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PubMed2005

Gender differences in general surgical careers: results of a post-residency survey.

BACKGROUND: This study's purpose was to gain perspective regarding general surgery career choices while examining gender differences. METHODS: Graduates of a general surgery residency (n = 189) received surveys addressing fellowship training, practice type, case composition, work hours, academic involvement, income, residency, and career satisfaction. RESULTS: Several gender differences were identified. Most men (64%) listed general surgery as their primary work type, whereas women most commonly reported breast surgery (38%, P < .001). More women worked <40 hours per week (25% versus 9%, P = .049). There was no gender difference in income for fellowship-trained surgeons, but a disparity in income >200,000 dollars favored non-fellowship-trained men (74% versus 36%, P = .0031). Both genders reduced work hours. Women reduced them exclusively for personal/family demands. Both genders reported satisfaction with their surgical careers (93%). CONCLUSIONS: Some gender differences in surgery were identified. However, both genders maintain a high level of satisfaction with their career choice.

Career Choice↗
PubMed1998

Environmental health sciences education--a tool for achieving environmental equity and protecting children.

Children are highly susceptible to deleterious effects of environmental toxins. Those who live in underserved communities may be particularly at risk because environmental pollution has been found to be disproportionately distributed among communities. Mounting evidence suggests that asthma rates are rising and that this disease can be caused or aggravated by air pollution. Although ambient air quality has generally improved, these improvements have not reached minority communities in equal proportions. This and other data has fueled the concept of environmental justice or environmental equity, which has led to community activism and government actions. One possible example of environmental inequity and its consequences is the Hunt's Point community, in the South Bronx, New York. This community experiences a high pollution burden with the siting of facilities that emit hazardous wastes into the air. Our approach to this problem has been the formation of mechanisms for bidirectional communication between community residents, government entities, and academic institutions such as Mount Sinai Medical Center. As a result of this experience, we believe that the key to achieving environmental health, especially in communities of color where many children are at risk, is to empower residents to take charge of their environment by providing relevant educational opportunities. Strategies for environmental health education include multitiered training approaches that include community residents, parent education, direct children education, and community education through professional counselors and train-the-trainer approaches. We propose that academic researchers must use community residents not just as subjects of our studies, but to increase our mutual understanding of environmental health, resulting in active participation of community members in research design, data collection, analysis, and dissemination of results in order to make intervention strategies more effective.

Child↗
PubMed2006

[Skills in management, co-operation and communication in the Pre-Registration House Officership].

INTRODUCTION: In aviation, it has been realised that technical training ensures competence in specific procedures, but does not counter errors due to communication or decision making in a dynamic environment. As a consequence, Crew Resource Management, consisting of training in co-operation, management, and communication skills, was introduced in order to serve as a countermeasure towards human errors. In the same way, medical school ensures academic and technical insight, but rarely offers systematic training in such non-technical skills. The aim of this study is to identify the standard of competence in skills of co-operation, management, and communication at the end of the Pre-Registration House Officership. METHOD: 30 skills of management, co-operation, and communication divided into five main areas were identified. Using the Delphi method through two rounds of questionnaires, an expert panel of 50 doctors evaluated six different standards of competence for each skill. RESULTS: The Panel reached consensus at a 75% level for five skills, all within the main area "Team communication in the acute situation". Consensus was not reached within any of the other four main areas. None of the 30 skills was evaluated as being irrelevant for the Pre-Registration House Officer by more than one panel member. CONCLUSION: There was broad agreement on the need for high standards of competence within the area of team communication. There was considerable disagreement within the panel with regard to the other main areas, but all of the skills listed in this study were found relevant to the Pre-Registration House Officer in the acute situation.

Clinical Competence↗
PubMed1992

Exposure of surgeons-in-training to radiation during intramedullary fixation of femoral shaft fractures.

Owing to the continuous turnover of registrars and radiographers, most of the trauma-related orthopaedic surgery in this academic hospital is done by inexperienced surgeons-in-training and the fluoroscopy by junior radiographers. This could result in excessive radiation doses. Calibrated lithium fluoride thermoluminescent chips were secured to various parts of the primary surgeon's body to quantify the radiation dose received during the insertion of an intramedullary nail. Closed intramedullary fixation of 15 fractures of the femur was done with interlocking as necessary. The total average exposure time was 14 minutes 45 seconds per procedure. Distal locking took up 31% of this time. The mean radiation dose to the surgeon's eyes and thyroid was 0.13 mGy and to the dominant hand 2.10 mGy. This would allow the performance of about 350 such procedures per year before the maximum permissible dose level was reached. Recommendations to decrease irradiation dosage are made.

Femoral Fractures↗
PubMedDate not supplied

Reimbursement for health care. Training, cost containment, and practice: effect on infectious diseases.

In 1978 the statement was made that if any more infectious disease specialists were trained they would be culturing one another. The increase in infectious disease consultants continues unabated. The number of training programs in infectious disease is rising in proportion to the number of fellows being trained; one-third of these training programs are in New York, California, and Texas, and a number of them are not associated directly with medical schools. It is often argued that there is no reason to restrict the number of infectious disease consultants because there is plenty for them to do. There are an equal number of arguments against unbridled growth, including the fact that the existence of specialists in most community hospitals with lead to fewer referrals to the teaching centers and the resulting lack of patients will lead training programs to atrophy. Infectious disease is destined to function best as an academic specialty whose trainees should pursue careers primarily as investigators. The number of clinicians leaving training should be reduced and not further glut the marketplace; they should be based in academic divisions and devote their clinical time and effort to the care of complex referral and to indigent patients.

Cost Control↗
PubMed1997

[Undergraduate curriculum reform at the Pontifical Catholic University Medical School: aims, methodology and advance status].

The Medical School of the Pontifical Catholic University is devoted to a reform process aiming to adequate undergraduate training to scientific, technological, cultural and social changes in medical practice in Chile and to incorporate novel teaching methodology. One of the main modifications is the change of the resulting professional from "a general physician capable of resolving most medical problems of rural or urban populations" to "a physician with a solid general training but qualified for a subsequent specialization". This requires curricular flexibility to obtain different professional profiles. Other important changes are a reduction in curricular contents and their vertical and horizontal integration, modernization of teaching methodologies with the incorporation of computing techniques and problem oriented teaching and the incorporation of new subjects such as molecular biology, clinical genetics, health economics. To achieve these objectives, a semi-flexible curriculum was devised, the curricular mesh has been modified extensively, an outpatient and a nine months elective internship were added. Most modifications have been implemented, remaining changes in 4th and 5th years. These changes required a reorganisation of academic structure, the use of new selection, training and perfecting criteria for teachers, better salaries for outstanding professors and improvement of teaching infrastructure. This reform must be seen as a medium term integral change in the context of an integral academic development plan.

Chile↗
PubMed1996

Position statement on training needs in addiction psychiatry.

Psychiatry has only recently developed training in the area of substance-related disorders. Nevertheless, these illnesses are highly prevalent and are associated with substantial morbidity and mortality. Patients with these disorders often do not encounter or have access to effective treatment. Because of this, the American Psychiatric Association recommends developing improved training to assure that 1) the basic psychiatric residency addresses essential aspects of addiction prevention and treatment, 2) addiction psychiatry fellowships are strengthened to provide needed manpower for consultation, academic teaching, and research, and 3) psychiatrists are trained to provide leadership for the multidisciplinary teams characteristic of this field. This statement was drafted by the Committee on Training and Education in Addiction Psychiatry. It was approved by the APA Assembly in November 1995 and by the Board of Trustees in December 1995.

Delivery of Health Care↗
PubMed1990

Graduate medical education: focus for change.

The author documents a significant broadening of the interest of both state and federal government in influencing graduate medical education. He states that the unwillingness of the academic medical community to address the issues of manpower supply and specialty distribution, the limited effectiveness of minority enhancement programs, and an ambiguous position on foreign medical graduates have invited government intervention. The author maintains that such intervention was inevitable because academic medical centers have focused only on the educational process and the quality of graduates but have not dealt with the need to shape the output of their training programs to meet national health needs. He challenges the academic medical community to seize the initiative in seeking the difficult-to-find solutions to major issues of medical training or be prepared to yield to the decisions of lawmakers and regulators.

Academic Medical Centers↗
PubMedDate not supplied

Chief residency in PM&R. A balance of education and administration.

The role of the Physical Medicine and Rehabilitation (PM&R) chief resident (CR) in physiatry residency education programs is the subject of annual deliberation in many academic centers. A national survey of PM&R programs was conducted to determine CR number, selection method, responsibilities, duration of service, and postresidency destiny. The questionnaire generated a response rate of 86% with 90% of programs reporting 1-3 CRs per year. A range of 1-11 CRs were selected annually per program. The most common methods of CR selection were faculty vote (45%), combined resident-faculty vote (22%), and other (33%). The prevalence of administrative responsibilities included orienting new residents (97%), formulating call schedules (92%), dispute mediation (88%), medical student-residency interviews (87%), rotation schedule configuration (64%), faculty meeting participation (61 %), social event promotion (59%), and elective and externship schedule development (31 %). Educational duties included teaching and organizing didactics (87%), organizing pharmaceutical and rehabilitation equipment inservices (77%), arranging didactics (77%), board review coordination (72%), arranging grand round speakers (66%), core curriculum lectures (61%), and facilitating resident research (37%). CR career goals included group practice (48%), academic faculty (29%), solo practice (5%), and fellowship (18%). Overall, PM&R CRs maintain considerable involvement in the educational aspects of residency training, although their clinical and administrative duties predominate. Although the PM&R CRs contribute significantly to the academic growth and development of their respective training programs, only a modest percentage (47%) of CRs choose to remain in academic physiatry via an attending (29%) or fellowship (18%) position.

Academic Medical Centers↗
PubMed2006

[Study of the introduction of the European Credit Transfer System (ECTS) in pediatrics and modification of the teaching methodology].

INTRODUCTION: Spanish medical faculties have initiated the new curriculum reform process within the framework of the European Higher Education Area and are required to incorporate the European Credit Transfer System (ECTS) to new syllabi before 2010. OBJECTIVES: To test the introduction of the ECTS in pediatrics and modify the teaching methodology. STUDY DESIGN: The theoretical and practical programs were adapted; academic objectives and a student evaluation system were established. Students were surveyed on starting the second term of the 2004-05 academic year before the theory examination and again on terminating the academic year: a 5-point Likert-type scale was used for responses. Priorities for generic and specific competencies selected by students were compared with those selected by the National Deans Conference (NDC). The results were analyzed using non-parametric tests. RESULTS: Fifteen credits became 11 ECTS, with 297 student working hours. The theory program was reduced from 80 to 52 lessons. The students prepared 14 tutor-supervised case presentations. The teaching staff considered that learning of theory was similar to previous years (66 %) and that practical learning improved (73.3 %). The students thought the program should continue (73.2 %) but 98.8 % considered the workload excessive. The students believed that their practical training and their ability to prepare and make case presentations significantly improved during the semester. Academic performance was significantly higher than that in students of the previous year. Students agreed with NDC priorities for 9/9 general and 4/17 specific competencies. Estimation of workload by students was significantly higher than that by staff, and 73.3 % of the students believed that workload should be reduced and the examination system improved. CONCLUSIONS: Introducing the ECTS improved academic performance, practical training, and self-directed learning. The project was satisfactory for staff and students. Student workload was underestimated.

Achievement↗
PubMed2005

The Professor of Public Psychiatry Model in Ohio: the impact on training, program innovation, and the quality of mental health care.

The Ohio Department of Mental Health and five of Ohio's University-based Departments of Psychiatry have developed strong working partnerships that have improved the quality of psychiatric residency education and Ohio's mental health services. Strategies integral to Ohio's Public Psychiatry Model include identifying a strong champion, integrating expert consultation, and developing consensus expectations using a small amount of catalytic funding. Successful outcomes include the establishment of public psychiatry leadership roles in Ohio's community and academic settings; positive community-focused residency training experiences; revised curricula; and spin-off opportunities, such as "Coordinating Centers of Excellence" to accelerate adoption of evidence-based practices in community settings.

Community Mental Health Services↗
PubMedDate not supplied

The AcCell series 2000 as a support system for training and evaluation in educational and clinical settings.

Providing effective training, retraining and evaluation programs, including proficiency testing programs, for cytoprofessionals is a challenge shared by many academic and clinical educators internationally. In cytopathology the quality of training has immediately transferable and critically important impacts on satisfactory performance in the clinical setting. Well-designed interactive computer-assisted instruction and testing programs have been shown to enhance initial learning and to reinforce factual and conceptual knowledge. Computer systems designed not only to promote diagnostic accuracy but to integrate and streamline work flow in clinical service settings are candidates for educational adaptation. The AcCell 2000 system, designed as a diagnostic screening support system, offers technology that is adaptable to educational needs during basic and in-service training as well as testing of screening proficiency in both locator and identification skills. We describe the considerations, approaches and applications of the AcCell 2000 system in education programs for both training and evaluation of gynecologic diagnostic screening proficiency.

Automation↗
PubMedDate not supplied

Medical subspecialty training and interest in cost containment education.

To investigate academic physicians' interest in learning methods to reduce health care costs, we asked the faculty and housestaff of a university-based department of internal medicine to rate their interest in 30 potential topics for medical grand rounds, a traditional forum for continuing medical education. The 30 topics were equally divided among clinical, research and cost-containment categories. The 29 housestaff and the 41 subspecialty faculty members clearly favored clinical and research topics over cost-containment topics (p less than 0.001). On the other hand, the nine general internists considered the cost-containment topics as attractive as the clinical and research topics and ranked them higher than did both the subspecialists (p less than 0.001) and the house-staff (p less than 0.05). Efforts to alter costs in academic medical centers may be hampered by the relative disinterest in cost-containment education among house officers and subspecialists, who are responsible for most of the health care delivery in this setting.

Attitude of Health Personnel↗
PubMed1995

Radiology practices in emergency departments associated with pediatric residency training programs.

To examine the current radiology practices in academic emergency departments (EDs) serving children, a postal survey was done of 116 directors of EDs that serve as routine teaching sites for pediatric residents. One hundred three ED directors (89%) completed the survey, representing 75 pediatric-only EDs and 28 combined pediatric/adult EDs. Thirty-four of these EDs offer a pediatric emergency medicine fellowship. Hospitals were self-categorized as children's hospitals in 41 and non-children's hospitals in 62. Radiologists immediately read every study in 8% of the 103 EDs. Overall, 66% of the EDs have a radiology resident in-house overnight, which is significantly more likely in non-children's hospitals than in children's (79 vs 46%, P < 0.001). Overnight, ED radiographs of children may at times be solely interpreted by emergency attending physicians in 57% or emergency house staff in 44%. In EDs that allow their house staff to interpret solo overnight, emergency attending physicians are readily available to help with these interpretations less than half the time. A radiologist's second opinion overnight is readily or usually available in 63% of EDs. When any emergency physician interprets a radiograph solo overnight, the interpretation is almost always or often available later to the radiologist during the official interpretation only 40% of the time. Overnight, pediatric cervical spine studies are cleared, at times, solely by emergency attending physicians in 46% and by emergency house staff in 4%. Only 18% of programs have a daily or weekly ED radiograph review with radiologists. An ED atlas of common radiographic variants or a pediatric radiology textbook is available in 69% of EDs.(ABSTRACT TRUNCATED AT 250 WORDS)

Child↗
PubMedDate not supplied

A case-based clinician training program for treating tobacco use in college students.

Tobacco use rates are high among college students, and while many of them try to quit every year, only a small percentage are successful at maintaining abstinence. Most colleges have campus health centers that offer treatment for tobacco cessation, but few students access these resources. Little is known about how to motivate young adult college students to seek treatment or assist them in their attempts to quit smoking. In the context of a comprehensive, group-randomized intervention study to decrease smoking among college students, a case-based tobacco cessation training program for campus health center providers and staff was developed and conducted at 14 intervention colleges during the 2003-2004 academic year. Six case studies were created for this training, using responses from 39 student elicitation interviews conducted at 12 colleges in Spring 2002. Common themes relating to smoking, quitting, and relapse experiences reported by students in the elicitation interviews were woven into the cases and integrated into the training program.

Female↗
PubMed1998

Teaching elementary students with developmental disabilities to recruit teacher attention in a general education classroom: effects on teacher praise and academic productivity.

Four fourth graders with developmental disabilities were trained to recruit teacher attention while they worked on spelling assignments in a general education classroom. The students were taught to show their work to the teacher two to three times per session and to make statements such as, "How am I doing?" or "Look, I'm all finished!" Training was conducted in the special education classroom and consisted of modeling, role playing, error correction, and praise. A multiple baseline across students design showed that recruitment training increased (a) the frequency of students' recruiting, (b) the frequency of teacher praise received by the students, (c) the percentage of worksheet items completed, and (d) the accuracy with which the students completed the spelling assignments.

Adult↗
PubMedDate not supplied

[Training of epidemiology personnel in Cuba].

We describe the academic characteristics of the Master of Epidemiology Program taught at the Instituto de Medicina Tropical "Pedro Kourí", in La Habana, Cuba. We provide a description of the structure of the course along with its didactical principles, the main objectives of the different academic modules and the number and background of graduates from seven Classes. We also discuss potential work areas for graduates and short-term perspectives for their continuing education.

Academies and Institutes↗