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Resident research and scholarly activity in internal medicine residency training programs.

OBJECTIVES: 1) To describe how internal medicine residency programs fulfill the Accreditation Council for Graduate Medical Education (ACGME) scholarly activity training requirement including the current context of resident scholarly work, and 2) to compare findings between university and nonuniversity programs. DESIGN: Cross-sectional mailed survey. SETTING: ACGME-accredited internal medicine residency programs. PARTICIPANTS: Internal medicine residency program directors. MEASUREMENTS: Data were collected on 1) interpretation of the scholarly activity requirement, 2) support for resident scholarship, 3) scholarly activities of residents, 4) attitudes toward resident research, and 5) program characteristics. University and nonuniversity programs were compared. MAIN RESULTS: The response rate was 78%. Most residents completed a topic review with presentation (median, 100%) to fulfill the requirement. Residents at nonuniversity programs were more likely to complete case reports (median, 40% vs 25%; P=.04) and present at local or regional meetings (median, 25% vs 20%; P=.01), and were just as likely to conduct hypothesis-driven research (median, 20% vs 20%; P=.75) and present nationally (median, 10% vs 5%; P=.10) as residents at university programs. Nonuniversity programs were more likely to report lack of faculty mentors (61% vs 31%; P<.001) and resident interest (55% vs 40%; P=.01) as major barriers to resident scholarship. Programs support resident scholarship through research curricula (47%), funding (46%), and protected time (32%). CONCLUSIONS: Internal medicine residents complete a variety of projects to fulfill the scholarly activity requirement. Nonuniversity programs are doing as much as university programs in meeting the requirement and supporting resident scholarship despite reporting significant barriers.

Adult↗

A successful psychiatric training program for medical residents.

The psychosocial skills of 24 PGY I medical residents receiving psychiatric training every other week during the internship year were evaluated and compared to a control group of 13 PGY I residents. After the internship year, the psychiatrically trained residents showed an increase in their ability to recognize emotional problems, whereas the control group recognized less depression. Psychiatrically trained residents were more sophisticated in psychosocial problem descriptions and plan formulations, whereas the control group formulated more poor psychosocial plans.

Clinical Competence↗

Enlisting indigenous community supporters in skills training programs for persons with severe mental illness.

OBJECTIVE: This study evaluated the generalization of skills training for severely and persistently mentally ill individuals who were paired with indigenous supporters. The supporters monitored the individuals' environments and prompted them to use their skills. METHODS: A total of 85 individuals with severe and persistent mental illness received six months of skills training. Forty-five of the participants received support from an individual of their choosing. The other 40 participants did not have supporters. At the end of the six-month skills training period, the supporters' participation was officially terminated, although they were encouraged to remain in their role for as long as both parties felt comfortable. The effects of the support were measured in terms of interpersonal functioning, acquisition and retention of the skills, psychopathology, global functioning, and satisfaction. Several process measures were also collected. RESULTS: The support procedures were evaluated favorably by both patients and supporters. The interpersonal functioning of the group with supporters was found to be significantly better than that of the nonsupported group at six- and 12-month follow-ups. No differences were found between the groups in symptoms-which were minimal during the entire training period-or skills learning and retention. CONCLUSIONS: The effects of support are likely applicable for a variety of individuals, supporters, and facilities. Indirect evidence suggested the importance of providing support for the supporters.

Adult↗

Rationale for including orofacial myofunctional therapy in university training programs.

This article provides information on the need felt by speech-language pathologists for training in orofacial myofunctional phenomena. Results of a survey indicate 97.7% of respondents felt training is necessary, while only 7.9% felt their training was adequate. ASHA position statements regarding orofacial myology are reviewed. ASHA and IAOM suggested competencies are also included.

Curriculum↗

Evaluation of a training program for persons with SCI paraplegia using the Parastep 1 ambulation system: part 5. Lower extremity blood flow and hyperemic responses to occlusion are augmented by ambulation training.

OBJECTIVE: To test whether 12 weeks of exercise conditioning using functional neuromuscular stimulation (FNS) ambulation alters the resting lower extremity blood flow and hyperemic responses to vascular occlusion in subjects with paraplegia, and to determine whether an association exists between limb flow and lower extremity fat-free mass. DESIGN: Pretest, posttest. SETTING: Academic medical center. PARTICIPANTS: Subjects with chronic neurologically complete paraplegia. INTERVENTION: Thirty-two sessions of microprocessor-controlled ambulation using electrically stimulated contractions of lower extremity muscles and a rolling walker. OUTCOME MEASURES: Subjects underwent quantitative Doppler ultrasound examination of the common femoral artery (CFA) before and after training. End-diastolic arterial images and arterial flow-velocity profiles obtained at rest and after 5 minutes of suprasystolic thigh occlusion were computer-digitized for analysis of heart rate (HR), CFA peak systolic velocity (PSV), CFA cross-sectional area (CSA), flow velocity integral (FVI), pulse volume (PV), and CFA (arterial) inflow volume (AIV). RESULTS: Significant effects of training on CSA (p < .0001), FVI (p < .05), computed PV (p < .001), and computed AIV (p < .01) were observed. Resting HR was lower following training (p < .05). The change for resting PSV approached but did not reach significance (p = .083). Analysis of postocclusion PV and AIV showed significant effects for conditioning status (p values < .01), postcompression time (p values < .0001), and their interaction (p values < .01). At 1 minute after occlusion, the posttraining AIV response was 78.2% greater in absolute magnitude and 17.4% more robust when expressed as a percentage change from its resting value than before training. Significant correlations were found between thigh fat free mass and both AIV and PV (p values < .05). CONCLUSION: Exercise training using FNS ambulation increases the resting lower extremity AIV in individuals with paraplegia and augments the hyperemic response to vascular occlusion. Improved posttraining blood flow is attributable both to vascular structural changes and upregulation of vascular flow control mechanisms. Limb mass is associated with the volume of arterial blood flow.

Adult↗

Education and training programs at the National Cancer Institute: 1938-1982.

The National Cancer Institute (NCI) has supported cancer research training and clinical cancer education since 1938, the latter in a variety of forms. These include direct clinical fellowships, followed by institutional grants designed to improve the education of students concerning cancer in medical and dental schools, and subsequently in teaching hospitals. The institutional grants went through three stages between 1948 and 1982, and have recently entered a fourth. Undergraduate Cancer Training Grants supported cancer teaching for medical and dental students. Clinical Cancer Training Grants expanded teaching activities to include post-resident trainees and medical and dental practitioners. Clinical Cancer Education Grants further extended cancer education and emphasized goals, objectives and evaluation, and focused on areas of weakness in cancer teaching such as epidemiology and cancer, cancer prevention and the role of radiation therapy. The various pressures within and without NCI that have influenced the development of these grant programs are discussed. Some cancer education activities supported by Cancer Control programs, both at NCI and another agency of the Public Health Service, are briefly mentioned. Aspects of the grant review process, program monitoring, and the impact of a professional organization developed in direct response to the first institutional cancer education grant program are described.

Cancer Care Facilities↗

Visiting aides training program.

This article describes a hospital-sponsored service program in which mature members of the community are given a course of supervised field training in the home care of recently discharged patients. The program benefits the trainee, the patient, and the general taxpayer.

Aged↗

What influences career choices among graduates of a primary care training program?

OBJECTIVE: To identify factors that influence primary care residents to become generalists or specialists. DESIGN: Structured survey and interview. SETTING: A large university-based, internal medicine residency program in primary care. PARTICIPANTS: Of 92 residency graduates who completed training between 1979 and 1993, 88 (96%) participated. MAIN RESULTS: Although 82% of the participating graduates reported themselves very committed to primary care at the beginning of residency, only 68% pursued generalist careers. Factors influencing career choice that were more important to generalists than specialists included breadth of knowledge used in primary care practice (p = .04), breadth of clinical problems in practice (p = .001), and opportunity for continuity of care (p = .01). Although salary was rated "not important," 50% of generalists and specialists advocated increased salaries for generalists as a way to increase interest in primary care. Other promoting factors included mentors, increased prestige for generalists, community-based training, lifestyle changes, and decreased paperwork. Seventy-three percent of participants felt it was easier to be a specialist than a generalist. CONCLUSIONS: A substantial minority of primary care residents pursue specialty careers. To produce more generalists, graduates recommend addressing income inequities, providing generalist role models, increasing community-based teaching, and increasing prestige for generalists.

Career Choice↗

Training program in maxillofacial prosthetics for medical artists.

A program in maxillofacial prosthetics for medical artists was initiated at the University of Illinois Medical Center in 1966 as a joint enterprise of the Center for Craniofacial Anomalies of the Abraham Lincoln School of Medicine and the Department of Medical Art of the School of Associated Medical Sciences. In the intervening years, 25 medical artists have been graduated from the program. The general background of the trainees, the scope of their training, and their clinical contribution were discussed and illustrated.

Anatomy, Artistic↗

Reduction of submaximal exercise myocardial oxygen demand post-walk training program in coronary patients due to improved physical work efficiency.

To assess the effects of walk training on external work efficiency and the determinants of myocardial oxygen demand (MVO2), we measured total somatic oxygen consumption (VO2), heart rate (HR), and systolic blood pressure (SBP) in eight male coronary (CAD) patients during submaximal treadmill walking before and after at least 14 weeks of prescribed exercise. Each patient was tested before and after training at the individually determined horizontal treadmill speed that induced ischemic ST segment depression in the pretraining test. Although maximal oxygen uptake (VO2 max) did not increase significantly with training, submaximal exercise HR and the product of HR and SBP were significantly (p less than 0.05) reduced by 10% (120 leads to 108/min) and 16% (185 X 10(2) leads to 156 X 10(2)), respectively, and none of the patients had ischemic ECG changes after training. The reductions in the cardiac response to exercise were due primarily to a 10% decrease (18.9 leads to 17.1 ml/kg/min, p less than 0.05) in somatic oxygen requirements (VO2), indicating that the patients became more efficient walkers and reduced their MVO2 in proportion to the decreased total VO2. Thus, enhancement of external work efficiency, an extracardiac factor, can lessen myocardial energy costs (MVO2) and thereby raise the exercise threshold for cardiac ischemia in CAD patients even when aerobic capacity (VO2 max) is not increased.

Adult↗

Development of occupational safety and health training programs in Poland.

The author describes a Polish-Swedish cooperative venture to develop curricula and training materials in the area of occupational safety and health. The resulting courses, which are consonant with the mandates of the revised Polish Labor Code, have been used to train yearly 1,300 people, including employers, employees, and 300 new trainers. A project to extend such training to workplaces is under way.

Curriculum↗