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PubMed2004

Developing a training program on issues in aging for correctional workers.

Older adults who are incarcerated and living in prisons represent an increasing, yet invisible, group among the aging population. Two factors in particular have contributed to this growth: the aging of the general population and the escalating number of prisoners serving long sentences. Working effectively with older inmates poses a challenge for correctional workers who are accustomed to dealing with a much younger clientele. In many states, correctional employees are required to obtain annual training, and educational institutions can play a major role in providing the expertise necessary in the development of quality training materials on issues related to aging. While continuing education programs to address the needs of workers in community-based and long-term care settings have grown rapidly, they have made negligible progress in more obscure settings such as prisons. This paper discusses the development of a 6-hour training program entitled "Issues in Aging for Correctional Workers." The training was developed through the interdisciplinary collaborative efforts of two faculty members who teach in the criminal justice and sociology/social work departments at a medium-sized liberal arts university in the upper Midwest.

Aged↗
PubMed1994

Are pediatric emergency medicine training programs meeting their goals and objectives? A self-assessment of individuals completing fellowship training in 1993.

The purpose of this study was to evaluate the overall training experience of those individuals completing fellowships in pediatric emergency medicine. Specific attention was given to the technical skills portion of training as set forth by the American Academy of Pediatrics Curriculum Committee on Pediatric Emergency Medicine. We surveyed those individuals completing their second year of fellowship training in pediatric emergency medicine. The questionnaire incorporated a self-assessment of the technical skills portion of the Subcommittee on Pediatric Emergency Medicine's most recent curriculum statement. It also contained several questions designed to evaluate the overall training experience. Eighty percent of respondents completing the self-assessment questionnaire rated their overall experience as favorable, whereas those who rated it unfavorable stressed a lack of training in research and teaching. Ninety-two percent of respondents felt they had a good clinical experience, but 80% expressed a need for further training in administration, 74% in research, and 46% in teaching. Although the majority claimed to be comfortable with most technical skills, several skills, including lifesaving procedures such as external pacing, peritoneal lavage, pericardiocentesis, shunt tap, airway foreign body removal, and needle cricothyrotomy, posed a significant degree of discomfort.

Clinical Competence↗
PubMed1997

Pediatric critical care training programs have a positive effect on pediatric intensive care mortality.

OBJECTIVE: Comparison of severity and diagnosis-adjusted mortality rates from pediatric intensive care units (ICUs) staffed by physicians training in pediatric critical care, as well as pediatric residents, with mortality rates from pediatric ICUs staffed with only pediatric residents. DESIGN: Cohort study. SETTING: Sixteen volunteer pediatric ICUs, eight with critical care fellowships, and eight without such programs. PATIENTS: Consecutive admissions until at least 14 deaths occurred at each site. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Descriptive data and Pediatric Risk of Mortality scores were collected. Severity and diagnosis-adjusted mortality risk for each patient was computed by a predictor developed in an independent sample. The effect of fellowship programs was analyzed at the institution level by ranking the pediatric ICUs in terms of observed/predicted mortality rates, and, at the patient level, by including a training factor into the predictor model. The use of monitoring and therapeutic modalities was compared in the two types of pediatric ICUs by severity-adjusted odds ratios. There were 2,744 admissions (145 deaths) to the eight fellowship pediatric ICUs and 3,006 admissions (150 deaths) to the eight nonfellowship pediatric ICUs. Institutional characteristics were not different between the two pediatric ICU sets. The raw mortality rates were similar (fellowship 5.28%; nonfellowship 4.99%, p = .714). Institution-level analyses indicated that fellowship pediatric ICUs performed better than nonfellowship pediatric ICUs; fellowship pediatric ICUs ranked better than pediatric ICUs without such programs (Wilcoxon rank-sum test, p = .020). However, both the best and the worst ranked pediatric ICUs had fellowships. Patient-level analyses also indicated that outcome was significantly influenced by the fellowship status of the pediatric ICU. Using two different patient-level analytic approaches, the odds of dying in a fellowship pediatric ICU vs. a nonfellowship pediatric ICU were 0.592 (95% confidence interval 0.468 to 0.749, p = .0001) and 0.714 (95% confidence interval 0.529 to 0.964, p = .028). Pediatric ICUs with fellowship programs performed more (p < .05) invasive monitoring, including intra-arterial catheters and central venous pressure catheters, and more technological therapies such as mechanical ventilation. CONCLUSIONS: Pediatric ICUs with critical care fellowship programs are generally associated with better risk-adjusted mortality rates than pediatric ICUs without such fellowship training programs. The cause for this effect requires a more in-depth study. The presence or absence of such training programs does not guarantee superior or inferior performance.

Child↗
PubMed1993

Moonlighting in a university surgical training program.

The impact of house officer moonlighting on training performance was assessed through a faculty questionnaire and house officer survey distributed in the Department of Surgery at Tulane University School of Medicine. Responses were obtained from 30 house officers and 15 faculty members. Most house officers who moonlighted did so one or two times each month; most were employed in emergency departments. Yearly earnings from moonlighting averaged approximately $10,000. Although many house officers were in debt from medical school, debt was not the primary reason for moonlighting. Many faculty members disapproved of moonlighting, but agreed to monitoring by clinical performance and American Board of Surgery In-Training Examination. A statistically significant relationship was found between yearly income from moonlighting and decreasing scores on the American Board of Surgery In-Training Examination.

Attitude of Health Personnel↗
PubMed1983

Evaluation of a residency training program in behavioral pediatrics.

The impact of behavioral training upon first-year residents was evaluated by assessing attitudes with regard to 15 clinical "entities," including behavioral disorders, physical disorders, and "mixed" disorders. Each entity was rated at four times: beginning of the year, start of the behavioral rotation, end of the rotation, and end of the year. Multiple-choice questions were also included to assess knowledge regarding behavioral pediatrics. Data were collected from 37 residents, from 1977 to 1980. For behavioral disorders and mixed disorders, residents' self-reported competence increased with regard to diagnosis, management, advising parents, and knowledge of resources. Further, the greatest change occurred during the 2-month rotation. In contrast, change in perceived competence for physical disorders was not specific to the rotation but, rather, increased evenly over the year. Ratings of faculty and housestaff interest remained constant across testing points, and residents' "desire to learn more" and prediction of "future relevance" showed a slight decrease over time, for all disorders. Knowledge regarding behavioral pediatrics increased significantly from the beginning of the year to the start of the rotation, and also during the rotation. These data demonstrate that changes in residents' perceived competence are directly related to their rotation experience, and suggest that behavioral issues can be introduced successfully during the first year of residency training.

Attitude of Health Personnel↗
PubMed2001

Training programs for healthcare professionals in domestic violence.

Although women who experience domestic violence seek healthcare services frequently, screening and counseling rates remain low, and healthcare professionals report feeling inadequately trained to care for abused women. The English language literature from 1989 to 1999 was searched to identify and evaluate published assessments of the education of healthcare providers in domestic violence toward women. Major deficiencies in program evaluation were found. They included the use of a historical comparison group, lack of an experimental design, selection of nonstandardized outcomes without clinical performance measures, short-term follow-up, limited documentation of course content and theory, and lack of focus on the impact of programs on abused women. Educational programs generally consisted of a single session of limited duration (1-3 hours). Based on published reports, it appears that few rigorously designed evaluations have been conducted of training programs for healthcare providers in the detection and treatment of women affected by domestic violence.

Curriculum↗
PubMed1998

The Network Project: a multidisciplinary cancer education and training program in pain management, rehabilitation, and psychosocial issues.

Despite recent advances in cancer pain management and education, the undertreatment of cancer pain remains a national health problem. In response to the need for interdisciplinary education and training, we have developed "The Network Project" at Memorial Sloan-Kettering Cancer Center. This program includes a 2-week observership in cancer pain management, psychosocial oncology, and cancer rehabilitation. The efficacy of the Network Project Observership Program was evaluated with the use of a knowledge and attitude inventory which contains questions pertaining to cancer pain, psychosocial oncology, and cancer rehabilitation, and follow-up questionnaires completed one year after participation in the program. The knowledge and attitude inventory was completed by each participant both before and after the observership period. Analysis of the 152 observers who participated in the first 3 years of the Network Project's Observership Program demonstrated a significant improvement in knowledge of cancer pain, psychosocial issues, and rehabilitation issues (P < 0.0001). In addition, observers reported a significant increase in their local educational and training activities in the year following participation in the Network Project (P < 0.01). The Network Project, funded by the National Cancer Institute, is an interdisciplinary, multimodal training program which has been demonstrated to be an effective means for improving and disseminating knowledge regarding the multidisciplinary management of pain and psychological distress in cancer patients.

Community Networks↗
PubMedDate not supplied

Comparison of the effects of walking and weight training programs on body image in middle-aged women: an experimental study.

Purpose. This study was conducted to determine the effect of a resistive training intervention on body image in middle-aged women compared to an exercise walking program. Another purpose was to develop two multivariate models to explain improvement in body image among the lifters and walkers. Design. A pretest-posttest experimental design with random assignment of subjects to two exercise groups was employed. Setting. Subjects trained in their own homes and were tested at the university. Subjects. Participants were 60 women recruited from the local community with an average age of 42.5 +/- 4.2 years. Intervention. Subjects were randomly assigned to a resistive training or exercise walking program, both of which were three days per week and 12 weeks in duration. Measures. Body cathexis was assessed using the Body Cathexis Scale; cardiovascular endurance was measured using the one-mile walk test, and muscular strength was assessed using standard weight training procedures. Results. After completion of the exercise interventions, lifters showed greater muscular strength than walkers, and walkers displayed greater cardiorespiratory endurance than lifters, as expected. Lifters also improved significantly more in body image than the walkers. Conclusions. Participation in a three-day-per-week resistive training program seems to improve body image in middle-aged women more than participation in a three-day per week walking program. Further, it appears that hard work and fitness improvements contribute significantly toward positive changes in body image.

Adult↗
PubMed2005

Evaluation of the restorative care education and training program for nursing homes.

Restorative care attempts to break the cycle of dependency and functional decline in nursing homes by addressing individual resident needs. The Restorative Care Education and Training (RCET) Program consists of a five-week workshop and resource manual for both supervisory and direct care staff. This paper describes the RCET approach and presents the implementation, process, and quasi-experimental outcome evaluation findings with 42 residents from six intervention sites and six ''wait-list'' facilities who received usual care. Baseline data supported the fact that staff primarily targeted residents with substantial functional impairments. Over four months, residents who received restorative care improved significantly on several functional outcome indicators, while the comparison sample declined in several areas of functioning. Interviews with facility directors and participating staff provided direction for modifying the RCET and insight regarding opportunities and challenges when implementing restorative care activities in nursing homes.

Adult↗
PubMed1987

Survey of ultrasound training in obstetrics and gynecology residency training programs in the United States.

A survey was mailed to all 292 nonmilitary obstetrics and gynecology residency programs in the United States. The extent and type of ultrasound training and degree of compliance with recommended guidelines was evaluated from the 230 (78.8%) responses. Criteria for evaluation were based on guidelines from the American Institute of Ultrasound in Medicine Joint Task Group on Training for Diagnosis in Obstetrical and Gynecological Ultrasound, and on recommendations from The American College of Obstetricians and Gynecologists. Although almost 98% of respondents claimed to have ultrasound "training" in their programs, more than 55% indicated no resident experience with either reading or writing ultrasound reports, and only 39% of program chiefs claimed greater experience than 200 ultrasound scans per resident over four years. Overall, it appears that current suggested guidelines are not being met.

Data Collection↗
PubMed1998

Computer-assisted training program for simulation of triage, resuscitation, and evacuation of casualties.

The purpose of this paper is to introduce a multimedia computer software package that has been developed for the Federal Armed Forces of Germany to train military physicians in trauma management. The program presents different groups of casualties with characteristic wounds and multiple injuries on a CD-ROM and provides many clinical options at each decision point. Automatically evaluating the decisions for accuracy, the objective of the program is to train for triage, resuscitation, and evacuation of wounded in combat under pressure of time. The computer-assisted instruction program is inexpensive and allows easily accessible self-instruction as a supplement to formal classroom training. Using this teaching software, it may be possible to teach a standardized emergency case-management algorithm for battlefield trauma. There was a high level of acceptance for this type of instruction. This is encouraging for medical educators involved in producing multimedia packages for teaching emergency medicine.

CD-ROM↗
PubMed2002

Combined internal medicine/psychiatry and family practice/psychiatry training programs 1999-2000: residents' perspectives.

Residents enrolled in internal medicine/psychiatry (IM/PSY) and family practice/psychiatry (FP/PSY) programs were surveyed to assess their views concerning training experiences and future plans. The FREIDA online directory was used to supplement missing information. Responses were received from 60% of residents (N=111), representing all active IM/PSY (n=20) and FP/PSY (n=9) programs. Variability existed in call, clinical, and didactic experiences. Residents generally were very pleased with training. Following graduation, most plan to practice a combination of skills, primarily in community or academic settings. Levels of recruitment were felt to be equal to or higher than those for colleagues in individual training specialties. Training in IM/PSY and FP/PSY programs is variable. Residents report high levels of satisfaction and plan to practice both specialties.

Journal Article↗
PubMed2003

Ghana postgraduate obstetrics/gynecology collaborative residency training program: success story and model for Africa.

OBJECTIVE: We describe a residency program in Ghana that was developed to train obstetrics/gynecologist specialists for Ghana and the subregion to promote and manage the reproductive health of women and to reduce a high maternal mortality rate. STUDY DESIGN: The Carnegie-supported program, begun in 1989, is a 5-year residency in the two medical schools in Ghana, but with one central coordinating office. It has features that equip the graduate resident to practice in his/her environment. The fourth year of the program is unique: the resident attends a hospital management course for 3 months, goes for a clinical rotation in the United States or United Kingdom for 3 months, and moves to live and work in a rural district hospital for 6 months. RESULTS: The success rate of the Ghanaian residents in the examination of the West African College of Surgeons has been three to four times higher than the overall pass rate. As of October 2002, the program had produced 26 specialists, all of whom are practicing in Ghana. In contrast, of 30 specialists who were trained abroad between 1960 and 1980, only 3 specialist had returned home by the end of the 1980s. The current chairpersons of the two medical schools are graduates of the program. Carnegie financial support for the program came to an end in January 2000, but the Ghana Ministry of Health has increased its support enthusiastically. The program is being sustained. Maternal mortality and morbidity rates are falling slowly in the two teaching hospitals; case fatality rates have been reduced markedly. New residents are entering the program and are progressing to completion. CONCLUSION: The program has been an unqualified success and merits replication.

Education, Medical, Graduate↗
PubMedDate not supplied

An introduction to simulation and visualization of biological systems at multiple scales: a summer training program for interdisciplinary research.

Advances in biomedical research require a new generation of researchers having a strong background in both the life and physical sciences and a knowledge of computational, mathematical, and engineering tools for tackling biological problems. The NIH-NSF Bioengineering and Bioinformatics Summer Institute at the University of Pittsburgh (BBSI @ Pitt; www.ccbb.pitt.edu/bbsi) is a multi-institutional 10-week summer program hosted by the University of Pittsburgh, Duquesne University, the Pittsburgh Supercomputing Center, and Carnegie Mellon University, and is one of nine Institutes throughout the nation currently participating in the NIH-NSF program. Each BBSI focuses on a different area; the BBSI @ Pitt, entitled "Simulation and Computer Visualization of Biological Systems at Multiple Scales", focuses on computational and mathematical approaches to understanding the complex machinery of molecular-to-cellular systems at three levels, namely, molecular, subcellular (microphysiological), and cellular. We present here an overview of the BBSI @ Pitt, the objectives and focus of the program, and a description of the didactic training activities that distinguish it from other traditional summer research programs. Furthermore, we also report several challenges that have been identified in implementing such an interdisciplinary program that brings together students from diverse academic programs for a limited period of time. These challenges notwithstanding, presenting an integrative view of molecular-to-system analytical models has introduced these students to the field of computational biology and has allowed them to make an informed decision regarding their future career prospects.

Computational Biology↗
PubMed2001

Effect of a statewide neonatal resuscitation training program on Apgar scores among high-risk neonates in Illinois.

OBJECTIVE: The national Neonatal Resuscitation Program (NRP), started in 1987, provided training to hospital delivery room personnel to standardize knowledge and skills to reduce neonatal morbidity and mortality and increase successful resuscitation during the first few critical minutes after birth. The Apgar score continues to be used as the best established index of immediate postnatal health. The purpose of this study was to evaluate the impact of the NRP instruction in Illinois hospitals by examining Apgar scores among high-risk infants who are likely to benefit from the NRP. METHODS: A retrospective 3-time period cohort design was used (before the introduction of the NRP, 1985-1988; transition when NRP training occurred, 1989-1990; and after NRP training was completed at least once for some delivery room personnel in each Illinois hospital, 1991-1995). Illinois computerized birth certificate files on a selected group of 636 429 high-risk neonates provided information on Apgar scores and maternal characteristics. The American Academy of Pediatrics provided instructor lists to determine when NRP training started and when it was fully implemented in Illinois. Illinois Department of Public Health provided data to categorize hospitals into levels based on type and intensity of neonatal services (Level I, II, II+, III). High-risk neonates were defined as meeting 1 of the following criteria: maternal age <20 years old or >35 years old, birth weight <2500 g or >4000 g, presence of a maternal medical risk factor, and no prenatal care or prenatal care started after the first trimester. Several exclusion criteria were applied including the following: birth records with missing data, multiple birth or congenital anomaly, and hospital information that indicate no birth deliveries in 1 of the 11 study years or delivery outside of a hospital. One-minute and 5-minute Apgar scores were divided into categories for analysis (0-3, 4-6, 7-10). No change or a decrease in a low (0-6) 1-minute Apgar when compared with the 5-minute Apgar was a primary measure to evaluate effect of NRP resuscitation. Variables examined included the following: race/ethnicity, maternal age, level of education, presence of maternal medical risk factor, trimester started prenatal care, complications of labor and delivery, and a low birth weight. Analysis consisted of chi(2) tests, relative risk calculations, and logistic regression to reveal independent associations with no change in low 1-minute Apgar score or continued low (0-6) 5-minute Apgar. RESULTS: A total of 636 429 high-risk birth records was selected for detailed analyses out of 2 077 533 births in Illinois between 1985 and 1995 for 193 hospitals. The number of active NRP instructors in Illinois changed dramatically during the study period; for example, 1 to 6 between 1987 and 1988 to 1096 to 1242 between 1991 and 1995. The percentage of neonates reported to have low (<7) 1-minute Apgar score decreased in 1991 to 1995 overall and for each of 4 hospital levels. Overall and by hospital level, there was a statistically significant lower proportion of high-risk newborns who showed a decrease or no change in their 5-minute Apgar scores after the NRP instruction. After adjusting for several maternal characteristics, logistic regression analysis revealed that high-risk newborns with a low 1-minute Apgar were more likely to increase their 5-minute Apgar after the NRP instruction in 1991 to 1995. Additional analyses indicated that very low birth weight and low birth weight newborns benefited the most from NRP instruction. CONCLUSION: Although previous research has shown that the NRP instruction improves knowledge and skill among health care personnel in the delivery room, both short-term and long-term, there has been little evidence to demonstrate NRP impact on infant morbidity. Several strategies were used in this study to control for bias and to adjust for secular trends in decreased infant morbidity during the study period. This study demonstrated sufficient support for the hypothesis that a significant improvement occurred among neonates in their Apgar score after the NRP instruction in Illinois. Empirical support is provided for the clinical effectiveness of NRP instruction.

Apgar Score↗
PubMed1974

The application of generalized correct social contingencies: an evaluation of a training program.

Two aides operating a kindergarten-style program for institutionalized mental retardates were trained, using observer feedback, to apply generalized "correct" social contingencies to 10 defined classes of appropriate and inappropriate child behaviors. A multiple baseline design was used to demonstrate, sequentially, the effects of the training procedure upon the attending behavior of each teacher. After withdrawal of feedback, a posttraining follow-up served to assess the durability of training. For both aides, the effect of training was to increase the proportion of appropriate child behaviors attended to, compared with baseline data, and a follow-up over a number of weeks indicated that the effects of training were apparently durable.

Attention↗