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PubMed2001

Humor in therapy: the case for training therapists in its uses and risks.

Formal humor training for therapists is proposed as an elective part of their academic curriculum. The paucity of rigorous empirical research on the effectiveness of this historically controversial form of clinical intervention is exceeded only by the absence of any training for those practitioners interested in applying humor techniques. A representative sample of its many advocates' recommendations to incorporate humor in the practice of psychological therapies is reviewed. Therapeutic humor is defined, the role of therapists' personal qualities is discussed, and possible reasons for the profession's past resistance to promoting humor in therapy are described. Research perspectives for the evaluation of humor training are presented with illustrative examples of important empirical questions. In addition to its potential salubrious effects on clients, therapeutic humor might have the positive side effect of preventing or minimizing professional burnout in therapists. This potentially major psychotherapeutic resource, highly praised by some, remains insufficiently evaluated and essentially untapped.

Humans↗
PubMed2003

Errors in a busy emergency department.

STUDY OBJECTIVE: We describe errors occurring in a busy ED. METHODS: This is a prospective, observational study of reported errors at an academic emergency department (ED) with 100000 annual visits. Trained personnel interviewed all ED staff with direct patient contact, during and at the end of every shift, by using standardized data sheets. RESULTS: One thousand nine hundred thirty-five ED patients registered during the 7-day study period in the summer of 2001. Four hundred error reports were generated, identifying 346 nonduplicative errors (18 per 100 registered patients; 95% confidence interval [CI] 15.9 to 20.0). Forty percent of errors were reported by nurses, 25% by providers, 19% by clerical staff, 13% by technicians and orderlies, and 3% multiple reporters. Errors reported for every 100 hours worked were similar for all groups (5.5; 95% CI 5.2 to 5.9). Errors were categorized as 22% diagnostic studies, 16% administrative procedures, 16% pharmacotherapy, 13% documentation, 12% communication, 11% environmental, and 9% other. Patients involved in errors were more likely to be older (P <.0001) and more likely to have higher visit level intensity (P <.0001) than registered ED patients. Ninety-eight percent of errors did not have a significant adverse outcome. Seven errors (0.36 per 100 registered patients; 95% CI 0.14 to 0.72) were associated with an adverse outcome. CONCLUSION: Reported errors occurred in almost every aspect of emergency care. Ninety-eight percent of errors in the ED do not result in adverse outcomes. System changes need to be implemented to reduce ED errors.

Academic Medical Centers↗
PubMed1999

Pediatric and Adolescent Gynecology experience in academic and community OB/GYN residency programs in Michigan.

OBJECTIVES: The purpose of this study is to assess training in Pediatric and Adolescent Gynecology (PAG) at the Obstetrics and Gynecology (OB/GYN) resident level. SETTING: Two large Michigan programs were studied: a university-based, inner-city program, and a suburban, community-based program. Seventy-one questionnaires were distributed to the residents, and descriptive and inferential analysis of answers to demographic, training, attitude, and knowledge-based questions regarding PAG was performed. RESULTS: Sixty-one questionnaires were returned, a response rate of 86%. The majority of respondents reported no PAG rotations or clinics and recalled limited didactic sessions with only 0-2 lectures. Ninety-eight percent of university residents and 94% of community residents requested more PAG training. Comfort levels about PAG issues were assessed on a 5 point scale (1 = low, 5 = high comfort); university residents scored 3.7 with pediatric patients and 4.4 with adolescents, and community residents scored 4.0 with the pediatric age group and 4.3 with adolescents. However, both groups responded with familiarity to knowledge based questions only 61% of the time. CONCLUSIONS: OB/GYN residents in both academic and community programs report little experience and scant training in PAG but express interest in obtaining the skills and information needed. It is concerning that residents lack the basic knowledge that is required for the routine daily care of this patient population. More emphasis needs to be placed on these issues in OB/GYN residency training programs.

Adolescent↗
PubMed1998

Primary health care needs for travel medicine training in Britain.

BACKGROUND: In the UK, travel health advice is mainly provided by practice nurses and general practitioners (GPs). The need for their improved education in travel medicine has been highlighted through previous studies and by an increasing number of requests for training. METHODS: A questionnaire-based survey of 3900 GP practices was conducted to assess training requirements and to establish the demand for an academic course in travel medicine. 1430 (37%) questionnaires were completed. RESULTS: 93% of practices provided a pretravel advice service. 87% of GPs advised an average of 10 travelers per month and only 48% immunized travelers. 98% of nurses advised and immunized an average of 28 travelers a month. 21% of GPs and two-thirds of nurses had attended one or more training sessions in travel medicine. Over 90% of the sample (83% of GPs and 98% of nurses) expressed an interest in attending a formal training program in travel medicine. Eligibility for Post Graduate Education Awards (PGEA) was important for most GPs (88%). Nurses valued approval by the English National Board for Nursing (88%) and a system of Credit Accumulation & Transfer (CATS) (82%). Funding for a course would be met in full by 18% of respondents (mainly GPs) and a further 20% would contribute to fees. Most GPs and nurses have ready access to a range of information sources, e.g., a postgraduate medical centre (85%) and a medical library (91%). Computerized access to information was feasible as 93% had a computer and 54% had a modem attached. CONCLUSIONS: The discipline of travel medicine is becoming increasingly specialized. Future practitioners will need to enhance their skills to meet the demands of today's travelers. Our results show that general practice staff are keen to develop such skills. Specialist training courses need to be expanded to meet this demand.

Communicable Disease Control↗
PubMed1998

Socioeconomic issues and education of neurologic surgery residents in the United States.

BACKGROUND: The goals of this project were to ascertain the extent to which socioeconomic issues are being formally addressed within neurologic training programs in the United States and to determine the perception of chief neurosurgery residents and program directors regarding training and preparation as it relates to these issues. METHODS: The chief neurosurgery residents and program directors for the 1995 academic year were identified and mailed a survey with questions regarding the formal training of socioeconomic issues within their programs. RESULTS: Residents indicated that 95% did not believe their residency program provided adequate training in socioeconomic issues; 97% and 95% respectively, did not feel adequately prepared to deal with the business aspects of a medical practice or to deal with insurance companies and the managed care environment; and 87% did not think they were adequately prepared to deal with a lawsuit. Moreover, from 25%-87% did not know the meaning of terms such as capitation, RVUs, PPOs, or IPAs. The program directors indicated that 58% of the programs did not formally deal with socioeconomic issues. CONCLUSIONS: This survey indicates that socioeconomic issues are not currently being properly addressed in a large proportion of neurosurgical residency programs. An overwhelming majority of the residents did not feel they are adequately prepared to deal with those nonmedical-surgical aspects of the practice of neurosurgery. This perception was corroborated by the response of the program directors. There appears to be a significant deficiency in the training of neurosurgical residents with regard to socioeconomic issues in the United States.

Education, Medical↗
PubMed2005

An analysis of the Research Fellowship Scheme of the Royal College of Surgeons of England.

BACKGROUND: The Research Fellowship Scheme of the Royal College of Surgeons of England commenced in 1993 with the aim of exposing selected surgical trainees to research techniques and methodology, with the hope of having an impact on surgical research and increasing the cadre of young surgeons who might decide to pursue an academic career in surgery. Over 11 million pounds sterling (approximately US 20 million dollars) has been invested in 264 fellowships. The College wished to evaluate the impact of the Scheme on the careers of research fellows, surgical research, and patient care. As the 10th anniversary of the Scheme approached. STUDY DESIGN: Two-hundred and sixty research fellows whose current addresses were available were sent a questionnaire. Two-hundred and thirty-eight (91.5%) responded. RESULTS: Three-quarters of the research fellows conducted laboratory-based research, with most of the remainder conducting patient-based clinical research. One-third of the fellows who have reached consultant status have an academic component to their post. The total number of publications based on fellowship projects was 531, with a median impact factor of 3.5. Almost all fellows had been awarded a higher degree or were working toward this. Half of the fellows received subsequent funding for research, mostly awarded by national or international funding bodies. CONCLUSIONS: The Research Fellowship Scheme of the Royal College of Surgeons of England has successfully supported many trainee surgeons in the initial phase of their research career. It has helped surgical research by increasing the pool of surgeons willing to embark on an academic career. Indirectly, patient care has benefited by promoting an evidence-based culture among young surgeons. Such schemes are relevant to surgical training programs elsewhere if more young surgeons are to be attracted into academic surgery.

Biomedical Research↗
PubMed1986

End user searching at Indiana University School of Dentistry: tailoring a program for a specific user group.

While many librarians support the concept of end user searching, they fear that large costs will be incurred with the introduction of such a program. This article describes an economical end user training program which was developed at the Indiana University School of Dentistry. End user training at IUSD is fully self-supporting and has been tailored to meet the needs of a very specialized user group.

Academic Medical Centers↗
PubMed1982

Surgical and urologic manpower in the United States, 1969 to 1978.

Between 1969 and 1978 the number of board-certified urologists increased by 71 per cent, while the population of the United States increased by 8.2 per cent. In 1978 the ratio of board-certified urologists to population was 1:32,416 and 326 of 370 first-year residency positions available in urology in the United States were filled. If we continue to produce urologists at the present rate the urologist to population ratio will be approximately 1:25,972 by year 2000. Thus, it appears that there are now too many urologists being trained yearly, which was indicated by 68 per cent of the academic program directors surveyed in 1979. In fact, to restore the ratio of urologist to population approximately 1:35,000 by year 2000 the number of urologists being trained yearly should be reduced to 156 or by approximately 50 per cent. The only reasonable chance of achieving a reduction in urologists being trained in the near future is by voluntary decreases in the size of training programs. There are many consequences of overproduction of urologists, including unnecessary surgery, atrophy of skills among practitioners and diminution of major training programs because of lack of patient referrals. Therefore, this issue is of equal importance to private practitioners and to academicians.

General Surgery↗
PubMed1984

The VA psychiatry service as a setting for residency education.

The authors report data from a survey of chairmen of academic departments of psychiatry and chiefs of Veterans Administration (VA) psychiatry services concerning administrative relationships between academic psychiatry departments and VA psychiatry services and the education of psychiatry residents in VA settings. The extent and quality of relationships, the interdependence of academic departments and VA psychiatry services, factors important for good VA training, and advantages and disadvantages of using the VA for residency education are documented. The authors present their conclusions and recommendations for improving the quality of relationships between academic departments and VA psychiatry services and for strengthening psychiatric education in the VA setting.

Academic Medical Centers↗
PubMed2006

Adherence of academic geriatric practitioners to osteoporosis screening guidelines.

OBJECTIVES: To examine the bone mineral density (BMD) testing habits of geriatricians and geriatric fellows at the University of Connecticut fellowship training program to evaluate their adherence screening guidelines. DESIGN: Retrospective chart review. SETTING: University based academic geriatric practice in Farmington, CT. PARTICIPANTS: Chart review of two hundred female patients over age 65 under care of seven faculty geriatricians and eight geriatric fellows in training. MEASUREMENTS: Data collected included BMD testing status, patient's osteoporosis risk factors and functional status. RESULTS: Physicians ordered BMD tests in 151 (76%) patients; 128 (64%) had a bone mineral density test within three years. A personal history of fracture was the only osteoporosis risk factor that correlated to higher rates of osteoporosis testing. Physicians were more likely to order BMD screening in younger patients (92% in 65-74 vs. 74% in ages 85+, P=.031), patients independent in activities of daily living (72% vs. 32, P=.002), and patients without dementia (70% vs.37%, p=.007). BMD testing results found 82% with osteopenia or osteoporosis. CONCLUSIONS: A geriatric group that is highly attuned to bone health demonstrated more optimal adherence to OP testing guidelines for all "at-risk" older women and better than reported previously. Functional status more strongly predicted BMD testing than osteoporosis risk factors. This study suggests that with improved physician education and familiarity with the disease, high rates of BMD testing for earlier identification of geriatric patients at risk for osteoporosis are achievable.

Activities of Daily Living↗
PubMedDate not supplied

Training surgery residents in group practice management.

As health care delivery continues to grow in complexity and uncertainty, academic practitioners must integrate clinical disciplines with research, financial management, marketing, law and many other areas. Jill Ridky, Ph.D., and Tom Bennett, M.B.A., D.Div., M.S.W., write about survey results on the current use and need for practice management training in residency programs.

Academic Medical Centers↗
PubMed1981

The nature of U.S. rheumatology practice, 1977.

A description of academic and community rheumatologist practice activities in the United States has been assembled from 826 responses to a 1977 survey of American Rheumatism Association members. Reported work hours and patient load are similar to other medical subspecialists, and three-fourths of the clinical time is devoted to persons with predominantly rheumatic disease problems. Significant differences in activities occur between academic and community practices and among rheumatologists with different training backgrounds. Few characteristics vary significantly across geographic regions containing divergent rheumatologist-population ratios. Descriptive productivity measures such as these are necessary for planning; they provide part of the empirical analysis required to give reality to manpower policies.

Academic Medical Centers↗
PubMed1998

Quo vadis, my transplant fellow: a discussion of transplant surgery fellowship training activity in the United States and Canada: 1991-1997. Education Committee of the American Society of Transplant Surgeons.

This is a discussion of transplant surgery fellowship training issues that pertain to educational quality guidelines of fellowship programs, the number of fellows being trained, and the individual's fate in securing transplant surgery positions after training. In 1995, the Council of the American Society of Transplant Surgeons (ASTS) revised the academic guidelines to enhance the educational standards of programs seeking ASTS approval as a transplant surgery fellowship training program. The criteria for accrediting training programs in kidney and liver transplant surgery were redefined, and new criteria for pancreas transplant surgery training were developed. Regarding the number of transplant surgery fellows being trained per year, during the period from 1991 to 1997, a total of 327 transplant surgery fellows completed training at ASTS-accredited transplant surgery fellowship training programs. The annual number of transplant surgery fellowship graduates has remained nearly constant at approximately 45 per year. However, the proportion of transplant surgery trainees who are foreign medical graduates has increased annually since 1995. Currently, 49% of the trainees are foreign medical graduates. Regarding the individual's fates in securing transplant surgery positions after training, the proportion of U.S./Canadian medical graduates who received transplant surgery training during the last year but are practicing in surgical disciplines other than transplant surgery appears to be increasing. Before 1996, it was rare for transplant surgery trainees to pursue surgical practice activities that did not include transplantation. Among the current group of 28 U.S./Canadian medical graduates who completed transplant surgery training between January 1997 and July 1997, six did not secure an acceptable position in transplantation. Instead, they are practicing in either general surgery or vascular surgery, or obtaining additional transplant training. These changes in the demographics and dynamics of transplant surgery fellowship training activity provoke important concerns.

Canada↗
PubMed2002

Facial nerve monitoring in chronic ear surgery: US practice patterns.

OBJECTIVE: The use of intraoperative facial nerve monitoring (IOFNM) improves facial nerve outcomes in acoustic neuroma surgery, but the role of IOFNM in chronic ear surgery (CES) is poorly defined. This study was performed to identify IOFNM practice patterns in the United States for CES. METHODS: A 10-item survey was mailed to a random sample of 500 active members of the American Academy of Otolaryngology-Head and Neck Surgery. RESULTS: The overall response rate was 45.2%. Of the respondents, 75% had access to IOFNM, and of this group, 66% used IOFNM at least some of the time. Otolaryngologists trained in the 1990s (P < 0.0001), those in an academic setting (P = 0.02), and those who perform more otologic than other types of surgery (P = 0.004) were more likely to use IOFNM. Although most respondents had access to IOFNM, only 32% thought that IOFNM should be required for CES. CONCLUSIONS: The majority of otolaryngologists who perform CES have access to IOFNM and will use it at least some of the time. IOFNM use is especially prevalent in otolaryngologists who have trained recently and in more experienced otologic surgeons. However, there are strong feelings against requiring IOFNM for CES.

Facial Nerve↗
PubMed2005

Revitalization of academic medicine in Albania.

The Faculty of Medicine in Tirana, the only institution providing medical training in Albania, has currently developed three separate branches of study, General Medicine, Dentistry, and Pharmacy. Since the early 1990s, following the collapse of the communist regime, many faculty members have been trained abroad in different areas of medical sciences. Yet, little emphasis is placed on research work and teaching of evidence-based medicine in both, undergraduate and postgraduate studies. Medical students are not exposed to sources of evidence, searching techniques, and important medical databases, such as PubMed and Cochrane Library. Exposing medical students and young physicians to probabilistic thinking, the importance of communication, and levels of evidence in medical practice is what the academic medicine in Albania should strive for. To address this challenge, the Faculty of Medicine in Tirana needs to strengthen the mobility of its students and their training in Western schools. These young and well-trained faculty members will provide the critical mass of future academicians required to develop a modern medical school in Tirana.

Academic Medical Centers↗
PubMed2001

Surgery in the United Kingdom.

Surgery in the United Kingdom has been practiced for nearly 2000 years. It has evolved as a result of the experiences of warfare and the introduction of the scientific basis of surgery. The influence of the 4 surgical royal colleges in setting standards for training and examinations has ensured that new surgeons are equipped for independent practice as consultants. Responsibility for the National Health Service rests with the government, which determines the number of trainee surgeons in the various surgical specialties. Conflicts between service provision and training are highlighted, as are the pressures on academic institutions to meet the demands of clinical surgery. The government's National Health Service plan for England promises a major expansion in undergraduate places and an increase of 7500 consultants in all specialties by 2004. Time will tell if these changes lead to an improvement in surgical services and a reduction in waiting times.

Education, Medical↗
PubMedDate not supplied

Survey of medicine/pediatrics residency training programs.

The American Board of Internal Medicine and the American Board of Pediatrics agreed in 1967 to create combined medicine/pediatrics residency training programs. These programs span four years and provide 24 months of training in each discipline, leading to Board eligibility in both. Little is known about their curricula because there is no separate residency review committee to critique the current programs. The directors of the 65 current programs were surveyed by mail. Fifty-seven (88%) responded to questions about: lengths of time programs had been in operation, attitudes toward quality of residents, program structures and curricula, and performances of graduates taking the Boards. More than half of the programs were established after 1980. Forty of the programs' graduates have passed the Medicine Boards, and 48 have passed the Pediatrics written Boards. Most programs were structured to have residents switch specialties every six months. Program Directors, both in Medicine and in Pediatrics, rated the quality of combined program residents the same as or slightly better than that of residents in non-combined programs. Medicine/pediatrics residencies have become a successful and important source of training for generalists' careers in and outside of academe, and in both primary and specialty care.

Humans↗
PubMed1996

Appraisal system for community child health doctors.

An appraisal system for Community Child Health Doctors in Nottingham is described and evaluated. All staff are invited to an annual meeting with their consultant, preparation documents having been filled in by both appraisee and appraiser beforehand. These form the basis of the session, which is predominantly a self-assessment. A written report of the appraisal is produced, with sections on current performance (kept by appraiser and appraise only), training needs, and objectives (copies sent to the academic team and the medical manager). The system was assessed by questionnaires to both appraisers and appraisees. There was general agreement that the system had been adequately explained, and that the preparation documents and the appraisal time were useful. The written report was generally accepted as being a reliable record of the appraisal. Three of the fifteen appraisees were unhappy with the system, feeling it was a negative experience which concentrated on weaknesses. Others made positive comments. It was not always possible to achieve protected time. Some of the reports were delayed. The appraisal system described was found to be acceptable and workable by most people involved. The need for adequate administrative and clerical support was noted.

Attitude of Health Personnel↗