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PubMed2002

Evidence for longitudinal ambulatory care rotations: a review of the literature.

PURPOSE: Block ambulatory rotations and longitudinal ambulatory care experiences are now common in U.S. medical schools, but little is known about their efficacy. Through a structured review of the medical literature from 1966 through March 2000, the authors summarize the characteristics of, the evidence for, and the evaluation of longitudinal ambulatory care rotations. METHOD: The authors searched Medline using the terms "outpatients," "continuity of patient care," "ambulatory care," "mentors," "preceptorship," "graduate medical education," "curriculum," and "clinical clerkship" cross-matched to "medical students" and "internship and residency" for literature published from 1966 through March 2000. They narrowed the list to only articles containing empirical outcome data focusing on medical students' experiences in longitudinal ambulatory care rotations. Each study was scored to assess its strengths and weaknesses. RESULTS: Seven articles met the search criteria. The articles identified the benefits of longitudinal ambulatory care experiences, including developing effective patient interactions and understanding chronic diseases. There were little or no differences in the students' overall knowledge acquisition when those with longitudinal experiences were compared with those in block rotations. DISCUSSION: Although longitudinal ambulatory care experiences are now common in medical schools, evidence supporting their widespread implementation is sparse. Few studies employ rigorous methods to evaluate educational outcomes. Research to identify benefits and costs, improve the quality and consistency of the students' experiences, and develop other innovative ways of teaching and learning ambulatory care is needed.

Ambulatory Care↗
PubMed2003

Assessing medical students' training in end-of-life communication: a survey of interns at one urban teaching hospital.

PURPOSE: Although interns are responsible for caring for dying patients, little is known about end-of-life education and training, including communication skills, in U.S. medical schools. This study of three consecutive cohorts of new interns assessed their perceptions of the amount and types of classroom and clinical instructional strategies used during medical school, their self-rated skill and comfort levels in different aspects of end-of-life communication, and the associations between these measures. METHOD: A self-administered questionnaire was given to three consecutive cohorts (1996-1998) of incoming interns (n = 162). Measures were self-reported amount and type of education and clinical experience with four end-of-life communication domains (giving bad news, discussing advance directives, discussing prognosis with the patient, and discussing with the patient's family) and self-perceived comfort and skill levels in relation to different types of end-of-life communication. RESULTS: A total of 157 interns completed the questionnaire. They reported very little classroom teaching, clinical observation, or clinical experience with end-of-life communication during medical school. They lacked comfort and skill in the end-of-life communication domains that were studied. More reported clinical observation and experience with caring for and communicating with dying patients was associated with greater perceived comfort and skill, while classroom teaching was not. CONCLUSIONS: These interns, mostly U.S. medical school graduates (98.7%, n = 155) reported little training and low self-perceived comfort and skill with important elements of end-of-life communication that might contribute to a lack of preparedness to address these issues during their internship. Further research that confirms and explains the underlying reasons for these findings seems warranted.

Adult↗
PubMed2004

Tracking the longitudinal stability of medical students' perceptions using the AAMC graduation questionnaire and serial evaluation surveys.

BACKGROUND: This study examined the longitudinal stability of students' perceptions by comparing ratings on similar survey items in three sequential evaluations: end-of-clerkship (EOC), AAMC graduation questionnaire (GQ), and a postgraduate survey (PGY1). METHOD: For the classes of 2000 and 2001, ratings were compiled from EOC evaluations and comparable items from the GQ. For both cohorts, selected GQ items were included in the PGY1 survey and these ratings were compiled. Matched responses from EOC versus GQ and PGY1 versus GQ were compared. RESULTS: Proportions of "excellent" ratings were consistent across EOC and GQ surveys for all clerkships. Comparison of GQ and PGY1 ratings revealed significant differences in only seven of 31 items. CONCLUSION: Student perceptions as measured by GQ ratings are notably consistent across the clinical years and internship. This longitudinal stability supports the usefulness of the GQ in programmatic assessment and reinforces its value as a measure of student satisfaction.

Attitude↗
PubMed2005

Mood change and empathy decline persist during three years of internal medicine training.

PURPOSE: To examine longitudinal changes in mood and empathy over the course of the internal medicine residency. METHOD: The authors conducted a cohort study of 61 residents who completed the Profile of Mood States (POMS) and the Interpersonal Reactivity Index (IRI) at six time points during their internal medicine residency at a university-based program. (POMS was administered five times, and IRI was administered six times.) The main outcomes measured were trends in mood disturbances and multiple domains of empathy over the three-year residency, and comparisons to norms. RESULTS: Response rates varied from Time 1 to Time 6 (98%, 72%, 79%, 79%, 94%, and 95%, respectively). Interns had better scores on four POMS subscales: Depression-Dejection (p = .0031), Anger-Hostility (p < .0001), Fatigue-Inertia (p < .0001), and Vigor-Activity (p < .0001) compared with later administrations, especially midinternship. By the end of residency all POMS scores were returning towards baseline (effects sizes in the .20 s), but only depression was no longer significantly different. IRI scores showed the decline in Empathic Concern remained over residency whereas Personal Distress peaked midinternship year but approached baseline at the end of residency. Compared with the general population, the graduating residents were less tense, depressed, and confused. Personal Distress was significantly lower than the norm group. CONCLUSIONS: Internal medicine residency presents challenges resulting in common mood disturbances. Although graduating residents appear to be better off than the population norms, some domains of their mood disturbances and empathy never fully recover from their internship year.

Affect↗
PubMed2005

The Health Policy and Legislative Awareness Initiative at the Pennsylvania State University College of Medicine: theory meets practice.

In a constantly evolving health care landscape shaped by many voices--including those of third party payers and government--physicians must learn to play a more proactive role to become better advocates for their patients and to uphold the basic tenets of their noble profession. As legislation and public health become increasingly intertwined with the practice of medicine, educators must provide future physicians with the tools to meet these new challenges. Accordingly, in 1996 Pennsylvania State University College of Medicine embarked on its Health Policy and Legislative Awareness Initiative, a medical school elective designed to provide theoretical knowledge as well as practical experience in legislative and policy issues for future physicians early in their careers. The Initiative has three key elements: a series of lectures taught by national and local experts covering a basic health policy curriculum, a mini-internship conducted at the office of a Pennsylvania State legislator, and a practical assignment leading to authorship of a resolution to a national medical organization or assisting in drafting a bill intended for introduction to the Pennsylvania State Legislature. Following several years of successful implementation and a moderate growth in enrollment, recent changes in the local and national scene have peaked the interest of most students to learn about the system in which they will practice medicine. Therefore, in addition to describing the Initiative in its current form, the authors discuss future plans for expanded elective opportunities and consider the issue of integrating health policy education into core medical school curricula.

Curriculum↗
PubMed2005

Residents' end-of-life decision making with adult hospitalized patients: a review of the literature.

PURPOSE: The authors performed a structured literature review to understand residents' experiences with end-of-life (EOL) decision making with adult hospitalized patients, specifically regarding decisions to withhold or withdraw advanced life-support measures. METHOD: An Ovid-based strategy was used to search Medline, ERIC, PsychINFO, and CINHAL databases for articles published between 1966 and February 2005, combining the domains of "resuscitation orders," "decision making," and "internship and residency." All quantitative and qualitative studies examining residents' EOL decision making with adult hospitalized patients were included. The authors developed and applied a scoring system for relevance and quality, performed data abstraction and quality assessment independently and in duplicate, then met to collate findings and identify factors in residents' EOL decision making. RESULTS: The searches yielded 884 articles, of which 26 were included. Variable methodologies precluded meta-analysis. In these studies, residents felt unprepared to handle patient EOL decision making, although exposure to EOL discussions helped them gain confidence. Residents' attitudes, skills, and knowledge were key determinants of whether EOL decisions were addressed. Many misinterpreted the terms "DNR" and "futility." Residents' understanding of the patient EOL decision-making process could be extremely variable, and their do-not-resuscitate discussions suboptimal. Residents' lived practice experience of the patient EOL decision-making process was often at odds with what they were taught in formal curricula. CONCLUSIONS: Educational strategies aimed at changing residents' knowledge, skills and attitude should address the hidden curriculum for the patient EOL decision-making process that is part of the experienced culture of every day practice. Future studies of this experienced culture would inform specific educational interventions.

Adult↗
PubMedDate not supplied

Critical care education: experience with a community-based consortium approach.

A continuous cycle of new orientees, cost-containment issues related to orientation, and conflicting job priorities prove to be challenging adversaries for critical care educators. The San Diego Chapter of the American Association of Critical Care Nurses (AACN) has met some of these educational challenges by providing a community-wide, consortium-based Critical Care Nursing Internship Program (CCIP) for novice critical care nurses. Over the last 15 years this CCIP has been instrumental in providing comprehensive education for more than 2,200 novice critical care nurses in San Diego County. This article discusses the background, rewards, and current challenges of the program. It also addresses a comparison between consortium-based education and the National AACN Essentials of Critical Care Orientation (ECCO) Program.

California↗
PubMed1989

Child psychiatry program directors' ratings of residency experiences.

Child and adolescent psychiatry program directors' (PDs) were asked to complete survey forms to rate the importance of required residency experiences and express views on length of training. There was a 93% return rate of questionnaires sent to the 129 academic programs represented in the Society of Professors of Child and Adolescent Psychiatry. The majority of PDs favor the status quo and do not want to add or subtract from the present requirements. Experiences most favored were those with older children, adolescents, and parents, and those in the use of psychopharmacology. Least favored experiences were with cognitive therapy, research, psychological testing, and teaching. There was little interest in eliminating the internship year or residency time with adults.

Adolescent Psychiatry↗
PubMedDate not supplied

Clinical engineering practicum: a new approach in clinical engineering education.

The emerging concept of a clinical engineer is that of a practitioner of engineering science as it applies to hospital medical devices and the technology of health care delivery. Therefore, in addition to the theoretical and scientific aspects of the clinical engineer's education, there must also be some form of experiential education under proper guidance. For most university-based clinical engineering programs, this takes the form of a hospital internship. The transition between the academic environment to the hospital environment is not always a smooth one, as there is a type of "culture shock" brought on by the new and extremely demanding situation encountered in the hospital. In an effort to improve the transition from university to hospital and allow the student to focus more sharply on his or her professional goals, the concept of the clinical engineering practicum was developed. Its function is to be an introductory learning experience and half-way point between the hospital and the university.

Biomedical Engineering↗
PubMedDate not supplied

Education of clinical engineers in the 1990s.

This paper presents definitions of the terms bioengineering, biomedical engineering and clinical engineering. These definitions lead to the conclusion that clinical engineers must be individuals with at least a four-year bachelor's degree in an engineering specialty who are also well versed in the design, modification and testing of medical instrumentation. Educational programs for clinical engineers in the 1990s must be based upon clear definitions of these professionals' roles. Clinical engineering education should include direct professional experience obtained through internship programs similar to the program described here.

Biomedical Engineering↗
PubMedDate not supplied

The BMET (biomedical equipment technician) career.

This feature article provides an overview of Biomedical Equipment Technician (BMET) careers. Job descriptions and career paths are given for BMET Is, IIs, IIIs, Equipment Specialists and Supervisors, including actual examples of career paths taken by BMETs "in the field." The usual educational requirements for each career are discussed, as well as internship programs such as the one at University Hospital in Stony Brook, New York. The Wentworth Center for Clinical Engineering (Boston) is given as an example of a collaborative BMET educational venture involving hospitals, industry, and students. BMET certification is discussed as a professional option. Finally, BMET careers in industry, shared services and government are described.

Allied Health Occupations↗
PubMedDate not supplied

Focus on: Westchester County Medical Center Division of Biomedical Engineering.

The Division of Biomedical Engineering (DBME), a vital element in the structure of any medical center, provides complete biomedical equipment services at Westchester County Medical Center (WCMC), through a Biomedical Instrumentation Program. Under this program, the DBME assumes direct responsibility for all diagnostic imaging equipment in radiology, radiation medicine and nuclear medicine; and patient care, surgical life support (respiratory care) equipment in critical care units, operating rooms, G.I. (gastro-intestinal) suites, renal center, burn center, emergency rooms, as well as clinical laboratories. In addition, the DBME provides academic and internship programs, research, design, database support, technology planning, and device inspection or evaluation. The DBME is "looking into the future" for a gradual migration of state-of-the-art technology into healthcare.

Biomedical Engineering↗
PubMed1979

Physicians' changing attitudes about striking.

Both interns and residents and practicing physicians express substantial support for physicians' organizing for collective bargaining and striking. These findings, from 1146 respondents to a 1976 survey of the alumni of the Albert Einstein College of Medicine, indicate that profound changes have occurred in physicians' views on these issues. Although the greatest support for striking came from interns and residents, with 67 per cent of them indicating they think physicians should be allowed to strike, the survey found an increasing pattern of militancy commencing with 1964 graduates. Physicians in private practice and those who spent two-thirds or more of their time in direct patient care were the most likely to support strikes by physicians (60 per cent), while the least support came from those fulltime on medical school faculties (39 per cent). No differences in support for striking were found in relation to sex, religion or size of community in which physicians practice. A longitudinal examination of the medical school Class of 1975 at matriculation, at graduation and during internship training reveals that a major growth of support for striking occurred between matriculation and graduation.

Attitude of Health Personnel↗
PubMed1986

Intern ranking versus subsequent house officer performance.

The rankings of candidates for pediatric internship by the Pediatric Intern Selection Committee (ISC) of the University of Virginia Medical Center were compared with subsequent performance rankings of house officers by faculty members and chief residents. Although a positive correlation was found between the rankings, the absolute magnitude of the correlation coefficients was relatively low and not statistically significant. We discuss factors responsible for the poor correlation and suggestions for ISCs.

Clinical Competence↗
PubMed1995

Recruiting the occupational and environmental medicine physicians of the future: results of a survey of current residents.

In July 1994, current occupational and environmental medicine (OEM) residents (n = 180) were surveyed about their motivation for decisions to enter OEM residencies, near-term and long-term career goals, and their opinions on various strategies for recruitment to the field. A total of 151 persons responded (84%), representing all 40 accredited OEM residencies in the United States and Canada. A total of 16% first learned about OEM in medical school, and 11% were first exposed during residency training. Most respondents (62%) decided to enter OEM residency training after beginning their professional working careers. Only 11% of respondents decided to enter OEM residency training before (2%) or during (9%) medical school, whereas 24% made their decision during internship or residency. Respondents were attracted to several aspects of OEM, but the prevention focus of the field (64%), lifestyle (56%), and worker and labor issues (53%) were most commonly cited. Although only 25% of respondents stated that a role model had a significant impact on their decision to pursue training in OEM, persons influenced by a role model were more likely to have made the decision to pursue a career in OEM during medical school or clinical residency training (odds ratio = 2.4; 95% CI, 1.0-5.4; Fisher's exact two-tailed P value = 0.04). In the short term, residents were most often interested in working for industry (32%), whereas over the long term, careers in consulting were most often preferred (39%). The data have important implications for strategies to increase recruitment to residency training programs in OEM and to increase staffing in the field.

Canada↗
PubMed1996

Optimizing professional education in public health.

Traditional public health education has lacked required practicums such as are the rule in other health professions. Described is a model professional education program that is built around required course work in all areas of public health and a series of mandatory internships at sites of public health practice, utilizing state and local health departments, other federal and state agencies, and public and private sites where students are supervised in public health rotations similar to those a medical, dental, nursing, or veterinary student would experience in a clinic or ward.

Curriculum↗
PubMed2006

The programs and context of medical education in Argentina.

There are 29 medical schools in Argentina (this number has increased rapidly in the last decade) offering a 6-year curriculum that usually consists of 3 years of basic science, 2 years of clinical sciences, and one internship year. Annually, 5,000 physicians graduate from these programs. Admission requirements vary depending on each university's policy. Some do not have entry requirements; others require a course, usually on the basics of mathematics, biology, chemistry or physics, and some introduction to social and humanistic studies. Each year, there are approximately 12,000 first-year medical students attending the 29 schools, which suffer a high dropout rate during the first years because of vocational problems or inability to adapt to university life. Some schools have massive classes (over 2,000 students), which makes it difficult for the schools to perfect their teaching. The number of full-time faculty members is low, and some of them have appointments at more than one medical school. Residency programs offer an insufficient number of places, and fewer than 50% of the graduates can obtain a residency position because of strict admission requirements. Coordination between the Ministry of Health, representing the health care system, and the Ministry of Education, representing the medical education system, needs to be improved. Despite the problems of medical education in Argentina, the movement to improve the education of health care workers is growing. The author offers two recommendations to help accomplish this goal.

Accreditation↗
PubMed2001

Description and use of the neuroscience nursing self-efficacy scale.

An instrument for assessing nurses' perceived self-efficacy in implementing a variety of neuroscience nursing tasks was developed. Self-efficacy theory served as the guiding framework. From 1988 to 1998, the instrument was used to assess changes in the perceived self-efficacy of 54 nurses who attended a neuroscience nurse-internship program. Self-efficacy was assessed during clinical orientation, prior to the beginning of the program, and at the end of the program. The results showed that the nurses' confidence in performing a variety of neuroscience nursing skills increased during the 6- to 10-month program. The instrument was also useful in helping program directors identify areas in which nurses could benefit most from the program and refine the program to meet the educational needs of the nurses.

Clinical Competence↗