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PubMed2003

Applicants' opinions about the selection process for oral and maxillofacial surgery programs.

PURPOSE: This study was conducted to investigate the characteristics of and opinions about the selection process of applicants to residency programs in oral and maxillofacial surgery (OMS) in the year 2000. The current investigation paralleled a survey completed in the 1970s, with additional questions to assess contemporary curriculum and surgical training evolution. Differences from the previous (1976) survey, a profile of applicants in 2000, and characteristics of OMS residency programs that applicants view as attractive are discussed. SUBJECTS AND METHODS: Questionnaires were sent to 307 applicants to OMS residency programs registered in the dental matching program. To provide a more direct comparison of the study completed in 1977, the current questionnaire used the original survey as a model. It was divided into 6 sections: general information, information from the formal application and letters of recommendation, the interview, the selection process, the characteristics applicants were seeking in a program, and a retrospective review of programs visited. RESULTS: In this study, 118 responses were received, representing 38% of the total. Respondents were predominately men (86%) and single, and attended dental school in all regions of the United States and the world. Respondents listed geographic location (65%) and national reputation (58%) as important factors for selecting programs to which to apply. Many respondents felt that a previous dental internship (85%), national board scores (83%), and class rank (79%) would be considered important in screening applicants for interview. A program's reputation, personalities of residents and attending staff, and clinical material were ranked as important factors contributing to program selection. Fifty-three of the 79 successful applicants reported that they were matched with their first-choice institution. Sixty percent of programs were considered worthy of revisiting by the respondents. CONCLUSIONS: Respondents in 2000 had more knowledge of the selection process before interviewing and submitted 2 times the number of applications than applicants in 1977. When selecting programs to which to apply, current applicants were less influenced by geographic location and the recommendations of other dentists. Applicants were attracted to programs that they perceive to have a good reputation and abundant clinical material. Residencies that convey a friendly atmosphere, favorable interpersonal skills of enrolled residents, and appealing personalities of the faculty were more attractive to candidates.

Adult↗
PubMed1996

[The Ulm emergency medicine training course. 1: Concept].

The course in emergency medicine was introduced by the German Federal Government to meet the requirements of the curriculum of the 4th year of medical education in 1992. The Department of Anaesthesiology of the University Hospital Ulm drew up a course consisting of one week of practical instructions (Table 3) for groups of 24 students, case presentation and accompanying lectures that cover the topics of emergency medicine (Table 2). The course is part of continuous education in emergency medicine. It starts with courses in "first aid" and "first medical attendance to emergencies" followed by the "course"in emergency medicine" and further training weeks on the "mobile intensive care unit (MICU)" during the "internship" as well as a course on emergency medicine for ambulance doctors and the training on he job by an emergency physician during residency (Table 1). The aim of the course is training competence (psychomotoric skills and clinical competence) for the primary care of life-threatening emergencies. The following educational methods were included in the concept: problem oriented learning, situation-oriented learning, learning by doing (cognitive apprenticeship).

Anesthesiology↗
PubMed1982

Changing patterns of graduate medical education.

Postgraduate medical education underwent substantial change during the 1970s: medical-school classes grew, the internship year was eliminated, and the numbers of M.D.s entering primary-care specialties increased. The purpose of this study is to develop a planning model of graduate medical education that can project the impact of these and other changes on the numbers and specialty mix of physicians completing training. The model is applied to an analysis of trends in graduate medical education and to the probable consequences of policy recommendations made by the Graduate Medical Education National Advisory Committee (GMENAC). The results show that the trend toward increasing percentages of M.D.s entering primary-care specialties from 1970 to 1976 changes to no increase from 1976 to 1980. Thus, the GMENAC policy recommendation to increase primary care further is not likely to occur spontaneously in the near future.

Career Choice↗
PubMed2002

National survey of clinical neuropsychology postdoctoral fellows.

The present study was designed to survey postdoctoral fellows in clinical neuropsychology about their perceptions of a variety of training standards and recommendations. Survey packets were mailed to the 78 training directors listed in Cripe's (1998) most recent listing of postdoctoral training programs at the time of survey. A response rate of 44% was achieved. Results were notable in that most fellows had been trained in clinical psychology, and mostly in Ph.D. programs. Approximately half had been trained and/or supervised by diplomates in clinical neuropsychology from the American Board of Professional Psychology. Continuing education was judged by respondents to be an insufficient substitute for formal training. Most respondents completed internships and postdoctoral residencies in a hospital setting, with greater than 50% of their time devoted to clinical neuropsychology.

Data Collection↗
PubMed1996

Hypnosis training in psychology intern programs.

The use of hypnosis is becoming increasingly common in clinical practice. This article examines hypnosis training in psychology internship programs. A survey was sent to all APA intern programs listed in the APPIC directory requesting information about opportunities for training and utilizing hypnosis during the intern year. Thirteen percent of responding programs (n = 424) reported regular seminars in hypnosis, while another 37% offer elective opportunities. However, of those programs that provide training, the average amount of time was approximately seven hours. The authors conclude that while training is provided to a significant percentage of interns, the amount of time is not enough to allow for its ethical use. It is suggested that as the use of hypnosis increases, training programs may want to consider opportunities for more adequate hypnosis training.

Curriculum↗
PubMed1996

Comparison of PhD programs in clinical and counseling psychology.

This survey of training directors of all APA-accredited PhD programs in clinical and in counseling psychology explored differences in curricula, program characteristics, predoctoral internships, and postdoctoral placements between the two programs. Minor differences emerged between the two types of programs with regard to curricular emphases, but these differences are far outweighed by similarities. Implications are discussed and support provided for the conclusion that a merger of the two specialties may be possible and desirable.

Counseling↗
PubMed2002

Assessment of empathy in different years of internal medicine training.

The operational measurement of physician empathy, as well as the question of whether empathy could change at different levels of medical education, is of interest to medical educators. To address this issue, 98 internal medicine residents from all 3 years of training were studied. The Jefferson Scale of Physician Empathy was administered, and residents' empathy scores correlated with ratings on humanistic attributes made by postgraduate program directors. No statistically significant differences in scores were found among residents of different training levels. Empathy scores remained also stable during internship (test-retest reliability = 0.72). Correlation between empathy and ratings on humanism was 0.17. Thus, the findings suggest that empathy is a relatively stable trait that is not easily amenable to change in residency training programs. The issue of whether targeted educational activities for the purpose of cultivating empathy can improve empathy scores awaits empirical scrutiny.

Education, Medical↗
PubMed2002

Medical students' experiences of diseases in internal medicine in university and community hospitals.

Because medical students in The Netherlands should achieve common national objectives, it is important to know whether clinical experiences in different hospitals are comparable. The research questions were: (1) Do students achieve learning experiences of the required diseases during the internship in Internal Medicine and to what extent do they achieve these experiences? (2) Are there differences between the diseases experienced at a university hospital and at community hospitals? Completed logbooks of students were analysed; the percentage of students that achieved the required diseases and the mean number of experiences of diseases were calculated. A t-test was done to test for differences. Medical students in the university and in community hospitals get broad experience (76-131%) of the required diseases. In both hospitals there are many students who are not achieving the requirements, but the mean number of experiences of students at the community hospitals is higher than those at the university hospital. To eliminate the differences between students from the university hospital and the community hospitals, the educational programmes within both hospitals should be adjusted.

Clinical Competence↗
PubMed2005

Working and training as an intern: a national survey of Irish interns.

The Medical Council of Ireland recently introduced some initiatives to enhance the education and training of interns. These include the development of a generic job description, a logbook to monitor training outcomes and a national network of supervisors to plan and oversee intern training. To get feedback on the impact of these reforms, the Medical Council surveyed all interns with Irish addresses in March 2003. Three hundred (65%) of 461 interns responded. The majority provided positive feedback on many aspects of their education and training, their work environment and professional relationships. However, a majority also reported a lack of protected time for education, a lack of formal educational programmes, insufficient feedback on performance and an unnecessarily stressful work environment. Overall, 61% reported being bullied and 4% had experienced sexual harassment. While feedback on the Irish internship experience is generally positive, further work is necessary to address the problems identified.

Agonistic Behavior↗
PubMed2006

Comparison of basic elements of human performance scores between urologists with various extents of experience.

BACKGROUND AND PURPOSE: An objective evaluation of innate ability and its ability to predict potential success as a surgical trainee is an appealing concept for the selection process of residency applications. The objective of this study was to evaluate whether basic elements of performance (BEP) could discriminate among resident applicants and urologists with various extents of surgical experience. SUBJECTS AND METHODS: One hundred forty-five participants were divided into four study groups: group A, 57 urology residency applicants to the 2002 and 2003 interview process; group B, 8 post-internship urology residents; group C, 19 urologists tested with BEP within 10 years of graduation from their residency training program; and group D, 61 urologists who had graduated from their residency training program more than 10 years prior to testing. The BEP measures consisted of 13 basic performance resources (BPR) including visual-information processing speed, visual-spatial immediate-recall capacity, and neuromotor channel capacity. RESULTS: The four study groups differed significantly in their mean age: group A=27.6 years, group B=29.1 years, group C=37.1 years, and group D=48.9 years (P<0.0005). There was essentially no significant difference between the groups with regard to immediate-recall memory, reaction time simple, or reaction time complicated. The younger participants (groups A and B) were faster than the older surgeons (groups C and D) (P<0.02). However, the older surgeons (groups C and D) were significantly more accurate than the younger groups (A and B) (P<0.0005). The only sex differences noted were in hand-grip strength and shoulder-strength scores, which were all higher in the men. CONCLUSIONS: There generally appears to be a lack of direct correlation between innate abilities and surgical experience. Urology resident applicants with no surgical experience and urology residents with limited surgical experience are faster but less accurate in innate skills testing than experienced practicing urologists.

Adult↗
PubMed1976

A method of developing and evaluating a clinical performance program for physical therapy interns.

A method used by interns and supervisors in developing and evaluating a clinical performance program during a 6-week internship in the Division of Physical Therapy at the University of Michigan Medical Center is presented. This method required a statement of educational resources available, establishment of criteria for judging acceptable performance, statement by the intern of his educational objectives, negotiation of a written contract, and maintenance of a log. The 32 participants thought that this was a rational and acceptable program and stated that they would, if given a choice, elect to follow the same procedure again.

Clinical Competence↗
PubMed2005

Near-miss errors in laboratory blood test requests by interns.

BACKGROUND: Human errors have proven to be one of the most formidable patient care challenges in acute hospital setting. AIM: To evaluate the at-risk period for near-miss errors in laboratory blood test requests, in an acute medical hospital. DESIGN: Hospital-based retrospective analysis. METHODS: We reviewed the database of voluntary reports for near-miss errors for laboratory blood test requests by 104 medical residents in their first postgraduate year (interns), over a 2-year period (October 2002 to September 2004). To identify patterns and causal factors we analysed the reports with respect to months of working experience, work hours, and work shifts of an extended duration. RESULTS: There were 52 near-miss events among patients cared for by the medical service (20 male patients, 32 females, mean age 72.6 +/- 9.7 years). The overall incidence of near-miss events when interns practiced during the first month of training vs. subsequent months was 1.6 (95%CI 0.77-2.9) vs. 0.6 (95%CI 0.44-0.83) cases per 100 intern-days at risk. The odds ratio for a near-miss event during the first month of intern training vs. subsequent months was 2.64 (95%CI 1.29-5.38). With respect to the interns' on-call shift schedule, one half of the near-miss episodes occurred during an intern's on-call days and another half of them during an extended on-call shift; none of the events occurred during a standard working shift. These events peaked in frequency when on-call interns had worked for 12-20 h. DISCUSSION: The first month of internship represents an error-prone period. The best interventions to reduce near-miss errors by recently graduated medical interns should be the subject of further research.

Aged↗
PubMedDate not supplied

Hospital postgraduate training: factors affecting prospective interns' ranking of a municipal hospital program in internal medicine.

This study examines the statistical relationship between potential influencing factors and the rank that prospective intern applicants assigned to Boston City Hospital in the National Internship and Residency Matching Program. Types of factors examined include personal considerations, the applicant's experience during the personal interview, hospital attributes, the academic program itself, and perceived house officer experience. A brief questionnaire was mailed to prospective interns ranked by the Department of Medicine. Analysis of questionnaire data indicates that personal reasons and two hospital characteristics, ancillary staff and type of hospital, were predominant influencing factors.

Boston↗
PubMed1989

Residents' hours and supervision.

One year of graduate medical education, the internship, had become the norm for graduates of most U.S. medical schools by 1920, and subsequently was adopted by most states as a criterion for licensure. The original concept of a "resident physician" carried with it responsibility for patients 24 hours per day, seven days per week. Recent public and media attention to the issues of residents' supervision and working hours has led to governmental efforts to restrict their hours and set minimum requirements for supervision. New York is the first state to impose specific requirements. The New York recommendations have implications for the concept of graded responsibility for residents, for learning the natural course of illness, and for the need to provide service in hospitals. Further, the recommendations raise four objections: they do not recognize differences by type of specialty or year of training; they might affect the length of time needed to acquire aggregate clinical skills; they affect different types of hospitals differently; and they would have a major effect on physician manpower. Hospitals and residency programs will face several difficult choices in responding to the regulations. To provide its members with guidelines for action, the Executive Council of the Association of American Medical Colleges has issued recommendations for residency hours and supervision, including the use of an 80-hour work-week averaged over four weeks, the continued use of graded supervision of residents in emergency rooms and in inpatient and ambulatory settings, and control of housestaff moonlighting.

Emergency Service, Hospital↗
PubMed1994

The Dalhousie University experience of training residents in many small communities.

BACKGROUND: Dalhousie University Faculty of Medicine provides a fully integrated postgraduate medical education program that prepares both primary care and other specialist physicians. Training takes place in many urban and rural communities. METHOD: In 1991-92 reviews were undertaken of the practice locations of (1) the 200 graduates of primary care residencies between 1987 and 1991 who were licensed to practice in one of the four Atlantic provinces and (2) the 371 graduates of other specialty residences between 1981 and 1991, regardless of practice location but including only those programs with more than ten graduates. The graduates of primary care programs had received training in either one-year rotating internships or two-year family medicine programs. RESULTS: Of the primary care trainees, 130 (65%) remained in practice in Atlantic Canada; of these trainees, 74 (57%) had practices in rural locations. For the other specialist trainees, 50% or more of those with practices in the Atlantic provinces practiced in rural locations in the following specialties: general surgery, internal medicine, ophthalmology, and otolaryngology. CONCLUSION: Postgraduate medical education at Dalhousie is somewhat unusual in that all first-year trainees are required to spend time in a small community as part of their training; hence, students who choose programs at Dalhousie often do so because of their interest in experience in a variety of communities, including those outside metropolitan areas. Still, it was surprising that graduates of some non-primary-care specialty programs, in addition to the graduates of the primary care programs, tended to choose rural practice locations. The site of postgraduate training appears to be one of the important factors in the selection of practice locations.

Education, Medical, Graduate↗
PubMed1995

Turning interns into senior residents: preparing residents for their teaching and leadership roles.

To assist new senior residents with their transition from internship to ward-team leadership, a practical teaching course has been implemented at the University of Washington that integrates the residents' roles as teachers and team supervisors. Residents develop leadership and problem-solving skills by discussing sample cases and videotaped vignettes of typical situations they will encounter. Teaching skills are practiced through small-group role-plays, which illustrate brief teaching opportunities in patient care. Residents learn managerial techniques, including how to clarify goals and expectations with team members, to conduct work rounds efficiently, to provide ongoing feedback as well as formal evaluation, and to develop criteria for grading. Emphasis is also given to residents' communication with attending physicians and ways residents can increase the attending physicians' effectiveness on the teams. Residents learn to teach and direct medical students, to refine case presentations, and to include students as valued team members. Because residency stresses can lead to coping problems, residents are taught to recognize burn-out, depression, and signs of substance abuse. Residents have been overwhelmingly positive in their evaluations of and responses to the teaching course. By working to develop problem-solving and teaching skills prior to undertaking their new responsibilities, residents are better prepared to be ward-team leaders. Factors in developing such a teaching course for residents are reviewed.

Curriculum↗
PubMed1997

Comparisons between older and usual-aged medical school graduates on the factors influencing their choices of primary care specialties.

PURPOSE: To examine whether there are differences between older (30+ years) and usual-aged graduates in the factors that influence their decisions to enter primary care. METHOD: A national survey of primary care physicians was conducted by mail in early 1993. The survey population comprised physicians who had graduated from U.S. allopathic medical schools in 1983 and 1984. The questionnaire consisted of four parts: practice characteristics, 19 variables influencing the physicians' decisions to enter primary care (rated on a scale from 5 = very strong influence to 1 = no influence), the timing of the decision to enter primary care, and demographic and personal information. Data were analyzed through several statistical methods. RESULTS: In all, 355 (22%) older and 1,241 (78%) usual-aged graduates who were practicing in primary care specialties responded. Compared with the usual-aged graduates, the older graduates were more likely to have grown up in rural or inner-city areas, to have obtained a second academic degree, and to have made the decision to enter primary care earlier. The older graduates' decisions to enter primary care had been more influenced by children and familial responsibilities, whereas the usual-aged graduates had been more influenced by internship and residency experiences and by parents and role models before medical school. CONCLUSION: This study provides empirical evidence to support the notion that nontraditional students (i.e., older ones) are more likely to commit themselves earlier to a career decision and less likely to be influenced by the socialization process during medical school. In this regard, age-specific factors should receive more attention in the analysis of the physician workforce.

Adult↗
PubMed2001

Retention and use of patient-centered interviewing skills after intensive training.

PURPOSE: Studies show that residents trained in patient-centered interviewing (PCI) are more effective in handling patients' emotions and are more skillful in gathering patients' data. This study evaluated the long-term use of PCI skills. METHOD: Fourteen residents received PCI training during internship, and their skills were evaluated before, immediately after, and two years after their training through directly observed patient interviews. A confidential survey evaluated the residents' actual use of PCI two years after the intensive training. Control groups of 14 interns prior to PCI training and 14 residents from another program not trained in PCI were also surveyed. RESULTS: Residents' use of PCI skills (optimization of setting, establishment of narrative thread, open-to-closed-ended questioning cone, avoid asking more than one question at a time, and (facilitation) were significantly improved, even two years after their training in PCI. The residents who received intensive block training reported using PCI techniques more frequently than did those in the control groups. However, the only significant difference in use of PCI skills between the intervention and control groups was found in reflection of patient's emotions. CONCLUSION: Medical residents retained PCI skills for two years. Further studies are needed to determine whether successful postgraduate training of physicians in PCI translates into a change in behaviors during their professional lives.

Case-Control Studies↗