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PubMedDate not supplied

Ethics and professionalism: what does a resident need to learn?

Training in ethics and professionalism is a fundamental component of residency education, yet there is little empirical information to guide curricula. The objective of this study is to describe empirically derived ethics objectives for ethics and professionalism training for multiple specialties. Study design is a thematic analysis of documents, semi-structured interviews, and focus groups conducted in a setting of an academic medical center, Veterans Administration, and community hospital training more than 1000 residents. Participants were 84 informants in 13 specialties including residents, program directors, faculty, practicing physicians, and ethics committees. Thematic analysis identified commonalities across informants and specialties. Resident and nonresident informants identified consent, interprofessional relationships, family interactions, communication skills, and end-of-life care as essential components of training. Nonresidents also emphasized formal ethics instruction, resource allocation, and self-monitoring, whereas residents emphasized the learning environment and resident-attending interactions. Conclusions are that empirically derived learning needs for ethics and professionalism included many topics, such as informed consent and resource allocation, relevant for most specialties, providing opportunities for shared curricula and resources.

Adult↗
PubMed1988

A path analysis of medical school and residency performance. Implications for housestaff selection.

The selection and subsequent performance of 212 internal medicine residents was examined by factor analysis and path analysis. A three-factor solution accounted for most of the variance among the nine selection variables. These three factors, labeled Board Scores, Faculty Evaluations, and Academic Distinction, were then combined with in-training residency performance evaluations and composite scores on the ABIM certifying examination to produce a comprehensive path model of house staff selection and performance. The Academic Distinction factor emerged as the strongest predictor of residency performance,; the Faculty Evaluations factor was also a significant component of the model. Standardized test scores correlated poorly with clinical performance. The data suggest that increased attention to the content of letters of reference could substantially improve their predictive validity. Other means of reporting subjective evaluations may also be needed to increase the stature of non-cognitive attributes in house staff selection decisions.

Chicago↗
PubMed1982

The effect of two years' training on aerobic power and muscle strength in male and female cadets.

During their first 2 years of training at the U.S. Military Academy, 11 male and 7 female cadets were studied on five occasions. VO2 max (1/min), lean body mass and body weight increased significantly in both groups. Percent body fat was significantly reduced only after the first summer of training and then returned to initial values. VO2 max (ml/kg.min) did not change in males during the study. However, females increased significantly after the initial 6 weeks of training (44.2 to 48.8 ml/kg.min). They remained at this level through the second summer of training. However, by the end of their second academic year, females' values dropped to 45.9 ml/kg.min. Maximal isometric strength measured 30-40% higher in males than in females. During the last year of training, arm and shoulder strength increased 10.2% in males, but was unchanged in females. Our results suggest that even extended military training did not enable females to significantly narrow the difference with male cadets in muscle strength and aerobic power.

Adult↗
PubMed1994

Fine needle aspiration of palpable breast masses with immediate cytologic interpretation in an OB/GYN residency training program: a preliminary report.

Increasing emphasis has been placed on the training of obstetrics and gynecology residents in the evaluation of patients with breast disease. In the past, one had to refer to the surgery, radiology, or pathology literature to obtain current information on fine needle aspiration. With the present mandate to include breast disease in the academic curricula of obstetrics and gynecology residency training, the Department of Obstetrics and Gynecology, Tripler Army Medical Center, initiated training in breast evaluation. This preliminary report describes the Tripler Obstetrics and Gynecology Department Breast Evaluation Clinic and presents the findings of the first 40 patients.

Adult↗
PubMed2004

Psychometric properties of an instrument designed to measure the educational quality of graduate training programs.

To assess the quality of residency education programs at an academic medical center for purposes of enhancing individual graduate medical education programs, we asked residents and fellows (N = 419) to evaluate their training programs using a Web-based questionnaire (response rate = 70%). Kruskal-Wallis tests, factor analysis, correlations, generalizability/decision studies, and mean plots were used to examine trainee responses and to assess the questionnaire's measurement properties. Exploratory factor analysis indicated that the instrument had a three-factor structure that correlated highly with overall program rating. Cronbach's alpha exceeded .80 for all factors, and decision studies revealed that 13 to 23 raters were needed to obtain G-coefficients greater than .70. Mean plots showed that the instrument could discriminate within and among training programs at the item level and the factor level, which should help target improvements across graduate training programs within large institutions.

Adult↗
PubMed1998

[School health in France: evolution and perspectives].

The school health service in France was attached to the Ministry of national education from 1945-1964, then to the Ministry of health until 1984, and has since returned to the Ministry of national education. From a global service in its beginnings, including physicians, nurses and social workers, it progressively grew into a social service on one hand, as well as a medical service and nursing service on the other, that act in close collaboration. Health and social personnel insure the technical advising of administrative heads of the Ministry of national education, at each level (ministerial, academic, and departmental). The strong coherence of the fundamental texts of the Ministry of national education allows the health and social service personnel to take health into account in the daily lives of establishments. They act as technical advisors in public health among school directors and heads of establishments. School medical centres are organised in districts of more than 5,000 inhabitants. The medical files of students are regrouped in these centres. The provision of personnel remains insufficient. The funds for functioning are sparse. The initial training of nurses and social workers depends on academic initiatives, while doctors benefit from a statuary initial training, either for eight weeks or a year. The school health teams implement new work procedures based on the methods of public health, the systematic health exams having been put into question. The March, 1998 "plan for relaunching school health" focuses on health education and prevention in schools.

Education↗
PubMed2000

Multimethod psychoeducational intervention for preschool children with disruptive behavior: two-year post-treatment follow-up.

This paper describes the 2-year post-treatment follow-up of preschool children identified as having high levels of disruptive behavior at kindergarten entry. They were assigned to four treatment conditions: A no-treatment group, parent-training only, treatment classroom only, and the combination of parent training with the treatment classroom. Interventions lasted the entire kindergarten academic year. Initial post-treatment results reported previously indicated no effects for the parent-training program but some efficacy for the classroom intervention program. For this report, the disruptive behavior (DB) children were subdivided into those who did (n = 74) and did not (n = 77) receive the treatment classroom. Two-year post-treatment follow-up results indicated no differences between the classroom treated and untreated DB groups. These groups also failed to differ in the percentage of children using available treatments across the follow-up period. The DB children in both groups had significantly more symptoms of ADHD and ODD than a community control group (N = 47) at follow-up. They also received higher ratings of externalizing problems on the parent Child Behavior Checklist, more severe ratings of behavior problems at home, and ratings of more pervasive behavior problems at school, and had poorer academic skills. Results suggested that early intervention classrooms for DB children may not produce enduring effects once treatment is withdrawn, and that better approaches are needed for identifying those DB children at greatest risk for later maladjustment.

Attention Deficit and Disruptive Behavior Disorder↗
PubMed1989

Criteria for selection of physical medicine and rehabilitation residents. A survey of current practices and suggested changes.

The growing number of medical graduates seeking residency training in Physical Medicine and Rehabilitation (PM&R) has made the resident selection process increasingly difficult. This circumstance has prompted a search for more efficient selection criteria. Forty-one PM&R residency program directors in the United States and Puerto Rico completed a survey on the way they selected their residents. The results indicate that personal applicant characteristics, as determined by interview, were more important than academic criteria in ranking residency candidates. Of the academic variables presented, participation in a PM&R elective at the program director's hospital and the Dean's letter were rated highest. The interview experience has a major influence on the ranking of an applicant for acceptance into a PM&R training program. Academic criteria should have more influence on applicant selection than they do at present. In addition, early identification and vigorous recruitment of resident candidates with an interest in research is essential for increasing the number of academic physiatrists within our specialty.

Educational Measurement↗
PubMed2005

"Entre dos mundos" (Between Two Worlds): bicultural skills training with Latino immigrant families.

This paper focuses on the acculturation model of second-culture-acquisition for Latino immigrants. Two theoretical frameworks, assimilation and alternation theories, are compared within the acculturation model. Empirical research findings suggest that assimilation is a risk factor for increases in negative health behaviors and mental health problems. Conversely, biculturalism appears to be an emerging protective factor that buffers assimilation stress, enhances socio-cognitive functioning, and increases academic achievement. A review of bicultural skills training interventions shows these programs are effective in decreasing the risk for problematic behavior. Finally, a refined model of bicultural skills training for Latino immigrant families is proposed based on the acculturation research literature and extensive interviews with Latino families in North Carolina.

Acculturation↗
PubMedDate not supplied

Capturing medical students' idealism.

PURPOSE: Students' idealism and desire to work with underserved populations decline as they progress from preclinical training through clerkships and residency. With an increasingly diverse population and increasing health disparities, academic health centers need to incorporate changes in their curricula to train socially responsible and idealistic physicians. International electives can provide valuable learning experiences to help achieve these goals. METHODS: Sixty-six preclinical medical students at the University of Texas Medical Branch participated in an international elective from 1997 to 2005. After 1 week of didactics, they spent 3 weeks as part of a multidisciplinary medical team in rural Nicaragua. Postelective questionnaires were administered. From students' responses, we identified common learning themes and grouped them under the categories of attitudes, awareness, and skills. Limitations included a self-selection bias, lack of a control group, and limited follow-up. RESULTS: After the elective, students had an increased interest in volunteerism, humanitarian efforts, and working with underserved populations both in the United States and abroad, as well as more compassion toward the underserved. Students also reported a heightened awareness of social determinants of health and public health, and a broadened global perspective, as well as increased self-awareness. CONCLUSIONS: Our findings illustrate that a well-structured, mentored experience in international health can have a positive impact on preclinical students' attitudes, including their compassion, volunteerism, and interest in serving under-served populations, all measures of idealism.

Attitude↗
PubMed1976

Curriculum for the new college of health sciences: A departure from the traditional medical education.

As an outgrowth of the Report of the Imperial Commission on the Study of Health and Medical Problems, The College of Health Sciences was established as the basic educational unit to provide comprehensive health care education within the framework of a team approach to Iranian national health care. The programs are to nonrestrictive, thereby demonstrating the principles of the concept and practice. Because of this, the College is a multidiscipline institution, and will expand to include programs of study in all health care specialties. The program of study for the equivalent of the baccalaureate degree in the College is based on functional analysis of the tasks to be performed by the primary care workers called behdars. The curriculum is task oriented and is made up to two sections, each of 33 months instruction. The first year concentrates on basic functional science and medicine in an academic setting, and the following two years are spent in clinical training in geographically diverse dispensaries and health care facilities. The second stage of the academic program will be available to graduate behdars who have successfully completed two or more years of work in the health care network and who display academic and professional excellence. Through a unit system approach these candidates for doctor of medicine will complete eleven months or more of comprehensive instruction in functional basic sciences, and this will be followed by two years in comprehensive hospital internship.

Allied Health Personnel↗
PubMed1995

A hospice/palliative medicine rotation for fellows training in hematology-oncology.

A clinical hospice/palliative medicine rotation for physicians enrolled in a three-year hematology/oncology fellowship was established in academic year 1993-1994 as a way to accomplish important training goals in pain management and the palliative care of patients with terminal illness. This study was conducted to obtain initial information about its effectiveness. Ten fellows, one at a time, evaluated new hospice/palliative medicine consultations, supervised the care of patients on an inpatient hospice/palliative care unit, and visited patients at home. For the first 13 months, seven fellows were assigned to this rotation for one month each, and three fellows were assigned to spend two separate months each. A self-report evaluation of the experience was administered at the end of each service month. In five of these 13 evaluations, the fellows reported their skills in managing pain and symptoms to be much improved, and in eight they indicated their skills were improved; none stated that there had been no change. Comfort and skill with discussing death, dying, and advanced directives with patients and families were reported by the fellows to be much improved in nine evaluations, improved in three, and unchanged in one. In nine evaluations, the fellows reported their understanding of hospice/palliative care as a program and approach to patient care was much improved; in two, improved; and in two, unchanged. All of the fellows would recommend this rotation to other fellows. A clinical rotation in palliative medicine and hospice care is a useful addition to the curriculum of fellows training in hematology-oncology.

Clinical Competence↗
PubMedDate not supplied

Clinical program leadership: skill requirements for contemporary leaders.

With knowledge of these leadership requirements and a shrinking base of experienced managers, healthcare organizations and professional societies have little choice in their approach to prepare for the leadership development challenges of the future. Organizations will focus leadership development, training, and continuing management education on integrating business tools and skills into clinical program management. The management requirements for clinical programs will continue to grow in complexity and the number of qualified managers will continue to diminish, New approaches to solving this shortage will evolve. Professional, forprofit companies, healthcare provider organizations, and academic programs will develop clinical program management training tracks. Organizations that create solutions to this management imperative will maintain their competitive edge in the challenging times that will greet the industry in the future.

Financial Management↗
PubMedDate not supplied

Changes in residents' attitudes and achievement after distance learning via two-way interactive video.

BACKGROUND AND OBJECTIVES: Training family practice residents in communities remote from academic medical centers has been difficult because of the lack of available local subspecialists and the concomitant need for subspecialists to travel to each of the remote training sites. To alleviate these problems, the Area Health Education Centers Program at the University of Arkansas for Medical Sciences sought to deliver high-quality presentations to family practice residents at remote locations, using two-way interactive video. The study 1) assessed the differences in attitudes of residents before and after a series of presentations and 2) evaluated the differences in achievement of residents based on who received the information by two-way interactive video or with the instructor on-site. METHODS: Four conferences were broadcast to five remote residency programs, and two local programs received identical conferences on-site. RESULTS: There was no difference in achievement between the two groups, but attitudes toward learning by interactive video declined. CONCLUSIONS: Interactive video is a viable instruction method for achievement. The negative attitude shift toward interactive video may have been because it was a new experience, or the preparation of the faculty was inadequate.

Arkansas↗
PubMed2001

Fellowship training and career outcomes for primary care physician-faculty.

PURPOSE: To examine associations between fellowship training and career outcomes among primary care physician-faculty. METHOD: A total of 821 full-time primary care physician-faculty from 24 representative U.S. medical schools were surveyed using a self-administered questionnaire. Primary outcomes were recent grant submissions and funding, career referred publications, rank, and salary. Findings were adjusted for demographic and professional characteristics. RESULTS: Of the 500 respondents, 234 of the physician-faculty had completed a fellowship and 266 had not. Fellowship-trained physician-faculty were more than four times as likely to have submitted a grant proposal and to have had a grant funded (both p < 0.0001) than were physician-faculty without fellowship training. They were also more likely to have had any refereed publications (OR 3.8, p < 0.0001) and to have achieved senior academic rank (OR = 1.9, p = 0.02). Among those with fellowship experience, the amount of research training was important. Those with at least one year of research experience in their fellowship program had more grant proposal submissions (OR = 1.9, p = 0.02), more grants funded (OR = 2.9, p = 0.0003), more publications (OR = 2.4, p = 0.02), and higher academic ranks (OR 2.3, p = 0.03) than did those with less research training. Salaries were similar in every comparison. CONCLUSION: Fellowship-trained primary care physician-faculty were more productive researchers and were more likely to have achieved senior academic rank than were their no-fellowship-trained peers. Even among physician-faculty with fellowship experience, more research training was associated with higher productivity and rank. Salaries were not affected by training experience.

Faculty, Medical↗
PubMed2000

Organization of orthopaedic trauma services: a survey of the Orthopaedic Trauma Association.

OBJECTIVES: This study was undertaken to collect information about the organization of orthopaedic trauma services in different types of hospitals, with particular emphasis on hospital support arrangements in different practice situations. DESIGN: A survey was sent to all members of the Orthopaedic Trauma Association (OTA) as part of the organization's newsletter. Fractoids. In addition, the survey was distributed by the OTA's E-mail discussion list, ORT-1. MAIN OUTCOME MEASUREMENTS: The survey included questions about the size and nature of the hospital, resident involvement, academic affiliation, number of orthopaedic physician staff, training of the staff, presence of an organized orthopaedic trauma service, distribution of call and patients, and hospital support. RESULTS: Fifty-seven responses were received from North American centers, of which six were duplications. Responses came from institutions of all types and sizes, although most came from urban, Level 1 trauma centers with academic affiliation. Twenty-nine hospitals had a designated orthopaedic trauma service, and twenty-six had a director. Eighteen institutions had ancillary staff (nurses, physician's assistants, etc.) assigned to the orthopaedic trauma service. Hospitals with an academic affiliation were statistically more likely to have a designated orthopaedic trauma service and to distribute trauma patients by subspecialty expertise. In hospitals with a designated orthopaedic trauma service or director, it was more common to have ancillary support staff and to have it funded by the hospital, although the differences did not rise to statistical significance. CONCLUSIONS: There are differences in organization of orthopaedic trauma care between hospitals, which may be related to hospital size, academic affiliation, and orthopaedic department organization. Further study is necessary to determine whether organizational differences translate into differences in patient outcome after trauma.

Benchmarking↗
PubMed1995

Wagons ho: forward on the managed care trail.

This paper describes the impact of managed care on an academic medical center department of psychiatry. Like the pioneers before us, academic medical centers have often traveled wilderness paths, training new generations of psychiatrists and providing research about and new understandings of psychiatric illness; under assault from powerful competitive forces, we have all too often circled the wagons in an attempt to survive what we perceive as an onslaught. We describe the ways in which our academic medical center department of psychiatry has responded to managed care forces, in particular, the impact of managed care on residency training, inpatient services, outpatient psychotherapeutic and psychopharmacological care, and faculty morale. We describe how we have worked closely with our medical colleagues, formed new committees, and initiated forays into capitated arrangements. Despite difficult external circumstances, we have been able to survive, regroup, provide leadership, and continue with renewed purpose.

Academic Medical Centers↗