanding that every RN is individually interviewed, then that researchers meet them again, this time in groups (by region), which enables among other things, to discuss certain positions which came out of a first analysis of discussions. In this aim, within a university hospital, twenty-four nurses working in internal Medicine, Psychiatry and Surgery, were interviewed by a research team. The context of this research is particular and interesting in several respects. The research was carried out in partnership between two institutions, one institution of university care and one institution of training in nursing care; the research team therefore includes people from both institutions. It is the encounter of two worlds that have a joint function, that is to train nurses, but that also have trend and themes that are specific to them, or even antinomic; all this in a context of educational and organizational changes of the nursing training. The research themes are the activities of training and supervision carried out, the arbitration of their caring and educational practice, the key moments of training and supervision, their objective look at this role, the ideal thing as they would see it. RN described a system which is not much formal, essentially marked out by key moments such as the entry in the care unit of the student, the welcome, exchanges with the student, punctuated with educational assessment and end-of-training assessment. When giving to the patients, RN develop some forms of activities with the student which ensure the work prescribed on behalf of their responsibilities, while trying to adapt themselves and interact with the student as well as with the contextual situation. The student's questions are uses as much to check her knowledge, her understanding of the caring situations, her ability to get organised, to argue as to understand her better in her real-life experience, her self-esteem, to put her well at ease, in confidence to facilitate her apprenticeship. The quality of dialogistic communication is strongly emphasized as necessary to training and supervision. Evaluation is an important part of the supervisory work and reference nurses actually showed a tension between a control position and a confidence position in the practice of the student's follow-up. RN expressed their wish to have specific time to train and supervise the student, would like to increase partnership with schools, and requested some educational support. Their talks brought to light the various skills, as much technical as social, that this role of training and supervision requires, but also the emancipatory impact of these various roles held.

Adult↗
PubMed1996

Quantitative assessment of procedural competence. A prospective study of training in endoscopic retrograde cholangiopancreatography.

BACKGROUND: Endoscopic retrograde cholangiopancreatography (ERCP) is a technically demanding procedure that can cause substantial complications. Competence in performing ERCP and the learning curve for achieving competence are poorly understood. OBJECTIVE: To evaluate the number of supervised ERCPs that physicians must do to achieve procedural competence. Competence was defined as a 0.8 probability of successfully completing specific technical components of ERCP and an overall grading of competence as judged by the attending physician. DESIGN: Prospective study. SETTING: University training program for gastroenterologists. PARTICIPANTS: 17 gastroenterology fellows at various stages of training. MEASURES: Experienced therapeutic endoscopists prospectively graded gastroenterology fellows during 1796 consecutive ERCPs. Fellows were graded on their overall level of competence for the procedure and on specific technical components of ERCP. RESULTS: Grading data were available for 1450 ERCPs (81%). The number of ERCPs done before adequate skill was achieved was 160 for cholangiography, 140 for pancreatography, 160 for deep cannulation of the pancreatic duct, 120 for stone extraction, and 60 for stent insertion. Fellows achieved overall competence after completing 180 to 200 ERCPs. The predicted probability of overall competence was 0.8 after 137 ERCPs and 0.9 after 185 ERCPs. CONCLUSIONS: At least 180 ERCPs were required before these gastroenterology fellows could be considered competent in ERCP. This number is much greater than that previously recommended, and these findings have substantial implications for training guidelines and issues of competence and certification in ERCP. The methods used to define and evaluate competence in ERCP could also be used to assess competence in other medical procedures.

Cholangiopancreatography, Endoscopic Retrograde↗
PubMedDate not supplied

[Optimizing French scientific and economic performance: the Cifre system of public-private partnership in doctoral research and Servier's contribution].

The European Union has set itself the daunting target of becoming the world's most competitive and dynamic knowledge-based economy by 2010. Any hope of success against the United States and the Asian tiger economies lies in the quality of scientific and technological research. In France, postgraduate training has long labored under a deep academia/industry divide. Although the universities have introduced supervised 3 year doctoral courses along the lines of the English-speaking countries, they still produce too many postdocs with little experience or understanding of, and little taste for, the private sector. This ignores career realities: the public sector can offer employment to only half the postdocs it produces. The rest must fall back on positions in the private sector, in some cases with a sense of failure, ill suiting them to drive the intellectual economy forwards compared to their international competitors. To combat the divide and emphasize the quality of the research training available within industry, the public/private National Association for Technical Research (ANRT), acting on behalf of the Ministry of Research, created the Industrial Research Training Agreement (Cifre) scheme in 1981. Higher education laboratories and private companies combine to offer doctoral students the opportunity to undertake their 3 year course in a mixed public/private environment (the exact ratio is not defined but in the case of the Servier Research Group, an early and active participant in the scheme, at least one third of the course is spent in the private sector). The doctoral thesis is thereby transformed into a meaningful career qualification. Funded by the Ministry, with maintenance grants to the students and compensatory payments to the companies, the Cifre scheme, which is currently being expanded, has produced 12,000 postdocs personally and intellectually equipped for careers transiting seamlessly between the public and private sectors, to the enrichment of each.

Charities↗
PubMed2004

Physician leadership is a new mandate in surgical training.

BACKGROUND: Traditionally, development of physician leadership has occurred at random in surgical training. One possible reason is that surgical educators have focused on detailed instruction on critical patient situations, resuscitation, and technical skills, but they have provided little formal training in the essential leadership skills. METHODS: To determine resident perceptions about the importance of these skills and individual strengths and weaknesses in these areas, a questionnaire was administered to 43 residents in our general surgery program. In part one of the questionnaire, the residents ranked 18 leadership skills on a scale of 1 to 4 in importance ("not important," "minimally important," "somewhat important," and "very important") for career development. The second portion of the questionnaire asked the residents to rate themselves on a similar scale with regard to their personal confidence and competence in these same areas. RESULTS: Twenty-three residents (53%) completed the entire questionnaire. The majority of the residents (92%) rated all 18 leadership skills "somewhat" or "very important" for career development. More than 50% of the residents rated themselves as not competent or minimally competent in 10 of the 18 areas. Ethics was the only area in which >75% of the residents believed themselves to be more than minimally competent. There were no significant differences between postgraduate training levels in any of the parameters calculated. CONCLUSIONS: We conclude that although residents see these nontraditional topics as an important part of their professional education, they do not necessarily feel confident or competent in these areas. Establishing a conscious effort to teach these topics and to emphasize their importance during training will enhance residents' self-image, performance, and potential as future leaders.

Adult↗
PubMed2006

The safety and quality of decision support systems.

OBJECTIVES: The use of clinical decision support systems (CDSS) can improve the overall safety and quality of health care delivery, but may also introduce machine-related errors. Recent concerns about the potential for CDSS to harm patients have generated much debate, but there is little research available to identify the nature of such errors, or quantify their frequency or clinical impact. METHODS: A review of recent literature into electronic prescribing systems, as well as related literature in decision support. RESULTS: There seems to be some evidence for variation in the outcomes of using CDSS, most likely reflecting variations in clinical setting, culture, training and organizational process, independent of technical variables. There is also preliminary evidence that poorly implemented CDSS can lead to increased mortality in some settings. Studies in the US, UK and Australia have found commercial prescribing systems often fail to uniformly detect significant drug interactions, probably because of errors in their knowledge base. Electronic medication management systems may generate new types of error because of user-interface design, but also because of events in the workplace such as distraction affecting the actions of system users. Another potential source of CDSS influenced errors are automation biases, including errors of omission where individuals miss important data because the system does not prompt them to notice them, and errors of commission where individuals do what the decision aid tells to do, even when this contradicts their training and other available data. Errors of dismissal occur when relevant alerts are ignored. On-line decision support systems may also result in errors where clinicians come to an incorrect assessment of the evidence, possibly shaped in part by cognitive decision biases. CONCLUSIONS: The effectiveness of decision support systems, like all other health IT, cannot be assessed purely by evaluating the usability and performance of the software, but is the outcome of a complex set of cognitive and socio-technical interactions. A deeper understanding of these issues can result in the design of systems which are not just intrinsically 'safe' but which also result in safe outcomes in the hands of busy or poorly resourced clinicians.

Decision Support Systems, Clinical↗
PubMed1997

Occupational health in Brazil.

Brazil is a recently industrialised country with marked contrasts in social and economic development. The availability of public/private services in its different regions also varies. Health indicators follow these trends. Occupational health is a vast new field, as in other developing countries. Occupational medicine is a required subject in graduation courses for physicians. Specialisation courses for university graduated professionals have more than 700 hours of lectures and train occupational health physicians, safety engineers and nursing staff. At the technical level, there are courses with up to 1300 hours for the training of safety inspectors. Until 1986 about 19,000 occupational health physicians, 18,000 safety engineers and 51,000 safety inspectors had been officially registered. Although in its infancy, postgraduation has attracted professionals at university level, through residence programmes as well as masters and doctors degrees, whereby at least a hundred good-quality research studies have been produced so far. Occupational health activities are controlled by law. Undertakings with higher risks and larger number of employees are required to hire specialised technical staff. In 1995 the Ministry of Labour demanded programmes of medical control of occupational health (PCMSO) for every worker as well as a programme of prevention of environmental hazards (PPRA). This was considered as a positive measure for the improvement of working conditions and health at work. Physicians specialising in occupational medicine are the professionals more often hired by the enterprises. Reference centres (CRSTs) for workers' health are connected to the State or City Health Secretariat primary health care units. They exist in more populated areas and are accepted by workers as the best way to accomplish the diagnosis of occupational diseases. There is important participation by the trade unions in the management of these reference centres. For 30 years now employers organisations have also kept specialised services for safety and occupational health. Although they are better equipped they are less well used by the workers than the CRSTs. At the federal level, activities concerned with occupational health are connected to three ministries: Labour, Health and Social Security. The Ministry of Labour enacts legislation on hygiene, safety and occupational medicine, performs inspections through its regional units and runs a number of research projects. The Ministry of Health provides medical care for workers injured or affected by occupational diseases and also has surveillance programmes for certain occupational diseases. The Ministry of Social Security provides rehabilitation and compensation for registered workers. In spite of a decrease in the number of accidents at work during the past 25 years, working conditions have not improved. Changes in the laws of social security in the 1970s discouraged registration and reporting of occupational injuries and diseases. In consequence death rates due to accidents increased. With the implementation of the CRSTs, the recorded incidence of occupational diseases has risen, not only because of improved diagnosis, but also because of stronger pressure from the unions and better organisation of public services and enterprises.

Accidents, Occupational↗
PubMed1995

Biliary manometry in swine: a unique endoscopic model for teaching and research.

Biliary manometry, the "gold standard" for the diagnosis of sphincter of Oddi dysfunction, is associated with technical and methodological problems. The lack of a suitable experimental model has hindered efforts to solve these problems. We report here on the first practical animal model for endoscopic biliary manometry, similar in technique to the procedure in humans. Piglets were sedated and intubated with a standard human duodenoscope. A standard water-perfused manometry catheter was inserted into the bile duct. The biliary sphincter was identified by a zone of high-pressure activity with superimposed phasic contractions. The sphincter responded normally to the administration of cholecystokinin and morphine by relaxation and contraction, respectively. This model should be useful for training in biliary manometry, and facilitate technical innovations in the field. Since it is relatively atraumatic, it may also be better than existing surgical models for studying the normal physiology and pharmacology of the sphincter of Oddi.

Animals↗
PubMed2002

Performance evaluation of swimmers: scientific tools.

The purpose of this article is to provide a critical commentary of the physiological and psychological tools used in the evaluation of swimmers. The first-level evaluation should be the competitive performance itself, since it is at this juncture that all elements interplay and provide the 'highest form' of assessment. Competition video analysis of major swimming events has progressed to the point where it has become an indispensable tool for coaches, athletes, sport scientists, equipment manufacturers, and even the media. The breakdown of each swimming performance at the individual level to its constituent parts allows for comparison with the predicted or sought after execution, as well as allowing for comparison with identified world competition levels. The use of other 'on-going' monitoring protocols to evaluate training efficacy typically involves criterion 'effort' swims and specific training sets where certain aspects are scrutinised in depth. Physiological parameters that are often examined alongside swimming speed and technical aspects include oxygen uptake, heart rate, blood lactate concentration, blood lactate accumulation and clearance rates. Simple and more complex procedures are available for in-training examination of technical issues. Strength and power may be quantified via several modalities although, typically, tethered swimming and dry-land isokinetic devices are used. The availability of a 'swimming flume' does afford coaches and sport scientists a higher degree of flexibility in the type of monitoring and evaluation that can be undertaken. There is convincing evidence that athletes can be distinguished on the basis of their psychological skills and emotional competencies and that these differences become further accentuated as the athlete improves. No matter what test format is used (physiological, biomechanical or psychological), similar criteria of validity must be ensured so that the test provides useful and associative information concerning current or future performance. The practical worth of any proposed testing or monitoring protocol should be carefully evaluated. In addition, the developmental stage of the athlete(s) in question should be reflected in the testing/monitoring programme. Finally, increasing technological innovations will bring to the pool deck or dry-land training area simple, fast and advanced diagnostic tools, particularly in the areas of blood-borne markers of training response and neuromuscular excitability.

Heart Rate↗
PubMed2006

Training of staff for the delivery of PET/CT services in the UK.

Evidence for the cost effectiveness of PET/CT imaging is now driving the widespread introduction of PET/CT services throughout the UK. The provision of PET/CT facilities will require a workforce of medical, scientific, technical and engineering staff who are adequately trained and fit for purpose. Suitably trained staff in this speciality are scarce. The development and accreditation of training courses and other educational resources for training programmes in all disciplines will therefore be required at a national and regional level. The implementation of PET/CT training can be achieved more cost-effectively by developing multi-professional learning resources whenever possible. It is intended that the recommendations would be implemented by close co-operation of both public and private healthcare providers together with educational establishments.

Curriculum↗
PubMedDate not supplied

[Rethinking nursing education and investing in persons: various contributions to the gestalt approach].

Despite the widespread emphasis on human wholeness, the training of health professionals has privileged technical competence, desconsidering the need to strengthen the person's process of inner growth. The purpose of this article is to reflect on the importance of a person's development as a basic tool of one's own work. The authors consider that there is no way to separate the personal from the professional dimension since each person interacts as a totality. Thus, the person exists in the professional Being or, dialectically speaking, the professional integrates the human being that it really is. These considerations, which are fundamental to each one's development, usually are not part of one's life, personal or professional learning. It is necessary to make this an essential part of nursing training, broadening the possibilities of integrating and transcending either side of the person, by introducing an holistic approach which contemplates the human being development in an integral and integrated way.

Education, Nursing↗
PubMedDate not supplied

[Quality improvement, training and clinical governance: the role of the chief medical officer and his staff].

PURPOSE: To allow chief medical officers and their staff to contribute to implemented quality and clinical governance programs and consequently give a more precise identity, in terms of prestige and professional value, to a Structure that can contribute significantly to the development of a high quality hospital. METHODS: Terminology used was briefly described; tasks assigned to the chief medical officer and staff were then analysed and lastly, a hypothetical integrated training program was outlined for directors/managers. CONCLUSIONS: Quality and professional training represent important tools for human resources management policy. In this context, chief medical officers could contribute specific and significant technical expertise if the development and implementation of training wand quality improvement is given high priority in its own culture and is well integrated within the organization.

Chief Executive Officers, Hospital↗