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Reported the results of a survey of the membership of the International Neuropsychology Society with regard to patterns of training in clinical neuropsychology. Considerable variations in pre- and postdoctoral training and internship programs were found.
The preparation of psychotherapy supervisors to provide supervision services is examined briefly in this paper. The persistent paradox of psychotherapy supervision training--that the supervisor role is considered highly important in graduate and internship programs, but graduate and post-graduate training in how to be a supervisor is very limited--is discussed. The need to resolve this paradox in psychology training is considered.
The present study examined career pathways and current work patterns for 110 graduates of an internship program. Results show that the group trained after 1980 went into private practice more rapidly than those trained prior to 1980. Both groups do extensive psychological testing. Implications are discussed.
This study assessed training experiences offered to interns and graduate students at 464 federally funded community mental health centers. Doctoral level internship programs existed at 128 centers, and practicum training was offered at 240 settings. Questionnaires filled out by directors reveal that although the majority of training programs are not as yet APA-approved, they have become an important component in the training network in terms of the number of students being trained. Training and exceptional areas of training are still in traditional clinical areas. However, there has been an evolution of training in community mental health/community psychology areas which is still gaining momentum. Data are presented on consultation settings, orientations to consultation, and the availability of training in consultation. The need for directing effort at obtaining financial support for training is indicated.
EM-PSYCH is a scheduling database for training programs. It stores scheduling records and generates schedules and letters informing students, supervisors, and advisors of deadlines. Since EM-PSYCH was originally designed for a psychoanalytic institute, the institute model is presented as well as the database model to illustrate how the database program can be applied. EM-PSYCH is very user friendly and makes scheduling and sending reminders efficient and easy. It can handle any number of trainees and can be modified for any number of years or schedule interval. It can be easily adapted for psychiatric residencies, medical student education, psychology internships, and other training programs.
A SUNY-Upstate cohort was observed during the four-year matriculation (1974--1978) of the students for changes in their career choices. Medical school exposure seemed to increase students' interest in all major specialties, with the exception of family practice for which there was an overall 3% decrease. Internship and residency appointments accepted indicated that 75% entered primary care specialties, 8% more than the national average for 1978.
Evaluation of the many new family care programs (FCP), and others of similar intent, however defined, is as essential as determining the value of any other curriculum change. Replies to a questionnaire from 101 U.S. and 15 Canadian medical schools indicated that 80% of the former and 93% of the latter had FCPs; 35% and 29%, respectively, were not evaluating their program by any method. No single evaluative technique was used by more than 42% of the American medical schools. A review of the literature on FCPs frequently indicated that the conclusions that could be drawn about the programs were ambiguous. Students in the University of Cincinnati Medical Center FCPs elected family practice or pediatric internships significantly more often than did the FCP nonparticipants, but they indicated that the program had little effect on this choice, despite almost uniformly favorable testimonials. We discuss the possibility that FCPs may be educating the wrong students, that FCPs, if not reinforced in other clinical areas, may have few lasting effects on student attitudes or career choice, and that we may be asking the wrong questions, and with inadequate methods.
Ninety-nine medical and surgical house officers were prospectively evaluated during internship and residency for the development of hepatitis B virus (HBV) infection. The overall incidence of hepatitis B was 10.2% per year. Eighty-six percent of episodes were subclinical. The greatest risk factor appeared to be frequent hand-to-mouth activity such as smoking or licking requisition labels. The presence of a hemodialysis or transplantation unit may be an additional institutional risk factor. HBV infection was not associated with a history of needle-sticks or contact with known antigen-positive patients. Educational efforts to minimize HBV infection should concentrate on handwashing techniques and discouragement of hand-to-mouth activity in patient care areas.
OBJECTIVE: To assess the internal consistency and inter-rater reliability of a clinical evaluation exercise (CEX) format that was designed to be easily utilized, but sufficiently detailed, to achieve uniform recording of the observed examination. DESIGN: A comparison of 128 CEXs conducted for 32 internal medicine interns by full-time faculty. This paper reports alpha coefficients as measures of internal consistency and several measures of inter-rater reliability. SETTING: A university internal medicine program. Observations were conducted at the end of the internship year. PARTICIPANTS: Participants were 32 interns and observers were 12 full-time faculty in the department of medicine. The entire intern group was chosen in order to optimize the spectrum of abilities represented. Patients used for the study were recruited by the chief resident from the inpatient medical service based on their ability and willingness to participate. INTERVENTION: Each intern was observed twice and there were two examiners during each CEX. The examiners were given a standardized preparation and used a format developed over five years of previous pilot studies. MEASUREMENTS AND MAIN RESULTS: The format appeared to have excellent internal consistency; alpha coefficients ranged from 0.79 to 0.99. However, multiple methods of determining inter-rater reliability yielded similar results; intraclass correlations ranged from 0.23 to 0.50 and generalizability coefficients from a low of 0.00 for the overall rating of the CEX to a high of 0.61 for the physical examination section. Transforming scores to eliminate rater effects and dichotomizing results into pass-fail did not appear to enhance the reliability results. CONCLUSIONS: Although the CEX is a valuable didactic tool, its psychometric properties preclude reliable assessment of clinical skills as a one-time observation.
OBJECTIVE: To determine whether interns' performances of technical, preventive, and communication aspects of patient care improve during the intern year. DESIGN: A descriptive study. At the beginning and end of the intern year, interns' consultations with three simulated (standardized) patients were videotaped and scored according to explicit criteria set by an expert panel. Problems simulated were urinary tract infection, bronchitis, and tension headache. SETTING: The casualty outpatient department in a general teaching hospital in New South Wales, Australia. PARTICIPANTS: Twenty-eight interns rotated to the casualty department. RESULTS: Little improvement over the intern year in technical competence or preventive care was observed, even though initial levels of compliance with criteria were quite low for some items. Greater improvement was apparent in the area of communication skills. CONCLUSIONS: The results suggest that the internship should be restructured to more adequately teach the skills required for primary care.
OBJECTIVE: To develop objective structured clinical examination (OSCE) stations to assess the ability of physicians to address selected clinical-ethical situations, and to evaluate inter-rater agreement in these stations. DESIGN: Two ten-minute OSCE stations were developed using video-taped encounters between attending physicians and standardized patients. One scenario involved a daughter requesting a do-not-resuscitate (DNR) order for her competent mother without the mother's knowledge; the other involved a competent elderly woman requesting not to be re-intubated if her congestive heart failure worsened. The scenarios were evaluated using foreign medical graduates taking an OSCE. Each candidate was scored on his or her interaction with a standardized patient in the two OSCE stations by two independent observers. PARTICIPANTS: Eight attending physicians from the Division of General Internal Medicine at the Toronto Hospital were used to develop the OSCE stations, and 69 foreign medical graduates taking the University of Toronto Pre-Internship Program OSCE were used to evaluate the stations. RESULTS: The inter-rater reliability coefficients for the DNR and intubation scenarios were 0.79 (95% CI 0.69-0.87) and 0.75 (95% CI 0.62-0.84), respectively. For the DNR station, the scores of the two examiners, on a scale of 0 to 10, agreed exactly for 34 candidates (50%), within one mark for 59 candidates (87%), and within two marks for 65 candidates (96%). For the intubation station, the scores of the two examiners agreed exactly for 27 candidates (40%), within one mark for 56 candidates (84%), and within two marks for 63 candidates (94%). CONCLUSIONS: The authors produced ethics OSCE stations with face and content validity and satisfactory inter-rater agreement. Ethics OSCE stations may be suitable for evaluating the ability of medical students and residents to address selected clinical-ethical situations.
OBJECTIVE: To explore the impact of internal medicine residents' roles as learners, teachers, and physicians on their performance in teaching and supervising interns; to generate insights for educational policy and research. DESIGN: Qualitative analysis of in-depth, semistructured, recorded interviews with a cohort of second-postgraduate-year (PGY-2) residents. Questions elicited their accounts of differences in the learning process between the first and second residency years, their responses to situations in which they lacked sufficient clinical knowledge, their views of their supervisory relationship with interns, and their assessments of changes in their role in patient care since their internships. Transcripts were independently analyzed by the interdisciplinary team of authors. SETTING: New York University/Bellevue Hospital Center's internal medicine residency (New York City), a highly competitive program in a major public hospital and a university medical center, emphasizing housestaff autonomy and self-reliance. PARTICIPANTS: A cohort of 18 of 21 medical residents at Bellevue Hospital Center during the last rotation of PGY-2. RESULTS: Intense conflicts confound residents' roles as teachers. These conflicts fall into three categories: 1) as learners, residents' own needs frequently coincide with those of interns in ways that may undermine their teaching--they are expected to nurture others despite their own considerable needs for emotional support, teach material that they barely grasp, and exert authority while feeling ignorant; 2) as team leaders, residents must ensure that interns get the hospital's work done, sometimes at the expense of teaching them; and 3) as clinicians, residents' first priority is to address the medical needs of patients--the learning needs of interns are secondary. CONCLUSION: Second-year internal medicine residents experience conflicts inherent in their simultaneous commitment to learning, teaching, and service that may undermine both their effectiveness in supervising interns and their own professional development. Potential remedies are to restructure residency programs so as to equip residents with training and support for their role as teachers, reduce the tension between training and service by delegating tasks to nonphysician personnel, and provide graded responsibility to housestaff as physicians and teachers.
There is a growing concern over the quality of medical education for undergraduates in India. This paper is an attempt to define a need-based curriculum and outline the initiatives taken by the Medical Council of India (M.C.I.) in developing a need-based curriculum. The steps include: clear delineation of goals and objectives of education; adoption of innovative teaching and learning methodology, adjustments in the course structure, updating of course content, rationalizing assessment strategy, and emphasis on structured and skill oriented internship. For effective implementation of these measures, strategies such as establishment of Medical Education Unites (MEUs), visible funding of education, more recognition to teaching and impetus to staff development activities have been suggested.
Games are defined as ongoing series of complementary ulterior transactions that are superficially plausible but have a concealed motivation to maximize pay-offs and minimize penalties for the initiator. While some games are harmless and part of socialization, others are destructive. Destructive game-playing in clinical supervision, in which game-playing (initiated by either supervisors or students) interferes with a student's realization of internship goals, has been documented in some allied healthcare professions but has not yet been studied in genetic counseling. Genetic counselors and clinical supervisors of genetic counseling students were anonymously surveyed regarding their experiences with destructive game-playing. Results show that such games do occur in genetic counseling clinical supervision. Some games are the same or similar to ones previously described in other health-care professions; others may be unique to genetic counseling. The purpose of this paper is to document these games as a first step to facilitating dialogue, understanding and awareness of them.
OBJECTIVE OF THE STUDY: The objective of the overall study was to create a foundation for improving the quality of counselling practice in pharmacies. The research question addressed in this sub-study was to describe drug-related problems (DRPs) in terms of frequency as well as type in people with angina pectoris, type 2 diabetes and asthma, as the problems were identified through medication reviews and home interviews. SETTING AND METHOD: During their pharmacy internships, fourth-year pharmacy students collected data for the study in 1999, 2000 and 2001 by carrying out medication reviews, conducting home interviews and registering DRPs for 414 patients. Data were collected from the following patient groups in the years indicated: in 1999, 123 angina pectoris patients; in 2000, 192 type 2 diabetes patients, and in 2001, 99 asthma patients. The interviews dealt with the patient's drug-related experiences, knowledge, perceptions, problems and actions. The DRPs were registered according to the so-called PI-Doc system. RESULTS: A medication review was supplemented by qualitative interviews with the three patient groups, which revealed a relatively high number of DRPs compared to other studies. An average of 2.8 DRPs were identified per angina pectoris patient; 4.1 DRPs per type 2 diabetes patient and 4.0 DRPs per asthma patient. "Inappropriate use of medicines by the patient" and "Other problems" (such as limited knowledge of the illness, inappropriate lifestyle, fear of medication, lack of information, etc.) were the two most common DRP sub-categories identified in all three patient groups. CONCLUSION: The study provided a profile of a pharmacy-based population of 414 patients visiting the pharmacy, all of whom are at high risk of experiencing drug-related problems. Pharmacy staff needs to take this high rate of DRPs in people with angina pectoris, asthma and type 2 diabetes into account when dispensing medicines to and advising patients from the three groups, especially when explaining how to use medicines appropriately.
PURPOSE: To evaluate the effectiveness of a teaching program designed to improve interns' cardiovascular examination skills. PARTICIPANTS: All 56 interns rotating on a mandatory 4-week inpatient cardiology service during 1 academic year (July 1989-June 1990). METHODS: We randomly assigned interns to receive either an eight-session physical diagnosis course ("teaching group") taught on the cardiology-patient simulator ("Harvey") or to receive no supplemental teaching ("control group"). Before and immediately after the teaching or control period, the interns were evaluated on three preprogrammed simulations (mitral regurgitation, MR; mitral stenosis, MS; aortic regurgitation, AR). Immediately after the control or the intervention period, the interns also evaluated patient volunteers. RESULTS: There were no baseline differences in the interns' ability to correctly identify the disease simulations. Both the intervention and the control interns showed similar, moderate improvement in their diagnostic ability on the simulator. The intervention interns improved on MR from 42% correct to 54% correct; on MS from 8% correct to 23% correct; and on AR from 46% correct to 58% correct. The intervention and the control interns performed similarly on patient volunteers: for MR, 20% correct versus 31%; for AR, 29% correct versus 33%; and for aortic sclerosis, 64% correct versus 33%, respectively. CONCLUSIONS: The interns had difficulty correctly identifying three valvular heart disease simulations before and after an educational intervention employing a cardiovascular-patient simulator. At no time did the proportion of correct responses exceed 64%. Our teaching intervention during internship was either of insufficient intensity or of insufficient duration to produce significant improvement in cardiovascular diagnostic skills.
PURPOSE: To analyze the factors influencing students to choose residency training in primary care (internal medicine, family medicine, and pediatrics) or nonprimary care specialties and study the combined effect of reported responses on their choice. MATERIALS AND METHODS: A 12-item questionnaire using a 7-point Likert scale was mailed to the 1,164 graduating seniors from 9 medical schools in 1991. Responses ranged from 1, very negative influence, to 7, very positive influence. Four indicated no influence. The overall response rate was 69%. Univariate analysis of factors associated with specialty choice was done with the Mantel-Haenzsel chi-square test. Odds ratios were calculated for each significant variable without controlling for other variables. Factors found to have univariate significance were then tested for combined significance with logistic regression analysis. The regression was performed on a randomly chosen training sample, and validated on a test sample. RESULTS: Forty-five percent of respondents chose an internship and planned residency training in a primary care specialty. Factors that remained positively associated with choosing a primary care specialty when controlling for other factors were desire to provide comprehensive care, to keep options open, and to undertake ambulatory care. Desire for monetary reward was negatively associated with choice of a primary care specialty. CONCLUSIONS: Positive educational experiences in the ambulatory setting should be enhanced, and disparity in remuneration among disciplines reduced.
In Russia, specialized education of clinical laboratory physicians who work in the positions of medical technologists, head of laboratory or one of its divisions is conducted in various forms of postgraduate training, namely internship, primary specialization courses, advanced study courses, graduate clinical studies and postgraduate fellowship. Such education is offered at 14 Departments for Clinical Laboratory Diagnostics, which are located within the Institutes for Advanced Medical Studies or at Faculties for Advanced Medical Studies in Medical Institutes. Until the present, the primary specialization courses and the advanced study courses have been the most prevalent forms of training clinical laboratory professionals. These two types of courses offer formal lectures, seminars as well as practical classes, and the course contents are regulated by a uniform curriculum promulgated by the Ministry of Health. Training in these courses is the necessary prerequisite to obtain degree of advanced qualification as an expert in clinical laboratory diagnostics, which in turn provides access to better remunerated positions.