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PubMed2003

Residency training in plastic surgery: a survey of educational goals.

With the advent of integrative plastic surgical training programs, requirements for earlier specialization decisions, and an increasing subspecialization within the practice of plastic surgery, the educational goals of residency training may have changed. The duration and extent of training required are also currently being questioned. This study was performed to better understand the necessary roles of plastic surgery residencies and to determine how these demands might optimally be met. Of 151 practicing plastic surgeons in the Ontario, Canada, region, 81 (53.6 percent) responded to a survey. General agreement was that 2 years was an optimal length of time for core surgical training, which should then be followed by at least 3 years of plastic surgical training. Opinions on the ideal length of time training in specific medical and surgical disciplines are discussed. Overall, respondents thought that two thirds of training should occur in tertiary care centers, with the remaining time spent at smaller community centers and private clinics. Nearly half of respondents thought that research training should be a mandatory part of the residency, although the amount of protected time for this activity varied substantially. Most thought that unrestricted elective time should also be available. Academic plastic surgeons rated the importance of research training (p < 0.01), critical appraisal skills (p < 0.05), and teaching skills (p < 0.05) as significantly more important than did their nonacademic colleagues. The authors present results from the Ontario region and a template for determining optimal characteristics for training programs. Further investigation may be of timely importance during a foreseeable future transition from traditional to integrative plastic surgery residency training.

Curriculum↗
PubMed2005

Radiation oncology career decision variables for graduating trainees seeking positions in 2003-2004.

PURPOSE: Radiation oncology trainees must consider an array of variables when deciding upon an academic or private practice career path. This prospective evaluation of the 2004 graduating radiation oncology trainees, evaluates such variables and provides additional descriptive data. METHODS: A survey that included 15 questions (one subjective, eleven categorical, and 3 continuous variables) was mailed to the 144 graduating radiation oncology trainees in United States programs in January of 2004. Questions were designed to gather information regarding factors that may have influenced career path choices. The responses were anonymous, and no identifying information was sought. Survey data were collated and analyzed for differences in both categorical and continuous variables as they related to choice of academic or private practice career path. RESULTS: Sixty seven (47%) of the surveys were returned. Forty-five percent of respondents indicated pursuit of an academic career. All respondents participated in research during training with 73% participating in research publication authorship. Post graduate year-3 was the median in which career path was chosen, and 20% thought that a fellowship position was "perhaps" necessary to secure an academic position. Thirty percent of the respondents revealed that the timing of the American Board of Radiology examination influenced their career path decision. Eighteen variables were offered as possibly influencing career path choice within the survey, and the top five identified by those seeking an academic path were: (1) colleagues, (2) clinical research, (3) teaching, (4) geography, (5) and support staff. For those seeking private practice, the top choices were: (1) lifestyle, (2) practice environment, (3) patient care, (4) geography, (5) colleagues. Female gender (p = 0.064), oral meeting presentation (p = 0.053), and international meeting presentation (p = 0.066) were the variables most significantly associated with pursuing an academic career path. The following variables were ranked significantly differently in hierarchy (p < 0.05) by those seeking an academic versus private practice path with respect to having influence on the career decision: lifestyle, income, case-mix, autonomy, ability to sub-specialize, basic research, clinical research, teaching, patient care, board structure, practice environment, and mentoring. CONCLUSION: These data offer descriptive information regarding variables that lead to radiation oncology trainee career path decisions. Such information may be of use in modification of training programs to meet future personnel and programmatic needs within the specialty.

Career Choice↗
PubMed1981

Impact of new Food and Drug Administration regulations on college, university, and experiment station researchers.

The Good Laboratory Practice regulations adopted by the Food and Drug Administration describe specific procedures to assure the integrity of the research results. Those studies conducted with the intent to provide data on the safety of drugs and chemicals will be required to comply with the published relations. The process of bringing research laboratories into compliance with the regulations may be either arduous or fairly routine depending on the organization, goals, and type of research. Typically, the Good Laboratory Practice regulations will increase sharply the cost of health safety information. Hiring more and better trained technical and professional personnel will be much of this expense. If university and experiment station researchers choose to avoid compliance with these regulations, then agricultural research science may not continue to be recognized as an authority on the safety of products used for production of human food. Irrespective of whether universities choose to conduct regulated research or delegate this role to other segments of society, academic institutions must assume the role of training those individuals needed to conduct toxicity research.

Laboratories↗
PubMedDate not supplied

Changing surgical education strategies in an environment of changing health care delivery systems.

Emerging changes in health care delivery will have a significant impact on the structure of surgical education in academic departments of surgery. Based on some assumptions as to the probable nature of the final product of this reform, this article encourages a proactive stance by surgical educators to anticipate changes and move toward restructuring in areas of curricular content, the teaching process, performance evaluation strategies, and faculty infrastructure of the academic department. Curriculum changes must bridge the gap between public health and medicine and continue the aggressive trend toward teaching in the outpatient setting. Surgical educators must adapt to evolving computer and instructional technology that will make multimedia presentations, distance education, teleconferencing, hypermedia, and virtual reality commonplace in the teaching setting. Increased emphasis on accountability and accreditation will require stringent criteria in performance and program evaluation methodology. The academic infrastructure will need to adapt to the changing goal of training more general surgeons and fewer specialists and yet maintain the fundamental responsibility of an academic surgeon for mentoring the medical student and surgical resident.

Computer-Assisted Instruction↗
PubMed1999

Trauma resuscitation/critical care fellowship for emergency physicians: a necessary step for the future of academic emergency medicine.

Emergency physicians (EPs) have long been de-facto providers of trauma resuscitation and critical care in academic and community hospital settings, and are significantly involved in out-of-hospital trauma care and trauma research. A one-year fellowship has been developed and implemented to provide advanced training in trauma resuscitation and critical care to EPs with a special interest in the field. This fellowship provides additional depth and breadth of training to prepare graduates for leadership roles in academic and specialized trauma centers. This is the first fellowship of its kind for EPs, and may serve as a model for fellowships at other institutions.

Baltimore↗
PubMed1992

Current status of chairpersons in physical medicine and rehabilitation.

There are currently 77 academic departments, divisions or units of physical medicine and rehabilitation (PM&R) in the United States. The authors conducted a survey to develop a profile of the current chairpersons of PM&R, as well as to assess the short- and long-term needs of the field. The survey addressed basic demographic information as well as the level of formal training and/or experience in various management, patient care and academic areas. The level of satisfaction with various aspects of the position such as workload, relationship with the university and role as a researcher were also measured. The chairpersons were asked when they plan to vacate their position and if they felt there were any members of their faculty who are qualified and ready to assume a chairperson position. Those that identified a qualified individual were then asked whether the person had formal training and/or experience in the various management, patient care and academic areas. The results indicate that, although the chairpersons have a high level of job satisfaction with respect to the challenge of the position and their administrative and supervisory roles, they are least satisfied with their role as a researcher. The field must be concerned with this finding, because academic PM&R units in the United States will experience a substantial change in leadership by the end of the 20th century. Approximately 39% of the current chairpersons who returned the questionnaire are planning to step down by 1999, with an additional 37% unsure when they will vacate the position.(ABSTRACT TRUNCATED AT 250 WORDS)

Administrative Personnel↗
PubMed1997

The need for comprehensive data on educational affiliations between academic health centers and managed care organizations.

Because of the emerging dominance of managed care, it is important to encourage the development of partnerships and affiliations between academic health centers (AHCs) and managed care organizations (MCOs) to train tomorrow's physicians to operate effectively in the new health care environment. But to what extent do such relationships exist now. In 1996, the authors sought to identify existing databases on the availability and extent of existing education partnerships and affiliations between AHCs and MCOs and the availability of such information to policymakers, the educational community, students, and residents. Despite a thorough search of the literature and interviews with representatives of education and practice organizations and with other experts in the medical education and managed care fields, the authors found no centralized or even partly centralized database on opportunities for training in managed care settings or on AHC-MCO partnerships. However, anecdotal evidence revealed eight such partnerships, each different from the others, that can serve as models for future partnerships; these are described. The authors speculate about why there are not more data describing AHC-MCO partnerships. They conclude by stating that the health care and health education industries have a variety of professional associations that could work together to assemble and make available such data to help build the educational and information infrastructure needed to train future physicians.

Academic Medical Centers↗
PubMed1976

Assessment of a cognitive training program for hyperactive children.

Modeling, self-verbalization, and self-reinforcement techniques were used to train hyperactive children in more effective and less impulsive strategies for approaching cognitive tasks, academic problems, and social situations. Eighteen hyperactive children took part in the training program. The control group, which received no training, consisted of 11 children, matched with the experimental group on age, IQ, and measures of hyperactivity and impulsivity. Several tests and measures, some of which have been shown to differentiate between hyperactive and normal children, were administered prior to training at the end of the 3-month training period, and after a further 3-month period in which no training took place. The trained group showed significantly greater improvement on several of the measures, both at the time of posttesting and on the follow-up evaluation.

Attention↗
PubMed2005

The American Association of Obstetricians and Gynecologists Foundation Scholars Program: additional data on research-related outcomes.

OBJECTIVE: The purpose of this study was to ascertain the progress of recipients of research training in obstetrics and gynecology in establishing an active research career in academic medicine. STUDY DESIGN: Existing data were used to examine the extent to which 41 individuals who had received American Association of Obstetricians and Gynecologists Foundation (AAOGF) fellowships had achieved outcomes indicative of a career in academic medicine. Outcomes included employment as a full-time faculty member, receipt of NIH research funding, number of publications, the types of journals in which these articles had appeared, and the type of research (eg, basic vs patient-oriented). RESULTS: Among individuals who were awarded their fellowship between 1984 and 1997, 88% held faculty appointments, and 40% of these positions were in institutions that were more research-intensive that the medical degree-granting institutions of fellows. Slightly more than half of former fellows had successfully competed for NIH research funding, with 22% being awarded at least one R01 grant. Overall, fellows produced a total of 878 articles, one third of which appeared in clinical journals, 18% were in basic biomedical research journals, and 48% were in journals that published both types of research. CONCLUSION: Previous AAOGF scholars have actively pursued research careers in academic obstetrics and gynecology. Their performance compares favorably with those of individuals receiving research training in other clinical specialties. A more complete understanding of their performance and the value added by the program would be possible if a core set of data on outcomes were available from other types of training efforts in both obstetrics and gynecology and other relevant disciplines.

Biomedical Research↗
PubMedDate not supplied

Using women's health research to develop women leaders in academic health sciences: the National Centers of Excellence in Women's Health.

While the number of women entering U.S. medical schools has risen substantially in the past 25 years, the number of women in leadership positions in academic medicine is disproportionately small. The traditional pathway to academic leadership is through research. Women's health research is an ideal venue to fill the pipeline with talented women physicians and scientists who may become academic leaders in positions where they can promote positive change in women's health as well as mentor other women. The Office on Women's Health (OWH) in the U.S. Department of Health and Human Services has contracted with 18 academic medical centers to develop National Centers of Excellence in Women's Health. Emphasizing the integral link between women's health and women leaders, each of the Centers of Excellence must develop a leadership plan for women in academic medicine as part of the contract requirements. This paper describes the training programs in women's health research that have developed at five of the academic medical centers: the University of Wisconsin, Magee Women's Hospital, the University of Maryland, Medical College of Pennsylvania Hahnemann University, and the University of Illinois at Chicago. We discuss some of the challenges faced for both initiation and future viability of these programs as well as criteria by which these programs will be evaluated for success.

Academic Medical Centers↗
PubMed2003

Addressing disparities in children's oral health: a dental-medical partnership to train family practice residents.

Providing oral health care to rural populations in the United States is a major challenge. Lack of community water fluoridation, dental workforce shortages, and geographical barriers all aggravate oral health and access problems in the largely rural Northwest. Children from low-income and minority families and children with special needs are at particular risk. Family-centered disease prevention strategies are needed to reduce oral health disparities in children. Oral health promotion can take place in a primary care practitioner's office, but medical providers often lack relevant training. In this project, dental, medical, and educational faculty at a large academic health center partnered to provide evidence-based, culturally competent pediatric oral health training to family medicine residents in five community-based training programs. The curriculum targets children birth to five years and covers dental development, the caries process, dental emergencies, and oral health in children with special needs. Outcome measures include changes in knowledge, attitudes, and self-efficacy; preliminary results are presented. The program also partnered with local dentists to ensure a referral network for children with identified disease at the family medicine training sites. Pediatric dentistry residents assisted in didactic and hands-on training of family medicine residents. Future topics for oral health training of family physicians are suggested.

Attitude of Health Personnel↗
PubMed1989

Graduate medical education in ambulatory care.

Graduate medical education is currently in transition, with educators being asked to re-examine the extent to which hospital-based teaching models still provide adequate comprehensive training. To educate future physicians adequately, the Department of Veterans Affairs (VA) will have to change its system for delivering ambulatory care services and for teaching in ambulatory care settings. Workshop discussions focused on five major areas regarding educating residents in the ambulatory setting: educational goals and objectives, clinical experiences, curriculum development and evaluation, faculty issues, and fellowship opportunities. Recommendations include the need for residency programs to develop explicit educational goals and objectives for resident training, the identification of transdepartmental needs and coordinated planning, the support of academic clinical faculty, research and development of educational programs, and further development of fellowship training in ambulatory care. Further integration of ambulatory care activities in graduate training will require significant effort, a shift in manpower and resources and, more fundamentally, a shift in attitude and commitment at all levels of the VA and medical schools.

Ambulatory Care↗
PubMed1993

Comparing the status of women and men in academic medicine.

OBJECTIVE: To explore the status and academic productivity of women compared with men in academic internal medicine. DESIGN: Mail survey done in 1986. SETTING: A total of 107 major teaching hospitals in the United States. PARTICIPANTS: Full-time (1693 of 2510) faculty in cardiology, rheumatology, and general internal medicine; 67% of eligible men and 70% of eligible women. MEASUREMENTS: Academic productivity defined as research grants awarded, abstracts accepted, and papers published in refereed journals; academic advancement as determined by academic rank and tenure status; and monetary compensation. RESULTS: Women entered academic medicine with shorter periods of fellowship training and were less likely to be members in the Alpha Omega Alpha honor society, but they had job descriptions similar to those of men, with similar allocation of work between research, clinical, and teaching activities. After adjustment, women and men were similar in the numbers of research grants funded as principal investigator (1.9 compared with 2.0), abstracts accepted (6.8 compared with 6.1), and papers published in refereed journals (28.8 compared with 29.2; all with P > 0.20). Women were as likely as men to have tenure, but they had lower academic rank (full or associate professor; 33% compared with 47%, P < 0.001) and received less compensation ($72,000 compared with $79,600 annually; P < 0.001). CONCLUSION: Although women do similar professional tasks and achieve similar levels of academic productivity, they receive fewer rewards for their work, both in academic rank and monetary compensation.

Achievement↗
PubMed1996

Trends in staffing an academic department of surgery in a tropical hospital: past, present, and future?

OBJECTIVE: To evaluate the effect of staff mobility on student teaching, the training of young surgeons, and the volume of research in an academic department of surgery of a tropical teaching hospital. DESIGN: Retrospective study of academic staffing in the department of surgery of the Ahmadu Bello University Teaching Hospital between 1975 and 1993. SETTING: Zaria, Nigeria. SUBJECTS: 42 academic staff, 1190 medical students, and 110 registrars (trainee surgeons). MAIN OUTCOME MEASURES: Number of academic staff in post, medical students, and registrars; number of research papers in latter years of the study. RESULTS: In 19 years, 42 academic staff worked for varying periods (1-15 years) in the university department of surgery in Zaria. These included six professors, 12 senior lecturers, and 24 lecturers. Although staff numbers diminished, numbers of students and registrars increased year by year. Average number of publications dropped from a peak of 14.4 to 7.4 a year. CONCLUSION: Staffing of the department has fallen steadily over the years and has adversely affected the department's primary responsibility of teaching students and training young surgeons.

Faculty↗
PubMed1994

The general surgeon through the looking glass: bright reflections from a tarnished image.

The image of the general surgeon is suffering in the eyes of trainees, peers, the public and even general surgeons themselves. The magnitude and importance of this to the future of the specialty is reviewed. A diminishing number of graduates are entering general surgical training, and only one-quarter ultimately complete their training and remain in general surgery practice. A lack of suitable academic role models and the dichotomy that exists between traditional insistence on uniform broad-based training for all and the realities of clinical practice are important parts of the image problem. This is particularly evident in small communities where the general surgeon may be ill prepared for the surgical needs of the community, or conversely where the present generation of general practitioners fails to recognize the capabilities of the general surgeon. The public does not know the meaning of the term general surgeon and fails fails to recognize and reward its highly specialist nature. Solutions to this image problem include the following: acceptance of and emphasis on the generalist nature of the specialty of general surgery; innovation and emulation of technologic advances but with careful evaluation; and reorganization of training programs with emphasis on core training in "surgery in general," flexibility tailored to ultimate career goals and preservation of in-depth general surgical experience for those who ultimately intend to serve its practice.

Canada↗
PubMed2000

Women in academic emergency medicine.

OBJECTIVE: To evaluate the achievement of women in academic emergency medicine (EM) relative to men. METHODS: This study was a cross-sectional mail survey of all emergency physicians who were employed at three-fourths full-time equivalent or greater at the 105 EM residency programs in the United States from August 1997 to December 1997. The following information was obtained: demographics, training and practice issues, roles and responsibilities in academic EM, percentage of time spent per week in clinical practice, teaching, administrative and research activities, academic productivity, and funding. RESULTS: Of the 1,575 self-administered questionnaires distributed by the office of the chairs, 1,197 (76%) were returned. Two hundred seventy-four (23%) of the respondents were women, and 923 (77%) were men. There was a significant difference noted between men and women in all demographic categories. The numbers of respondents who were nonwhite were extremely small in the sample and, therefore, the authors are hesitant to draw any conclusions based on race/ethnicity. There was no difference in training in EM between men and women (82% vs 82%, p = 0.288), but a significantly higher proportion of male respondents were board-certified in EM (84% vs 76%, p < 0.002). Women in academic EM were less likely to hold major leadership positions, spent a greater percentage of time in clinical and teaching activities, published less in peer-reviewed journals, and were less likely to achieve senior academic rank in their medical schools. CONCLUSIONS: These findings mirror those of most medical specialties: academic achievement of women in academic EM lags behind that of men. The paucity of minority physicians in academic EM didn't permit analysis of their academic achievements.

Academic Medical Centers↗
PubMed1999

Survey on neurosurgery subspecialty fellowship training. Congress of Neurological Surgeons Education Committee.

BACKGROUND: The ongoing controversy on the certification of neurosurgery subspecialties has not been settled. There has been no detailed report on why a resident chooses to undergo further training in the form of a postgraduate fellowship. A survey was devised to investigate the reasons, as well as factors, that prompt the resident to pursue fellowship training. METHODS: The names of the surveyed residents were obtained from the Congress of Neurological Surgeons database, and the names of the neurosurgery fellows were obtained from individual program coordinators by phone. A survey, a cover letter, and a return envelope were mailed to each prospective respondent. The data were entered on the Paradox for Windows program, and multiple queries were run to obtain tabulated results. RESULTS: The overwhelming majority (84.6%) of the resident respondents considered fellowship a possibility. Academic medicine was also the choice of career for most (60.3%). The most popular reported fellowships were spine (25.6%), pediatric (16.5%), and vascular (16.1%). The three top reasons for pursuing fellowship training were "personal interest for knowledge," "job market demand," and "academic prestige." "Inadequate training during residency" was a distant fourth. For respondents citing "inadequate training during residency" as one of the top three reasons, there were proportionally higher respondents in the fields of peripheral nerve, endovascular, and skull base neurosurgeries. CONCLUSION: A significant number of residents consider fellowship a way to further their personal interest and knowledge, as well as increase their marketability. Relatively few from the surveyed group considered their residency training experience deficient in the subspecialty areas, with the exception of peripheral nerve, endovascular, and possibly skull base neurosurgery.

Career Choice↗
PubMed1999

Testing for HIV: current practices in the academic ED.

The objective of this study was to determine common practices for testing for Human Immunodeficiency Virus (HIV), particularly in patients with other sexually transmitted diseases (STD) in emergency departments (ED) with residency training in Emergency Medicine. Via mail, 112 directors of academic emergency medicine programs in the United States were surveyed. Surveys from 95 academic institutions were completed, returned, and included in the analysis. Three EDs (3%) routinely tested for HIV in patients with suspected STD. HIV testing was performed in the ED in 54% of responding institutions under special circumstances such as employee testing after occupational exposures (54%), cases of rape (46%), and suspicion of HIV infection by clinical manifestations other than suspected STD (36%). Based on the results it was determined that academic EDs do not routinely test for HIV in patients suspected of having a STD and have variable testing practices and policies regarding other possible HIV exposures.

AIDS Serodiagnosis↗