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PubMed1988

[Developmental continuities of psychoanalysis and psychotherapy in Germany since 1939].

The history of psychoanalysis in Germany during the Second World War must be seen in the context of institutional and professional developments along the lines of the intersection of medicine and psychology during the first half of the twentieth century. The moral ambiguities of the integration of psychoanalysis and psychotherapy into the structures of modern industrial society were magnified and brutally supplemented in the course of the partial professionalization of these disciplines in Germany under the Nazi dictatorship. A study of the continuities in the history of psychoanalysis and psychotherapy in Germany since 1939 can provide insight into the moral and practical vicissitudes of professionalism in modern society as well as into the social history of Germany under Hitler.

Germany↗
PubMed1995

The managerial revolution: medicine as a business.

Medicine and management should be more closely integrated not just at the level of health policy and health services management but also in matters of professional education and training. Learning is a continuous process from entering medical school to retirement and should reflect the transition from learning shaped by the curriculum to learning driven by the needs of the qualified professional in a career service post. The senior clinician does much more than practise clinically. He or she is a leader, a manager, a resource allocator, a teacher and team player. In these roles the values and priorities of the professional and the organization will not always coincide. In postgraduate training and in continuing medical education more joint activity should be developed around 'medicine for non-medical managers' and 'management for doctors'. Much of this shared learning and development will be local and problem-based around local issues of quality, resources and priorities. However, the 'regional' postgraduate dean will play an increasingly pivotal role in maintaining the balance between the needs of the individual and the organization. To achieve this objective of closer integration postgraduate medical education funding should be brought together under a national finance levy against purchasers and allocated through devolved budgets managed by 'regional' postgraduate deans against explicit performance criteria agreed between the professional organizations, universities and health services management.

Capital Financing↗
PubMed1995

The role of users and usergroups in the continuing development of medical record systems for family physicians.

In the Netherlands there is a unique situation in the control structure of the use of IT in Family Medicine. Professional Organizations Software houses, Universities and User groups are working together in the development of a Reference Model. Already in 1985 the first model was created by the Working Committee for Information and Automatisation ( WCIA ). It was decided that this model should be updated every five years. The explained 1995 model, which is now under development, will mean a large step toward changes in enhancing the quality of professional use of IT in Family Medicine, in enhancing the quality of the software and standards in Medical Information Technology.

Family Practice↗
PubMedDate not supplied

Faculty development for teaching online: educational and technological issues.

The purpose of this article is to describe the process of creating a faculty development program for online instruction. Both educational and technological issues are discussed. Factors that will facilitate and barriers that will impede the implementation of online courses are included. Many faculty concerns regarding online courses relate to the issues of quality and student learning. Faculty development activities are directed to ensure that courses are developed using sound educational theory and principles. Online courses are first about student learning; using the technology is second. Thus, faculty development programs must be two-pronged, involving instructional design and technology. It is an ongoing process that must be focused on continual training and development.

Attitude of Health Personnel↗
PubMed2003

ASSERT: the effectiveness of a continuing medical education video on knowledge and attitudes about interpersonal violence.

PURPOSE: Developing ways to educate busy clinicians is especially challenging when the subject includes medical, social, and legal aspects, as is the case with interpersonal violence (IPV). Organizations such as the American Medical Association and the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) recommend routine IPV screening for patients. Videotape efficiently provides training in multiple locations using experts from different fields. The authors created and evaluated a multidisciplinary continuing medical education (CME) videotape on IPV. METHOD: The video, ASSERT: A Guide to Child, Elder, Sexual, and Domestic Abuse for Medical Professionals, was developed by experts from medicine, social work, nursing, and law. The video featured role-plays to demonstrate different approaches to these difficult clinical encounters. Pre- and post-viewing questionnaires assessed the video's effectiveness. RESULTS: In all, 120 physicians and 172 other personnel (e.g., nurses, social workers) at 24 sites associated with four academic medical centers completed paired questionnaires. Using a conservative level of significance (p <.002), there was significant improvement for physicians in 77% of the knowledge items and 75% of the attitude items from pre- to post-viewing questionnaires. A total of 73% of viewers would recommend the video to colleagues. CONCLUSIONS: The IPV video, using experts from multiple disciplines, improved knowledge and attitudes about child, elder, sexual, and domestic violence, and was rated highly by clinicians. The video was useful for preparing for a JCAHO accreditation visit.

Chi-Square Distribution↗
PubMed1985

Presymptomatic testing for Huntington's disease.

Recombinant DNA technology has made possible the identification of a DNA marker for Huntington's disease (HD). In spite of limitations to a presymptomatic test based on this work, and a variety of ethical and policy concerns associated with presymptomatic testing in general, it is likely that such a testing program can and will soon be developed. Its impact needs to be carefully considered by the health care community and policymakers. A presymptomatic test for HD is sought by those at risk and should be made available with proper safeguards to protect confidentiality. Given its potential impact, testing should be offered in a setting that provides diverse and continuing support. Research institutions with a variety of counseling programs, health care professionals, HD lay organizations, and society at large can work together to develop programs that provide the support necessary for responsible, autonomous decision making.

Age Factors↗
PubMed1980

Nursing the dying: implications of Kübler-Ross' staging theory.

Society's failure to value the work of nurses, the professionals most frequently involved in the care of the dying, is attributed to a cultural definition of nursing as a second-class occupation and the public's need to deny the realities of the suffering and indignities often associated with the process of dying. Efforts within the field of nursing to improve the care of the dying, by shifting emphasis from a narrow physical focus to a more holistic patient and family focus, preceded the past decade's contributions of Elisabeth Kübler-Ross. Although her staging theory has been cited as having limitations in development and in interpretation, Kübler-Ross' influence towards increasing awareness of the needs of the dying and others experiencing major losses has been substantial as evidenced by many references to staging theory in nursing literature, by a marked increase in attention to holistic care of the dying in the basic and continuing education programs of nursing, and by specialty role development in nursing care of the dying. This decade has also witnessed the major growth of professionalism in nursing, including strides towards professional autonomy. Conflict with the traditional pattern of medical dominance and bureacratic constraints in institutions is inevitable, especially when the medical goal of cure is not attainable. Change to an interdisciplinary model of care is viewed as essential for optimal care of the dying and their families.

Attitude to Death↗
PubMed2003

The Arts in Medicine: setting up and evaluating a new special study module at Leicester Warwick Medical School.

CONTEXT: A special study module (SSM) option was introduced for medical students at Leicester Warwick Medical School in January 2000. Its aim was to enhance students' knowledge and understanding of people's experiences and emotions in relation to health and sickness through study of the arts. The module was set up and run through collaboration between the medical school and the University of Leicester's Department of English. This paper describes the context of SSMs in the arts and their relevance to medicine, and examines student perceptions of the benefits gained from this particular course. METHOD: Students were exposed to a core series of arts-based seminars, and were given time to research a chosen study topic looking at an artist or art form in relation to health and sickness issue(s). They were assessed on their written submissions on these study topics according to the module objectives. Students were encouraged to develop a reflective style of learning by keeping learning journals. CONCLUSIONS: Evaluation demonstrated that the students considered that their professional development had been enhanced by taking time to study the arts. Students also felt that they would continue to use the arts to this end after the module had finished. Summative assessment showed that the objectives were achievable by the great majority of students.

Attitude to Health↗
PubMed2003

Academic nursing education guidelines: tool for bridging the gap between theory, research and practice.

The aim of the present study was to develop educational guidelines to be used as a tool for the integration of theory, research and practice to ensure that nursing knowledge and practical skills form the basis of academic nursing education. An additional aim was to describe the nursing competence expected of the students at four academic levels: introductory, intermediate and advanced levels I and II. Clinical nursing education plays a crucial role in assisting nursing students to integrate the theory and practice of nursing at the baccalaureate level, as well as in further specialization and in-depth nursing studies at the advanced level. A research group consisting of lecturers from the Institute of Nursing, Göteborg University, Sweden, was given the objective to formulate educational guidelines for clinical practice within nursing education. The study took the form of a literature search. In addition, the Delphi method, aimed at reaching a consensus of opinion among colleagues, was used. Based on the literature review and the collegial discussions, four core concepts emerged: professional stance, reflective processes, problem-solving processes, and practical skills, from which the educational guidelines were developed. Guidelines were formulated both in general and abstract form. They were not connected to a specific care context, specific patient group or specific nursing problems. The most important objective of academic education is that the student develops abilities and techniques necessary for life-long learning. Students will, in their professional life as nurses, continuously meet situations where they are challenged to take appropriate decisions and actions. This demands training in problem-solving, reflection, decision-making and the ability to use both deductive and inductive learning strategies. The guidelines describe what is expected of the students in terms of nursing competence and personal qualifications to ensure that they will be ready to meet the demands of their future profession.

Clinical Competence↗
PubMed2000

Dermatologist and electrologist perspectives on laser procedures by nonphysicians.

BACKGROUND: As hair removal technology continues to evolve and new equipment comes to market, conflicts may develop between dermatologists and electrologists regarding the professional control and use of these devices. METHODS: A total of 1004 Fellows of the American Academy of Dermatology and 719 electrologists from the southern United States were anonymously surveyed about clinical laser procedures (CLPs). RESULTS: Compared to electrologists, dermatologists were more likely to support clinical laser regulations that placed licensed physicians in control (P =.001) and preferred that a delegating physician be physically present on the premises when CLPs were performed (P =.001). If a laser device was invented for permanent hair removal that was identical to traditional needle/probe electrolysis in every respect except energy type ("laser fiberoptic probe," LFP), electrologists were more likely than dermatologists to support independent use of this device by electrologists (P =.001). A greater percentage of electrologists from Texas, a state without electrolysis licensing, were more likely to support the unlicensed use of the LFP and CLPs than electrologists from states requiring electrolysis licensing. CONCLUSIONS: These data are consistent with previously published literature and permit a greater understanding of the multiple attitudinal, regulatory, and ethical issues involved when considering delegated and independent CLPs by electrologists.

Allied Health Personnel↗
PubMed1995

Academic health centers and HMOs: a systems perspective on collaboration in training generalists physicians and advancing mutual interests.

Academic health centers (AHCs) and health maintenance organizations (HMOs) often hold each other at arm's length because of fundamental organizational differences. AHCs view HMOs as too intrusive in the clinical management of patients and too concerned with the financial bottom line. HMOs view AHCs as organizationally fragmented and expensive in providing health care services. AHCs must expand their primary care networks and reassess their mission and public accountability in training a more balanced physician workforce. HMOs are growing rapidly and need well-trained generalist physicians to support that growth. This paper uses an organizational systems model in examining AHCs and HMOs to identify common needs, mutual interests, areas for potential collaboration, and bridging strategies. These include health care systems development, professional education, information management systems, and health services research. As the financing and delivery of health care continue to change and to become more integrated, both organizations have much to gain from collaboration.

Academic Medical Centers↗
PubMed1992

Implementing managed care and case management: the neuroscience experience.

The case management model for patient care in the neuroscience area was recently implemented in the neurosciences area at a tertiary care hospital. Understanding of the concepts of case management and managed care were essential to the implementation process. Clustering of case types and appointment of group leaders made the development of individual care maps a manageable task. Case management of 2 case types, Parkinson's disease and Guillain Barré syndrome are described, including the rationale for selection, care map development and education. The process of continuing education focused on operational issues regarding utilization of the map and professional issues such as health teaching responsibilities.

Cost Control↗
PubMed1994

Terminal care: improving teamwork in primary care using Significant Event Analysis.

Significant Event Analysis can be used to improve the effectiveness of a Primary Health Care Team caring for terminally ill patients. A method of doing this is described in detail. Positive team qualities were confirmed and enhanced. Significant areas for improvement were identified: insufficient information had been given to some key workers, changes in medication had been poorly planned, continuity of care, and emotional and professional support of team members were inadequate. A strategy for change was developed and implemented. Performance was reviewed a year later. It was found that the Significant Event Analysis had caused changes in team practices, and was valid and reliable enough to be used as a tool for improving teamwork in primary care in future.

Humans↗
PubMed2005

Training in family psychology: a competencies-based approach.

After providing an overview of the family psychology landscape and the competencies-based movement in professional psychology, attention is paid to eight family-specific competencies in the following areas: the application of scientific knowledge to practice, psychological assessment, psychological intervention, consultation and interprofessional collaboration, supervision, professional development, ethics and legal issues, and individual and cultural diversity. Effective strategies for providing family-focused education and training to psychology trainees at the doctoral, internship, and postdoctoral levels and to psychologists through continuing professional education in these core competency domains are provided.

Clinical Competence↗