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PubMed2000

Intern Prescribing for Common Clinical Conditions.

To examine the ability of interns to prescribe appropriately for common clinical conditions at the commencement and completion of the intern year. Interns' perceptions of their ability to prescribe and the perceived influences on their practices were also assessed. The study was conducted at a teaching hospital in urban New South Wales, Australia. A self-complete questionnaire was administered to 56 interns at the beginning and end of internship. At the beginning of the year respondents were asked to identify how equipped they felt they were to perform specific functions related to prescribing practice. Interns were also asked to write hospital prescriptions for four common clinical cases scenarios: post-operative pain, urinary tract infection, asthma, and community-acquired pneumonia. At the end of the year interns were asked to prescribe for the same clinical scenarios and also asked to identify the main influences on their practice. At the beginning of the year 54% of interns felt equipped to choose an appropriate drug for common clinical conditions, however, few felt they were able to determine the appropriate dose (23% of respondents) or dose frequency (25%). A previously validated four-point rating scale was used by two assessors to judge appropriateness of prescribing [Kappa = 0.6]. At the beginning of the year at least two-thirds of interns were prescribing 'inappropriately' for all clinical conditions. By the end of the year 75% were prescribing 'appropriately' for all conditions. The main perceived influences on prescribing practices were registrars, consultants, books and pharmacists.The use of hypothetical clinical cases to explore prescribing ability has shown that doctors are ill-equipped to perform various aspects of prescribing on graduating from medical school. Although our findings may not translate into practice directly they highlight the existence of a potential problem that warrants further study, especially in the areas of actual practice and the influences on it in the early postgraduate years.

Journal Article↗

PubMed2004

The need for substance abuse training among mental health professionals.

This study examines substance abuse as encountered by practitioners in six major mental health professions, from private practice to organizational settings. Respective national professional associations surveyed representative samples of their members, including psychiatrists, psychologists, professional counselors, social workers, marriage and family therapists, and substance abuse counselors. About one in five clients seen in private practice of mental health professionals had substance abuse disorders, with somewhat higher rates in organized mental health treatment settings. For a large majority of clients, substance abuse was secondary to a mental disorder. A significant minority of these practitioners reported having little or no training to address substance abuse, either from formal graduate education, internships, or continuing education.

Education, Professional↗

PubMed1990

Ethical and malpractice issues in hospital practice.

Ethical and malpractice issues arising in hospital practice are reviewed. Topics include (a) preparation and authorization to carry out clinical responsibilities, (b) personnel procedures, (c) financial and political forces influencing hospital policies, (d) billing procedures, (e) clinical procedures for responding to patients' needs, (f) confidentiality, (g) discrimination, (h) internship and training issues, (i) sexual abuse of patients, and (j) staff conflicts influencing patient care.

Ethics, Medical↗

PubMed2000

The affirmation of the scientist-practitioner. A look back at Boulder.

In the aftermath of World War II, several influences were paramount in forcing academic psychology to recognize, albeit reluctantly, the coming professionalization of psychology. The federal government, wishing to avoid a repeat of blunders following World War I that led to significant dissatisfaction among veterans, took proactive steps to ensure that mental health needs of the new veterans would be met. The USPHS and the VA were mandated to expand significantly the pool of mental health practitioners, a direction that led not only to the funding of the Boulder conference but also to the development of APA's accreditation program, funded practical and internship arrangements with the VA, and the USPHS grants to academic departments for clinical training. The GI Bill, amended to include payment for graduate education, created tremendous interest in graduate programs in psychology. As a result, psychology programs were inundated with funded applicants, most of whom were interested in the application of psychology to clinical and other applied fields. Graduate psychology departments were mixed in their views of this "blessing." The reality of a separate curriculum for professional training in psychology was a bitter pill for some academic psychologists to swallow. Graduate departments feared that control of their programs would be taken over by external forces and that they would lose their right to determine their own curriculum. Further, they feared the domination of clinical training within their own departments and the effects of such educational emphasis on their traditional experimental programs. The Boulder conference brought together these disparate needs and concerns, although one can argue about how well some points of view were represented with respect to others. It was a time of high anticipation and fear. The conference could easily have ended in failure, with such diverse interests being unable to reach any consensus. There are many letters in the correspondence of committee members that suggest disagreements serious enough to prevent the development of any single model of training. Instead, by most yardsticks that one could apply, the conference succeeded, perhaps beyond the dreams of many of those in attendance who were most invested in a model for professional training. In evaluating the legacy of Boulder, several points are apparent. First, the conference succeeded because 73 individuals were able to agree to some 70 resolutions in 15 days, creating the scientist-practitioner model of professional training. Such consensus was arguably a remarkable achievement. The endorsement of the model by academic units followed with little evident resistance, although it is clear that some Boulder-model programs were developed that bore little resemblance to the model's insistence on significant training in both research and practice. Second, as a response to social and political needs, the conference was clearly a success. The cooperation of the APA, the USPHS, and the VA benefited all three entities. Clinical psychology was given the financial support and backing to advance it as a profession, and the federal government was able to begin the process of securing the personnel needed to address the mental health needs of the nation. The architects of Boulder were clear that their vision of training for professional psychology should be viewed as dynamic and experimental rather than fixed and prescribed. Certainly there are several variants of professional training extant today, yet the overwhelming majority of currently accredited programs in psychology label themselves as "Boulder-model" programs or "scientist-practitioner" programs. Still, new national conferences on professional training in psychology occur with some regularity as participants seek to resolve many of the same concerns debated by those at Boulder. The grand experiment goes on.

Colorado↗

PubMed1998

Empirically supported treatments: implications for training.

This article discusses the role of empirically supported treatments (ESTs) in the training of clinical psychologists. Training in ESTs can be integrated in ways that vary depending on the level of training and setting. Predoctoral programs, internships, postdoctoral programs, and continuing education are discussed in regard to special challenges and sequencing of training. A preliminary set of guidelines for training in ESTs is suggested.

Empiricism↗

PubMed1998

Being bolder with the Boulder model: the challenge of education and training in empirically supported treatments.

A number of factors interfere with the realization of the scientist-practitioner model of training in applied psychology. Resistance to empirically supported treatments (ESTs) may arise from both academic faculty and internship supervisors who have an investment in approaches of longer standing but with less empirical justification. A possible problem with ESTs, however, is that they typically derive from studies that use treatment manuals, which, originally developed to define the independent variables in psychotherapy research, have become central in graduate training. Because manuals can constrain clinician behavior and because they are almost always associated with categorically defined diagnostic categories, one can lose sight of the idiographic analysis of single cases. Reliance on manualized treatment can discourage functional analysis of the complexities of individual cases. Achieving some synthesis of this dialectic poses a significant challenge to the continuing development of the science and profession of applied psychology.

Empiricism↗

PubMed2000

Predictors of growth from 1 to 18 months among breast-fed Ghanaian infants.

OBJECTIVE: To examine factors associated with the physical growth of breast-fed Ghanaian infants during the first 18 months of life. DESIGN: A community-based longitudinal study. SETTING: The study was carried out in Techiman, a district capital and major food trading center in the Brong Ahafo region of Ghana. SUBJECTS: One-month old infants (n=216) with birth weight >/= 2.5 kg were recruited from Maternal and Child Health Centers. METHOD: From 6 to 12 months, infants were provided with one of four types of nutritionally enhanced complementary foods. Anthropometric assessments were completed monthly from 1 to 12 months and every other month from 12 to 18 months. Information was collected on household characteristics, morbidity from common infections and dietary intakes. Blood samples were collected at 6 and 12 months to assess iron, zinc, riboflavin and vitamin A status. Multiple regression analysis was used to examine factors associated with growth during the age intervals of 1-6, 4-6, 6-12 and 12-18 months as well as size attained at 12 and 18 months. RESULTS: Prevalence of diarrhea and fever were negatively associated with growth during the first year of life. No significant relationship was found between respiratory illness (defined as cough or purulent nasal discharge) and growth. With the exception of dietary zinc intake, dietary variables were generally not significantly associated with growth. Maternal education was positively associated with growth during most of the age intervals. CONCLUSION: These findings suggest that interventions to reduce morbidity and improve the education of girls may benefit children's growth in this population. SPONSORSHIP: Nestle Foundation; Rockefeller Foundation African Dissertation Internship Award; Fulbright Scholarship. European Journal of Clinical Nutrition (2000) 54, 41-49

Anthropometry↗

PubMed1998

A 50 year perspective on endocrine neoplasia: clinic to genes and back.

Having completed medical school and internship in 1947 when effective therapeutic interventions were quite limited (mostly to surgery), I became impressed with the importance of diagnosing the then known treatable diseases. As a young army medical officer, I was exposed to those who emphasized pheochromocytomas and parathyroid adenomas as treatable conditions. After completing internal medicine training, I continued my search for these conditions but it was not until 1958 that I first encountered my first patient with hyperparathyroidism (HPT) who happened to be in a family with many others affected. After leaving the small clinic in Indiana where I practiced for 19 years, in 1970 I came to Henry Ford Hospital where I continued my search for hereditary HPT and encountered families of MEN-2 by applying calcitonin studies to the families of our cases of medullary thyroid cancer. Early genetic linkage studies suggested that progress in the field would benefit from a workshop on MEN-2 and Nancy Simpson agreed to host the first workshop in Kingston in 1984. This and the five subsequent workshops brought together those interested in the field and resulted in the remarkable advances being made in the diagnosis and treatment of endocrine neoplasias and in the understanding of these conditions and of neoplasia in general.

Humans↗

PubMed1997

Problem-based medical education: development of a theoretical foundation and a science-based professional attitude.

Problem-based learning, combined with early patient contact, integration between different subject areas, elements of multiprofessional education, and special emphasis on the development of communications skills has become the basis for the medical curriculum at the Faculty of Health Sciences in Linköping. Critics have questioned the depth of the scientific and theoretical aspects of the curriculum. Through a series of specific measures in the organization of the curriculum and examinations, and due to the pedagogical principles involved per se, our claim is that students graduating at Linköping do possess the required theoretical knowledge and a scientific attitude to the practice of medicine, at least equivalent to that obtained in a more conventional medical curriculum. One such specific measure is that all students perform one field study and two scientific studies during the course of the curriculum. An investigation of student opinions regarding the value of performing scientific projects of their own have shown that these projects have had a positive impact on the students' general scientific attitude and their willingness to engage in future scientific work. The specific skills acquired, as confirmed by oral examinations, were largely determined by the scientific nature of the chosen field of study. Our graduates have not yet progressed far enough in their careers for comparisons to be made on the basis of the Swedish Licensing Board Internship Examinations, but continuing evaluations of students, graduates and licensed doctors emerging from the curriculum will provide future evidence as to whether our present evaluation is correct.

Attitude of Health Personnel↗

PubMed2002

A pre-employment programme for overseas-trained doctors entering the Australian workforce, 1997-99.

OBJECTIVES: Overseas-trained doctors (OTDs) have limited access and formal interaction with the Australian health care system prior to joining the Australian medical workforce. A pre-employment programme was designed to familiarize OTDs with the Australian health care system. METHOD: All OTDs who had passed their Australian Medical Council (AMC) exams and were applying for a pre-registration year in New South Wales were invited to participate in the voluntary, free programme. A 4-week full-time programme was developed consisting of core group teaching and a hospital attachment. The curriculum included communication, health and workplace skills; and sessions on culture shock and the role of junior doctors. A pilot programme was run in 1997. The programme was repeated in 1998 and 1999. The OTDs' confidence regarding the general duties of internship, and attitudes towards hospital workplace skills were examined. RESULTS: The 66 OTDs reported greater understanding of staff and communication issues and familiarization with the hospital environment. They reported a more realistic understanding of the role of a junior doctor, the need for separation of workplace and personal responsibilities and knowledge of pathways for future professional development. The course structure, with a focus on hospital attachments, establishment of a peer network, and workplace familiarization facilitated entry into the hospital workforce. CONCLUSION: The pre-employment programme enabled the OTDs to have a more equitable entry into the public hospital system, resulting in a more integrated, confident and functional workforce.

Australia↗

PubMed1998

A review of journal clubs in postgraduate medical education.

OBJECTIVE: To review the goals, organization, and teaching methods of journal clubs, summarize elements of successful clubs, and evaluate their effect on reading habits, and effectiveness in meeting teaching goals. Examples of clubs that utilize principles of adult learning are reviewed. DATA SOURCES: English language articles identified through a MEDLINE search (1966-1997) using the MeSH terms "internship" and "residency," and text words "journal club" and "critical appraisal." STUDY SELECTION: Articles on learning goals and organization were included if they represented national or regional surveys with a response rate of 65% or greater. Articles that evaluated teaching effectiveness were included if they used a controlled, educational design, or if they exemplified important adult learning principles. DATA EXTRACTION: Data were manually extracted from selected studies and reviews. DATA SYNTHESIS: A major goal for most clubs is to teach critical appraisal skills. Clubs with high attendance and longevity are characterized by mandatory attendance, availability of food, and perceived importance by the program director. Residents who are taught critical appraisal report paying more attention to the methods and are more skeptical of the conclusions, and have increased knowledge of clinical epidemiology and biostatistics, but studies have failed to demonstrate that these residents read more, or read more critically. Reading guidelines may be useful for teaching critical appraisal skills, and may be associated with increased resident satisfaction. CONCLUSIONS: Journal club formats are educationally diverse, can incorporate adult learning principles, and are an adaptable format for teaching the "new basic sciences."

Adult↗

PubMed2003

[Communication and interaction in psychosomatic education: use of standardized patients].

An amendment to the German medical curriculum in April 2002 will place communication and social skills at the centre of medical training. In addition to providing cognitive knowledge, psychosomatic courses offer the opportunity to integrate affective learning, with a focus on communication and interaction processes. In winter term 2001/2002 a training with standardised patients was implemented and evaluated as part of the psychosomatic internship of the Department of General Internal and Psychosomatic Medicine at the Medical Hospital of the University of Heidelberg. Quantitative and qualitative results showed that training with standardised patients is well accepted and that acceptance is independent of student gender, career choice, or interests. These training units are easy to integrate into psychosomatic practical courses. The results discussed here will focus on the role and importance of various elements of medical training.

Adult↗

PubMed2002

Estimation of the risk of bloodborne pathogens to health care workers after a needlestick injury in Taiwan.

OBJECTIVES: To estimate the number of health care workers (HCWs) in Taiwan at risk annually for contracting hepatitis B virus (HBV), hepatitis C virus (HCV), and HIV after a needlestick and sharps injury (NSI) with a used hollow-bore needle. METHODS: All patients hospitalized in 1 tertiary hospital between September 1997 and June 1998 had routine pathological work-ups. On the first day of the months of September 1997, December 1997, March 1998, and June 1998, 1805 samples of deidentified residual sera randomly sampled from 18,474 inpatients older than 6 years were serologically tested for antigens to HBV (HBsAg and HBeAg) and antibodies to HCV (anti-HCV) and HIV (anti-HIV) with enzyme-linked immunosorbent assay reagents. The frequency of NSIs with contaminated devices in HCWs from 16 public teaching hospitals between July 1996 and June 1997 and the serologic results were used to extrapolate the estimated annual rate of seroconversion in HCWs after an NSI. RESULTS: Of the 1805 samples tested, 16.7% were seropositive for HBsAg (of which 1.7% were positive for HBeAg), 12.7% were positive for anti-HCV, and 0.8% were positive for anti-HIV. Of the 7550 NSIs reported by 8645 HCWs, 66.7% involved a contaminated hollow-bore needle. From these data, 308 to 924 HCWs were estimated to be at risk for contracting HBV; 334 to 836 were at risk for contracting HCV; and, at the most, 2 were at risk for contracting HIV. The estimated annual number of contaminated NSIs sustained by 4 categories of HCWs ranged from 0.3 to 0.7, resulting in 543 nurses, 113 technicians, 80 physicians, and 66 supporting staff to be at risk annually of acquiring HBV infection. The numbers of HCWs estimated to be at risk of acquiring HCV were 596 nurses, 90 physicians, 84 technicians, and 30 supporting staff. The risk of acquiring HIV was low, with 1 nurse and possibly 1 other staff potentially exposed annually. CONCLUSIONS: Our estimates of the risk for seroconversion after an NSI have demonstrated that an occult risk can be formulated into a quantifiable risk. The number of susceptible HCWs at risk for seroconversion is as many as 1762 annually. With the number of nurses employed and the frequency with which they use sharps and sustain an NSI, 64.7% of all possible seroconversions will be in the nursing staff. This is a salient reminder of the importance of the introduction of early training in safe-needle-handling techniques before nurses enter their internship in countries where safety equipment, safety instructions, and staff vaccination programs are absent.

Adolescent↗

PubMed2001

Use and barriers to use of laboratory data by clinical dietitians.

The results of this study reveal two general areas of concern for clinical dietitians in the use of laboratory data--their lack of confidence in their own interpretive skills and the perceived resistance of physicians. Although clinical dietitians receive theoretical and applied training on the use of laboratory values in their undergraduate education and dietetic internship, clinical managers should be aware that they need support and continuing education to use their laboratory assessment skills to the fullest. Also, dietitians should demonstrate more clearly to physicians their knowledge, skill, and needs in this area. They should initiate and continue dialogue about the importance of laboratory analysis to nutrition care and improved patient outcome. Evidence-based data and clear documentation of improved medical outcomes should help overcome barriers to use of laboratory data by clinical dietitians.

Adult↗

PubMed2004

Is culture important in the choice of role models? Experiences from a culturally diverse medical school.

In a multicultural student population at a South African medical school, for over one-third of students (Years 1-5) undertaking a traditional curriculum, culture was an important consideration in their choice of a role model. This was particularly so for senior students, perhaps reflecting their relatively recent exposure to patients and their forthcoming internship. Some student comments might, however, be interpreted as reflecting a rigid perception of culture that could translate into a possible lack of respect for other cultures. It is therefore imperative that each institution provide appropriate early and continuous mainstream diversity training, as well as identify role models to match the student profile. With the increasing diversity of students globally, this issue of culture should assume even greater importance in medical education than it is currently afforded.

Career Choice↗

PubMed1994

Adapting undergraduate preclinical courses to changes in clinical applications.

The availability of new technologic tools has greatly changed differential diagnosis. To assess the importance of these tools in current clinical practice, the authors determined the frequencies of use of new imaging methods in diagnosis, staging, and follow-up in 71 oncology cases. The new methods were found to have replaced traditional diagnostic procedures to a substantial extent. To familiarize medical students with the new techniques, lectures on sectional anatomy given by radiologists were integrated into traditional anatomy courses for a group of 50 students. Two years later, after their initial exposure to clinical practice, the 42 students remaining in the group answered a questionnaire regarding the usefulness of the sectional anatomy segment of their anatomy training. Of these 42 students, 14 rated the sectional anatomy exposure "very helpful" to comprehension in the clinical internship and 21 rated it "helpful." The students suggested that the program be reinforced by an integrated textbook. This preliminary study suggests that basic preclinical courses should be modulated to reflect new methods that come into routine use in clinical practice.

Anatomy↗

PubMed2006

Rehabilitation students' attitudes toward persons with disabilities in high- and low-stakes social contexts: A conjoint analysis.

PURPOSE: The primary objective of this research is to examine factors influencing rehabilitation services students' attitudes toward people with disabilities in two social contexts using a conjoint analysis design. METHOD: Ninety-nine students in rehabilitation counselling participated in a conjoint measurement study featuring 55 stimulus cards representing varying disability types, genders, races or ethnicities, grade point averages, internship evaluations, and employment statuses for both high-stakes scenarios and low-stakes scenarios. The participants were instructed to order the stimulus cards to indicate their preferences for associating with different people with disabilities in two social contexts: A high-stakes context as a rehabilitation administrator hiring a counsellor and a low-stakes context as a mentor/companion. RESULTS: The results showed that age and disability type were most involved in the decision-making process in the low-stakes group, and performance-related variables were most important in the high-stakes context. Attitude was significantly affected by client characteristics unrelated to disability including age and race or ethnicity, and factors influencing attitude formation differed across the two social contexts. CONCLUSION: Conjoint analysis can contribute to our understanding of the formation of attitudes or preferences in multiple social contexts. Using these results, it may be possible to develop effective attitude change strategies.

Adolescent↗

PubMed2006

Giuseppe Levi: mentor of three Nobel laureates.

Giuseppe Levi (1872-1965), Professor of Anatomy at the University of Turin, had broad research interests and was a pioneer of in vitro studies on cultured cells. He provided a number of contributions on the nervous system, especially on the plasticity of sensory ganglion cells. An influential and magnetic teacher and mentor, he gathered around him a large group of brilliant students. He has the peculiar primate to count among his students three Nobel laureates in Physiology or Medicine: Salvador Luria, Renato Dulbecco, and Rita Levi-Montalcini. For all three of them, the internship in Levi's laboratory provided an exceptional initial stimulus. They remained in close contact with each other and with Levi even after the 1940s when they migrated to the United States for political and racial reasons, engaging in different fields of research. Rita Levi-Montalcini, who was awarded the Nobel Prize (1986) for the discovery of Nerve Growth Factor, was stimulated and assisted in her work by Giuseppe Levi during the difficult years of World War II. With Giuseppe Levi, she pursued early studies on the relationships between neural centers and their peripheral target of innervation, and she has witnessed in her writings the enthusiasm of her mentor.

Anatomy↗