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PubMed2000

The future of the palliative medicine fellowship.

The field of palliative medicine has grown rapidly in recent years, and its growth has been accompanied by increasing interest in palliative care education. This editorial suggests that the field's growth to date has been aided by palliative medicine training programs that are based on an "apprentice" model. However, if the field of palliative medicine is to enjoy continued growth in the future, this model will be insufficient. Instead, it will be essential that palliative care training programs shift to a more traditional "academic" model of postgraduate education.

Editorial↗
PubMed1999

Including the kids across the hall: collaborative instruction of hearing, deaf, and hard-of-hearing students.

This study follows graduate interns and their cooperating teachers through a collaborative student teaching experience in D/HH and hearing classrooms at the same grade level. Teacher teams, enrolled in a graduate course on collaboration, designed and conducted collaborative instruction (K-junior high school level), which focused on cooperative learning activities. Measures included student evaluations and separate intern and teacher evaluations of student performance, the integrated instructional units, and professional collaboration. Student evaluations included positive responses to integrated instruction by both groups, though there was more trepidation expressed by some D/HH students. Teachers reported very positive outcomes for all students including increased motivation to learn about and to interact with the other group and, for D/HH students, an increase in socially and academically appropriate behaviors. Specific student needs for training prior to integrated experiences were noted. Teachers stressed the importance of topic selections that would involve the expertise of all participants equally, needs for teacher in-service training and, administrative support for collaborative planning.

Journal Article↗
PubMed2003

The reorganization of basic science departments in U.S. medical schools, 1980-1999.

The evolution of biomedical science and technology over the last 50 years has made biomedical research inherently interdisciplinary. Such changes have led observers to speculate about the ways in which traditional basic science departments in U.S. medical schools are being changed or consolidated. The authors describe their findings from a study that constructed a 20-year longitudinal database (1980-1999) to examine how basic science departments have been reorganized at U.S. medical schools. The data reveal that, in fact, there were fewer basic science departments in the traditional disciplines of anatomy, biochemistry, microbiology, pharmacology, and physiology in 1999 than in 1980. But as biomedical science has developed in an interdisciplinary manner, new basic science departments have been added. The most frequent type of change, however, has been in the renaming of existing departments. Overall, there were more, not fewer, basic science departments and more, not fewer, faculty members in these departments. These changes, taken together with the growth of interdisciplinary research centers and institutes and changing patterns of biomedical PhD training, affect both teaching and research in academic medicine. First, basic scientists are becoming increasingly dissociated from the traditional disciplines around which medical students' education is often organized. Second, the organization of biomedical research is in a state of transition that is responding to advances in scientific knowledge, technology, and targets of opportunity.

Curriculum↗
PubMed2006

Creating an infrastructure for training in the responsible conduct of research: the University of Pittsburgh's experience.

In response to public concerns about the consequences of research misconduct, academic institutions have become increasingly cognizant of the need to implement comprehensive, effective training in the responsible conduct of research (RCR) for faculty, staff, students, and external collaborators. The ability to meet this imperative is challenging as universities confront declining financial resources and increasing complexity of the research enterprise. The authors describe the University of Pittsburgh's design, implementation, and evaluation of a Web-based, institution-wide RCR training program called Research and Practice Fundamentals (RPF). This project, established in 2000, was embedded in the philosophy, organizational structure, and technology developed through the Integrated Advanced Information Management Systems grant from the National Library of Medicine. Utilizing a centralized, comprehensive approach, the RPF system provides an efficient mechanism for deploying content to a large, diverse cohort of learners and supports the needs of research administrators by providing access to information about who has successfully completed the training. During its first 3 years of operation, the RPF served over 17,000 users and issued more than 38,000 training certificates. The 18 modules that are currently available address issues required by regulatory mandates and other content areas important to the research community. RPF users report high levels of satisfaction with content and ease of using the system. Future efforts must explore methods to integrate non-RCR education and training into a centralized, cohesive structure. The University of Pittsburgh's experience with the RPF demonstrates the importance of developing an infrastructure for training that is comprehensive, scalable, reliable, centralized, affordable, and sustainable.

Academic Medical Centers↗
PubMed1986

Medical education and experience affecting intra-observer variability.

Intra-observer variability for history and simple test evaluation was assessed in a group of 10 final-year medical students and in five senior hospital staff members. Substantial agreement between the results of two evaluations made 7-10 days apart was found in 20 out of 30 instances for staff and in 17 out of 60 instances for students. However, there were instances when variability seemed to be unrelated to the academic standard of students or to the training and experience of staff. It is concluded that the nature of diagnostic procedure and present training in medical school or long-term experience may not be the only factors that affect intra-observer variability in everyday simple diagnostic applications.

Diagnosis↗
PubMed1986

The modified essay question: effect of author location on student performance.

The Department of Family Medicine at Jefferson Medical College, Philadelphia has utilized the modified essay question (MEQ) as an evaluative instrument in its required third-year clerkship since 1976. Previous analysis had indicated that students who participated in their clerkship at the university family practice centre (FPC) consistently performed at a higher level on their MEQ examinations than students who participated in clerkship activities at affiliated FPCs. In order to test the hypothesis that university-taught students had higher final examination scores because university teachers developed and graded the examinations, MEQs were developed by affiliate teachers and used for one half of five final examinations during the 1982-83 academic year. Students at the university-trained site continued to perform better than affiliated-trained students, even on MEQs developed by their own teachers. These results, as well as the significant administrative time involved in the project, have caused the Department of Family Medicine to revert to its previous policy of university teachers being responsible for the final examination.

Authorship↗
PubMed2005

The establishment of sperm morphology satellite training laboratories in Africa.

Summary Discrepancies in the results of semen analysis can be caused by a variety of factors, for example, a microscope for semen analysis can be situated in the practice of an urologist, cytologist or microbiologist, or even in a health care office in the countryside in a developing country. The study aimed to evaluate the (i) sperm morphology assessment skills of the participants who attended WHO seminology workshops and (ii) to appraise the possibility of using trained technologists to set up satellite training facilities in their own area. The Centre for Research in Reproductive Health, Ogun State University Teaching Hospital (Nigeria) initiated training sessions in their area. Subsequently, 16 technologists were trained in three sessions. Papanicolaou-stained slides, supplied by Tygerberg were used as test material. Pre- and post-training results were used to calculate the mean percentage of normal cells as well as the percentage deviation from the reference laboratory. The mean percentage normal spermatozoa recorded by the Nigerian trainees during pre-training evaluations differed by 38% from the reference value, compared with a post-training difference of 16% (P < 0.001). Tertiary academic hospitals can play an important educational role in the region. The present results underline the power of long distance educational programmes. Similar laboratories are currently being set up in Kenya and Zambia.

Humans↗
PubMed2006

A cluster-randomized educational intervention to reduce inappropriate prescription patterns for elderly patients in general practice--The Prescription Peer Academic Detailing (Rx-PAD) study [NCT00281450].

BACKGROUND: Age-related alterations in metabolism and excretion of medications increase the risk of adverse drug events in the elderly. Inappropriate polypharmacy and prescription practice entails increased burdens of impaired quality of life and drug related morbidity and mortality. The main objective of this trial is to evaluate effects of a tailored educational intervention towards general practitioners (GPs) aimed at supporting the implementation of a safer drug prescribing practice for elderly patients > or = 70 years. METHODS/DESIGN: Approximately 80 peer continuing medical education (CME) groups (about 600 GPs) in southern Norway will be recruited to a cluster randomized trial. Participating groups will be randomized either to an intervention- or a control group. The control group will not receive any intervention towards prescription patterns in elderly, but will be the target of an educational intervention for prescription of antibiotics for respiratory tract infections. A multifaceted intervention has been tailored, where key components are educational outreach visits to the CME-groups, work-shops, audit and feedback. Prescription Peer Academic Detailers (Rx-PADs), who are trained GPs, will conduct the educational outreach visits. During these visits, a set of quality indicators (QIs), i.e. explicit recommendations for safer prescribing for elderly patients, will be presented and discussed. Software will be handed out for installation in participants' practice computers to enable extraction of pre-defined prescription data. These data will subsequently be linked to corresponding data from the Norwegian Prescription Database (NorPD). Individual feedback reports will be sent all participating GPs during and one year after the intervention. Feedback reports will include QI-scores on individual- and group levels, before and after the intervention. The main outcome of this trial is the change in proportions of inappropriate prescriptions (QIs) for elderly patients > or = 70 years following intervention, compared to baseline levels. DISCUSSION: Improvement of prescription patterns in medical practice is a challenging task. Evidence suggests that a thorough evaluation of diagnostic indications for drug treatment in the elderly and/or a reduction of potentially inappropriate drugs may impose significant clinical benefits. Our hypothesis is that an educational intervention program will be effective in improving prescribing patterns for elderly patients in GP settings.

Aged↗
PubMed2006

Can antibiotic prescriptions in respiratory tract infections be improved? A cluster-randomized educational intervention in general practice--the Prescription Peer Academic Detailing (Rx-PAD) Study [NCT00272155].

BACKGROUND: More than half of all antibiotic prescriptions in general practice are issued for respiratory tract infections (RTIs), despite convincing evidence that many of these infections are caused by viruses. Frequent misuse of antimicrobial agents is of great global health concern, as we face an emerging worldwide threat of bacterial antibiotic resistance. There is an increasing need to identify determinants and patterns of antibiotic prescribing, in order to identify where clinical practice can be improved. METHODS/DESIGN: Approximately 80 peer continuing medical education (CME) groups in southern Norway will be recruited to a cluster randomized trial. Participating groups will be randomized either to an intervention- or a control group. A multifaceted intervention has been tailored, where key components are educational outreach visits to the CME-groups, work-shops, audit and feedback. Prescription Peer Academic Detailers (Rx-PADs), who are trained GPs, will conduct the educational outreach visits. During these visits, evidence-based recommendations of antibiotic prescriptions for RTIs will be presented and software will be handed out for installation in participants PCs, enabling collection of prescription data. These data will subsequently be linked to corresponding data from the Norwegian Prescription Database (NorPD). Individual feedback reports will be sent all participating GPs during and one year after the intervention. Main outcomes are baseline proportion of inappropriate antibiotic prescriptions for RTIs and change in prescription patterns compared to baseline one year after the initiation of the tailored pedagogic intervention. DISCUSSION: Improvement of prescription patterns in medical practice is a challenging task. A thorough evaluation of guidelines for antibiotic treatment in RTIs may impose important benefits, whereas inappropriate prescribing entails substantial costs, as well as undesirable consequences like development of antibiotic resistance. Our hypothesis is that an educational intervention program will be effective in improving prescription patterns by reducing the total number of antibiotic prescriptions, as well as reducing the amount of broad-spectrum antibiotics, with special emphasis on macrolides.

Anti-Bacterial Agents↗
PubMed2003

Mindfulness-based stress reduction lowers psychological distress in medical students.

BACKGROUND: Medical students confront significant academic, psychosocial, and existential stressors throughout their training. Mindfulness-based stress reduction (MBSR) is an educational intervention designed to improve coping skills and reduce emotional distress. PURPOSE: The purpose of this study was to examine the effectiveness of the MBSR intervention in a prospective, nonrandomized, cohort-controlled study. METHODS: Second-year students (n = 140) elected to participate in a 10-week MBSR seminar. Controls (n = 162) participated in a didactic seminar on complementary medicine. Profile of Mood States (POMS) was administered preintervention and postintervention. RESULTS: Baseline total mood disturbance (TMD) was greater in the MBSR group compared with controls (38.7 +/- 33.3 vs. 28.0 +/- 31.2; p < .01). Despite this initial difference, the MBSR group scored significantly lower in TMD at the completion of the intervention period (31.8 +/- 33.8 vs. 38.6 +/- 32.8; p < .05). Significant effects were also observed on Tension-Anxiety, Confusion-Bewilderment, Fatigue-Inertia, and Vigor-Activity subscales. CONCLUSION: MBSR may be an effective stress management intervention for medical students.

Adaptation, Psychological↗
PubMedDate not supplied

An evaluation of the impact of lecturer practitioners on learning.

The aim of this study was to determine if nursing diploma students recognized a difference in the nature of classroom teaching between lecturer practitioners and university-based senior lecturers in nursing. The study generated both qualitative and quantitative data from a sample of 117 student nurses completing an elderly care module. Analysis of the data suggested that the students associate lecturer practitioners with a realistic, evidence-based presentation of contemporary nursing practice, which they found both academically liberating, and efficacious to their practical training. Such associations were less apparent when analysing student responses to senior lecturer teaching. The study underlines the potential of lecturer practitioners to make a positive and far-reaching contribution to the future of nurse education.

Attitude of Health Personnel↗
PubMed2003

Case studies from morning report: librarians' role in helping residents find evidence-based clinical information.

In primary care specialties, Morning Report is a traditional vehicle for expanding medical residents' training in diagnosis and treatment. At one academic medical center, residents and faculty in the Department of Family and Community Medicine use case-based teaching, centered around planning and reviewing patient management, to review intriguing cases from patient encounters in the department's hospital service. Seeking to improve the level of evidence-based information exchanged at Morning Report, department leaders invited reference librarians from the health sciences library to attend weekly Morning Report. The librarians saw this as an opportunity not only to improve residents' information-seeking skills, but also to improve librarians' teaching skills and understanding of the needs of users in clinical settings. This paper describes the evolution of librarians' involvement in Morning Report, examples of the kinds of contributions librarians have made in this setting, and changes made in Morning Report sessions to facilitate this activity.

Academic Medical Centers↗
PubMed1998

Students, clinicians and university tutors: triangulation of clinical data.

The relationship between intuitive clinical awareness and scientific knowledge is reciprocal: clinical hunch fuels scientific theory which in turn informs clinical practice. This paper demonstrates how students may have a pivotal role in a data triangulation process by acting as a channel for the flow of information between speech and language clinicians and academic institutions involved in the education and training of speech and language therapists. The results of a preliminary survey of students' and clinicians' views about the usefulness of collaboration around clinical data are used as the basis for generating a model which shows the shared roles and responsibilities of the participants as well as the crucial focus on improved client management.

Adult↗
PubMed1994

Careers and training in tropical health.

Tropical health is described as an academic discipline, as an institution, and in terms of professional practice. Poverty, and not climate, is the major determinant of the distribution of tropical disease. A recent World Bank Report analysed global disease and made recommendations about public funding of essential services; this approach emphasised "vertical" programs of disease control. An alternative approach, defined as "primary health care" in the Declaration of Alma Ata, emphasised community development and has had a major influence on health services in developing countries. Conflict between these approaches could be partly resolved by strengthening district health services. A strong technical background and a general understanding of factors affecting health and health care are prerequisites for Australians wishing to work in developing countries.

Career Choice↗
PubMed2000

[Huriet law: application in a regional cancer centre (Centre Léon-Bérard, Lyon)].

Clinical research is one of the main activities in cancer centres and is submitted in France to a specific law (named "loi Huriet") which includes good clinical practices. We are now conducting a general program of quality evaluation and improvement in the regional cancer centre of Lyon (centre Léon-Bérard). Part of this program is an audit of the application of the Huriet law. Since no instrument exist for measuring this application, we have created a specific one, that attribute notation according to the different aspects of the law. Results show a good level of conformity but sometime non sufficient. There is no difference between the two studied years. Quality changes according to promoters (private or academic) and monitoring. Written procedures and specific training for the different actors are required to improve quality of clinical research with focus on the patient interest.

Cancer Care Facilities↗
PubMed1991

Assessing the scientific strength of Chile.

We use analysis of co-citation and relative citation rates to assess the scientific strength of Chile as compared with other developing countries and to evaluate the potential for increased international collaboration between Chile and the United States in science and engineering. Co-citation is the citation of two scientific papers by a third paper. By examining frequency and patterns of co-citation, the intellectual structure and evolution of scientific disciplines and research specialties can be traced. Chile is especially "strong", as defined by the co-citation model we employ, in biomedicine and clinical medicine, and in astronomy. A relative citation rate is the ratio of the number of citations a paper receives to the average number of citations for all papers published in the same journal over time. Analysis of relative citation rates of papers published by authors with Chilean addresses show that Chilean physics, including earth and space sciences, is of unusually high quality, considerably higher than any other developing country and comparable to several industrialized countries. We conclude that Chile's scientific capacity is advanced enough to absorb and benefit significantly from strategic additions to the country's resources and capabilities for research. These would include increases in: exchanges of researchers in specific fields with U.S. and other Latin American academic, industrial, and government scientists and engineers; training at outstanding U.S. and Latin American institutions; laboratory equipment, computer time, communications links, and library materials; and funding from U.S. and international organizations. It is also apparent that Chile is strong enough in certain fields to cooperate with the U.S. in mutually beneficial international efforts.

Authorship↗
PubMedDate not supplied

From nursing to nursing administration: making the transition easier.

When nurses get involved in nursing administration, they may experience difficulties with the managerial role. There are several reasons why these difficulties occur: failure to recognize that the skills required for management are different than those required for nursing; refusing to "let go" of former nursing duties; inconsistent emphasis on the development of managerial capability among nursing supervisors; and insufficient formal training in management. Suggestions for making the transition to management easier are presented. These include developing the proper mix of skills for management; delegating authority properly; systematizing on-the-job-training for supervisors; and restructuring the formal academic preparation that nurses receive while in B.N. programs.

Clinical Competence↗
PubMed1985

Emergence of pediatric hematology/oncology as an independent specialty.

The slow emergence of pediatric hematology as a recognized specialty was due to the fact that blood diseases were of relatively little concern to early pediatricians. Infectious and nutritional disorders were far more urgent problems. However, in the early 1940s it became apparent to some that pediatric hematology was acquiring a well-defined body of knowledge which would qualify it as being a discrete discipline of medical science. But in order to win independent status in the academic and political arenas, acquisition of other credentials and additional achievements were needed. These academic-political needs included the organization of training programs, establishment of a certifying examination, publication of a specialty journal, and the founding of a professional society. These achievements were accomplished by the foresight, cooperation, and hard work of many people. Yet there are many unsatisfied needs that remain.

Argentina↗