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PubMed2004

Achieving competency in psychological assessment: directions for education and training.

This article provides an overview of issues related to the development and evaluation of competency in psychological assessment. Specifically, we delineate the goals, ideas, and directions identified by the psychological assessment work group in the Competencies Conference: Future Directions in Education and Credentialing in Professional Psychology. This is one of a series of articles published in this issue of the Journal of Clinical Psychology. Several other articles that resulted from the Competencies Conference will appear in Professional Psychology: Research and Practice and The Counseling Psychologist. The psychological assessment group was charged with the tasks of: (a). identifying the core components of psychological assessment competency; (b). determining the central educational and training experiences that will aid competency development; (c). explicating strategies for evaluating competence; and (d). establishing future directions for furthering the identification, training, and evaluation of competence in psychological assessment. We present a set of eight core competencies that we deemed important for achieving psychological assessment competency and discuss four guidelines for training in the domain of psychological assessment. A variety of methods for evaluating competencies in this domain are suggested, with emphasis on using a collaborative model of evaluation. Recommendations for future directions include strengthening the academic prerequisites for graduate school training; increasing training in culturally sensitive measures; incorporating innovative assessment-related technologies into training; and addressing discontinuities between academic training, internship, and practice environments.

Competency-Based Education↗
PubMed2004

Becoming a competent clinician: basic competencies in intervention.

This article summarizes the results from the Intervention Work Group of the Competencies Conference: Future Directions in Education and Credentialing in Professional Psychology. The generic charge presented to the Intervention Work Group was "to address issues related to interventions." The Intervention Work Group identified four competency components of knowledge, skills, and abilities: (a). foundational competencies; (b). intervention planning; (c). intervention implementation; and (d). intervention evaluation competencies. A fifth component that included "practice management" was labeled as "others." Each component is discussed, including competencies that were deemed an essential knowledge, skill, and/or value. A discussion of training for intervention competence and assessing that intervention competence is included. Future directions for the science and practice of psychology in the intervention arena are summarized. This is one of a series of articles published in this issue of the Journal of Clinical Psychology. Several other articles that resulted from the Competencies Conference will appear in Professional Psychology: Research and Practice and The Counseling Psychologist.

Clinical Competence↗
PubMed2004

Consultation and interprofessional collaboration: modeling for the future.

Consultation and interprofessional collaboration by psychologists occur with individuals, groups, programs, and organizations. The practice of consultation and interprofessional collaboration involves interdisciplinary relationships, preparation, and advanced skill development within specialty areas of psychology (e.g., clinical, counseling, industrial-organizational, and school). The Workgroup on Consultation and Interdisciplinary Relationships engaged in a planning process at the Competencies Conference: Future Directions in Education and Credentialing in Professional Psychology to address fundamental issues regarding consultation and interprofessional collaboration in professional psychology. The Workgroup articulated working definitions, consensus points about psychologists as consultants and interprofessional collaborators, a consulting and interprofessional competency blueprint for preparation and assessment strategies, and future directions. This is one of a series of articles published in this issue of the Journal of Clinical Psychology. Several other articles that resulted from the Competencies Conference will appear in Professional Psychology: Research and Practice and The Counseling Psychologist.

Cooperative Behavior↗
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↗
PubMed1989

Recent developments in antitrust: challenges to medical autonomy.

Once exemptions from antitrust scrutiny were removed, economic arguments have proved effective in dissolving the hegemony formerly held by psychiatrists over the provision of mental health services. A growing number of courts, legislatures, and insurance companies have been persuaded by psychologists that they can provide at least comparable services at lower costs than psychiatrists. The fact that psychotherapy is less obviously a "medical" procedure than surgery or other physical treatments has facilitated the establishment of the psychologists' position. After these gains, there are indications that other mental health providers will follow the paths established by psychologists. Cost-containment efforts in the mental health care industry, particularly through health maintenance organizations, have already led to increased utilization of nondoctoral providers for initial screening services, and psychiatrists have even filed countersuits alleging restraint of their trade through the exclusive use of lower-cost providers (State Medical Society of Wisconsin v. Schweiker et al., 1982). With the clear message from many courts and legislatures that profession will no longer serve to distinguish among mental health providers, it appears that the validity of psychiatrists' assertions that independent practice by nonmedical mental health professionals will result in lower quality of care for patients will be tested in the marketplace, with peer review and tort litigation serving as the barometer by which that quality will be measured. And, as other nonmedical professionals establish their credentials through licensure and recognition by consumers, we can expect that they will also seek recognition of their capacities to provide (and be reimbursed for) professional services through the courts. With this greater access to consumers of mental health care will also come, of course, greater public scrutiny and greater risk of malpractice liability.

Allied Health Personnel↗
PubMed1994

Preceptored introduction of laparoscopic techniques for cholecystectomy into a large university-affiliated medical center.

Faced with the task of introducing laparoscopic techniques for cholecystectomy into the practice of a large department composed of individuals with varied backgrounds and experience, our surgical staff decided to grant provisional provileges to five surgeons, two from the full-time faculty and three from the community, who had completed a formal course in laparoscopic cholecystectomy. These five surgeons agreed to assist one another through 10 cases a piece before performing any procedures on their own or serving as preceptors for additional surgeons. Other surgeons could obtain credentials for this procedure by satisfying the same course criteria and receiving assistance from one of the five original surgeons during their first 10 cases. In the 14 months after September 1990, 250 laparoscopic cholecystectomies were performed by 19 different attending surgeons at our hospital. One death from hemorrhage (0.4%) and two bile duct injuries (0.8%) occurred in these patients. One of the bile duct injuries occurred after conversion to open cholecystectomy, as did the hemorrhage, which was from a vessel within the parenchyma of the gallbladder bed which rebled even after temporary control through open ligature technique. The second bile duct injury, the result of injudicious application of hemoclips for hemostasis, was minor in degree and the only injury to occur in a procedure conducted exclusively through the laparoscope. This experience demonstrates that laparoscopic techniques can be safely introduced into an environment involving multiple surgeons by adherence to a careful protocol of preceptored assistance.

Academic Medical Centers↗
PubMedDate not supplied

Training for laparoscopic surgery.

Laparoscopic cholecystectomy has rapidly become the procedure of choice for most patients with symptomatic gallbladder disease. Laparoscopic surgery, however, has not been a required component of most general surgery training programs. The demonstrated efficacy of laparoscopic surgery dictates that this discipline be rapidly incorporated into residency programs. Laparoscopic cholecystectomy and other surgical endoscopic procedures have been an integral part of the training program at the University of Maryland since 1989. Currently, residents who are completing their training have performed on average 50 to 75 laparoscopic procedures as the primary surgeon and 25 to 30 as the first assistant. In addition to training future community and academic physicians, those surgeons currently in practice must receive appropriate instruction in laparoscopic surgery. Most practicing surgeons attend a 2- to 3-day intensive course offering both didactic and hands-on experience. Additional exposure to clinical cases is achieved by working with other surgeons with laparoscopic expertise. Full credentialing in laparoscopic cholecystectomy generally requires proctoring by a surgeon from the local community. Since 1990 faculty from the University of Maryland have been active in the local community serving as proctors to surgeons in 14 hospitals.

Credentialing↗
PubMed1993

The present role and future considerations of video-assisted thoracoscopy in general thoracic surgery.

The past 2 years have witnessed the evolution of video-assisted thoracoscopy in the United States. Performance of the procedure has now moved from the university center to the community hospital. It is clear that thoracoscopy is the modality of choice for both the diagnosis and management of pleural disease (except mesothelioma); the identification of undiagnosed peripheral pulmonary nodules; the removal of simple mediastinal cysts; and the performance of wedge biopsy for interstitial lung disease and simple pericardial procedures. Its role in the management of primary lung cancer and esophageal disease remains to be defined. There are four areas that currently need to be addressed as the present role of therapeutic thoracoscopy evolves: (1) instrumentation, (2) economics, (3) a credentialing process, and (4) its application in certain procedures. All of these are addressed in this presentation.

Costs and Cost Analysis↗
PubMed1995

Quality initiatives and the power of the database: where we stand.

Many efforts to improve the quality of care focus on information drawn from databases. Such information can be very useful; however, the acquisition and analysis of data must be undertaken with caution. Six issues related to quality of care and the acquisition and analysis of data that pose problems for thoracic surgeons are the limitations and dangers of the right to know, the inadequacy of current databases, outcomes analysis and whether they help or hurt us, increased scrutiny of our practices, practice guidelines and the standards of care, and credentialing. To maximize the benefits of databases, physicians must participate in the process of data acquisition and analysis and the formation of practice guidelines. Speaking out against the misuse of incomplete or inaccurate data and supporting Society initiatives that address these concerns will help us as we strive to maintain a strong physician-patient relationship and to deliver optimal care to our patients.

Bias↗
PubMedDate not supplied

Initial experience using an endoscopic simulator to train surgical residents in flexible endoscopy in a community medical center residency program.

INTRODUCTION: The importance of training surgical residents in GI endoscopy has been recognized for years. Despite advice from SAGES and the RRC, few programs have managed to incorporate effective flexible endoscopy training into their curriculum, making it difficult for their graduates to be credentialed in GI endoscopy. Prior to October 2001, our residents obtained their entire clinical experience in the endoscopy unit with staff surgical endoscopists. Attendance was inconsistent because of their many other responsibilities, and residents often used much of their clinical endoscopic exposure gaining basic familiarity with the equipment, precluding the development of therapeutic facility. Since October 2001, we have used the Simbionix endoscopic simulator to supplement resident training in GI endoscopy. With the advent of virtual-reality simulators, and studies validating their effectiveness in teaching fundamental technical skills, we report our initial success in implementing a formal GI endoscopy curriculum using a virtual reality endoscopic simulator to provide basic experience before the clinical endoscopic experience begins. METHODS: Residents are given monthly assignments of simulated cases on the GI Mentor simulator. Junior residents complete the diagnostic case modules; senior residents complete the therapeutic modules. Data were accumulated over the course of two years with a total of five PGY-I and eight senior surgical residents completing assigned cases on the simulator. Objective criteria were measured from their performance on the simulator to determine the efficiency of the examination for each case completed. RESULTS: Preliminary data collected over the course of two years indicates that residents improve the efficiency of their endoscopic examinations over time as measured by objective criteria. Junior surgery residents attained an aggregate average of 59% efficiency in their examinations whereas senior surgical residents who had previous experience with the simulator, attained an aggregate efficiency of 80%. CONCLUSIONS: A formal flexible endoscopy curriculum enhances surgical resident training and positively impacts careers in general and gastrointestinal surgery. Endoscopic simulators allow surgical residents to master the technical aspects of GI endoscopy quickly, thereby permitting them more benefit from their clinical exposure in the endoscopy unit. We anticipate that our formal curriculum in GI endoscopy training will prepare our graduates well for careers that include flexible endoscopy as a component of their clinical practices, and position them to be credentialled in GI endoscopy upon graduation.

Colonoscopy↗
PubMed2006

Laparoscopic colon resection for cancer.

LAC has become an acceptable alternative in the treatment of colon carcinoma. New data should elucidate better the potential advantages in postoperative recovery, QOL, and cost reduction. Appropriate credentialing for LAC remains essential for widespread application of LAC while preserving patient safety.

Clinical Competence↗
PubMed2000

The pioneer spirit in perioperative advanced practice--two practice examples.

Perioperative nurses have options in advanced practice instead of leaving the acute care setting. One of the newest advanced practice roles is the acute care nurse practitioner (ACNP). This role may be ideal for perioperative nurses who want to remain in perioperative practice and grow clinically by pursuing advanced practice. This article presents two collaborative practice examples for the ACNP in the perioperative setting. The authors describe new frontiers in advanced perioperative practice and analyze the emerging advanced practice role of the ACNP. This challenging and exciting role is well suited to perioperative practice in a general and trauma surgery practice. The academic preparation, certification, and credentialing necessary to practice as an ACNP are explained.

Adolescent↗
PubMed2001

Perceptions and evaluation of the computerized registration examination for dietitians.

In September 1999, the format for the Registration Examination for Dietitians changed from a paper-and-pencil test to a computerized design. The purpose of this study was to determine how examinees reacted to the computerized exam experience. We surveyed 304 registered dietitians in Region VI states who had been eligible as of August 1, 1999, to earn this credential. The response rate was 61% (n=185). Average time between completing the supervised practice program and taking the exam was 5.7 months. Most (n=125) found the computerized format to be satisfactory even though 54.7% reported having anxiety about taking computerized exams. The major difficulties experienced by the examinees were scheduling problems and poor communication on the part of the testing centers. Exam takers need to be better informed about procedural issues, exam center environment, and the limitations of the testing centers.

Adult↗
PubMed2000

Perspectives of a cardiac surgery resident in-training on off-pump coronary bypass operation.

BACKGROUND: Contemporary residency training in the cardiac component of cardiothoracic operation is focused mainly on attaining technical proficiency in coronary artery revascularization. Most trainees in cardiothoracic operation are required to perform 35 cases of coronary revascularization in order to fulfill the minimum requirements for certification by the American Board of Thoracic Surgery. Although experience in minimally invasive coronary revascularization is not required for board certification in cardiothoracic operation, it is recognized by both trainees and program directors as an important component of contemporary training in less-invasive surgical approaches (LISA) for coronary artery disease. The objective of this study was to describe the training of residents in off-pump coronary revascularization in an accredited training program. METHODS: A retrospective analysis of a single resident's experience in minimally invasive coronary revascularization over an 18 month period in a 2-year residency program in cardiothoracic operation was carried out. RESULTS: Of the 166 total cases of coronary bypass operation, the resident performed 61 cases (37% of the total) off-pump as primary surgeon with attending supervision. Patients undergoing off-pump coronary bypass had an average of 2.4 grafts (range 1 to 5) and conventional coronary artery surgeon (on cardiopulmonary bypass) performed by the resident had an average of 4 grafts (range 2 to 5). The marginal/circumflex system was bypassed in patients that required revascularization of the marginal/circumflex system, which was 56% (n = 36 of 62) in the off-pump group and 90% for the conventional group using cardiopulmonary bypass. The conversion rate from off-pump technique to conventional coronary bypass using cardiopulmonary bypass was 3.2% in this series. CONCLUSIONS: Technical innovations and evolution of techniques to better stabilize the heart for off-pump coronary revascularization have made the procedure both effective and safe. Our experience has shown that cardiothoracic residents can be taught the skills necessary to perform coronary revascularization off cardiopulmonary bypass. There are currently no standards for the training of cardiothoracic residents in off-pump coronary artery operation. We propose that at least 50 cases be performed under supervision by a trained surgeon to obtain adequate credentials in minimally invasive coronary revascularization.

Aged↗
PubMed1998

The Health On the Net Code of Conduct for medical and health Websites.

Internet has become one of the most used communication media. This and the fact that no constraining information publishing policy exists have created an urgent need to control the quality of information circulating through this media. To this purpose, the Health On the Net Foundation has initiated the Code of Conduct (HONcode) for the health/medical domain. This initiative proposes guidelines to information providers, with the aim, on the one hand, of raising the quality of data available on the Net and, on the other hand, of helping to identify Internet sites that are maintained by qualified people and contain reliable data. The HONcode mainly includes the following ethical aspects: the author's credentials, the date of the last modification with respect to clinical documents, confidentiality of data, source data reference, funding and the advertising policy. This article presents the HONcode and its evolution since it was launched in 1996.

Advertising↗
PubMed1999

Sonographic assessment of traumatic injury. Future developments.

In all its forms and applications, sonography plays a significant role in the management of injured patients, from the emergency department to beyond hospital discharge. The use of new and existing sonographic technology will increase because sonographic imaging and measurements are generally less invasive; are inexpensive; use no ionizing radiation; and are portable, repeatable, and, in many instances, as accurate as the so-called "contemporary gold standards." The training and credentialing of physicians in sonography is in evolution and will be an increasingly important issue with more widespread use and broader applications. The future of sonography in trauma care in the next millennium is bright, and surgeons and surgical residents are encouraged to gain proficiency and learn about this new surgical frontier as it evolves.

Costs and Cost Analysis↗
PubMed1992

Medical staff privileges for ethics consultants: an institutional model.

On January 1, 1991, the Joint Commission required hospitals to be equipped for resolving moral dilemmas that arise in the care of a patient. Regulation of those professing expertise in clinical ethics is new and untested yet must be evaluated and further developed to protect patients from practitioners who lack expertise in clinical ethics but may promote themselves as qualified. The authors report the development of standard criteria for clinical ethics consultation privileges as one model to protect patients. An institutional medical staff model utilizing approved credentialing mechanisms is a generous umbrella under which patients may be protected, qualified clinical ethicists may practice, and continuous quality improvement may be sought.

Credentialing↗
PubMed1997

Emergency department ultrasound services by emergency physicians: model for gaining hospital approval.

We anticipate that over the next few years, emergency physician use of emergency department ultrasound will become the standard of care. However, many EDs are hampered in their efforts to gain hospital approval for emergency physician use of ultrasound because of the lack of publicized information regarding the goals of such use, the scope of emergency physician ultrasound privileges, emergency physician ultrasound credentialing criteria, and ED ultrasound quality-improvement plans. In this article we address these issues and provide an example of a proposal used successfully to gain hospital approval for ED use of ultrasound by emergency physicians.

Credentialing↗