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PubMed2004

Surgery or general medicine--a study of the reasons underlying the choice of medical specialty.

CONTEXT: The reality of medical services in Brazil points towards expansion and diversification of medical knowledge. However, there are few Brazilian studies on choosing a medical specialty. OBJECTIVE: To investigate and characterize the process of choosing the medical specialty among Brazilian resident doctors, with a comparison of the choice between general medicine and surgery. TYPE OF STUDY: Stratified survey. SETTING: Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (HC-FMUSP). METHODS: A randomized sample of resident doctors in general medicine (30) and surgery (30) was interviewed. Data on sociodemographic characteristics and the moment, stability and reasons for the choice of specialty were obtained. RESULTS: The moment of choice between the two specialties differed. Surgeons (30%) choose the specialty earlier, while general doctors decided progressively, mainly during the internship (43%). Most residents in both fields (73% general medicine, 70% surgery) said they had considered another specialty before the current choice. The main reasons for general doctors' choice were contact with patients (50%), intellectual activities (30%) and knowledge of the field (27%). For surgeons the main reasons were practical intervention (43%), manual activities (43%) and the results obtained (40%). Personality was important in the choice for 20% of general doctors and for 27% of surgeons. DISCUSSION: The reasons found for the choice between general medicine and surgery were consistent with the literature. The concepts of wanting to be a general doctor or a surgeon are similar throughout the world. Personality characteristics were an important influencing factor for all residents, without statistical difference between the specialties, as was lifestyle. Remuneration did not appear as a determinant. CONCLUSION: The results from this group of Brazilian resident doctors corroborated data on choosing a medical specialty from other countries with different social and educational characteristics. This congruence indicates that the choice involves very similar desires and needs in different settings and has little dependence on the students' educational context.

Adult↗
PubMed2004

Education in pharmacoeconomics: an international multidisciplinary view.

There is a global need for more training in pharmacoeconomics. Pharmacoeconomics is a relatively new discipline that draws from other more established disciplines; hence, multidisciplinary collaboration is recommended. Descriptions of opportunities for pharmacoeconomics education can be found in the literature and on websites, but research on the trends in pharmacoeconomics education is largely limited to training in US pharmacy schools. Although basic pharmacoeconomics concepts and methods can be standardised for different countries and cultures, specific applications and examples will differ by region. There are also different levels of educational need (awareness, application, conceptualisation) and different methods of receiving pharmacoeconomics education (short courses, internships, fellowships, graduate degrees). In order to assess educational goals, some educational programmes have moved toward the concept of developing and measuring 'learning outcomes', defined as the knowledge, skills and attitudes needed to fulfil the societal roles expected of the learner. This method can improve the standardisation of the educational process; however, there is still much work to be done in order to achieve real consensus on 'learning outcomes' in pharmacoeconomics.

Clinical Competence↗
PubMed2005

Design and initial results from a supported education initiative: the Kansas Consumer as Provider program.

Despite increased attention to consumer-providers, there remains a lack of models that prepare, support, and sustain consumers in provider roles. This article describes the Consumer as Provider (CAP) Training program at the University of Kansas School of Social Welfare, which creates opportunities for individuals with severe psychiatric disabilities to develop knowledge and skills to be effective as human service providers. CAP fosters a partnership between colleges and community mental health centers where students experience classroom and internship activities. Outcome from a 2-year longitudinal study on CAP graduates indicates increased employability, especially in social services field, and higher post-secondary educational involvement.

Adult↗
PubMed1997

Evaluating the impact of a clinical training program in the addictions.

This research examined students who were enrolled in a specialized addiction treatment training program to evaluate the impact of this year-long internship experience on their professional lives. Achieving an 87.5% survey completion rate, the vast majority of program graduates assessed the overall training program and its component activities very positively. The topics and activities associated with "drug dependence" were evaluated more positively than the training events associated with pathological gambling. Furthermore, the majority of program graduates obtained jobs in the addiction field. As a result of the training program, approximately 74.5% of respondents stated that they had changed their beliefs about addiction. In addition, many respondents commented that their participation in the program changed their stereotypes of people with addiction. The findings provide suggestions and guidance for other clinical training programs that can gain from the experiences of fellows who studied at the Norman E. Zinberg Center for Addiction Studies.

Adult↗
PubMed2006

Future directions in training zoological medicine veterinarians.

The American College of Zoological Medicine (ACZM) is dedicated to excellence in furthering the health and well-being of both captive and free-ranging wild animals. Currently there are 14 ACZM-approved residency programs in zoological medicine. In addition, eight non-approved residencies and 15 internships in North America provide training opportunities in this field. This article outlines some of the training opportunities for both veterinary students and graduate veterinarians that would best position them for entry into a zoological medicine training program. Although there is a growing number of opportunities for individuals to serve in captive and free-ranging wildlife health positions, existing training programs are inadequate to meet these needs. It is also acknowledged that there is an increasing number of veterinary students entering veterinary schools with an interest in zoological medicine and that the job market is still limited. However, positions and opportunities in zoological medicine are available for those individuals with the drive, dedication, and passion to succeed.

Animals↗
PubMed1998

Experiential learning of clinical skills by beginning nursing students: "coaching" project by fourth-year student interns.

To fulfill the requirements for the internship program, fourth-year academic nursing students participated in a leadership program and became coaches for novice students who were beginning their first clinical rotations in the hospital. The concept of coaching is recognized in theory, research, and clinical education as an educational tool, which provides mutual benefits for the coachee and the coach. The project lasted 12 weeks, 2 clinical days per week. The coaches served as a source of support and knowledge and assisted in problem solving for the beginning students. As nurse educators who oversaw the project, the authors summarized the program as it was developed and implemented at the Assaf HaRofeh School of Nursing including problems, revisions, and final conclusions and discussion.

Education, Nursing, Baccalaureate↗
PubMed1975

Residency training in primary care internal medicine. Report of an operational program.

The Primary Care Program at the Massachusetts General Hospital is designed to develop competence in the full range of problems encountered by general internists delivering primary care. House staff spend 3 years in the program, which starts with internship, includes a senior residency, and fulfills the requirements for board eligibility in internal medicine. Half of the training is provided in outpatient care settings. House staff assume responsibility for organization and operation of an ambulatory medical unit. In addition, there is supervised instruction in office gynecology, orthopedics, ear, nose and throat, dermatology, and psychiatry. Close integration with the traditional inpatient-oriented training program is maintained to ensure commensurate growth and competence in management of acute, life-threatening disease.

Boston↗
PubMed1999

Placebo medication use in patient care: a survey of medical interns.

The use of placebo medication, long recognized by clinicians, often has serious practical implications, such as patient deception. Past evidence has suggested that resident physicians tend to misuse placebo medication. Interns from two consecutive years of a residency program were surveyed anonymously to assess their knowledge and use of placebos. Of the 74 interns surveyed, 44 (59%) were familiar with placebo use in patient care. Fifty percent of these interns familiar with placebo use had learned about placebos from another physician. All interns who had learned about placebos during their internships had learned from another physician, whereas interns who had gained their knowledge of placebos as medical students were as likely to have learned from the medical literature as they were to have learned from a physician (P = 0.027). Interns aware of placebo use were more likely to consider placebo administration for suspected, factitious pain (P = 0.022). The present study uncovered no relationship between interns' estimations of placebo efficacy and the utility they attributed to placebos in assessing a complaint of pain. This suggests that conceptual inconsistencies underlie their use of placebos. Interns often learn of placebos as medical students and are influenced by physician-mentors. Placebo use in patient care is an area of attention for medical educators.

Health Knowledge, Attitudes, Practice↗
PubMed1995

The evolution of pharmacy residency training programs and corresponding standards of accreditation.

Practice-based pharmacy training has a long history, particularly in institutional pharmacy practice. Formal pharmacy residency training programs and accreditation standards were first developed in the early 1960s. Practitioners now practice in a much different environment. Residency programs and accreditation standards have changed dramatically to meet the needs of practitioners, patients, and employers. The authors trace the evolution of programs from general internships through clinical practice and specialty residencies and fellowships and the development of standards and competency-based training.

Accreditation↗
PubMed1995

Graduate health administration field experiences: a university and health service delivery systems partnership.

The importance of experiential components of education to professional preparation has been evidenced in the curricula of academic institutions in several disciplines. Graduate programs in health administration offer a variety of alternative residency, internship, and other field experiences for students to apply academic theory to practical phenomena. Using a case study approach, this article presents the advantages of field experience options to both students and health care delivery sites. Components of a model of experiential alternatives in a graduate health administration program are described.

Curriculum↗
PubMed1998

Optimal internship/residency-interview assignments for health care administration student placement.

Interview assignment is an issue of importance to all health care administration programs containing internships and residencies. More generally, many master's and doctoral level educational programs in social work, clinical psychology, and other health fields are faced with the interview assignment problem. We present a linear programming approach, which has been employed at the Baruch College/Mt. Sinai School of Medicine Graduate Program in Health Care Administration, for determining optimal internship/residency-interview assignments. Specifically, a capacitated transportation model, with the objective of maximizing the overall utility of the interview assignments, was implemented. This research is intended to demonstrate to academic program directors dealing with such problems the value of this objective method and to assist educators in their efforts to optimize the student internship/residency placement process at their various institutions.

Career Choice↗
PubMed1988

Management education focuses on new leadership ideas.

A widely accepted new leadership approach concerns transactional and transformational leadership. Transactional leadership consists of planning, implementation, and evaluation. Transformational leadership consists of charisma, intellectual stimulation, and individualized consideration that can motivate followers. The six orientations that characterize the Catholic healthcare ministry imply both types of leadership. Fundamental values, knowledge, and skills required for healthcare organization management are acquired through health administration education. The themes prevalent in today's Catholic healthcare ministry and the leadership qualities they imply are addressed by all aspects of such education: degree programs, field experience, continuing education, and research and consultation. Much of a master's degree program concentrates on transactional leadership because its content is better formulated and easier to teach. The development of transformational leadership qualities during master's study primarily provides a foundation on which students can build. Health administration programs in cooperation with healthcare organizations have created three models for field experience: internships, residencies, and fellowships. Many master's programs deliver continuing education programs for both types of leadership, and research and consultation contribute to this education.

Catholicism↗
PubMedDate not supplied

[Post-graduation aspects in Medical School of the Universidade de Minas Gerais].

The post-graduation at Medical School of Federal University of Minas Gerais (UFMG) is composed by 9 courses and has been for 30 years. Among these, 6 courses have Masterate and Doctorate levels, and 3 have only Masterate. It has already been produced 584 thesis and dissertati Doctorate courses with A (20%), B (20%), C (60%). The average amount of produced thesis and dissertations has been through 2 and 8 by year. The integration proposal of Medical internship and Masterate will be an opportunity of reducing the length of Masterate. The Post-Graduation Center (CPG) coordenates the post-graduation politics and activities at Medical School of UFMG.

Brazil↗
PubMed1999

Decreasing supply of family physicians and general practitioners. Serious implications for the future.

OBJECTIVE: To document a decrease in the supply of family physicians (FPs) and general practitioners among Canadian graduates of medical schools since rotating internships ceased to serve as a route to national licensure. DESIGN: Review of data from the Association of Canadian Medical Colleges, the Canadian Post-M.D. Education Registry, and the Canadian Institute for Health Information to track final training fields and eventual types of practice of graduates of Canadian faculties of medicine from 1987 to 1997. SETTING: Canadian faculties of medicine and residency training programs. MAIN OUTCOME MEASURES: Number of Canadian medical graduates entering family medicine training programs from 1991 to 1998, number of Canadian graduate physicians exiting from these training programs, and proportion of each graduating class (1987 to 1994) practising as FPs or GPs in Canada in 1997. RESULTS: In 1993, 890 physicians (51% of graduates) were trained as FPs or GPs. By 1994, although the proportion remained at 40%, the number of Canadian graduates entering family medicine had dropped to 646, and by 1998, to 619. CONCLUSIONS: A deficit of FPs is already noticeable in the practice environment. For the way in which medical care is delivered in Canada, with FPs serving as first contact for patients, the authors conclude that the number of graduating FPs in Canada will not be sufficient to provide the primary care services Canadians need.

Canada↗
PubMed1999

[Reflections apropos of the 3d cycle of general medicine in French universities].

Since more than thirty years following scientific advances and according to recommendations from (Brussels) European Community Commission, medical studies reform has continuously progressed. These reforms have been applied as well to the third cycle. The National Evaluation Community using comparative evaluation and notation for each medical university has tried to acknowledge the quality of these reforms. One cannot ignore the efforts made by medical schools, although results obtained in theoretical and practical learning for this third cycle of general practice are not altogether satisfying. Several reflections can be underlined: lack of definition of general practice is in part responsible for its marginalization along medical studies course; an obvious disinterest from university leaders in teaching medical practice, and an internship examination now essentially meant for specialization in is also to be blamed for social disqualification of general practice.

Curriculum↗
PubMed1999

[Emergency and intensive care medicine as an interdisciplinary training requirement].

While substantial and practical qualification for medical practice within the framework of emergency medical services have to be proven by an advanced training, there are no special training programs for in-hospital emergency situations. As in the emergency room a transparent in-hospital emergency management has to be established including definite competencies to avoid time delays and inadequate treatment due to disputes about competence. Especially surgical intensive care medicine is an interdisciplinary task, requiring the participation of the surgeon as a responsible partner. Thus, the physician working in ICUs needs professional qualification and specialized knowledge as well as marked competence to co-operate. In any case the final clinical responsibility has to be taken over by physicians who not only have performed their internship on a ICU but are highly qualified in the whole range of intensive care medicine including all topics required in advanced intensive care medicine curricula.

Clinical Competence↗
PubMedDate not supplied

Screening for chronic impairments using medical interns in rural Haryana, India.

BACKGROUND: With the increase in life expectancy, prevalence of impairments and disabilities are expected to increase in India. However, there have been very few studies to estimate the magnitude of the problem in rural India. This is essential, if appropriate rehabilitation services are to be planned in the country. METHODS: The study was done in the rural field practice area of the All India Institute of Medical Sciences at Ballabgarh, Haryana. The survey was conducted by successive batches of interns posted at Ballabgarh as a part of their compulsory rotating internship programme. The diagnostic criteria were based on history and simple clinical examination done at the domiciliary level. RESULTS: A total population of 25,509 in twelve villages were screened. The total impairment rate was 5.4% with no significant men/women difference. The prevalence of physical impairment was 4.7 per 1000 population. The prevalence of corneal opacity in children below 15 years of age was 4.7 per 1000. Prevalence of cataract was almost 35% in the population over 60 years of age and 15% in the population between 45 to 60 years. Auditory impairment was 19.6 per 1000 as ascertained by history. Three-fourths of this was conductive deafness and was found mainly in people above 60 years of age. CONCLUSION: Utilizing the rural field practice areas of medical colleges for collection of data on issues of national health importance would not only strengthen the health system in the country but also improve medical education. There is a need for a comprehensive preventive, promotive, curative and rehabilitative approach to disabilities in India.

Adolescent↗