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PubMed2005

A look at the educational preparation of the health-diagnosing and treating professions: do dietitians measure up?

Basic educational requirements for dietitians were developed almost 80 years ago and remain largely unchanged. In the interim, other health professions have increased their academic standards. A review of the educational preparation of 16 health-diagnosing and treating professions was undertaken to better understand the standards for dietetics education within a larger context. Educational standards for each profession were obtained and reviewed for types of degrees; duration of post-secondary, college-level education; division of didactic and clinical education; and presence of accredited post-professional education. Findings reveal that at least 11 of the professions studied offer first professional degrees. Differences were noted in duration and sequencing of undergraduate education, didactic or classroom education, and especially supervised practice. Models to facilitate comparison between educational standards were developed. The current educational model in dietetics is designed to prepare entry-level practitioners and academics who comprise less than 20% of the profession. This review supports the need to investigate educational opportunities for beyond-entry-level dietitians, and to develop educational programs that amplify the existing models for educating dietitians.

Accreditation↗
PubMed2006

The scope of naturopathic medicine in Canada: an emerging profession.

In Canada, naturopathic medicine is an emerging profession that is gaining formal recognition, including provincial/territorial regulation. While naturopathic medicine has undergone significant growth and legitimization, it still faces substantial challenges to acceptance as a full-fledged health care profession within the Canadian health care system. For example, professionalization theories indicate the importance of clear professional boundaries as well as the need for 'new' groups to find a place in the system of professions. This has been problematic for naturopathic practitioners who continue to practice within a broad scope of practice that encompasses many different therapeutic modalities. Development of statutory regulation also requires delineation of a specific, well-defined scope of practice. The purpose of this study was to describe naturopathic practitioners' perception of their training and their current scope of practice. Two thirds (n = 315) of all licensed Canadian naturopathic practitioners responded to the survey. The results showed that naturopathic practitioners are trained in, and practice, a wide range of therapeutic modalities and diagnostic procedures. Practitioners disagreed about their scope of practice, as 57% thought it was too restrictive, 31% felt it was about right and 13% thought it was too broad. A large majority felt there was some or a great deal of overlap with other practitioners' scope of practice. We conclude that multiple challenges are facing naturopathic medicine, including scope of practice, overlap with other professions, social closure, scarcity of vacancies and lack of cohesion. The future of naturopathic medicine will depend on how effectively the profession will use available strategies to overcome barriers to statutory self-regulation.

Adult↗
PubMed2001

Medical audit: threat or opportunity for the medical profession. A comparative study of medical audit among medical specialists in general hospitals in The Netherlands and England, 1970-1999.

Medical audit has been introduced among hospital specialists in both the Netherlands and England. In the Netherlands following some local experiments, medical audit was promoted nationally as early as 1976 by the medical profession itself and became a mandatory activity under the Hospital Licensing Act of 1984. In England it was the government who promoted medical audit as a compulsory activity for medical specialists, in particular since 1989. In this article the development and introduction of medical audit in the two health care systems is described and its impact on the clinical autonomy of medical specialists gauged. It is concluded that in both countries external pressures seem to have been crucial in the 'compulsory' introduction of medical audit. Although there are differences in the organisation and culture of the medical profession in the two countries, in both countries medical audit turned out to be an instrument 'controlled' by the profession itself. The question whether medical audit is instrumental in preserving clinical autonomy has also been addressed. Our conclusion is that in its present form medical audit in the two countries has not been a threat to the clinical autonomy of the medical profession. At the same time it is clear that the study of one quality instrument is insufficient to draw conclusions about the development of clinical autonomy, let alone autonomy in general. Moreover, it remains to be seen how medical audit can survive alongside quality improvement mechanisms such as accreditation, certification, performance indicators and formal quality systems (ISO, EFQM) where hospital management executes more control. The history of medical audit in the Netherlands and England over the past 30 years does illustrate, however, the capability of the profession to maintain autonomy through re-negotiated mechanisms for self-control.

England↗
PubMed1996

Can educational accreditation drive interdisciplinary learning in the health professions?

BACKGROUND: Accreditation in higher education serves as a means of assuring the public of academic program quality and of promoting continuing review and self-improvement by educational units. Educational program accreditation is a means of seeking continuous improvement in the academic activities of programs and institutions. Discussions of interdisciplinary education raise questions about the responsiveness of accreditation to such approaches. ACCREDITATION AS A STIMULUS FOR CONTINUOUS IMPROVEMENT: Some health professions accrediting agencies have followed the lead of industry and have adapted their approach and philosophy of evaluation to a continuous improvement philosophy, while others continue to perpetuate an "inspection" mentality. The perpetuation of such an approach limits the value of the accreditation process. Accrediting agencies need to focus attention instead on stimulating professional preparation to develop in students the knowledge, skills, and competencies needed for health professions practice. Since such practice frequently occurs in team or interdisciplinary settings, the accreditation evaluation can support practice by incorporating an interdisciplinary perspective. THE CHALLENGES OF INTERDISCIPLINARY EDUCATION FOR ACCREDITATION: As models of interdisciplinary education are developed in the health professions, accreditation will be challenged to evolve in its effectiveness to evaluate interdisciplinary learning experiences. The accrediting community will need to recognize the barriers posed by interdisciplinary learning, as well as the special skills and situations needed to offer effective interdisciplinary experiences. Without this perspective the usefulness of accreditation will be diminished. A CHARGE FOR THE FUTURE: Standards and procedures for accreditation will need to be revised to address the unique characteristics of interdisciplinary education. A set of mock accreditation standards to guide the evaluation of interdisciplinary health professions education learning experiences is proposed. Finally, questions are posed about the role of accreditation in the context of interdisciplinary health professions education.

Accreditation↗
PubMedDate not supplied

Cyclical evolution of nursing education and profession in Iran: religious, cultural, and political influences.

This article was written to gain some insight into the underlying social and/or cultural forces that have, over the centuries, influenced the development of nursing education and the nursing profession in Iran, one of the most ancient civilizations of the world. As a native of Iran deeply involved in the nursing profession and in many aspects of nursing education, I decided to review my many years of experience and observations in these fields in Iran to better understand how the noble profession evolved as it did in my native country. For the years following the Islamic Revolution of 1977 to 1979, I was forced to rely on information gathered from my professional colleagues. An extensive search of the literature yielded a better understanding of the very early years. Analysis of this data seemingly produced a potpourri of such basic issues as modes of education, cultural/religious states of consciousness, and the rights of women. These are not factors generally considered germane to the development of the nursing profession and nursing education, although the latter two have proven to be crucial issues in understanding the development and current status of nursing education and the nursing profession in Iran.

Arab World↗
PubMed2006

[Nurse turnover: A differential analysis of the predictors for intent to change the job and intent to leave the profession].

In a cross-sectional questionnaire study predictors for the intent to leave the nursing profession on the one hand and predictors for the intent to change the job within the nursing profession on the other hand are examined. Data were collected by a national survey of nursing personnel in Germany. The sample of the study consists of 454 nurses working in acute care hospitals. As possible predictors work-related psychological stress, the strain due to illness and behaviour of the patients, psychosomatic pains, organisational, structural as well as sociodemographic variables are taken into account. The relevant predictors are identified by two multiple, linear regression analyses. Psychosomatic pains, low decision latitude, high psychological job demands, short job tenure, the strain due to aggressive and nagging patients, bad cooperation between doctors and nurses, low support by the supervisor and professional status (supervising position) turn out to be predictive for the intent to leave the nursing profession (R2 = 30%). For the intent to change the job within the profession significant predictors are low social support by colleagues, low support by the supervisor, psychosomatic pains, age, short job tenure, and the number of beds in the unit (R2 = 44%). The results indicate, that for the prevention of professional exit early individual measures should be taken where-as the improvement of communication and cooperation among colleagues could keep nurses from job rotation within the profession.

Cross-Sectional Studies↗
PubMed2002

[Results of videostroboscopic examinations of vocally healthy candidates for voice intensive professions].

BACKGROUND: Questions regarding the vocal aptitude for voice professions are common in the daily phoniatrical and otorhinolaryngological practice. According to the classification by Koufman, Isaccson and Stemple professions can be classified into four groups. While it is common to perform laryngeal investigations and analyses of the vocal efficacy for candidates of elite vocal performers (level 1), i. e. singers and actors, those examinations are usually not executed for voice and speaking intensive professions (level 2) like teachers, as there is no legal base. This group is, however, predisposed with regard to professional voice disorders. METHODS: Aim of the study was therefore to determine the frequency of laryngeal findings in a group of previously asymptomatic subjects using videostroboscopic examinations and to assess the risk concerning the emergence of professional voice disorders. 545 candidates for voice intensive professions have been examined with regard to the existence of any organic or secondary organic alterations on the vocal folds. RESULTS: One third of the subjects showed benign laryngeal alterations, which were not consequentially associated with auditive alterations of the voice sound and/or a consciousness of a voice disorder. Apart from 33 organic laryngeal alterations 129 phonation associated alterations of the vocal fold were determined. CONCLUSIONS: These subjects should especially in cases of excessive vocal demand and additional the efficacy reducing factors be regarded as a high risk group with regard to the emergence of professional voice disorders. The results underline the necessity to require vocal examinations and vocal assessment analyses for candidates of voice intensive professions in order to avoid professional voice disorders.

Adolescent↗
PubMed1995

Back pain in the working population: prevalence rates in Dutch trades and professions.

An analysis of three health surveys in the Dutch working population is described, aimed at the identification of Dutch trades and professions with relative high and low prevalence rates of back pain. The sample was representative of the working population in the Netherlands and consisted of 5840 men and 2908 women. The analysis included 33 trades and 34 professions, with at least 50 respondents for each. A total of 26.6% of the workers reported back pain quite often. Almost 2% reported absence from work in the last two months, and 4% considered their back pain to be a chronic disabling disease. There was a substantial variation in prevalence rate of low-back pain between trades and professions ranging from 12% to 41%. Trades with relatively high prevalence rates were found to be the building materials industry, the construction industry and road transportation, and the wholesale industry. Trades with relatively low prevalence rates were found to be banking, public administration and commercial services. Workers in the construction industry and supervisory production workers, plumbers, drivers and cleaners have a relatively high prevalence rate of back pain. Chemists, scientists, bookkeepers, secretaries and administrative professions have a relatively low prevalence rate of back pain. It is concluded that high prevalence rates of back pain are found in particular in non-sedentary professions. Priorities in prevention of back pain should be directed towards the group with relatively high prevalence rates identified above.

Adolescent↗
PubMed2005

Students' conceptions of the medical profession; an interview study.

Students' beliefs and attitudes towards the medical profession have been studied in relation to career choices, but most research has been restricted to either predetermined aspects or to a limited number of specialties. This study aimed at getting unprompted insight in the students' perceptions of their future profession in dimensions that may be determinants of study success and career choice. Undergraduate and graduated medical students were interviewed and asked to characterize the medical profession in general and four contrasting specialties in particular. Grounded Theory methodology was used to analyse the data. Participants were medical students at the start of their training (n = 16), during clerkships (n = 10) and after graduation (n = 37). Beginning students perceive the medical profession in limited dimensions: the activities of a physician, their relationship to patients and the physician's knowledge, skills and personality. They do not see many differences between specialties, in contrast with students with clinical experience and graduate students. Undergraduate students' perception is focussed more on social aspects of the profession compared to graduates.

Attitude↗
PubMed1994

A survey of alcohol and other drug use behaviors and risk factors in health profession students.

This survey assessed the alcohol and other drug (AOD) use habits and risk factors of health profession students at a midwestern university health science center. The authors administered a 75-item survey to 1,707 students in selected classrooms: 984 students responded for a return rate of 57.6%. In 1990, they found, alcohol use among the health profession students in the past year was comparable to that of undergraduate college students nationally (86%), although significantly fewer health profession students drank heavily (27% had five or more drinks in the past 2 weeks, compared with 41% of college students). The percentage of health profession students who reported using tobacco or illicit drugs was lower than the percentage of undergraduate students who used these substances. At the time of the study, 16% of the respondents may have had a potential current alcohol problem and 3.5% a potential drug problem. Pharmacy students most often reported negative consequences from their AOD use. Peer pressure influenced the drinking decisions of 55% of the respondents; students in dentistry and pharmacy experienced the least support from peers for their decisions to abstain from drinking. Family histories of alcohol problems were reported by 38% of the respondents, and family histories of drug use by 14.8%. Male health profession students, when compared with the female professional students, drank more and experienced more consequences of their drinking or drug use and were also more influenced by peers.

Adult↗
PubMed1998

Multidisciplinary education outcomes of the W.K. Kellogg Community Partnerships and Health Professions Education initiative.

This evaluation highlights several points to be considered by others instituting multidisciplinary approaches to health professions education. Community-based, multidisciplinary experiences appear to reinforce support students' interests in pursuing primary care careers. The multidisciplinary, community-based approach to health professions education did not affect academic learning. Project leaders and students reported no risks in terms of board scores between CPHPE students and others in traditional programs. The multidisciplinary, community-based approach to health professions education created opportunities at some sites for students to see "team medicine" in action. It was practical and helped students to understand how they could be more effective in their roles as opposed to competitive. Students require socialization within their own individual disciplines as well as socialization across disciplines. The differences in the structures of traditional health professions education schools interfered with the development of multidisciplinary contexts for learning at some sites. Campus faculty were not necessarily socialized to engage in multidisciplinary efforts. Their disciplines generally do not recognize and reward this behavior. Early and continuous faculty development may significantly help projects to improve communication and develop a better understanding of the contexts of curricular changes across disciplines. This evaluation was exploratory. Further research is needed to better understand what forms of multidisciplinary curriculum are most effective and economically feasible, what forms survive over time, and whether the intended final outcomes of the CPHPE initiative are achieved, not only with medical students but also with the other health professions students.

Curriculum↗
PubMed2004

Revisiting the idea of a national center for health professions education research.

The need for a national center for health professions education research is more compelling today than when originally proposed 15 years ago. There is a general consensus as to the need for better assessment of the educational outcomes of U.S. health professions schools, especially in light of the large investment society makes in the health education infrastructure. The author reviews briefly the current state of research in medical education as an example of health professions education research, from both qualitative and quantitative perspectives, and uses the emergence of the teaching academy movement as an example of how innovation in medical education is often implemented (i.e., the "cottage industry approach"). The substantial obstacles facing medical education research are discussed, including significant conceptual, curricular, financial, and outcomes-related challenges. The author proposes the creation and organization of a national center for health professions education research, consisting of four research divisions: basic, translational, applied, and systems. The funding for the center would be derived from a research and development assessment on existing federal investments in health education. The hurdles to the creation of such a center are reviewed and include intellectual, financial/political, and regulatory ones. The author suggests that a national center for health professions education research can be an effective mechanism for the study of many complex issues in health education and health care delivery for which the public desires accountability.

Delivery of Health Care↗
PubMed2005

Perceptions of operating room tension across professions: building generalizable evidence and educational resources.

BACKGROUND: Effective team communication is critical in health care, yet no curriculum exists to teach it. Naturalistic research has revealed systematic patterns of tension and profession-specific interpretation of operating room team communication. Replication of these naturalistic findings in a controlled, video-based format could provide a basis for formal curricula. METHOD: Seventy-two surgeons, nurses, and anesthesiologists independently rated three video-based scenarios for the three professions' level of tension, responsibility for creating tension and responsibility for resolution. Data were analyzed using three-way, mixed-design analyses of variance. RESULTS: The three professions rated tension levels of the various scenarios similarly (F=1.19, ns), but rated each profession's responsibility for creating (F=2.86, p<.05) and resolving (F=1.91, p<.01) tension differently, often rating their profession as having relatively less responsibility than the others. CONCLUSIONS: These results provide an evidence base for team communications training about tension patterns, disparity of professional perspectives, and implications for team function.

Anesthesiology↗
PubMed2004

Nursing ethics and conceptualizations of nursing: profession, practice and work.

BACKGROUND: Nursing has been understood as a calling, vocation, profession, and most recently, a practice. Each of these conceptualizations has associated with it an ethics that has emphasized particular aspects of nursing reflecting the social position of nursing in a given historical period. The ethics associated with current understandings of nursing as a profession and a practice are, we believe, no longer adequate to address the social realities and moral challenges of health care work. AIM: The aim of this paper is to discuss the limitations of the ethics associated with profession and practice and to show why the concept of work can contribute to a nursing ethics. DISCUSSION: The characteristics that have socially defined professionals, among them the possession of a unique body of knowledge, provision of an altruistic service to society, and autonomy in the sense of control over their work and work conditions, only partially reflect the realities of contemporary health care work. This is true even for physicians, an exemplar of a professional group. The ethics associated with the professions has tended to limit what counts as a moral concern and who is authorized to label them as such. More recently, the idea of a practice has been used to argue for an ethics in which professional activities of a certain kind and understood in a specific way are inherently moral. However, this approach is limited for similar reasons. Because morality cannot be separated from the social organization of health care, we argue that considering nursing primarily as work, in contrast to a profession or a practice, offers the possibility of an ethics that more completely reflects the complexity of contemporary health care. CONCLUSION: Beyond the obvious conclusion that nursing is work, conceptualizing nursing as work points to changing social realities that are raising significant ethical issues. As a concept, work inherently conveys value, connects intellectual and manual labour, and recognizes social divisions of labour. At the moment an ethics of work is merely an idea, but we believe that such an ethics would lead nurses to ask different questions and propose different answers to the moral challenges of the present and near future.

Codes of Ethics↗
PubMed1990

Specialists without spirit: crisis in the nursing profession.

This paper examines the crisis in the nursing profession in Western industrial societies in the light of Max Weber's theory of rationalisation. The domination of instrumental rational action in modern industrial societies in evident in the field of modern medicine. The burgeoning mechanistic approach to the human body and health makes modern health care services increasingly devoid of human values. Although the nursing profession has been influenced by various changes that took place in health care during the last few decades (for example greater reliance on technology), the underlying values of the nursing profession still emphasise a broad definition of the well-being of patients. Hence, in recent years the irrational consequences of growing technological medicine in North America has resulted in a serious crisis in the nursing profession. To resolve this crisis the authors propose a reorganisation of modern health care services on the basis of a new paradigm which is compatible with both the health care needs of the people and the main emphasis in education and training of the nursing profession.

Altruism↗
PubMed2006

Risk of affective and stress related disorders among employees in human service professions.

OBJECTIVES: To examine the risk of affective and stress related disorders among men and women employed in human service professions. METHODS: Population based case-control study using data from national registers. Cases (n = 28 971) were identified in the Danish Psychiatric Central Research Register among all hospitalised patients and outpatients aged 18-65 who received a first time ever diagnosis of affective (ICD-10, F30-39) or stress related (ICD-10, F40-48) disorder from 1 January 1995 to 31 December 1998. Each case was assigned five never admitted referents (n = 144 855) of the same gender and age, randomly drawn from a 5% sample of the Danish population obtained from Statistics Denmark's Integrated Database for Labour Market Research. Occupation held the year before matching was classified according to the Danish version of the International Classification of Occupation. Health care, education, social work, and customer services were defined as human service professions and constituted 21% of all employed in the study. Adjusted risks (hazard ratios) relative to all other occupations were calculated for 24 human service occupations. RESULTS: The relative risk of depression in human service professions was 1.35 (95% CI 1.24 to 1.47) for women and 1.49 (95% CI 1.29 to 1.73) for men. The risk of stress was 1.18 (95% CI 1.11 to 1.26) for women and 1.49 (95% CI 1.32 to 1.67) for men. Specific professions contributed differentially to the magnitude of risk, with education and social services displaying the highest risks. No increase in risks was found in customer service occupations. Gender was a significant modifying factor with the highest risk levels in men. CONCLUSIONS: There was a consistent association between employment in human service occupations and the risk of affective and stress related disorders. Risks were highest for men working in these typically female professions. More work is needed to distinguish work hazards from effects attributable to selection mechanisms and personality characteristics.

Adult↗
PubMed1996

Audit in the therapy professions: some constraints on progress.

AIMS: To ascertain views about constraints on the progress of audit experienced by members of four of the therapy professions: physiotherapy, occupational therapy, speech and language therapy, and clinical psychology. METHODS: Interviews in six health service sites with a history of audit in these professions. 62 interviews were held with members of the four professions and 60 with other personnel with relevant involvement. Five main themes emerged as the constraints on progress: resources; expertise; relations between groups; organisational structures; and overall planning of audit activities. RESULTS: Concerns about resources focused on lack of time, insufficient finance, and lack of access to appropriate systems of information technology. Insufficient expertise was identified as a major constraint on progress. Guidance on designing instruments for collection of data was the main concern, but help with writing proposals, specifying and keeping to objectives, analysing data, and writing reports was also required. Although sources of guidance were sometimes available, more commonly this was not the case. Several aspects of relations between groups were reported as constraining the progress of audit. These included support and commitment, choice of audit topics, conflicts between staff, willingness to participate and change practice, and concerns about confidentiality. Organisational structures which constrained audit included weak links between heads of professional services and managers of provider units, the inhibiting effect of change, the weakening of professional coherence when therapists were split across directorates, and the ethos of regarding audit findings as business secrets. Lack of an overall plan for audit meant that while some resources were available, others equally necessary for successful completion of projects were not. CONCLUSION: Members of four of the therapy professions identified a wide range of constraints on the progress of audit. If their commitment to audit is to be maintained these constraints require resolution. It is suggested that such expert advice, but also that these are directed towards the particular needs of the four professions. Moreover, a forum is required within which all those with a stake in therapy audit can acknowledge and resolve the different agendas which they may have in the enterprise.

Allied Health Occupations↗
PubMed1986

The professions: a critical review.

The professions have recently been subjected to intense scrutiny in the media. Increasingly, criticism is levelled at the professions collectively rather than at individual professions. Even when difficulties afflict a particular profession the resulting public debate affects other professional bodies. The changes that one profession makes to meet such criticisms inevitably influence the others. If, for example, a professional group decides to permit advertising by its members, the case of those who prefer to retain a restriction is weakened. If barristers may at some future date be consulted without the intermediation of a solicitor, why should not surgeons receive patients who have not visited a general practitioner?

Insurance, Liability↗