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PubMed1978

Perioperative diabetic consultation: a plead for improved training.

To determine the clinical and educational impact of an academic general internal medicine consultation service, the investigators selected as a model the perioperative management of diabetes mellitus. They analyzed 17 consultative episodes over two years by retrospective medical record review to identify patterns and shortcomings. Most patients were elderly black females with maturity-onset diabetes mellitus exhibiting numerous past diabetic complications and other active general medical problems. Major findings included common failure to define the consultation purpose or document adequately follow-up visits, incomplete professional adherence to published guidelines for perioperative diabetic management, and correlation between failure to document the consultant's own physical examination and failure to reach new conclusions. Median cost for consultant-recommended tests was $179 (range $82 to $552) without clear linkage between medical care process and outcome. Consultative skills must be taught more effectively if medical consultations are to have maximal impact.

Adult↗
PubMed1995

Practical approaches to a major educational challenge. Training students in the ambulatory setting.

Medical schools and residency training programs are recognizing the need to expand education in ambulatory medicine. Inpatients wards increasingly provide treatment for only the most critically ill patients and are required only for very specialized procedure-oriented technology. Most diagnostic and management decisions are being made in outpatient settings. This shift in where medical care occurs has led to a reassessment of the educational value of training students and house staff primarily on hospital-based wards. New training initiatives in ambulatory medicine are being developed in medicine, pediatrics, and family medicine, and the principal sites for most of this training are primary care offices, clinics, and health maintenance organizations. Program planners and individual preceptors are confronting numerous obstacles in their efforts to find effective solutions to the dilemmas raised by the need to train large numbers of students in these settings. This article will explore many of these obstacles, including the unique learning requirements of third-year students, the elements of a quality clinical training environment, and the precepting skills needed for this educational task. Finally, we propose for debate a model for ambulatory medical education that focuses on strengthening the ties between academia and the numerous training sites. By taking optimal advantage of academic and community attributes, we are more likely to be assured quality medical education, skilled teaching, and rigorous scholarship in ambulatory medicine.

Ambulatory Care Facilities↗
PubMedDate not supplied

Communicating science to our patients and the public.

Communicating dental science, especially on issues of health and safety, is assuming increased importance in dental practice and in the relation of the profession to the public. Effective risk communication requires knowledge, balance and sensitivity to the concerns of our patients and the public. It is a skill that takes preparation, training and practice, and schools and professional organizations should be encouraged to include it in their educational programs. Presenting dental science to the public is a more difficult challenge than for the individual patient since there is no readily available site for exchange, such as the office, and no personally established relationship, credibility or trust. A larger cadre of trained spokespersons from the practice, public health, academic and research communities is needed, and more extensive multi-lingual and multi-cultural educational material should be made available for community outreach. Oral presentations to the public require different skills of both a verbal and nonverbal nature than for office communication or professional group presentation-and guidelines are offered.

Communication↗
PubMed1997

[Intra- and extramural workshop for care, teaching, and research].

Medical care and its development, education, training and research are closely linked in academic medical centres. Traditionally, hospital-based disciplines can make use of the university hospital as a 'workshop' for the combination of these activities. In the Netherlands, however, there is no structurally financed workshop for the non-hospital based medical disciplines, such as family medicine, public health medicine, and nursing home medicine. In the Academic Medical Centre, University of Amsterdam, an integrated hospital and primary health care oriented academic workshop is being developed, for all medical disciplines, including social medicine (e.g. preventive care) and general practice.

Academic Medical Centers↗
PubMed1997

[Essential aspects of the reorganization of medical education at the University of Chile School of Medicine].

The Medical School of the University of Chile is enforcing deep transformations in its curricular setting, to cope with the physician model of the next century. It is following the universal trends that look for new objectives, methodologies, scenarios and resources in medical teaching. These goals should be accomplished very soon, allowing the School to be in the lead of curricular transformations. These changes have overflowed the limits of curricular renovation and a process of institutional reorganisation is aiming to increase its efficacy and yield. The bases of this reorganisation are the search for excellency, the renovation of academic staff with the incorporation of better trained professionals, the integration of basic and clinical disciplines in coherent programmatic proposals and the configuration of structures to organise and articulate medical knowledge. Optimisation of education has also extra-institutional implications with the establishment of accreditation systems for professionals and educational institutions. These systems are mandatory world wide and guarantee the capability of educational institutions and their products. The School of Medicine is committed in this achievement along with the Association of Medical Schools and The Superior Education Council.

Chile↗
PubMed1998

Survey of factors influencing the selection of academic plastic surgeons.

The purpose of this study was to evaluate the importance of factors influencing the selection of candidates for academic positions in plastic surgery. This study reports the results of a survey investigating these factors. The survey was conducted in 1994, canvassing the chairpersons from the 120 plastic surgery programs in the United States and Canada with responses from 91 (76 percent) of the plastic surgery programs. The study examined individual accomplishments and areas of additional training. Training in a specific area of clinical interest, clinical and basic science experience, and training in cosmetic surgery were the most highly rated areas of additional training. The ideal time to receive this training was also assessed for each area of additional training. Postgraduate degrees in basic science, epidemiology, or clinical research were not highly rated. The highest rated personal accomplishments were the personal interview, letter of reference from the program chairperson, publications, and presentations. Despite the survey's attempt to evaluate factors other than personal characteristics (i.e., honesty, integrity, affability, etc.) more than 25 percent of the respondents indicated that these attributes are highly rated and cannot be judged separately. The information collected in this survey represents an opinion from 1994, which defines some of the factors that are considered important when residents and newly trained plastic surgeons are considering a career in academic plastic surgery.

Academic Medical Centers↗
PubMed1994

Graduate education in the biomedical sciences: critical observations on training for research careers.

Several aspects of the processes for the pre- and postdoctoral training of PhDs and the postdoctoral research training of MDs are critically examined. The size of the predoctoral pipeline, the sources of support for the students in it, trends in the annual production of bioscience PhDs, and prospects for growth in opportunities, as defined in increases in availability of public and private funds for research, are catalogued. Evidence for the existence of a surplus of research scientists--based on the size and growth of the pool of postdoctorals, the success rates now being experienced by young postdoctorals in competing for National Institutes of Health (NIH) grants, and the success of young postdoctorals in securing career employment--is evaluated, and the conclusion that the nation is producing too many research scientists is suggested. The pros and cons of "downregulating" the production of scientists are explored, the difficulties of reaching a national consensus on the degree of reduction and the partition of reduction among fields of science and academic institutions and academic departments are described, and the mechanisms conceivably available for accomplishing the task--reducing NIH training funds, autoregulation by academic institutions and/or scientific disciplines, and reliance on the decisions of well-informed (probably by the National Academy of Sciences) degree candidates--are enumerated; a preference for the last of these mechanisms is indicated. The NIH's formal training programs are compared with its informal support of training under research grants; questions that the latter practice raises are identified. The striking disparity between the duration of training for conventional predoctoral PhD candidates and that for dual-degree (MD-PhD) aspirants is noted. The measurement problems of assessing the duration of postdoctoral training are highlighted. The fact that dual-degree scientists seem to compete little, if any, more successfully for the great bulk of NIH research grants than do singly-degreed MDs or PhDs is noted, suggesting the advisability of a fresh and objective review of these dual-degree programs, especially the NIH's Medical Scientist Training Program, to reassess their value in the light of their cost. Some characteristics of careers in the biomedical sciences are outlined. Data are presented on the high turnover rates of first-time-ever entrants into the pool of NIH grantees or, stated otherwise, the relatively low rates of survival of principal investigators (PIs) in the NIH research grant system; a method of estimating the steady-state number of NIH ex- PIs "around" at any given moment is proposed.(ABSTRACT TRUNCATED AT 400 WORDS)

Biological Science Disciplines↗
PubMed2001

A guide to planning careers in hematology and oncology.

Numerous opportunities exist for successful careers in the fields of hematology and oncology. Trainees must choose between dedicated training in one or both disciplines, and between careers in private practice or academic medicine. Individuals who favor academic careers must decide between patient-oriented clinical investigation and laboratory research. This article addresses the factors that influence these decisions and inform trainees about critical elements of the training experience that foster successful career development in academic medicine and private practice. Counsel on employment opportunities is provided along with advice on evaluating the merits of employment offers.

Career Choice↗
PubMed2004

The use of personal digital assistants in the health sciences: results of a survey.

OBJECTIVES: The purpose of this study is to determine how personal digital assistants (PDAs) are used on an academic health sciences campus to define the level of training and support the library can provide to the students and faculty. METHOD: A Web-based questionnaire was developed. A total of 1,538 health sciences faculty and residents were sent an email message requesting participation. Data from the returned surveys were analyzed with SPSS. RESULTS: Sixty-one percent of survey respondents used PDAs. The address book, date book, and calculator were the most common uses reported for PDAs. Residents also reported a high use of drug databases on their PDAs. Most survey respondents indicated they would like to learn more about clinical resources for PDAs. CONCLUSIONS: Many opportunities exist for librarians to provide training and support for PDAs, in addition to evaluation and promotion of clinical software for PDAs.

Academic Medical Centers↗
PubMedDate not supplied

Leadership in academic medicine: reflections from administrative exile.

Physicians are drawn into diverse leadership roles in academic medicine, but little in our education and training prepares us for these responsibilities. Fortunately, there is growing convergence in the literature on the attributes of successful leaders for knowledge-based organisations. Top-performing leaders seem to be self-effacing team-builders who eschew rapid-cycle strategic planning and management trends, focusing instead on strategic and incremental changes that will gradually transform their organisations. Academic physicians and search committees often concentrate on personal achievement and intellectual or technical mastery in research and clinical care. In contrast, the literature on leadership suggests other-directed skills matter more, eg mentorship, learning and teaching competencies, and so-called emotional intelligence. As a corollary, teaching hospitals, universities, and professional colleges or societies are long-term organisations with a rich history. Leadership in such a context demands stewardship of tradition along with patient pursuit of changes required to ensure that the organisation evolves successfully.

Academic Medical Centers↗
PubMed1984

The academic medical center today.

Some recent circumstances, including the nation's economic difficulties, a probable physician surplus, a declining need for acute-care medical beds, and an overwhelming public perception that medical care is too expensive, are creating serious problems for academic medical centers today. To survive, many academic medical centers probably will make certain short-term adaptations that will be viewed as undesirable by many. We suggest four initiatives that may help academic centers maintain their vital national role. These initiatives include becoming major public advocates for the medical care needs of the least fortunate; a sharp reduction in the training of subspecialists; the commitment of more of their faculty practice income to academic research, teaching, and support of low-income students; and refocusing attention on the training of young persons to be the physicians of tomorrow.

Academic Medical Centers↗
PubMed2002

The role of interactive training skills courses in medical education at the Ankara University School of Medicine.

BACKGROUND: The Department of Medical Education at Ankara University School of Medicine offered a teaching program for their physician educators. One hundred and fifty professors from different disciplines attended this 5-day training course. DESCRIPTION: Two certified master trainers designed the program, which consisted of the following topics: adult learning principles, creating a positive training climate, interactive training techniques, clinical demonstration, coaching principles, effective use of audiovisual materials, developing and using knowledge and competency-based assessment instruments, and organizing training sessions. Master trainers managed all the courses and guided the other trainers according to the principles of group dynamics. Of the overall participants, 30% attended voluntarily (n = 45) and 70% attended compulsorily (n = 105). EVALUATION: In general, 97.5% to 100% assessed the course as either good or very good, with no difference in assessment between the two groups (p > .05; one-way analysis of variance). Course topics and time arrangements for each training session were rated optimal by 82% of participants, and all of them recommended that "all faculty should attend this course." CONCLUSION: The positive effects of these courses have led the School of Medicine's academic council to agree by consensus to accept the training skills course certificate as a criterion for eligibility to become a trainer at the School of Medicine. They also decided to institute educational reform, including changing the curriculum and using new educational methodology such as interactive techniques and problem-based learning.

Education, Medical, Undergraduate↗
PubMed2002

Gender discrimination and sexual harassment in medical education: perspectives gained by a 14-school study.

PURPOSE: The authors attempted to determine male and female medical students' exposures to and perceptions of gender discrimination and sexual harassment (GD/SH) in selected academic and nonacademic contexts. METHOD: An anonymous, self-report questionnaire was administered in the spring of 1997 to senior medical students at 14 U.S. medical schools. Data were collected about students' exposures to GD/SH during undergraduate medical education and outside the medical training environment. Students' perceptions of GD/SH in various medical specialties and practice settings were also measured. RESULTS: Of the 1,911 questionnaires administered, 1,314 were completed (response rate, 69%). Both men and women reported exposures to GD/SH. More women than men reported all types of exposures to GD/SH across all academic and nonacademic contexts. Differences between men and women in the frequencies of exposures were greatest outside the medical training environment (t = 15.67, df = 1171, p <or=.001). Within academic medical training contexts, the differences by sex were most evident in core clerkships (t = 11.17, df = 1176, p <or=.001). Women students perceived the prevalence of GD/SH to be significantly (p <or=.001) higher in a number of medical specialties than did men. However, both groups believed these behaviors to be most common in general surgery and obstetrics-gynecology. Women perceived significantly more GD/SH in academic medical centers and community hospitals. Both groups perceived these behaviors to be significantly more prevalent in academic medical centers than in community hospitals, and more prevalent in community hospitals than in outpatient office settings. CONCLUSIONS: This study suggests that mistreatment in the form of GD/SH is prevalent in undergraduate medical education, particularly within core clerkships. Interventions focused on particular specialties and training periods may be helpful.

Adult↗
PubMed1992

The "health of the public" approach to medical education.

The author examines the growing discontinuity between medical education and the general health needs of society. He explains and illustrates this failure of the academic medical center in several ways: by a parable; by reporting the results of his informal survey of faculty and residents; by presenting the findings of an international conference on medical education; and by giving a detailed description of the design and impact of the "Health of the Public" program, launched by the Pew Charitable Trusts and the Rockefeller Foundation in 1986. He maintains that there is an imbalance in the training of physicians and other health professionals because academic medical centers are dominated by supply-side thinking--which is driven by new knowledge and technology and the resulting need to find patients to fit the interests and technical capabilities of specialists and the equipment and services of hospitals--and have under-emphasized demand-side thinking, which concerns the patient and the health expectations, needs, and trends in the community. The author maintains that academic medical centers can continue to achieve the recognition they seek, but can do so by making the changes needed to better balance the driving forces of supply and demand. Only by doing this will they fulfill their fundamental mission of fostering the health of the public.

Academic Medical Centers↗
PubMed2007

Development and implementation of new educational concepts in a dental curriculum.

The Academic Centre for Dentistry Amsterdam introduced a fully renewed 5-year dental curriculum in September 2003. In this article, the educational principles and didactic choices that form the basis of the curriculum development are presented and attention is given to the process of development and the implementation strategy that constitute such an important part of the success of introducing a new curriculum. Special characteristics of the new curriculum are the clinical training practice, professional conduct, the elective profiles and academic education. In clinical practice, groups of students from different levels run a group practice in which they learn to work together, delegate tasks, solve clinical problems and apply evidence-based dentistry. In the new curriculum students learn to conduct themselves as professionals. In the third and in the fifth year, students choose an elective profile oriented, respectively, on research and on clinical knowledge and skills. Academic education is an important spearhead in this curriculum in which students not only learn why research is important to dentistry but also how dentists can use research to their own benefit. In development and implementation, a stepwise approach was used in which as many people as logistically possible were involved.

Competency-Based Education↗
PubMed1980

Effects of age on adaptive behavior levels and academic skill levels in autistic and mentally retarded children.

This study investigated the effect of age on adaptive behavior and academic skill in autistic and mentally retarded children. Subjects were 47 autistic and 128 mentally retarded children from a special school. Cross-sectional comparisons were made between junior and senior groups using ratings obtained from teachers on adaptive behaviors and academic skills. We found that the levels of toilet training, eating skills, participation in group activities, and self-control in the autistic children improved significantly with age. The skills of number concepts in the autistic children also improved with age. However, these adaptive and academic levels were in general significantly lower than those of the mentally retarded children. The levels of initiative did not improve significantly in either the autistic or the mentally retarded children, and they were significantly lower in the autistic children. The implications of these findings in the context of our previous study on the changes of communication and maladaptive behaviors with age in the autistic children are discussed.

Activities of Daily Living↗
PubMed2005

Auditory training improves neural timing in the human brainstem.

The auditory brainstem response reflects neural encoding of the acoustic characteristic of a speech syllable with remarkable precision. Some children with learning impairments demonstrate abnormalities in this preconscious measure of neural encoding especially in background noise. This study investigated whether auditory training targeted to remediate perceptually-based learning problems would alter the neural brainstem encoding of the acoustic sound structure of speech in such children. Nine subjects, clinically diagnosed with a language-based learning problem (e.g., dyslexia), worked with auditory perceptual training software. Prior to beginning and within three months after completing the training program, brainstem responses to the syllable /da/ were recorded in quiet and background noise. Subjects underwent additional auditory neurophysiological, perceptual, and cognitive testing. Ten control subjects, who did not participate in any remediation program, underwent the same battery of tests at time intervals equivalent to the trained subjects. Transient and sustained (frequency-following response) components of the brainstem response were evaluated. The primary pathway afferent volley -- neural events occurring earlier than 11 ms after stimulus onset -- did not demonstrate plasticity. However, quiet-to-noise inter-response correlations of the sustained response ( approximately 11-50 ms) increased significantly in the trained children, reflecting improved stimulus encoding precision, whereas control subjects did not exhibit this change. Thus, auditory training can alter the preconscious neural encoding of complex sounds by improving neural synchrony in the auditory brainstem. Additionally, several measures of brainstem response timing were related to changes in cortical physiology, as well as perceptual, academic, and cognitive measures from pre- to post-training.

Attention↗