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PubMed1996

Perceived workplace harassment experiences and problem drinking among physicians: broadening the stress/alienation paradigm.

Sociologists who embrace the stress or alienation paradigms generally focus on explaining problem drinking in low status occupations. By contrast, this paper argues that a broadened conceptualization of stress and alienation which incorporates abusive work relationships has utility for explaining male and female drinking outcomes in both high and low status occupations. We provide empirical data on the relationship between perceived abusive experiences and drinking outcomes in a cohort of male and female physicians in their internship year of training. The data show that perceived sexual harassment, discriminatory treatment and psychological humiliation relate to various drinking outcomes in men and women, controlling for drinking prior to the internship year. While females were more likely to report experiencing abuse, these perceived experiences had deleterious effects on drinking outcomes for both genders. Personal vulnerability (narcissism) brought into the training environment somewhat influenced the later reporting of abusive experiences by males but not by females. Regression analyses showed that, for both males and females, work-place abusive experiences in interaction with personality vulnerability best explained drinking outcomes. The implications of these results for the design of future alcohol-related work-place studies are discussed.

Adult↗
PubMed1996

Self-assessment of confidence of internee doctors in performing common surgical operations.

A total of 140 internee doctors who had just completed or were about to complete their internship training from four leading Medical College Hospitals of Bangladesh were asked to fill up a pre-tested structured questionnaire. Of them 115 were male and 25 were female. All the participants had 6 months compulsory training in Medicine, 123 had 6 months training in Surgery and 17 had 6 months training in Obstetrics-Gynecology. Over 50% doctors expressed lack of confidence in performing ligation, vasectomy, splinting simple fractures, venesection, episiotomy, hydrocele operation, circumcision, proctoscopy and inguinal herniorrhaphy and expressed the need for further training in those procedures. Only 10% and 1.43% internees stated that they were confident about performing ligation and vasectomy independently. Internees from Chittagong Medical College Hospitals expressed their inability to perform ligation and/or vasectomy independently. So it was recommended that surgical training should be made mandatory for all internee Doctors with extension of the Internship period by at least 6 months. Emphasis should be laid on training in vasectomy and ligation. A pre-registration evaluation test may be introduced at the end of their training period.

Bangladesh↗
PubMed1997

[Medical education at Universidad de los Andes, Santiago, Chile].

Universidad de los Andes School of Medicine started in 1991 with a new medical curriculum aimed at providing a medical education for its students, that is, it attempts to give, together with technical proficiency in medical matters, formation of character and a strong ethical attitude. The curriculum lasts for seven years: five of basic, pre-clinical and clinical theoretical and practical courses, followed by two years of internships in Internal Medicine, Surgery, Obstetrics and Pediatrics, plus a four month period of an elective internship. The courses have an integrated design, in which each matter is presented from multiple perspectives, e.g. in Internal Medicine together with the clinical aspects of disease, the pathophysiology and the pharmacology of the drugs used are presented. Also the Pathology of each disease is given in coordination in the Pathology course. General educational matters such as Anthropology, Psychology, Origin of Living Beings, Theology and Medical Ethics are interspersed in the curriculum. An important feature is the personal counselling system, in which each student may choose an academic counsellor and discuss with him (her) the subjects of his choosing. Clinical practice is given in a system that includes five hospitals and five private clinics that range from general medical practice to Psychiatry or Ophthalmology.

Chile↗
PubMed2004

Overlap among clinical, counseling, and school psychology: implications for the profession and Combined-Integrated training.

Health care providers within psychology currently fall into three dominant practice areas: clinical, counseling, and school psychology. This article reviews data from four different sources-archival descriptions, training curricula, internship and employment outcomes, and professional activities-to examine the overlap among the three practice areas. Archival descriptions revealed substantial similarities, with smaller but interesting differences. A comparison of actual curricula from 10 programs accredited in each of the three practice areas yielded similar findings: Programs across the three practice areas were much more similar than different. Within-practice area variations among programs were nearly as large as across-practice area differences. We briefly review the professional activities of clinical, counseling, and school psychologists, again demonstrating considerable similarity. We conclude by explaining implications for doctoral training programs, internships settings, and professional credentialing.

Counseling↗
PubMed2002

Educating a new generation of clinical laboratory scientists.

In many countries the new generation of laboratory scientists comes from the graduates of the biological sciences. Their training in the sciences is usually of high quality, but is almost totally lacking in the clinical application of their scientific knowledge. They obtain this clinical knowledge most often by on-the-job training and experience. This paper describes a new undergraduate academic program in Laboratory Medicine developed at the Faculty of Medicine of the Technion, the Israel Institute of Technology. The program is carried out with the collaboration of the Faculty of Biology and the Faculty of Medicine, and upon completion of the classroom studies there is a period of internship for practical experience. The first students of the program are now in their internship period and will graduate this year.

Chemistry, Clinical↗
PubMed2002

Student nurses in Taiwan at high risk for needlestick injuries.

PURPOSE: To describe the prevalence and characteristics of needlestick injuries (NSI) in student nurses in Taiwan. METHODS: A self-administered questionnaire was completed by 931 student nurses from 16 hospitals randomly selected from the 132 accredited hospitals. RESULTS: The questionnaire was completed by 708 of 931 students who were contacted for participation in this study. NSI during internship was reported by 61.9% (438/708) of students, of whom 14.2% (62/438) made a formal report. The majority (70.1%) of NSI occurred in the patient's room. Hollow-bored needles contributed to half (219/438) of the NSIs of which 86.8% were syringe needles. Just over half (53.2%) of those items involved in NSIs had been used on patients. Of the hollow-bored needles involved in NSIs, 21.5% had been used on a patient with an infectious disease. Vaccination against hepatitis B virus (HBV) was lacking in 47.6% of students. CONCLUSIONS: NSIs and non-reporting of NSIs were highly prevalent in nursing students. More intensive education programs should be directed at students to increase their awareness of and compliance with Universal Precautions (UP) before commencing their practical work experience. Students need to practice prompt post-exposure evaluation so that the need for early intervention can be assessed. In addition, any public health and infection control strategy should include a universal catch-up HBV vaccination program among students before commencement of internship.

Blood-Borne Pathogens↗
PubMedDate not supplied

Two models of in-service training to improve midwifery skills: how well do they work?

This program evaluation compared the knowledge, confidence, and skills of Indonesian village midwives who attended an intensive in-service training with midwives who received an internship program and midwives who attended no program. The five key skills compared were prevention of infection, use of the partograph, manual removal of placenta, bimanual uterine compression, and neonatal resuscitation. Midwives from the intensive in-service that combined competency-based skill training with peer review and continuing education scored higher on the knowledge test and demonstration of the five key skills and reported managing complications better than midwives who attended no training program. Midwives from the internship program scored intermediate between the intensively trained and the untrained midwives. Overall, skill scores were 71% for midwives in the intensive program, 62% for the interns, and 51% for midwives with no in-service training. Village midwives from the intensive program scored significantly higher in the practical demonstration of manual removal of placenta, bimanual compression, and neonatal resuscitation than the interns, but the scores on infection prevention and use of the partograph were not different between the two groups. Differences in the volume of training opportunities between the two programs could be responsible for the different outcomes.

Clinical Competence↗
PubMed2002

Basing pharmacy counselling on the perspective of the angina pectoris patient.

AIM OF THE STUDY: A participatory action research study design was developed and tested in 40 Danish internship pharmacies as part of a 3-year study supported by the Research Centre for Quality in Medicine Use. The aim of the study was to create a foundation for improving the quality of counselling practice in pharmacies by comparing the pharmacy staff's views on, knowledge of and behaviour towards a specific patient group with the knowledge, perceptions and medication use of the same patients. METHOD: Pharmacy students in their fourth year collected data for the study. In 1999, the students carried out 123 qualitative interviews with angina pectoris patients and collected 569 questionnaires from pharmacy staff in 40 internship pharmacies. RESULTS: The results indicate that discrepancies exist between the patients' and pharmacy staff's perspectives on important issues such as knowledge about medicines (patients)/provision of information about medicines (pharmacy staff), experienced side effects (patients)/information about side effects (pharmacy staff), knowledge on prevention and lifestyle (patients)/information on lifestyle and prevention (pharmacy staff) and expectations of pharmacies (patients)/initiatives started in pharmacies (pharmacy staff). CONCLUSION: The study gives reason to believe that angina pectoris patients might benefit if pharmacies provided more information on the relationship between lifestyle factors and angina pectoris, the possible side effects of medicines and the function of medicines.

Angina Pectoris↗
PubMed2006

BEME systematic review: predictive values of measurements obtained in medical schools and future performance in medical practice.

BACKGROUND: Effectiveness of medical education programs is most meaningfully measured as performance of its graduates. OBJECTIVES: To assess the value of measurements obtained in medical schools in predicting future performance in medical practice. METHODS SEARCH STRATEGY: The English literature from 1955 to 2004 was searched using MEDLINE, Embase, Cochrane's EPOC (Effective Practice and Organization of Care Group), Controlled Trial databases, ERIC, British Education Index, Psych Info, Timelit, Web of Science and hand searching of medical education journals. INCLUSION & EXCLUSIONS: Selected studies included students assessed or followed up to internship, residency and/or practice after postgraduate training. Assessment systems and instruments studied (Predictors) were the National Board Medical Examinations (NBME) I and II, preclinical and clerkship grade-point average, Observed Standardized Clinical Examination scores and Undergraduate Dean's rankings and honors society. Outcome measures were residency supervisor ratings, NBME III, residency in-training examinations, American Specialty Board examination scores, and on-the-job practice performance. DATA EXTRACTION: Data were extracted by using a modification of the BEME data extraction form study objectives, design, sample variables, statistical analysis and results. All included studies are summarized in a tabular form. DATA ANALYSIS AND SYNTHESIS: Quantitative meta-analysis and qualitative approaches were used for data analysis and synthesis including the methodological quality of the studies included. RESULTS: Of 569 studies retrieved with our search strategy, 175 full text studies were reviewed. A total of 38 studies met our inclusion criteria and 19 had sufficient data to be included in a meta-analysis of correlation coefficients. The highest correlation between predictor and outcome was NBME Part II and NBME Part III, r = 0.72, 95% CI 0.30-0.49 and the lowest between NBME I and supervisor rating during residency, r = 0.22, 95% CI 0.13-0.30. The approach to studying the predictive value of assessment tools varied widely between studies and no consistent approach could be identified. Overall, undergraduate grades and rankings were moderately correlated with internship and residency performance. Performance on similar instruments was more closely correlated. Studies assessing practice performance beyond postgraduate training programs were few. CONCLUSIONS: There is a need for a more consistent and systematic approach to studies of the effectiveness of undergraduate assessment systems and tools and their predictive value. Although existing tools do appear to have low to moderate correlation with postgraduate training performance, little is known about their relationship to longer-term practice patterns and outcomes.

Clinical Competence↗
PubMed1995

A prospective, randomized trial of a six-week ambulatory medicine rotation.

BACKGROUND: Medical schools are placing increased emphasis on training students in the ambulatory setting, but few studies show the benefit or academic risk of such innovation. The authors studied the effect of such a new rotation with a rigorous study design. METHOD: From a group of 166 third-year students at the Uniformed Services University of the Health Sciences F. Edward Hébert School of Medicine assigned in 1990-91 to do six weeks of their third-year medicine clerkship at Walter Reed Army Medical Center, 106 volunteers were randomized to six weeks either on the usual rotation on the general medicine wards (69 students) or to a new ambulatory rotation (37 students). Multiple pre- and postclerkship parameters were used to evaluate clerkship skills and knowledge; eventual internship choice was determined. RESULTS: The randomization was successful. Postclerkship performances were the same in (1) the medicine subject examination of the National Board of Medical Examiners, (2) a multiple-choice test in interpreting laboratory results, (3) blinded rating by an expert panel of the quality of final written histories and physical exams, (4) blinded rating by an expert panel of the students' written case analyses of their own patients, and (5) a written multiple-step examination of problem-solving ability. Any differences between groups favored the ambulatory group. An increase in choice of primary care internships among students randomized to the ambulatory rotation was not significant. CONCLUSION: It is possible to study innovative rotations using a prospective, randomized design. Substituting a six-week block ambulatory experience for a ward rotation did not decrease students' abilities to write up or analyze complex cases.

Ambulatory Care↗
PubMed1999

The InterCon network: a program for education partnerships at the University of Texas-Houston Health Science Center.

The University of Texas-Houston Health Science Center (UT-Houston) has created programs and activities to address the state's pressing needs in minority education. Through InterCon, a network of universities and K-12 schools, UT-Houston works with its partners to identify competitive candidates in the current pool of minority graduates with bachelor's degrees and to help them--along with their non-minority counterparts--progress in their education. Another objective is to expand the pool of minorities underrepresented in medicine who complete high school and go to college. In 1994 UT-Houston and Prairie View A&M University created a collaborative venture to provide new educational opportunities at UT-Houston for Prairie View's predominantly African American students. A three-track summer internship program--a result of that collaboration--has since been expanded to partnerships with other minority and majority universities throughout Texas. In 1998, for example, 108 undergraduate students from these universities (and 40 other universities nationwide) participated in research, professional, and administrative summer internships at UT-Houston. The InterCon network also has partnerships with K-12 schools. UT-Houston works with inner-city, suburban, and rural school districts to develop education models that can be transferred throughout the state. The partnerships deal with helping to teach basic academic skills and computer literacy, improve science-related instruction, meet demands for health promotion materials and information for school-initiated health and wellness programs, and develop distance-learning paradigms. UT-Houston views InterCon as a program helping Texas institutions to engage and adapt to the socioeconomic factors, demographic changes, and technology explosion that currently challenge public education.

Community-Institutional Relations↗
PubMed2003

The Biomedical Humanities program: merging humanities and science in a premedical curriculum at Hiram College.

The Biomedical Humanities program at Hiram College, established in 1999, engages premedical and other qualified students in ethical and informed decision making, improves their ability to interact with persons of different backgrounds and cultures, provides them an active introduction to basic medical research and clinical practice, and coaches them in communicating across barriers, appreciating that scientists and humanists typically learn and work differently. The program offers both a major and a minor in biomedical humanities topics. The major requires the core biology and chemistry curriculum necessary for further studies in medicine as well as courses in genetics and statistics. The remainder of the major is devoted to four core areas: Communications, Relationships and Cultural Sensitivity, Ethics and Medical Humanities, and a nonacademic core area, Experiential Learning. Many of the ethics and medical humanities options are team-taught interdisciplinary courses. The Experiential Learning area requires students to take two special topics seminars, two service seminars, and two internships-one shadowing a professional in his or her area of interest and one engaging in basic biomedical research. The shadowing internship and service seminars focus not only on career exploration, but also on human interactions. Students reflect on the personal interactions they observe during their various experiences, and on their own strengths and weaknesses. Essays, designed to help students learn more about their roles in these settings, push them to deal with the sociopolitical issues involved in their service. The major, a robust and vital component of Hiram's undergraduate program, has attracted academically gifted students with a diverse array of career goals.

Bioethics↗
PubMedDate not supplied

Educational preparedness for physical therapists and occupational therapists in burn care.

The background of physical therapy (PT) and occupational therapy (OT) students in burn care training may be variable during their professional education. The purpose of this study was to evaluate whether professional programs in PT and OT are meeting the burn care educational needs of their students. PTs and OTs currently practicing in burn care were asked to give their opinion of the most important curricular topics related to burn care, report their perception of their own entry-level preparedness for burn care, recount therapy interns preparation for burn care internships, and recommend topics that should be included in a therapy program burn care curriculum. Therapists felt prepared in basic sciences and somewhat prepared in specific burn care practice topics. Study participants felt more prepared for burn practice if they completed an internship in burn care. Enhancing content on burn-related treatment interventions was the most common suggestion for curricular revision.

Adult↗
PubMed1994

Improving the preregistration experience: the New Zealand approach.

There is currently much debate about how to improve undergraduate medical education, and in particular on how best to prepare students for clinical responsibility. For 20 years a period of trainee internship has formed part of New Zealand medical students' undergraduate training, and the model could have much to offer the United Kingdom. Students take their final examinations at the end of the second clinical year; they spend their final year in a series of eight clinical attachments, during each of which they shadow a preregistration house officer or senior house officer. As trainee interns they are paid 60% of a house officer's salary for their clinical work, which is supervised by the firm's registrars and consultants under the overall responsibility of the head of the academic department. The order of the attachments is determined on educational, not service, grounds, and trainees have to attend educational sessions and pass assessments on each attachment. The trainee internship, funded jointly by the education and health departments, offers a more seamless transition from student to house officer and aims at improving both general medical education and clinical training.

Clinical Clerkship↗
PubMed2005

Self-prescribing among young Norwegian doctors: a nine-year follow-up study of a nationwide sample.

BACKGROUND: Self-prescribing among doctors is common, but no longitudinal studies have documented this issue. We studied the self-prescribing behaviour among young Norwegian physicians and the predictors of self-prescribing. METHODS: We conducted a nationwide, prospective and longitudinal study following young Norwegian physicians from internship through the subsequent nine years using three postal questionnaires. Chi-square tests and logistic regression models were applied. RESULTS: About 54% of the physicians in their fourth and ninth postgraduate years had self-prescribed medication at least once during the previous year. Among those who had used prescription medication during the previous year, about 90% had self-prescribed. Self-prescribing behaviour did not differ significantly between men and women, or according to the type of work at any time. The most frequently self-prescribed medications were antibiotics (71%-81%), contraceptives (24%-25%), analgesics (18%-21%), and hypnotics (9%-12%). Those who had needed treatment for mental problems had self-prescribed hypnotics and sedatives to a greater extent than the others. Being male, having self-prescribed during internship, somatic complaints, mental distress, subjective health complaints, and not having sought help from a general practitioner, were significant adjusted predictors of self-prescribing in the ninth postgraduate year. CONCLUSION: The level of self-prescribing among young Norwegian physicians is relatively high, and this behaviour is established early in their professional lives. Although self-prescribing is acceptable in some situations, physicians should seek professional help for illness. Efforts to inculcate more rational help-seeking behaviour should probably start in medical schools.

Analgesics↗
PubMed1978

Teaching psychological assessment: training issues and teaching approaches.

Clinical psychology graduate programs need to pay attention to important issues involved in teaching psychological assessment, if graduate students are to be adequately prepared. Recent studies have suggested a gap between academic training in psychological assessment and internship expectations. Graduate students are not as well prepared as many internship settings would like. In addition to learning the fundamentals, students need help in dealing with issues of categorizing individuals, using tests in helpful ways, taking responsibility for decision-making, and developing a balance between critical evaluation of tests and appreciation of their usefulness. Teaching approaches for dealing with these issues are discussed. The importance of academic and clinical agencies working together is stressed. Goals for graduate training in assessment are suggested.

Journal Article↗
PubMedDate not supplied

[Nursing for indigenous people: applying curricular guidelines].

Report on the Curricular Internship II in a Rural Indian Community, performed by students of the Nursing program from Manaus Nursing School--Federal University of Amazonas, carried out from October through December, 2002. It provided students with an opportunity to understand the health-disease process in Indian areas and to make nursing interventions. The training period was divided into three phases: a preparatory week, including meetings and lectures with the team delivering health care to Indian populations, and a seminar/report on the activities performed. Students reported that nurses need to have anthropological, ecological, and social knowledge in order to understand the health-disease process. This internship period provides emancipatory education, centered around a kind of regional reality, and follows recommendations established in current curricular guidelines, by favoring a teaching practice focused on local realities.

Brazil↗
PubMed1984

Playing doctor, seriously: graduation follies at an American medical school.

In American medical schools, the period of time between the announcement of internships and graduation is known as FYBIGMI, for "Fuck You Brother I Got My Internship." At University Medical School (pseudonym), as at most American medical schools, this period culminates in an elaborate musical comedy (attended by faculty and relatives) in which faculty are abused, patients are represented in terms of stigmatized stereotypes, and the students demonstrate a profane familiarity with cultural taboos. Using the analytic methods of cultural anthropology, this examination of the FYBIGMI performance at U.M.S. focuses primarily on the seniors' presentation of their newly acquired professional identity, which is constituted in the skits by recurring oppositions to socially stigmatized, medically self-destructive patients. In this oppositional logic, racial stereotypes play a particularly large role. In addition, the seniors establish their new social status by inverting their relationship to their (former) supervisors on a personal basis, and by confronting the audience with their professional ability to treat cultural taboos with profane familiarity. The FYBIGMI theatrical, and its representation of professional identity, is analyzed in relation to a proposed model of the underlying structure of the process of medical education, that is, an escalating dialectic of intimidation and self-congratulation.

Black or African American↗