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PubMedDate not supplied

Monitoring the clinician scientist scheme.

The National Clinician Scientist Scheme was devised to enable future leaders of academic medicine to continue post-doctoral research and at the same time complete their specialist registrar training. The awards are generously funded by the major grant-giving bodies and are held in a variety of specialties in academic departments across the UK. Award winners are given the suffix A to add to their existing national training number (NTN) achieved in open competition in the relevant specialty. The deanery whence they came is permitted an additional NTN to be awarded to the clinician scientist's successor in the deanery specialty training programme. The clinician scientist's further clinical training is arranged on an individual basis to dovetail with their ongoing research.

Education, Medical↗
PubMed2005

Graduate education in occupational hygiene: a rational framework.

Occupational hygiene has been an important part of occupational health since it first emerged after World War II as the science and art that deals with the anticipation, recognition, evaluation and control of human exposures to hazards in the working environment. A need exists for well-qualified professionals who can not only respond to hazards that are currently known and understood, but also to ones that are not yet known or understood. For this, graduate-level academic programs in occupational hygiene must go beyond the training of skills and imparting of facts. Rather they must provide the education that enables the development of critical faculties, allowing future self-learning and the study of new scenarios not yet anticipated. Ideally, occupational hygiene should be taught firstly in the interdisciplinary context of the whole of occupational health (including occupational medicine, occupational health nursing, occupational safety and ergonomics) and secondly in relation to the wider field of public health (including epidemiology and biostatistics). In addition, modern occupational hygiene education also needs to embrace the management and social sciences. The Education and Research Centers (ERCs) sponsored in the United States by the National Institute of Occupational Health (NIOSH) have refined this approach and provided a useful model for all occupational hygiene education, identifying the need for both masters and doctoral-level endeavor. Other countries might usefully consider integrating existing academic programs in order to emulate the NIOSH approach, perhaps through internal and external partnerships. In terms of content, such education needs to be carried out within a framework that places human exposure to hazardous agents at the center of the anticipation-recognition-evaluation-control rationale. Such a framework also places occupational hygiene in the context of the other occupational and environmental health disciplines. Finally it has to be acknowledged that occupational hygiene is (indeed always was) a changing field. Academic programs need to be responsive to such changes, and the range of responses must include not only curricular modifications but also changes in the way that the education itself is delivered. The internet provides interesting new opportunities for distance learning that appear to have the potential not only to be efficient and convenient in terms of time and resources but also to be valid in terms of meeting the desired educational objectives.

Education, Medical, Graduate↗
PubMed2006

How endangered is dynamic psychiatry in residency training?

The future of psychodynamic psychotherapy in residency training is in jeopardy. New priorities and forces currently aligned in academic psychiatry challenge the importance of psychodynamic psychotherapy and, by extension, its core concepts of the unconscious, defense and resistance, transference and countertransference, and the past repeating itself in the present. The exit of psychoanalysts from academic centers in the last quarter of the past century was propelled by forces including biological psychiatry, managed care, and competition from other mental health disciplines. ACGME psychotherapy competencies introduced in 2001 renewed the focus on psychotherapy training in residency and set a residency training standard for psychotherapy competency. A recent shift in academia prioritizing evidence-based medicine and a shortage of psychiatrist researchers may threaten those gains.

Biological Psychiatry↗
PubMed2005

Communities as teachers: learning to deliver culturally effective care in pediatrics.

A patient's culture has an effect on her or his view of illness, decision to seek care, and adherence to treatment plans and follow-up visits. In this article, we describe community-academic partnerships designed to teach improved delivery of culturally effective care conducted in pediatric residency training programs in New York, New York, and San Diego, California. Columbia University-Children's Hospital of New York-Presbyterian focuses most of residents' cultural-training experiences within 1 community program, a home-visitation program (Best Beginnings) with which residents work in various capacities throughout residency. The University of California, San Diego and Naval Medical Center San Diego use a series of cultural "immersion experiences" as a primary method. The creation of community-academic partnerships for the purpose of service and training can be a critical asset in the development of culturally effective care training: community partners become teachers and local communities serve as classrooms.

California↗
PubMed2002

Academic geriatric programs in US allopathic and osteopathic medical schools.

CONTEXT: By 2030, 20% of the US population will be older than 65 years compared with 12.4% in 2000. The development of geriatric medicine research and training programs to prepare for this increasing number of older individuals is largely dependent on the successful establishment of academic geriatric medicine programs in medical schools. OBJECTIVE: To assess the structure, resources, and activities of academic geriatric medicine programs in US allopathic and osteopathic schools of medicine. DESIGN, SETTING, AND PARTICIPANTS: Survey distributed to the academic geriatric medicine leaders of the 144 US allopathic and osteopathic medical schools in March 2001. MAIN OUTCOME MEASURES: Organizational structure, program information, curriculum, budgetary issues, and characteristics of academic geriatric medicine leaders. RESULTS: A total of 121 program directors (84%) responded. Most schools (87%) had an identifiable academic geriatric program structure, with 67% established after 1984. The greatest proportion of faculty and staff time (40%) was spent in clinical practice, followed by research and scholarship (12%), residency and fellowship education (10% each), and medical student education (7.8%). Clinical practice accounted for the greatest portion (27%) of revenue, and 25.7% of the programs had total annual budgets of less than $250,000, while 11% had budgets of greater than $5 million. The largest obstacles to achieving the goals of an academic geriatric medicine program were a lack of research faculty and fellows and poor clinical reimbursement. CONCLUSIONS: Most US medical schools have an identifiable academic geriatric medicine program; most have been established within the last 15 years. Resources are needed to train faculty for roles as teachers and researchers and to develop medical school geriatric programs of the size and scope equivalent to other academic disciplines.

Data Collection↗
PubMed1995

Expanding rural primary care training by employing information technologies: the need for participation by medical reference librarians.

The use of rural sites to train badly needed primary care providers requires access to sophisticated medical information not traditionally available outside of academic health centers. Medical reference librarians can play a key role in the development of primary care training sites in rural settings. Electronic information technologies, with proactive support from medical reference librarians, can provide current and detailed information without concern for distance from the health science center library. This paper discusses recent developments in technology, describes current challenges to the application of this technology in rural settings, and provides policy recommendations for medical reference librarians to enhance rural primary care training.

Area Health Education Centers↗
PubMed2004

Effects of Clinical Field-Experience Setting on Athletic Training Students' Perceived Percentage of Time Spent on Active Learning.

OBJECTIVE: Our purpose was to examine undergraduate athletic training students' perceptions of how time is utilized during clinical field experiences while enrolled in Commission on Accreditation of Allied Health Education Program (CAAHEP)-accredited athletic training programs and to determine the effects of clinical field-experience length and setting, academic standing, sex, clinical assignment, and National Collegiate Athletic Association level on active learning. DESIGN AND SETTING: Using the Athletic Training-Clinical Education Time Framework (AT-CETF) and Utilizing Time and Active Learning Survey, subjects completed a 1-day, self-reported observation of how their clinical field-experience time was utilized. SUBJECTS: Program directors at 131 CAAHEP-accredited athletic training programs were sent survey packages. Seventy-two (41%) male subjects and 105 (59%) female subjects from 25 institutions completed the survey packages. Eight of the 10 National Athletic Trainers' Association districts were represented in the study. MEASUREMENTS: The AT-CETF is a behavioral time-profiling framework that measures athletic training students' perceptions of utilization of clinical field-experience time based on the performance domains associated with the 1999 National Athletic Trainers' Association Board of Certification Role Delineation Study and literature related to time and learning. RESULTS: Subjects spent 51% of their clinical field-experience time engaged in active learning, 9% in managerial activities, 17% in unengaged activities, and 23% in waiting activities. Multiple 2 x 2 x 3 analyses of variance (length of clinical field experience x academic standing x clinical field-experience setting) revealed a significant difference between the levels of clinical field-experience setting and the dependent variables of perceived percentage of active learning time and waiting time. A 2 x 3 analysis of variance (sex x clinical assignment) revealed a significant difference between the levels of clinical assignment and the dependent variable of perceived percentage of active learning time. CONCLUSIONS: The type of clinical field-experience setting and clinical assignment affects the amount of time spent in active learning. Therefore, profiling students' use of time may allow educators to identify clinical field-experience settings that maximize active learning time, expose students to their own unique learning situations, and offer students access to clinical field-experience settings aligned with their professional goals.

Journal Article↗
PubMed2001

Effects of perceptions and mentorship on pursuing a career in academic medicine in obstetrics and gynecology.

PURPOSE: To understand the perceptions of residents and Fellows in obstetrics and gynecology about the impacts of race or ethnicity, gender, and mentorship experiences on pursuing careers in academic medicine. METHOD: Two surveys were administered: one to a sample of 2,000 Fellows of the American College of Obstetricians and Gynecologists, and one to the 4,814 obstetrics and gynecology residents taking the 1998 in-training examination. The questionnaires asked about demographics, perceptions about careers in academic medicine, and residents' experiences with mentorship. RESULTS: Response rates were 96.8% for residents and 40.6% for FELLOWS: Of the residents, 26.1% indicated they would not consider a career in academic medicine. First-year women residents were more inclined to pursue careers in academic medicine than were first-year men (p =.042), but their interest declined during residency. Women residents (43%)-especially minorities-felt that men were mentored and recruited more for faculty positions, while men (38%) felt that women were mentored and recruited more. Fellows' reports of recruitment did not differ by gender. Most white residents did not perceive racial or ethnic bias in mentoring or recruiting, while most non-white residents did. Almost one third of non-white women residents felt that supervisors were more likely to condescend to women and minority individuals. CONCLUSIONS: It is likely that neither men nor women residents in obstetrics and gynecology receive adequate mentorship for careers in academic medicine. Perceptions of bias are a serious barrier to developing racial, ethnic, and gender diversity in leadership positions.

Attitude of Health Personnel↗
PubMed2006

Psychomotor testing predicts rate of skill acquisition for proficiency-based laparoscopic skills training.

BACKGROUND: Laparoscopic simulator training translates into improved operative performance. Proficiency-based curricula maximize efficiency by tailoring training to meet the needs of each individual; however, because rates of skill acquisition vary widely, such curricula may be difficult to implement. We hypothesized that psychomotor testing would predict baseline performance and training duration in a proficiency-based laparoscopic simulator curriculum. METHODS: Residents (R1, n = 20) were enrolled in an IRB-approved prospective study at the beginning of the academic year. All completed the following: a background information survey, a battery of 12 innate ability measures (5 motor, and 7 visual-spatial), and baseline testing on 3 validated simulators (5 videotrainer [VT] tasks, 12 virtual reality [minimally invasive surgical trainer-virtual reality, MIST-VR] tasks, and 2 laparoscopic camera navigation [LCN] tasks). Participants trained to proficiency, and training duration and number of repetitions were recorded. Baseline test scores were correlated to skill acquisition rate. Cutoff scores for each predictive test were calculated based on a receiver operator curve, and their sensitivity and specificity were determined in identifying slow learners. RESULTS: Only the Cards Rotation test correlated with baseline simulator ability on VT and LCN. Curriculum implementation required 347 man-hours (6-person team) and 795,000 dollars of capital equipment. With an attendance rate of 75%, 19 of 20 residents (95%) completed the curriculum by the end of the academic year. To complete training, a median of 12 hours (range, 5.5-21), and 325 repetitions (range, 171-782) were required. Simulator score improvement was 50%. Training duration and repetitions correlated with prior video game and billiard exposure, grooved pegboard, finger tap, map planning, Rey Figure Immediate Recall score, and baseline performance on VT and LCN. The map planning cutoff score proved most specific in identifying slow learners. CONCLUSIONS: Proficiency-based laparoscopic simulator training provides improvement in performance and can be effectively implemented as a routine part of resident education, but may require significant resources. Although psychomotor testing may be of limited value in the prediction of baseline laparoscopic performance, its importance may lie in the prediction of the rapidity of skill acquisition. These tests may be useful in optimizing curricular design by allowing the tailoring of training to individual needs.

Adult↗
PubMed1997

Ensuring the survival of the clinician-scientist.

Many forces threaten the survival of the clinician-scientist as an academic species, among them: (1) the changing health environment; (2) the complexity of and rapid advances in biomedical science, which necessitate that MD-PhD graduates "retool" after completing their clinical training; (3) the length and rigor of the research training required to train clinician-scientists adequately; (4) the scarcity of funding for subspecialty training positions; (5) the perception that the successful clinician-scientists in academic medicine are those who focus on basic, rather than clinical, research; (6) the indebtedness of young physicians when they complete medical schools; (7) the fierce competition for research funding; and (8) pessimism among senior faculty about the clinician-scientist's potential for survival. There are solutions to these issues that must be vigorously pursued to ensure the survival of the clinician-scientist: (1) Rigorous six- to seven-year programs (e.g., two in internal medicine, four to five in a subspecialty) for physicians must be established. They should include a minimum of three years of research and should lead to board certification in internal medicine, pediatrics, psychiatry, etc., board certification in a subspecialty, and a PhD in clinical science. (2) These programs must have a choice of three tracks, (a) disease-oriented basic research, (b) clinical investigation in patients, and (c) health services research. Such a program--the PhD in Clinical Science program--has recently been approved and begun at the University of Colorado. (3) Funding organizations such as the National Institutes of Health should designate their training resources primarily for programs with a minimum of three years of formal and rigorous research training. (4) These rigorous research training programs must be integrated with young-faculty awards for clinician-scientists to ensure continuity in their investigative careers. (5) Loan-repayment programs must be developed to repay student loans of clinician-scientists during their first five years as faculty members. (6) Against the background of these changes, senior faculty as mentors must articulate to emerging clinician-scientists the excitement of being involved in future discoveries in biomedical science.

Certification↗
PubMed2003

Refugee health and medical student training.

BACKGROUND AND OBJECTIVES: Cultural awareness training is an increasingly important priority within medical curricula. This article describes an academic family practice-community partnership focusing on health care needs of refugees that became the model for a medical school selective on cultural sensitivity training. METHODS: The monthly Refugee Health Night program featured dinner with preceptors and patients, international sessions on special medical needs of refugees, and actual clinical encounters with patients. Students were not expected to become culturally competent experts but, rather, health care providers sensitive to and appreciative of cultural context, experience, and expectations. We worked with students to develop sensitive methods of inquiry about mental health, especially around issues of war and torture. We used problem-based cases to emphasize primary care continuity and the benefit of establishing trust over time. RESULTS: Over 2 years, 50 students and nearly 300 refugees (more than 73 families) participated. Students reported that their interactions with the refugees provided positive learning experiences, including expanded knowledge of diverse cultures and enhanced skills for overcoming communication barriers. Patients of refugee status were able to have emergent health care needs met in a timely fashion. CONCLUSIONS: Providing health care for refugee individuals and families presents many challenges as well as extraordinary opportunities for patients and practitioners to learn from one another.

Culture↗
PubMed2002

The academic writing experiences of a group of student nurses: a phenomenological study.

AIMS: To investigate the academic writing experiences of a group of preregistration nursing students. To explore issues surrounding how academic writing skills were developed, integrated and received into the student's educational programme and how these skills impacted on various aspects of their educational and clinical experience. BACKGROUND: The development of an academic writing style is seen to be an integral skill that the student must be willing to learn and undertake within higher education settings. Academic styles of writing have been imported into nursing education as a consequence of its integration into higher education. I wanted to investigate the experiences of learning an academic style of writing for students early on in their nursing career. There is little, if any, research that seeks to investigate or measure these experiences of nursing students. METHODS: A phenomenological approach to investigate the academic writing experiences of a group of preregistration students. FINDINGS: There is an expectation that preregistration students will quickly acquire academic writing skills when most will have had little or no prior experience. There appeared to have been little emphasis placed on facilitating the development of these skills in the educational programme. The lack of emphasis and support proved to be problematical for these nursing students. The emergence of a theory-practice divide also figured strongly. Students were, however, able to appreciate the need and place for academic writing skills and most were able to identify the structural processes that were integral to acquiring such skills. CONCLUSION: A plethora of anecdotal evidence, supported by the findings in this study, suggests that most nursing students' struggle with the demands placed upon them when writing academic assignments. The need for greater emphasis and support throughout the whole period of training are highlighted in the findings of this study. It is known that nursing loses large numbers of its students to the academic rigors of its educational programmes. Where this is the case, the findings of this study support the need for nurse educationalists and curriculum planners to revise and reform the way that they approach and deliver the demands of an academic style of writing with their students.

Education, Nursing↗
PubMed1998

Predicting patient satisfaction: a study of two emergency departments.

To identify perceptions that predict overall patient (dis)satisfaction with Emergency Department (ED) care, we studied responses to a survey mailed to all discharged patients over a 6-month period (Academic Hospital), and to a telephone interview of a random sample of discharged patients over a 1-year period (Community Hospital). The survey and interview both assessed overall satisfaction, as well as satisfaction with perceived waiting times, information delivery, and expressive quality of physicians, nurses, and staff. Data for 1176 patients (training sample) and 1101 patients (holdout sample) who rated overall satisfaction as either "very good" or "very poor" (Academic Hospital), and for 856 patients (training sample) and 431 patients (holdout sample) who rated overall satisfaction as either "excellent" or "poor" (Community Hospital), were retained for analysis. For both hospitals, nonlinear tree models efficiently achieved overall classification accuracy exceeding 98% in training analysis and 95% in holdout analysis (all p < .0001). The findings suggest that overall patient (dis)satisfaction with care received in the ED is nearly perfectly predictable on the basis of patient-rated expressive qualities of ED staff, particularly physicians and nurses. Interventions designed to reinforce positive (and extinguish negative) expressive health-care provider behaviors may cut the number of extremely dissatisfied patients in half.

Chicago↗
PubMed2004

Athletic Training Education Program Directors' Perceptions on Job Selection, Satisfaction, and Attrition.

OBJECTIVE: To determine the potential reasons for becoming a program director and reasons for leaving the program director position within athletic training education programs accredited by the Commission on Accreditation of Allied Health Education Programs (CAAHEP); in addition, to describe the most and least beneficial and satisfying aspects of the program director position. DESIGN AND SETTING: In 1999, we sent a validated survey to athletic training education program directors of CAAHEP-accredited athletic training education programs. SUBJECTS: Of 113 athletic training education program directors of accredited undergraduate programs, 83 participated, for a response rate of 73.4%. MEASUREMENTS: The survey consisted of open-ended questions regarding potential reasons for becoming a program director and possibly leaving the program direction position and most and least beneficial and satisfying aspects of the position. We used inductive content analysis to determine themes for the responses to the open-ended questions. Descriptive statistics, including percentages, were calculated to report the data. RESULTS: Academic environment was the primary theme for becoming an athletic training education program director and professional appointment was the primary theme for possibly leaving the position. Professional advancement and student growth and success were the primary themes for the most beneficial and satisfying aspects. Workload and student issues and discipline were the primary themes for the least beneficial and satisfying aspects. CONCLUSIONS: Factors that affect job selection, satisfaction, and attrition are related to academic environment, teaching, students, professional advancement, program development/advancement, workload, personal issues, and athletics.

Journal Article↗
PubMedDate not supplied

From clinical activities to didactics and research in occupational medicine.

BACKGROUND: The daily practice of Occupational Physicians in the mot industrialized countries suggests that the frequency of traditional occupational diseases is progressively lowering, their gravity is decreasing, and the etiological factors are changing. This trend should be quantitatively and qualitatively verified with ad hoc studies. The information is particularly relevant for Academic Institutions where medical students and residents in occupational medicine are trained. OBJECTIVES: To analyse the trends of clinical diagnoses and health surveillance activities conducted in the last 15 years by an Italian Institute of Occupational Health, and to gain information on the most relevant topics to be taught in academic program and to be addressed with future research. METHODS: Data sources were represented by the computerised registration of a) diagnostic activities and b) health surveillance programs, conducted by the Institute of Occupational Medicine of the University of Brescia, a highly industrialized area in Northern Italy. The observation period was from 1990 to 2005. The health surveillance programs regarded workers pulled from an iron foundry, a veterinary institute, a health departments for the assistance of elderly subjects, a nursery schools and a municipal department for road maintenance. RESULTS: Diagnostic activities were conducted on 9080 subjects, who had been referred for suspected occupational disease. The diagnosis of occupational disease was confirmed for 3759 cases. Multiple diseases were diagnosed in 1554 subjects, yielding the total number of 5721 occupational diseases. The most frequent diagnoses accounted for allergic skin disease (23.4%), followed by pneumoconiosis (20.4%), chronic obstructive pulmonary disease (15.9%), noise hearing loss (7.1%), musculoskeletal disorders (6.9%), respiratory allergies (6.9%), cancer (5.9%), miscellaneous (6.4%). When limited to the last quinquennium, the analysis showed a definite increase of muskuloskeltal disorders, cancer, and, although at a lesser extent, diseases due to psychosocial factors. The analysis of the health surveillance programs regarded 1207 workers, and showed that various non occupational diseases caused limitation to individual work fitness. The most frequent conditions were musculoskeletal disorders (65%) and skin diseases (14%). CONCLUSIONS: The results from these two investigations are important not only for the didactic program run by the Institute, but also because they indicate the most relevant topics to be addressed with future research, at least at a local level.

Academies and Institutes↗
PubMed1992

Academic success of integrated hearing-impaired pupils who had enrolled in the early written-oral language program.

Data on academic success were analyzed for 37 hearing-impaired pupils who had been trained by the Written-Oral Language Method before school age. Seventy-one percent of pupils whose average hearing level was less than 89 dB and 77% of pupils whose hearing was 90 to 120 dB succeeded academically. Degree of hearing impairment, speech intelligibility, and gender were not important to their success. Linguistic competence evaluated just before enrollment in a normal educational setting at 6 years of age was the only factor significant to their academic success. However, we propose that the investigation of other factors, IQ and age at the start of preschool training program, must be analyzed in more detail in the future.

Child Language↗
PubMed1993

Training older adults to work as psychiatric case management aides.

Adults who were age 55 and over were trained to work as case management aides for individuals with serious and persistent mental illness. The training program was a cooperative effort of several state, academic, and private agencies in the New Orleans area, including the department of psychiatry at a state university medical center, the State Office of Mental Health, a consortium of colleges and universities providing educational opportunities for older adults, and the American Association of Retired Persons. The program curriculum included ten weeks of classroom instruction and a four-month field practicum. Of the 14 participants in the initial group of trainees, 13 sought and received employment as case aides. At follow-up three months after employment, supervisors of the case aides rated their job performance as excellent.

Activities of Daily Living↗