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PubMed2002

Pressures on dental education--a personal view.

Dental schools and hospitals currently find themselves in the awkward position of being expected to be more productive whilst suffering a shortage of resources. In essence, they are expected to provide both education and NHS healthcare, yet scant attention is paid to the urgent issue of the resources required to achieve this. The same is true in medicine where the Government has promised 2000 more medical school places by 2005, a rise of almost 60%, to guarantee a decade of unprecedented expansion in doctor numbers in the NHS. However, the country's ability to train doctors is compromised by a shortage of academics available to teach them.

Delivery of Health Care↗
PubMedDate not supplied

Statistics in physiology and pharmacology: a slow and erratic learning curve.

1. Learning how to apply statistical analyses to the results of experimental or clinical studies may take a lifetime of trial (and sometimes error), as it has done in the author's case. There is no evidence that biomedical investigators of the present generation are on a steeper learning curve. Gross misunderstandings of the purpose and functions of statistical analysis are apparent in applications to research grant-giving bodies and ethics committees, in manuscripts submitted to journals and sometimes in published papers. 2. Although estimation of minimal group (sample) size for a given power is an essential step in planning clinical studies, it seems to be used rarely in laboratory experimental work. This is despite exhortations to restrict the number of animals used to a minimum. 3. Most investigators use hypothesis testing to analyse their results, but their understanding of the meaning of the resultant P-values is slight. 4. A flaw found almost universally in biomedical manuscripts is to make multiple inferences from the results of a single study. The goal of statistical analysis is to maintain the familywise type I error rate (risk of false-positive inference) at a predetermined level (usually 5%). But, when multiple inferences are made from the same experiment, the risk of false-positive error is inflated. There are two solutions to this problem: (i) use a multiple comparison procedure to control the familywise type I error rate; and (ii) test a single, global hypothesis. 5. Biomedical investigators have been quick to acquire computer statistics software and to use it to analyse their experiments. However, they have been slow to recognize the limitations of this software. These include: (i) inadequate documentation of routines, so that neither the user nor the reader of published papers can be sure how the tests have been executed; (ii) flawed algorithms for the execution of statistical procedures; and (iii) failure to recognize that the best software for their purposes is that which takes them just beyond their statistical horizons. 6. The obvious solution to these difficulties is to recruit a biomedical statistician into every research group, at a relatively trivial cost. However, properly qualified biostatisticians are in desperately short supply in Australia. It follows that research groups, national grant-giving agencies and academic institutions must make provision for the proper training and subsequent employment of biostatisticians.

Data Interpretation, Statistical↗
PubMed2004

Suicide-preventive activities in psychiatric care: evaluation of an educational programme in suicide prevention.

To promote implementation of suicide-preventive activities, the Swedish National Centre for Suicide Research and Prevention of Mental Ill-Health (NASP) introduced a 200-h academic, postgraduate educational programme (based on the training-of-trainers model) in suicide prevention. This programme was provided at Karolinska Institute, Stockholm, for key persons in psychiatric care. Twenty-nine key persons from 11 psychiatric intervention clinics in Stockholm County attended the first course. Preconditions for implementing suicide-preventive activities were assessed by means of semi-structured interviews with all course participants still working in the intervention clinics (n=10). In all but one of these 10 clinics, a wide range of suicide-preventive activities had been implemented as a result of the NASP course. Activities varied in scope, but the key persons seemed to have succeeded in pinpointing the key elements in suicide prevention - the need for specific knowledge about the suicidal process and for well-defined suicide-preventive routines. However, organizational factors and staff turnover were obstacles to maintaining and making the activities routine. There is a need to strengthen the course participants' formal roles as implementers and encourage the clinical management in their continuous implementation of suicide-preventive activities.

Adult↗
PubMed1987

Recruitment and retention of minority students in a physician assistant program.

The authors report two years of experience in the recruitment and retention of minority physician assistant students and the employment patterns of graduates from one physician assistant program. Recruitment strategies increased the proportion of minority students to 54 percent in the first year of the program and to 44 percent in the second year. The number of years of postsecondary education and clinical experience acquired by the minority students before admission to the program tended to have less impact on their performance in training than did their prior completion of formal academic degree programs and prior level of clinical responsibility. Attrition was higher for the minority students than nonminority students, and the minority students took longer than nonminority students to complete the program. The rates at which the students passed the certifying examination of the National Commission on Certification of Physician's Assistants were comparable for the two groups. Minority graduates tended to practice in areas of health manpower shortage.

Adult↗
PubMed1995

Educating physicians for the twenty-first century.

The author reviews the fundamental changes that have taken place in the U.S. health care system since 1935, predicts what that system will be like in the early part of the next century, and discusses the implications for academic medicine. Specifically, he maintains that physicians being trained today will practice within the context of large organizations, with payment for care being either by employment-based insurance or by some form of government-subsidized insurance. Care will be delivered across diffuse networks, and most physicians will be paid according to capitation or salary schemes. The role of technology will be high and will revolutionize the health care system, which will be focused on prevention and maintenance of function rather than cure. The success of the system will be measured by its cost-effectiveness and by how well it works to maintain the mental, social, and physical functions of its participants. Finally, the obligation of the physician will be not only to individual patients but also to the populations and communities from which patients come. Training physicians to meet these obligations and to function effectively in the revolutionized system will involve changes in medical education to more appropriately socialize students into the next century's medical culture. The author reviews in detail the various elements of the medical culture that must be addressed by medical education, gives examples of the kinds of changes that must be made, and describes efforts at his school to reinforce across the curriculum the population-based model of clinical practice.

Attitude of Health Personnel↗
PubMed1997

Protecting time for teaching in the ambulatory care setting.

The current drive for efficient clinical teaching threatens the educational mission of academic medical centers. With pressures to increase clinical productivity, protected time and compensation for teaching have become scarce resources for clinical teachers in all settings. Although it may yield new approaches to education, the push for efficiency may ultimately result in insufficient time for teaching and may cause some clinical preceptors to stop teaching completely. Further, it may lead to the illusion that comprehensive teaching truly requires little time. Since the future of American health care depends upon the provision of high-quality clinical education to young physicians, this situation presents a potential national crisis. In this article, the authors discuss the complex nature of teaching, its time requirements, and the special challenges of teaching in outpatient settings. To avoid overemphasizing efficiency to the detriment of education they recommend adhering to two principles: (1) academic medical centers are educational as well as training institutions, and therefore should provide a broad-based education as well as training in clinical skills; and (2) the clinical teaching process is complex and adequate time must be provided for its many phases, including planning, instructing, and reflecting. Finally, the authors make recommendations for ensuring the delivery of high-quality education in ambulatory care settings.

Ambulatory Care↗
PubMed1998

Leading among leaders: the dean in today's medical school.

The magnitude and pace of change in the health care environment demand that medical schools change. Leading in a time of great change is difficult, and it is ironic that just when stability in leadership is most needed, the average tenure of deans is dropping. Indeed, the path to leadership in academic medicine is strewn with inherent ironies, paradoxes, and idiosyncrasies. For example, few people who become leaders in academic medicine aspire to, plan for, or seek training for leadership, yet leadership skills are essential to meet today's complex institutional demands. Also, most medical school deans were once medical students, and were selected and trained to be assertive, independent physicians, not to collaborate. For faculty, the medical school environment traditionally values individual autonomy and rewards individual achievement, not behavior that supports a larger community interest. Yet today's deans must be skilled at collaborative behavior, since they must have a vision for their schools and find ways to offer direction to the faculty and others to realize that vision. The author offers ideas about leadership and its development, and stresses that good leaders must above all curtail their egos in order to do what is best for their institutions. What a dean does as an individual is not nearly as important as what a dean enables others to do. The author also provides a checklist of dean's characteristics and responsibilities to help deans-to-be understand the job and current deans to think about how to succeed and thrive. He concluded by reiterating that the culture of individual faculty success based on individual entrepreneurism is passé. To operate in the new collaborative culture, today's successful dean must meld persuasion with educational statesmanship, always informed by a vision of how the school can prosper and serve.

Education, Medical↗
PubMedDate not supplied

Continuing medical education: interests of former and current residents of a physical medicine and rehabilitation residency program.

To plan targeted, relevant continuing medical educational activities, a study was undertaken to assess demographic data, practice patterns, and current continuing medical educational needs of former graduates of the physical medicine and rehabilitation program. A survey was sent to the 168 physicians who had completed a physical medicine and rehabilitation residency program from 1961 to 1995 and to the 34 then current residents in the program. Questions were asked regarding gender, year of completion of residency, certification, fellowships, current employment situation, size of practice community, work time distribution, and busiest areas of clinical practice. In addition, from a list of 47 topics plus "other," the respondents indicated in which topics they had a current strong interest in continuing their education. They also responded to questions about their most important considerations when deliberating about attending an educational activity, the amount of notice required regarding an upcoming course, and the preferred duration of educational activities. The response rate of former residents was 56% and of then current residents was 100%. Topics of interest to greater than half of the respondents, in descending order, were musculoskeletal/soft tissue disorders, therapeutic injections/nerve blocks, industrial medicine, back and neck pain rehabilitation, and sports-related disorders. There were significant differences on some topics based on gender, year of residency completion, academic affiliation, private practice, and ratings of residency training in that topic. The most important consideration when deciding whether to attend an educational activity was, by far, interest in topic, followed by provision of continuing medical educational credits. There are among physiatrists several differences in educational interests that challenge continuing medical education planners to determine efficient, effective ways to deliver continuing medical education to meet these needs within the financial and time constraints imposed by today's clinical practice.

Athletic Injuries↗
PubMed1997

Characteristics of occupational medicine practitioners and practice in Canada.

To obtain baseline information with respect to occupational medicine practice in Canada, a questionnaire survey of members of the Occupational and Environmental Medical Association of Canada was carried out by mail in 1993. One hundred eighty-six responses were received (56% of the membership). The average age of the respondents was 49.5, 12% were female, and 55% worked full-time in occupational medicine. Practice types included corporate settings (58%), clinics (23%), government agencies (14%), worker's compensation boards (7%) and academic settings (5%). Sixty percent had some formal training in occupational medicine, and 46% had occupational medicine certification by either the Royal College of Physicians and Surgeons of Canada, the Canadian Board of Occupational Medicine, or the American Board of Preventive Medicine. Younger physicians were more likely to be female and have gone directly into occupational medicine. Women were more likely to be working full-time in occupational medicine but worked fewer hours per week. Those physicians with specialty qualifications were older and more likely to be working full-time in occupational medicine and be active in professional activities. The Association intends to continue surveying its members on a triennial basis, identifying trends in the practice profiles and continuing education needs.

Adult↗
PubMed1989

Some ambiguities of the student's role in undergraduate nurse training.

Proposed changes in the way in which nurses are educated and trained will lead to stronger links between the academic and practical worlds of nursing. However, little or no attention has been focused on the potential difficulties associated with such a move for the student in this new and changing role. Important ambiguities of the student's role need to be addressed if the degree nursing student is to make the most of available opportunities for learning. In this paper we draw a distinction between two kinds of ambiguity in the role of nursing degree student during clinical placements. The first type is essential to the very nature of degree education in nursing, since the ambiguities here all entail problems in bridging the gap between the world of practical nursing and that of education. They include whether he or she is to regard the role as one of learner or producer of work; whether to become unreflectively acculturated to the organization or to reflect on its norms and values; and the student function within the organization. A second kind of ambiguity is not essential to nurse education, but is an unintended consequence of placement arrangements. The student is thrust into the clinical field as a short-term member of an organization; their position is anomalous and the motive for their involvement is largely different from that of permanent employees. These ambiguities of the role are also the source of important learning opportunities.

Attitude of Health Personnel↗
PubMed1999

The Royal Melbourne Hospital Lithium Clinic.

The Lithium Clinic at the Royal Melbourne Hospital was an innovative program for the management of mood disorders. The Clinic was a model for teaching and research, as well as a vehicle for expert treatment of patients. Many psychiatrists gained valuable experience and training during their period of involvement and many academics and psychiatric researchers were involved with the Clinic. Important research was performed in the Clinic, some aspects of which are highlighted in this paper.

Antimanic Agents↗
PubMed1998

Interdisciplinary collaborative training for school-based health professionals.

Changes in the nation's health and education systems have mandated that disciplines work together in a coordinated and collaborative manner to meet the complex health and educational needs of children and adolescents. This need for interdisciplinary collaborative training becomes even more of an issue for professionals providing services in school-based health centers. Although several foundation projects have focused on training health care professionals and other service disciplines, there are relatively few reports of interdisciplinary training of school health professionals. Two projects--the California State University Interprofessional Collaboration Training Project and the Catholic University of America School Nurse Practitioner Program--are reviewed and suggestions are presented for expanding interdisciplinary training of school-based health professionals in academic institutions.

Adolescent↗
PubMed2003

Spirituality and religion in Canadian psychiatric residency training.

OBJECTIVE: Mental health professionals are increasingly aware of the need to incorporate a patient's religious and spiritual beliefs into mental health assessments and treatment plans. Recent changes in assessment and treatment guidelines in the US have resulted in corresponding curricular changes, with at least 16 US psychiatric residency programs now offering formal training in religious and spiritual issues. We present a survey of training currently available to Canadian residents in psychiatry and propose a lecture series to enhance existing training. METHODS: We surveyed all 16 psychiatry residency programs in Canada to determine the extent of currently available training in religion and spirituality as they pertain to psychiatry. RESULTS: We received responses from 14 programs. Of these, 4 had no formal training in this area. Another 4 had mandatory academic lectures dedicated to the interface of religion, spirituality, and psychiatry. Nine programs offered some degree of elective, case-based supervision. CONCLUSION: Currently, most Canadian programs offer minimal instruction on issues pertaining to the interface of religion, spirituality, and psychiatry. A lecture series focusing on religious and spiritual issues is needed to address this apparent gap in curricula across the country. Therefore, we propose a 10-session lecture series and outline its content. Including this lecture series in core curricula will introduce residents in psychiatry to religious and spiritual issues as they pertain to clinical practice.

Canada↗
PubMed2001

Career success after flexible training in psychiatry: a survey of former flexible trainees in the Thames regions.

This article outlines the findings of a study which indicate that flexible training in psychiatry was considered adequate to prepare doctors for both full-time and part-time work and that those wishing to work part time had no difficulty in finding jobs after accreditation. However, there was evidence to suggest that part-time consultants experienced more problems and less job satisfaction and that part-time training and working may restrict opportunities for an academic career.

Adult↗
PubMed1994

Using student-managed interventions to increase homework completion and accuracy.

We examined the effectiveness of self-managed individual and group contingency procedures in improving the completion and accuracy rates of daily mathematics homework assignments. A group of sixth-grade students having homework difficulties in mathematics were selected for the study. There was substantial improvement in the amount of homework completed over baseline for a majority of the students, whereas the results for accuracy were mixed. Students who participated in the self-management training made significant gains on standardized measures of academic achievement and curriculum-based measures of classroom performance. Parents also reported significantly fewer problems associated with homework completion following the intervention. Students who were allowed to select their own performance goals made superior improvements in the number of homework assignments returned compared to students who were given a specified goal by the classroom teacher. Parents, subjects, and the classroom teacher responded positively on consumer satisfaction measures following termination of the study.

Journal Article↗
PubMedDate not supplied

Collaborative e-learning using streaming video and asynchronous discussion boards to teach the cognitive foundation of medical interviewing: a case study.

BACKGROUND: Advances in electronic technology have created opportunities for new instructional designs of medical curricula. OBJECTIVE: We created and evaluated a 4-week online elective course for medical students to teach the cognitive basis for interviewing skills. METHODS: Ten students, from 2 medical schools, studied online modules on interviewing concepts and viewed videos illustrating the concepts. They then participated in asynchronous discussion groups designed to reinforce course concepts, stimulate reflective learning, and promote peer learning. RESULTS: In qualitative evaluations, learners reported improvements in self-awareness; increased understanding of interviewing concepts; and benefits of online learning vs face to face learning. Participants reported high levels of satisfaction with online learning and with achievement of course objectives. Self-reported knowledge scores increased significantly from pre-course completion to post-course completion. CONCLUSIONS: Online education has significant potential to augment curriculum on the medical interview, particularly among students trained in community settings geographically distant from their academic medical center.

Clinical Competence↗
PubMed1989

National Study of Internal Medicine Manpower: XVI. Subspecialty fellowship programs, 1988 update.

Much of the debate about medical manpower during the 1980s has focused on the growing number of medical subspecialists. We examined the number of subspecialty fellows since 1976, paying particular attention to data collected in the 1987-1988 academic year. The number of fellows in subspecialty training at a given time has increased by 27% since 1976; however, much of this increase is due to the increased length of the training programs. The number of first-year fellows has increased only 7% since 1976. Growth in the number of fellowships has varied by subspecialty. The number of fellowships in geriatrics, critical care, and general internal medicine has increased dramatically. Additionally, the traditional subspecialties-cardiology, pulmonary disease, gastroenterology, infectious diseases, rheumatology, and allergy-immunology-have all grown to some extent. Program directors in all subspecialties anticipate continued growth in the coming years.

Fellowships and Scholarships↗
PubMed1989

Celebration: AHRA (American Healthcare Radiology Administrators) 15th anniversary. Changes in education.

Fifteen years have witnessed great change in methods of training radiologic technologists. Formerly, on-the-job training was the norm; now schools with stringent academic and clinical standards are the prime source for employees. These papers reminisce, note the evolution and progress of education, and cite the current shortage of qualified people in the field.

Education, Continuing↗