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PubMed1998

The pillars of health management education: lessons from the CEE experience.

AUPHA faculty members have had the opportunity to provide health care executive training and to work in partnership with academic institutions in Central and Eastern Europe and in the New Independent States of the former Soviet Union. This article presents some observations on health management education that demonstrate the similarity in issues faced by programs in the U.S. and in CEE. The health management educational partnership program was designed to provide technical assistance to emerging health management programs in the CEE. The partnership program has been mutually beneficial for several reasons. The role of physicians in leadership and the management educational needs that result provide one example of an issue that health management educational programs must address. The emergence of the roles of other health professions and growing contribution that they will make has its parallel in the American ascendance of the role of interdisciplinary team in clinical decision making. The partnership and executive training experiences have caused U.S. partners to focus consciously on pedagogical methods. The nature of the issues faced by emerging CEE health management programs suggests that mutual support among programs in the region after the partnership program is necessary in order to provide a forum for debate. The focus of the debate should continue to be on the role of management in health reform, content of curriculum, research focus and pedagogical methods appropriate for health care management undergraduate and graduate programs. The result will be a strengthening of the health management academic discipline in the region. The future of the AUPHA should predicated on the same principles, the roots from which it has grown.

Curriculum↗
PubMed2001

Translation of nutritional sciences into medical education: the Nutrition Academic Award Program.

For the past 40 y the scientific community has decried the inadequacy of the training of physicians and other health professionals in the subject of human nutrition. In 1997 the National Heart, Lung, and Blood Institute developed the Nutrition Academic Award (NAA) Program, an initiative to improve nutrition training across a network of US medical schools. The purpose of this funding, which began in 1998, is to support the development and enhancement of nutrition curricula for medical students, residents, and practicing physicians to learn principles and practice skills in nutrition. The NAA recipients developed the Nutrition Curricular Guide for Training Physicians, a plan to incorporate clinical guidelines into physician practice skills, create educational and assessment practice tools, and evaluate curricula, materials, and teaching tools. Dissemination of NAA activities and materials will be facilitated by a national website, presentations and publications, and consultants and advisors from the NAA nutrition education programs. The NAA Program constitutes a major new effort to enhance nutrition knowledge and skills among health care providers and to effectively apply the science of human nutrition to clinical medicine. This article describes the purpose and aims of the NAA Program, the organizational structure of the network of recipients, a profile of the recipients and individual programs at 21 medical schools, the various strategies to overcome barriers in training physicians in human nutrition, and collaborative and dissemination efforts.

Awards and Prizes↗
PubMedDate not supplied

Collaborative community-based research and innovation.

This work describes the results and lessons learned from a community-academic partnership to research the effect of training on the capacity of rural home care aides to care for older persons with dementia. The research study increased the aides' knowledge of Alzheimer's and related disorders and, for one group, the aides' satisfaction. The authors used content analysis to identify barriers and facilitators of success of the research partnership. These factors are discussed and placed within a framework of innovation concepts.

Academic Medical Centers↗
PubMed2000

The time and financial impact of training fellows in endoscopy. CORI Research Project. Clinical Outcomes Research Initiative.

OBJECTIVE: To use a national endoscopy database (Clinical Outcomes Research Initiative, CORI) to determine 1) if fellow involvement increases procedure time; and 2) the financial impact of fellow participation for academic centers compared to private practice. METHODS: CORI database from 4/1/97 to 4/1/99 was used to compare endoscopists from private practices, academic medical centers, and Veterans Administration hospitals, with or without fellows-in-training. Data were captured in a computer-generated endoscopy report and transmitted to a central database for analysis. Duration of procedure (minutes) was recorded for diagnostic esophagogastroduodenoscopy (EGD), EGD with biopsy, diagnostic colonoscopy, and colonoscopy with biopsy, in ASA 1 patients. Financial outcomes used 1999 Medicare reimbursement rates for respective procedures and were calculated as procedures per hour on a theoretical practice of 4000 procedures. RESULTS: Teaching fellows endoscopy added 2-5 min for EGD, with or without biopsy, and 3-16 min for colonoscopy, with or without biopsy. Calculating the number of procedures/h of endoscopy, the reimbursement loss resulting from using fellows-in-training in a university setting would be half a procedure/h. In Veterans Administration hospitals, training of fellows would lose a full procedure/h. In a model of 1000 procedures each of EGD, EGD with biopsy, colonoscopy, and colonoscopy with biopsy, the reimbursement difference between private practice physicians or academic attending physicians and procedures involving fellows-in-training would be $500,000 to $1,000,000/yr. CONCLUSIONS: Fellow involvement prolonged procedure time by 10-37%. Thus, per-hour reimbursement is reduced at teaching institutions, causing financial strain related to these time commitments.

Academic Medical Centers↗
PubMed2002

The current state of geriatric medicine: a national survey of fellowship-trained geriatricians, 1990 to 1998.

The rapid growth of the older population has focused national attention on the need for physicians trained in geriatric medicine. To gain insight into the evolving status of the field, with particular focus on career decision-making and academic career development of trainees, we conducted a survey of physicians recently completing geriatric fellowships. The 107 accredited extant geriatric fellowship programs in the United States and Puerto Rico were contacted to identify trainees from 1990 to 1998. A mailed survey addressed relevant career development and training issues. Four hundred ninety out of 787 (62%) physicians responded; 20% completed 1 year and 80% 2 or more years of training. Half made the decision to pursue a career in geriatrics during residency, 27% decided before/during medical school, and a mentor influenced 48%. Currently, 80% have a Certificate of Added Qualifications in geriatric medicine, 69% hold academic appointments, 78% teach, 39% participate in research, and 44% author publications. Most are doing predominantly clinical work in multiple settings. Further analysis of the 1996-to-1998 cohort revealed that those completing fellowships of 2 or more years are more likely to identify all geriatrics as their professional focus, conduct and author research, work with multidisciplinary teams, and participate in professional geriatric societies. This national survey documents career decision-making and the academic and clinical profiles of physicians completing geriatric fellowship training in the past decade. Longer fellowship training is associated with academic career development. Although there is a national need to train clinical geriatricians, the additional need to train and fund future geriatric academic leaders requires increased attention.

Adult↗
PubMed2001

Residents' preferences and preparation for caring for underserved populations.

Access to care by low-income persons and residents of rural and poor inner-city areas is a persistent problem, yet physicians tend to be maldistributed relative to need. The objectives were to describe preferences of resident physicians to locate in underserved areas and to assess their preparedness to provide service to low-income populations. A national survey was made of residents completing their training in eight specialties at 162 US academic health center hospitals in 1998, with 2,626 residents responding. (Of 4,832 sampled, 813 had invalid addresses or were no longer in the residency program. Among the valid sample of 4,019, the response rate was 65%.) The percentage of residents ranking public hospitals, rural areas, and poor inner-city areas as desirable employment locations and the percentage feeling prepared to provide specified services associated with indigent populations were ascertained. Logistic regressions were used to calculate adjusted percentages, controlling for sex, race/ethnicity, international medical graduate (IMG) status, plans to subspecialize, ownership of hospital, specialty, and exposure to underserved patients during residency. Only one third of residents rated public hospitals as desirable settings, although there were large variations by specialty. Desirability was not associated with having trained in a public hospital or having greater exposure to underserved populations. Only about one quarter of respondents ranked rural (26%) or poor inner-city (25%) areas as desirable. Men (29%, P <.01) and noncitizen IMGs (43%, P <.01) were more likely than others to prefer rural settings. Residents who were more likely to rate poor inner-city settings as desirable included women (28%, P =.03), noncitizen IMGs (35%, P =.01), and especially underrepresented minorities (52%, P <.01). Whereas about 90% or more of residents felt prepared to treat common clinical conditions, only 67% of residents in four primary care specialties felt prepared to counsel patients about domestic violence or to care for human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) or substance abuse patients (all 67%). Women were more likely than men to feel prepared to counsel patients about domestic violence (70% vs. 63%, P =.002) and depression (83% vs. 75%, P <.01). Underrepresented minority residents were more likely than other residents to feel prepared to counsel patients about domestic violence (P <.01) and compliance with care (P =.04). Residents with greater exposure to underserved groups were more prepared to counsel patients about domestic violence (P =.01), substance abuse (P =.01), and to treat patients with HIV/AIDS (P =.01) or with substance abuse problems (P <.01). This study demonstrates the need to expose graduate trainees to underserved populations and suggests a continuing role of minorities, women, and noncitizen physicians in caring for low-income populations.

Academic Medical Centers↗
PubMed1986

Whither primary care in the academic health science center?

Five forces that shape the form and function of the future academic health center are a mandate to decrease health care costs, a surplus of physicians, intense competition for the provision of tertiary medical care, a suboptimal diagnosis-related group (DRG) case mix, and decreasing funding for manpower training and research. All five forces cause the academic health center to be much more in need of strong primary medical care services. This article describes the current relationship between primary care and the academic medical center, new contributions that primary care can make to the academic medical center, and the benefits that would accrue to both the academic medical center and primary care should a closer working relationship develop. These benefits include increased outpatient volume and revenue, a more balanced inpatient case mix, better primary medical care education, an enhanced community reputation, and greater influence by primary care on academic medical center policies. Published and personal case study experiences that show some of the potential problems with a closer working relationship between primary care and the academic medical center are described.

Academic Medical Centers↗
PubMed1991

A characterization of the imminent leadership transition in academic family medicine.

Of the 106 identified chairmen of academic departments, divisions, or sections of family medicine in the United States in 1990, 97 (92%) responded to a survey designed to characterize the current chairmen of family medicine and estimate requirements for future chairmen. Even though 43% had occupied the chair for less than five years, over half, not limited to older chairmen, intended to leave within five years. Reasons for leaving varied, including being required to leave, career choice, personal reasons, and especially dissatisfaction with the job. Only half of current chairmen identified one or more qualified applicants for chairmanship within their own departments. The formal training and experience of these potential chairmen strongly resembled the training and experience of current chairmen, especially the fact that they had little training or experience in research. In the 1990s, the demand for academic chairmen of family medicine is likely to be large, the competition for capable candidates keen, and the challenges great for new chairmen, who will probably be young, residency-trained family physicians with relatively limited academic experience.

Adult↗
PubMed2006

The Columbia Cooperative Aging Program: an interdisciplinary and interdepartmental approach to geriatric education for medical interns.

Although there is a critical need to prepare physicians to care for the growing population of older adults, many academic medical centers lack the geriatric-trained faculty and dedicated resources needed to support comprehensive residency training programs in geriatrics. Because of this challenge at Columbia University, the Columbia Cooperative Aging Program was developed to foster geriatric training for medical interns. For approximately 60 interns each year completing their month-long geriatric rotations, an integral part of this training now involves conducting comprehensive assessments with "well" older people, supervised by an interdisciplinary team of preceptors from various disciplines, including cardiology, internal medicine, occupational therapy, geriatric nursing, psychiatry, education, public health, social work, and medical anthropology. Interns explore individual behaviors and social supports that promote health in older people; older people's strengths, vulnerabilities, and risk for functional decline; and strategies for maintaining quality of life and independence. In addition, a structured "narrative medicine" writing assignment is used to promote the interns' reflections on the assessment process, the data gathered, and their clinical reasoning throughout. Preliminary measures of the program's effect have shown significant improvements in attitudes toward, and knowledge of, older adults as patients, as well as in interns' self-assessed clinical skills. For academic medical centers, where certified geriatric providers are scarce, this approach may be an effective model for fostering residency geriatric education among interns.

Aging↗
PubMed2005

Barriers facing junior doctors in rural practice.

INTRODUCTION: Early postgraduate, or junior doctors, are still required to practise in rural and remote communities, and they continue to face numerous issues and difficulties. Within the hospital setting, exposure to rural practice appears to be very limited during internship, and also to some extent, during the second postgraduate year and beyond. This is a major issue for those required to undertake country relieving, rural terms or who will be bonded to rural and remote practice for several years after internship. This research investigated the current issues and difficulties faced by junior doctors, required to undertake rural and remote practice in Queensland, Australia. METHODS: An exploratory study was undertaken. Primary data were collected through semi-structured interviews held with key stakeholders. Stakeholders included: directors of clinical training; medical educators; junior doctors; rural practitioners; academic rural practitioners; and medical administrators. Of the 23 people approached, a total of 19 agreed to be interviewed. The response rate was 82.6%. RESULTS: Similar to the issues identified in the literature, there are currently a number of barriers influencing the ability of junior doctors to practise competently and confidently when undertaking practice in rural and remote communities. Minimal clinical experience, lack of supervision and on-site support, inadequate orientation and uninformed expectations, limited access to relevant education, and the influence of isolation, results in an overall lack of preparation both professionally and personally. When asked, respondents supported the identification of core skills and knowledge, and integration of these and other issues affecting rural practice, into their hospital-based programs. Current hospital-based education and training programs were not adequately preparing junior doctors for rural and remote practice. It was commented that orientation and education, with a rural emphasis, could assist junior doctors in their preparation for country relieving, rural terms and longer placements. CONCLUSIONS: Data collected in this study have confirmed that junior doctors are still being sent to undertake country relieving in their second postgraduate year. Hence, the issues remain for junior doctors when undertaking practice in rural or remote communities, including country relievers and scholarship holders. Results from this study suggest that prior recommendations have not been fully implemented. A recommendation is that initiatives at the undergraduate level, including increasing rural exposure and integration of rural context into training, be further developed at the early postgraduate level. Core rural competencies should be identified and realistic preparation and support strategies put in place in the hospital setting. This will further the effort to prepare junior doctors for rural practice and minimise some of the barriers currently experienced.

Attitude of Health Personnel↗
PubMed2003

Academic health leadership: looking to the future. Proceedings of a workshop held at the Canadian Institute of Academic Medicine meeting Québec, Que., Canada, Apr. 25 and 26, 2003.

The academic health sector will face major changes in governance, health care delivery, educational requirements and research programs over the next decade. Increased emphasis on disease prevention and health outcomes, the need for evidence to support both clinical and policy decisions, educational changes both in content and delivery, and the importance of working in teams will challenge the academic health care community. Large research teams may require new ways of training and nurturing young investigators, including improved grant writing and knowledge translation, human resource management skills and the ability to interact with disciplines that have different research methodologies. MD/PhD and Clinician Investigator Programs may help to fill these gaps in medicine, but nursing is faced with a serious shortage of doctoral-trained educators and researchers and may need targeted programs to achieve a critical mass of academics able to accept leadership roles. The success of the Quebec model of support for health research networks and researchers is encouraging. There is a leadership gap within health care institutions that spans jurisdictions and affects both institutional performance and individual careers. Young investigators need good mentors and adequate protected time to acquire the skills necessary for leadership roles. Policy changes within health care institutions and academic organizations will be necessary to adapt to the coming decade. The Canadian Institute of Academic Medicine is committed to developing better mentoring strategies for the next generation of academic leaders and to creating formal assessments of major Canadian health issues that can be used by health care advocacy groups when talking with policy-makers.

Biomedical Research↗
PubMed1983

Evaluation of common predictors for selection of postdoctoral dental students.

Certain predictors are traditionally presumed to be reliable measures for selection of candidates for general dentistry training programs. The purpose of this study was to assess the relative value of academic standing, letters of recommendation, and personal interview impressions by comparing them with performance during training. Predictor data were collected from the application files of all postdoctoral trainees in the advanced general dentistry training program at the Eastern Dental Center of the past ten years (N = 154). However, only 102 postdoctoral students had information available for all three predictor criteria. Performance was rated subjectively on completion of training by two faculty members on a six-point rating scale. The highest correlations between predictors and performance were to academic achievement (r = 0.347). Weaker, though statistically significant, correlations were found for the personal interview (r = 0.206) and letters of recommendation (r = 0.192). Although these predictor criteria will continue to be used in the selection of candidates, administrators and selection committees must be aware of the limitations of such criteria in predicting performance.

Education, Dental, Graduate↗
PubMed1992

Preliminary assessment of a scientific curriculum in a surgical residency program.

A structured, basic science curriculum was instituted for surgical residents of the University of Connecticut (Farmington) Integrated Residency Program during the 1990-1991 academic year in concordance with American Board of Surgery guidelines. The impact of the new program was measured by comparing performance on monthly basic science examinations, the in-training examination, and "mock" oral examinations for the 1990-1991 academic year with that of the preceding academic year. While monthly examination scores improved for the entire group of residents (67.7 vs 64.6), in-training and oral examination scores did not change significantly. Categorical residents generally demonstrated superior performance and greater improvement than did preliminary residents. Data analysis suggested that the new curriculum was an effective educational device and that university-designed monthly examinations were valid testing instruments, but there was an apparent incongruity between the goals of the curriculum and the American Board of Surgery In-Training Examination.

Attitude↗
PubMed1997

Residency training in Massachusetts: a new approach to state-university collaboration.

Traditional state-university collaborations, known as public-academic liaisons (PALs), have resulted in improved quality of service and enhanced residency training. Recent national trends for treating persons with serious mental illness, including moving services from institutional settings to community-based care and emphasizing the use of rehabilitative approaches as well as changes in the health care delivery system itself, have led to preliminary rethinking of some discrete aspects of more traditional approaches. Rather than discrete changes, Massachusetts has responded to these emerging trends with a new and comprehensive initiative that emphasizes one set of statewide standards in these emerging content areas for all residency training programs. Consistent with new practices in health care delivery, this new initiative was fielded through a process of competitive bidding rather than through traditional allocation of service positions. The development, implementation, and initial outcomes of this new approach are presented and implications for mental health administrators are discussed.

Community Mental Health Services↗
PubMed2004

Commitment and collaboration for excellence in older persons' mental health: the ACT experience.

OBJECTIVE: To describe the development of the older persons' mental health service in the Australian Capital Territory (ACT), a region with both urban and rural characteristics. METHODS: Elements include: (i) collaboration with health-care and non-governmental organizations; (ii) provision of consultation-liaison service to patients, family and professional care-providers via collaboration with general practitioners; (iii) partnerships built through consultation, regular communication, education and training of primary health-care providers; and (iv) development of a multidisciplinary academic centre in partnership with the local universities designed to enhance roles in education, training and research. The disciplines of general practice, nursing, psychology, social work and psychiatry collaborate in service provision, education and an active research centre. CONCLUSIONS: An expanded, multidisciplinary comprehensive service has been developed from an initial consultation-liaison model, illustrating that commitment and collaboration with existing services and carer groups can advance care.

Aged↗
PubMedDate not supplied

Preparing public health leaders for the 1990s.

Public health leadership is urgently needed throughout the world. In most local, provincial, and national jurisdictions, such responsibility has been assumed by doctors of clinical medicine, who know much about treatment of disease in individual patients but very little about prevention of disease and promotion of health in populations or the management of health systems. Effective leadership in public health requires a new profession, with generalized education in the basic tools of social analysis, health and disease in populations, promotion of health and prevention of disease, and health care systems and their management. More than 40 distinct scientific subjects have been developed in these fields over the years, and current faculties are qualified to teach them. To provide this education would require about 5 years of academic and field studies, after a bachelor's degree. Schools of public health now train doctoral-level specialists who are prepared in the PhD tradition for academic posts. These schools should also develop educational programs for doctoral-level generalists who are qualified to provide community health leadership at local, provincial, and national levels.

Curriculum↗
PubMed1991

Pathways to improved radiologic research. An NIH workshop.

In summary, the workshop recommended two years of research training as being essential for radiologists to acquire the skills and knowledge necessary to begin a successful research career in today's funding and academic environment. Many pathways can combine two years of research training and provide fulfillment of existing requirements to achieve specialty certification and subspecialty credentialing. Departments of radiology supporting the beginning qualified investigator should allow him or her approximately 75% research time for the first three years of the academic appointment. Departmental research time accorded faculty members may best be concentrated on a few individuals, providing them sufficient time to be competitive for peer-reviewed grants and enabling research advances to provide a solid foundation for the future of radiologic imaging.

Humans↗