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Charcot frequently used Shakespearean references in his neurologic teaching sessions. With these citations, he emphatically stressed how objective observation and an attention to detail were essential to expert clinical diagnosis. At the same time, Charcot presented his personal credentials as a cultured man. Charcot's interest in Shakespeare permeated many aspects of his professional work, and also his private and family life.
A survey of fellowship-trained otolaryngologists was undertaken. Seven hundred forty-four questionnaires were mailed, and 344 were returned. The survey respondents were asked questions regarding their fellowship training, location of practice, attitudes regarding certification, relevancy of fellowship to practice, and quality of fellowship training, among others. Results of this survey provide some information regarding the ongoing proliferation of fellowships in Otolaryngology--Head and Neck Surgery and the philosophies of those having taken fellowships. Generally, this survey indicates that fellowship-trained specialists feel that there are enough fellowships currently, and suggestions are made to improve the quality of fellowship training. Almost 70% of this survey's respondents prefer a Certificate of Added Qualifications from the American Board of Otolaryngology for credentialing and validation of their fellowship training.
As academic pediatricians, we are easily caught up in the peripheral details of life. Keeping up with the financial demands, the umpteenth credentialing for managed care, the particular needs of our own institutions.
The financial consequences of major changes in the financing of health care have affected academic health centers disproportionately, threatening the very survival of some, even when they are vitally needed in their communities. This report describes one model to respond to these changes, which uses the strengths of 2 academic health centers for mutual benefit. Meharry Medical Center and Vanderbilt University Medical Center, both in Nashville, Tenn., formed an alliance, with surgery as the first area of focus. The Meharry Medical Center-Vanderbilt University Medical Center Alliance was formed in 1998 and was designed to preserve the integrity of each institution while advancing the student teaching program at Meharry Medical Center, broadening Vanderbilt residents' clinical experience, and providing enhanced opportunities for research at both institutions. Surgery was the first program developed in this alliance, and we report the results to date. Quality faculty have been recruited, cross credentialing has been accomplished, and several programs have been shared. This has resulted in increased surgical volume, improved contracting with managed care organizations, and enhanced research opportunities. This model is working and expanding to the benefit of both institutions.
The first recertification process of the American Board of Surgery was completed in 1980. The process consisted of a review of diplomates' credentials, peer review, a requirement for continuing education in surgery, submission of an operative experience list, and a multiple-choice examination. Of the 478 diplomates who completed the process, 471 were recertified. The mean score for participants in the examination was 82.8% correct. The passing score was 67.2% correct. An analysis of examination scores, correlated with biographic and demographic data, showed that the highest scores were achieved by the younger diplomates and those who indicated that their practice was full-time academic.
BACKGROUND: Antibiotic drug restriction policies have become widespread in North America hospitals mandating medical infectious disease consultation for use of routine antimicrobial agents. OBJECTIVE: To determine physician and institutional attitudes regarding the credibility of surgeons in the area of infectious disease. DESIGN: A survey of the Surgical Infectious Disease Society (SIS) membership. PARTICIPANTS: Members of the SIS practicing in the United States and Canada (n = 464) were sent a simple opinion poll regarding surgical infectious disease specialists. After receiving the survey, the SIS members were given approximately 4 weeks to anonymously complete the questionnaire and return it to our office. RESULTS: Responses were received from 198 SIS members (43%). Most were from large (> 400 bed) institutions (63%), and the majority of them were from university centers (76%). Predictably, 86% of the respondents were in full-time academic practice. Some SIS respondents (21%) had undergone special training in infectious disease, and of these, 63% actually had completed a formal surgical infectious disease fellowship. Antibiotic restriction policies were nearly universal and required in 87% of institutions. Only 44% of surgeons in these hospitals, however, were privileged to release antibiotic drugs. Medical infectious disease physicians recognized surgical expertise in infectious disease in few instances (32%). The great majority of responding SIS members (81%) believed that an examination or certification in infectious disease for surgeons was not warranted. CONCLUSIONS: Antibiotic drug restriction is prevalent in North America, and medical infectious disease specialists do not generally recognize surgical expertise in the area of infectious disease. Despite this environment, responding SIS members believe that special credentialing of surgeons in the area of infectious disease is unnecessary.
CONTEXT: Mass gatherings like the 1996 Olympic Games require medical services for large populations assembled under unusual circumstances. OBJECTIVE: To examine delivery of medical services and to provide data for planning future events. DESIGN: Observational cohort study, with review of medical records at Olympics medical facilities. SETTING: One large multipurpose clinic and 128 medical aid stations operating at Olympics-sponsored sites in the vicinity of Atlanta, Ga. PARTICIPANTS: A total of 10715 patients, including 1804 athletes, 890 officials, 480 Olympic dignitaries, 3280 volunteers, 3482 spectators, and 779 others who received medical care from a physician at an Olympic medical station. MAIN OUTCOME MEASURES: Number of injuries and cases of heat-related illness among participant categories, medical use rates among participants with official Games credentials, and use rates per 10000 persons attending athletic competitions. RESULTS: Injuries, accounting for 35% of all medical visits, were more common among athletes (51.9% of their visits, P < .001) than among other groups. Injuries accounted for 31.4% of all other groups combined. Spectators and volunteers accounted for most (88.9%, P < .001) of the 1059 visits for heat-related illness. The rates for number of medical encounters treated by a physician were highest for athletes (16.2 per 100 persons, P < .001) and lowest for volunteers (2.0 per 100). Overall physician treatment rate was 4.2 per 10000 in attendance (range, 1.6-30.1 per 10000). A total of 432 patients were transferred to hospitals. CONCLUSIONS: Organizers used these data during the Games to monitor the health of participants and to redirect medical and other resources to areas of increased need. These data should be useful for planning medical services for future mass gatherings.
The Henry Ford Health System is a large, vertically integrated health care delivery system, with its core service delivery team comprised of a 1000-person salaried medical group. Oncology services are coordinated through its Cancer Center, which organizes regional distribution of oncology services for residents of southeast Michigan. Oncology services are delivered through five regionally distributed sites, affording a vast majority of cancer services to be provided for patients a short distance from their homes. The System owns the largest health maintenance organization in Michigan (Health Alliance Plan) and its organizational structure affords the opportunity of offering purchasers specific oncology service contracting opportunities. Advantages of providing comprehensive oncology services through an integrated health system include: 1) standardized cancer care guidelines, 2) medical information exchange through an electronic medical record, 3) interdisciplinary cancer care provided by salaried physicians, minimizing potentially conflicting financial issues in treatment decisions, 4) state-of-the-art care afforded through availability of involvement in a large number of National Institutes of Health-sponsored clinical trials, 5) high standards of credentialing for oncology physicians, and 6) integrative managed care perspectives and continuous attention to cost and quality of care issues.
Research productivity of counseling psychologists with credentials in clinical neuropsychology were examined. Eighteen were ABPP/ABCN Diplomates. Division 40 Fellows, or both. They published an average of 3.06 (SD= 4.82; range = 0 to 20) neuropsychologically relevant, first-authored articles over the past 5 years. When counseling psychologists were compared to a random sample of ABPP/ABCN diplomates with doctoral degrees in other areas of psychology, no reliable differences emerged between the groups in age, research productivity, or number of years between graduation and receipt of the ABPP/ABCN diploma. Research contributions of neuropsychologists with degrees in counseling psychology are comparable to those of ABPP/ABCN diplomates who were trained in other areas of psychology (e.g., clinical, developmental, and physiological).
Two cases of left ventricular free wall rupture occurring in temporal relation to interventional coronary procedures are presented as autopsy-verified pseudocomplications. The possible impact of pseudocomplications on operator-specific registry data and credentialing is briefly discussed.
Two hundred and forty-eight college students viewed a vignette from a therapy-analogue session. Before Ss viewed the vignette they all read a summary that described the vignette plus an additional description that stressed different aspects of the therapist. One-fifth of the Ss were told of the therapist's excellent reputation, one-fifth were told of the therapist's excellent training and credentials, one-fifth were told of the therapist's high fee, and one-fifth were told of the therapists' androgenous personality. The remaining one-fifth of the Ss, who served as controls, were told nothing further; they only received the standard description of the vignette. After the vignette, Ss completed measures designed to assess their perception of therapist credibility and attractiveness. The results indicate that the androgenous therapist was rated as most credible and attractive (whereas the high-fee-charging therapist was least credible and attractive.) Explanation for these results and implications are discussed.
BACKGROUND: Decision aids are interventions designed to help people make specific and deliberative choices among options (including status quo) by providing (at a minimum) information on the options and outcomes relevant to a person's health status. A systematic review is needed to summarize what is known about their efficacy. OBJECTIVES: 1. To create an inventory of existing decision aids. 2. To conduct a systematic review of randomized controlled trials of decision aids aimed at improving people's decision making and outcomes. SEARCH STRATEGY: The following electronic databases were searched: MEDLINE, EMBASE, PsycINFO, CINAHL, Aidsline, Cancerlit, the Cochrane Controlled Trials Register. In addition, individuals known to be active in the field of decision support were contacted. SELECTION CRITERIA: We screened titles and abstracts for all interventions providing structured, detailed, and specific information on treatment or screening options and outcomes to aid decision making. Information about the decision aids was compiled in an inventory and those evaluated in a randomized controlled trial were reviewed in detail. DATA COLLECTION AND ANALYSIS: Using Cochrane review methods, two reviewers independently screened and extracted data on several evaluation criteria. Results of randomized trials were pooled using weighted mean differences and relative risks with all data analysed using a random effects model. MAIN RESULTS: Eighty-seven decision aids were identified. Twenty-three of them had been evaluated in 24 randomized controlled trials. Among the trials comparing decision aids to usual care interventions, decision aids performed better in terms of: a) greater knowledge of options in seven of seven studies (weighted mean difference (WMD = 19 out of 100, 95% confidence interval (CI): 13,25); b) more realistic expectations in two of three studies (RR=1.48 95%CI 1.02, 2.14); c) lower decisional conflict related to feeling informed in three of three studies (WMD = -9.0 of 100 95%CI: -15, -3); d) reducing the proportion of people who were passive in decision making in three of four studies (RR = 0.63, 95% CI: 0.5, 0.8). When simpler decision aids were compared to more detailed ones, the relative improvement was significant in: a) improved knowledge in two of seven studies (WMD = 4 out of 100, 95% CI: 2, 5); b) realistic expectations in two of two studies (relative risk (RR ranged from 1.5 95%CI: 1.3,1.8); and c) decisional conflict in one of two studies (WMD= -4 95% CI -8,-0.2). There was a consistent trend for decision aids to do no better than comparison interventions in affecting: satisfaction with the decision in five of six studies, satisfaction with the decision making process in four of five studies, and anxiety in four of five studies. Decision aids had a variable effect on which screening or treatment options were selected. Exposure to decision aids relative to controls resulted in a consistent non-significant trend toward reduced preference for major surgery over conservative options by 21 to 42 per cent in five of five studies; however, they had no impact on circumcision in two of two studies. For colon and prostate cancer screening choices, the results were inconsistent. Two studies have shown no impact on persistence with chosen option and few studies have shown significant benefits on general health outcomes (two of three studies), or disease-specific health outcomes (one of four studies). REVIEWER'S CONCLUSIONS: The number of decision aids is expanding, but there is considerable overlap in some areas leaving gaps in others. Trials of decision aids indicate that they are superior to usual care interventions in improving knowledge and realistic expectations of the benefits and harms of options; reducing passivity in decision making; and lowering decisional conflict stemming from feeling uninformed. When simpler versions of decision aids are compared to more detailed aids, the differences in knowledge are marginal but there are other benefits in terms of creating realistic expectations and in reducing decisional conflict. To date, decision aids have had little effect on anxiety or satisfaction with the decision making process or satisfaction with the decision. Their effects on choices vary with the decision. The effects on persistence with chosen therapies and health outcomes require further evaluation. The essential elements in decision aids for different groups and different types of decisions need to be established. Consensus needs to be reached regarding standards for developing and evaluating decision aids.
BACKGROUND: Mechanical neck disorders (MND) are common, disabling and costly. Massage is a commonly used modality for the treatment of neck pain. OBJECTIVES: To assess the effects of massage on pain, function, patient satisfaction and cost of care in adults with neck pain. To document adverse effects of treatment. SEARCH STRATEGY: Cochrane CENTRAL, MEDLINE, EMBASE, MANTIS, CINAHL, and ICL databases were electronically searched, without language restriction, from their inception to September 2004 SELECTION CRITERIA: Studies using random or quasi-random assignment were included. DATA COLLECTION AND ANALYSIS: Two reviewers independently conducted citation identification, study selection, data abstraction and methodological quality assessment. Using a random-effects model, we calculated the relative risk and standardized mean difference. MAIN RESULTS: Nineteen trials met the inclusion criteria. Overall, the methodological quality was low, with 12/19 assessed as low-quality studies. Trials could not be statistically pooled because of heterogeneity in treatment and control groups. Therefore, a levels-of-evidence approach was used to synthesize results. Assessment of the clinical applicability of the trials showed that the participant characteristics were well reported, but neither the descriptions of the massage intervention nor the credentials or experience of the massage professionals were well reported. Six trials examined massage as a stand-alone treatment. The results were inconsistent. Of the 14 trials that used massage as part of a multimodal intervention, none were designed such that the relative contribution of massage could be ascertained. Therefore, the role of massage in multimodal treatments remains unclear. AUTHORS' CONCLUSIONS: No recommendations for practice can be made at this time because the effectiveness of massage for neck pain remains uncertain. Pilot studies are needed to characterize massage treatment (frequency, duration, number of sessions, and massage technique) and establish the optimal treatment to be used in subsequent larger trials that examine the effect of massage as either a stand-alone treatment or part of a multimodal intervention. For multimodal interventions, factorial designs are needed to determine the relative contribution of massage. Future reports of trials should improve reporting of the concealment of allocation, blinding of outcome assessor, adverse events and massage characteristics. Standards of reporting for massage interventions, similar to CONSORT, are needed. Both short- and long-term follow-up are needed.
For over 20 years, above-level testing with the College Board Scholastic Aptitude Test (SAT) has been used to assess the abilities of well over 1,000,000 highly able 12-13-year-olds (students in the top 3% in intellectual ability). In this population, the predictive validity of the mathematical part of the SAT, SAT-M, for academic and vocational criteria has been demonstrated over 10-year gaps. Here, we document aspects of the psychological and achievement profiles of these highly able students, paying particular attention to sex differences. Males score higher on SAT-M (i.e., mathematical reasoning ability) than females; this difference is accompanied by differences between the sexes in spatial-mechanical reasoning abilities and in a number of lifestyle and vocational preferences. Collectively, these attributes appear to play a key role in structuring male-female disparities in pursuing advanced educational credentials and careers in the physical sciences. After profiling a number of the behavioural characteristics of the highly able, we examine some underlying biological correlates of these phenotypic manifestations. These include hormonal influences, medical and bodily conditions and enhanced right hemispheric activation.
Occupational health care services are changing in response to rapid changes in health care organization generally; this trend is not reflected in the occupational medicine literature. San Diego is a large and rapidly developing metropolitan area with a balance of heavy, light, and service industries and is relatively isolated and self-contained in health services, making it useful for monitoring health services trends. We examined local trends in the supply of health services as reflected by facilities, manpower, and other indicators between 1974 to 1984. We also assembled findings of local market surveys and certain other sources into a profile of occupational health care resources in the metropolitan area. Corporate medical departments did not keep up with the growth of industry over the decade; freestanding "industrial medicine clinics," by contrast, began with a single facility and proliferated to 13. In the last three years, freestanding "urgent care centers" entered the health care market in force and now outnumber industrial medicine clinics. Despite an overall massive increase in the number of physicians in the area, occupational physicians with specialty credentials or eligibility remained few and primarily based in institutions, while the number of uncertified physicians and of medical groups accepting occupational medicine referrals increased considerably. Employers reported approval of acute care, traditional screening, and employee assistance services far more often than of preventive services, but if they approved of a service, they usually provided it, except in the case of employee assistance services. We conclude that the role of preventive services and of trained personnel in delivering occupational health care is declining, rather than increasing, in the face of competition and changes in the general health care system. Corporate and in-plant medical services are not keeping up with the growth of industry, and no class of health facility matched the growth of industrial medical clinics except urgent care centers, with which they are beginning to compete. The implications of this study for occupational medicine as a specialty, for the standards of patient care, and for the role of prevention is a matter of grave concern if they reflect national trends. Further studies of occupational health services are urgently needed to assess the significance of these findings.
As the continuing medical education (CME) enterprise evolved over the last half century, a variety of rules, national and state regulations, and reporting requirements developed, with a resultant substantial variation in what is required of a physician. That CME needs fundamental reform is not news to those who read the literature. Yet many of the physicians who are served by the current CME system are comfortable with it. Following an initial report of the Council of Medical Specialty Societies, representatives of major stakeholders in CME met voluntarily over 3 years to explore, agree on, and finally propose changes to the present CME system. Their belief in the need for change and their recommendations achieved a collegial outcome; fundamental systemwide changes must occur in CME. This involves educational methods and physician performance, particularly in self-assessment. It also involves the leadership of organized medicine in accreditation, certification, credentialing, licensure, and credit recording, reporting, and funding. The multiple parties involved who control various aspects of CME agreed to focus on the physician end user and to create a revised CME system that would allow simplified and identical reporting of the CME experience and credits for individual physicians. The system also would offer a simplified and more rational approach to credit. Recommendations and action plans to accomplish the objectives were agreed on and have been assigned to organizations according to commitment and relevant historical interest.
The Certified Rehabilitation Registered Nurse (CRRN) certification has become a visible and coveted credential for the practicing rehabilitation nurse. This article presents practical information about preparing for and taking the CRRN examination. Strategies for implementing a study plan and organizing information to increase retention are suggested. In addition, this article offers recommendations for decreasing test anxiety and increasing confidence in test taking.
At the Competencies Conference: Future Directions in Education and Credentialing in Professional Psychology, the Scientific Foundations and Research Competencies Work Group focused on identifying how psychologists practice scientifically. This article presents the subcomponents associated with the core competency of scientific practice. The subcomponents include: 1). access and apply current scientific knowledge habitually and appropriately; 2). contribute to knowledge; 3). critically evaluate interventions and their outcomes; 4). practice vigilance about how sociocultural variables influence scientific practice; and 5). routinely subject work to the scrutiny of colleagues, stakeholders, and the public. In addition, the article briefly discusses how the depth of training for and assessment of each subcomponent will vary by training model. Implications and future directions for individual psychologists, training programs, and the profession are discussed. This is one of a series of articles published in this issue of the Journal of Clinical Psychology. Several other articles that resulted from the Competencies Conference will appear in Professional Psychology: Research and Practice and The Counseling Psychologist.