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Rehabilitation engineering training for the future: influence of trends in academics, technology, and health reform.

A perspective is offered on rehabilitation engineering educational strategies, with a focus on the bachelor's and master's levels. Ongoing changes in engineering education are summarized, especially as related to the integration of design and computers throughout the curriculum; most positively affect rehabilitation engineering training. The challenge of identifying long-term "niches" for rehabilitation engineers within a changing rehabilitation service delivery process is addressed. Five key training components are identified and developed: core science and engineering knowledge, synthesized open-ended problem-solving skill development, hands-on design experience, rehabilitation breadth exposure, and a clinical internship. Two unique abilities are identified that help demarcate the engineer from other providers: open-ended problem-solving skills that include quantitative analysis when appropriate, and objective quantitative evaluation of human performance. Educational strategies for developing these abilities are addressed. Finally, a case is made for training "hybrid" engineers/therapists, in particular bachelor-level engineers who go directly to graduate school to become certified orthotists/prosthetists or physical/occupational therapists, pass the RESNA-sponsored assistive technology service provision exam along the way, then later in life obtain a professional engineer's license and an engineering master's degree.

Biomedical Engineering↗

Educating the rehabilitation engineer as a service provider.

This paper reviews a 12-month masters-level rehabilitation engineering training program to prepare engineers to be rehabilitation service providers. The extent of the rehabilitation engineering shortage is discussed. The curriculum is then provided with descriptions of 16 courses, the program's internship, and a comparison with other training programs. A listing of the intended customers of the program graduates is given along with a description of the advisory committee to help interface with these customers. Four educational goals consisting of disability and technology, major rehabilitation systems, applied skills, and life-long learning are discussed. The results of six years' experience with this program, including a survey of graduates, are presented.

Biomedical Engineering↗

How do Australian doctors with different pre-medical school backgrounds perform as interns?

AIM: To assess whether there is any advantage to be gained with respect to performance in the first year of postgraduate medical training (internship) by selecting medical school candidates with different educational backgrounds. Specifically, we were interested in comparing the performance ratings of interns who entered medical school with secondary (directly from high school) or tertiary (at least one year of a university degree) level educational backgrounds. FOCUS: We compared the performance ratings of interns according to the subjects or degree undertaken at a secondary or tertiary level, respectively. The effects of age and gender were also examined to determine their influence on performance ratings. METHOD: All graduates (N=235) from the University of Newcastle Medical School, Australia who commenced their intern year in the state of New South Wales from 1993 to 1996 inclusive were eligible for the study. The outcome measure was a score derived from a valid and reliable clinical supervisor rating scale. Independent variables were level of previous educational experience (secondary or tertiary entry), and subjects studied by secondary level entrants (predominantly science or equal proportions of humanities and science) and degree undertaken by tertiary level entrants (arts or science or allied health or nursing). RESULTS: The records of 173 (73% of eligible sample) were included in the analyses. There were no significant differences between the mean ratings of interns with respect to previous educational background, subjects studied at secondary school or degree undertaken. Age and gender did not significantly affect performance ratings.

Journal Article↗

An interview with Professor Robert J. Lefkowitz, M.D. Interview by Vicki Glaser.

Robert J. Lefkowitz, M.D., is James B. Duke Professor of Medicine and Professor of Biochemistry at the Duke University Medical Center. He has been an Investigator of the Howard Hughes Medical Institute since 1976. Dr. Lefkowitz received a Bachelor's degree from Columbia College and an M.D. degree from Columbia University College of Physicians and Surgeons. After serving an internship and one year of general medical residency at the College of Physicians and Surgeons, he served as a Clinical and Research Associate with Drs. Jesse Roth and Ira Pastan at the National Institutes of Health. He then completed his medical residency and research and clinical training in cardiovascular disease at the Massachusetts General Hospital, Boston. During this time, he continued his research in the laboratories of Dr. Edgar Haber and was a teaching fellow at Harvard Medical School. On completing his training, he was appointed Associate Professor of Medicine and Assistant Professor of Biochemistry at the Duke University Medical Center.

Drug Industry↗

Application of demand-control theory to sign language interpreting: implications for stress and interpreter training.

The translation work of sign language interpreters involves much more than language. The characteristics and goings-on in the physical environment, the dynamics and interactions between the people who are present, and even the "inner noise" of the interpreter contribute to the accuracy, or lack thereof, of the resulting translation. The competent interpreter must understand and respond appropriately to the language and nonlanguage aspects of each interpreting assignment. We use the framework of demand-control theory (Karasek, 1979) to examine the complex occupation of sign language interpreting. Demand-control theory is a job analysis method useful in studies of occupational stress and reduction of stress-related illness, injury, and burnout. We describe sources of demand in the interpreting profession, including demands that arise from factors other than those associated with languages (linguistic demands). These include environmental, interpersonal, and intrapersonal demands. Karasek's concept of control, or decision latitude, is also explored in relation to the interpreting profession. We discuss the prevalence of cumulative trauma disorders (CTD), turnover, and burnout in the interpreting profession in light of demand-control theory and data from interpreter surveys, including a new survey study described herein. We conclude that nonlinguistic demand factors in particular and perceived restrictions in decision latitude likely contribute to stress, CTD, burnout, and the resulting shortage of sign language interpreters. We make suggestions for improvements in interpreter education and professional development, including the institution of an advanced, supervised professional training period, modeled after internships common in other high demand professional occupations.

Journal Article↗

House calls in Lebanon: reflections on personal experience.

BACKGROUND: Home health services play an important role in decreasing hospital admissions and physicians' medical house calls play an integral role in home health services. There is no national survey of physicians' house call practice in the Lebanon. OBJECTIVES: The aim of this study was to provide some information about house call practice in the Lebanon. METHOD: Data on patients examined during house call visits between 1 January and the end of December 1995 were reviewed. RESULTS: During this period, 137 patients were seen at their home. Eighty-four patients (62%) were female and 53 patients (38%) were male. Ages ranged from 1 to 85 years. The number of cases seen in 1 month averaged 11. The diagnosis differed according to the age group of patients examined. Most of the house call visits occurred between 6.30 p.m. to 12.00 p.m. (47%). Fifteen patients (11%) were admitted to the hospital. CONCLUSION: The rate of cases per month was similar to those reported elsewhere. Physicians might feel reluctant to conduct house calls out of hours. Our study revealed that the majority of patients were seen between 6 p.m. and 12 p.m., and only 6% were seen after 12 a.m. It is our belief that house calls are an integral part of family practice and need to be stressed during the internships of all primary care physicians.

Adolescent↗

Survey of HIV/AIDS knowledge and attitudes of Kuwaiti family physicians.

OBJECTIVES: This study aimed to explore Kuwaiti family physicians' attitudes and knowledge about HIV/AIDS. METHODS: One hundred and sixty-two Kuwaiti family physicians (95 females and 67 males) from all four health catchment areas have completed a 30-item self-administered questionnaire to measure HIV/AIDS-related attitudes and knowledge. RESULTS: Knowledge was lacking in areas dealing with HIV-related neuropsychiatric complications and other issues concerning HIV/AIDS, special populations and range of normal sexuality. The majority of physicians expressed negative attitudes toward homosexuality and about AIDS patients in general. Eighty-three per cent of Kuwaiti family physicians would opt out of treating AIDS patients. More than half of the physicians would avoid coming into social contact with HIV-seropositive persons. No significant difference was found for the total knowledge and attitude scores for gender. CONCLUSION: The results of this survey revealed that even in the second decade of the AIDS epidemic, some Kuwaiti family physicians continue to have a lack of proper knowledge about HIV and harbour negative attitudes toward AIDS patients. There is a need to promote an AIDS education early in the medical internship training years which addresses many underlying socio-cultural factors.

Acquired Immunodeficiency Syndrome↗

National standards for the licensure of nursing home administrators: what should be sought?

In recent years a national debate has focused on the licensure of nursing home administrators. Congress mandated licensure goals in 1970, but recently has considered eliminating the requirement that states license nursing home administrators. Data showing trends during 1977-1987 in education, internship, professional examinations, and reciprocity requirements are evaluated in this paper, and three recommendations for national standards are made.

Health Facility Administrators↗

Cardiopulmonary rehabilitation specialization: survey and suggested curriculum.

Findings exploring further educational commitment and job potential in the carciopulmonary rehabilitation area are presented based on a nationwide survey to 100 physical therapy departments. Results show 1) 99 percent of the sample population believed postgraduate work was necessary; 2) 72 percent indicated that caridac and plumonary rehabilitation techniques should be offered together; 3) 51 percent idinicated willingness to complete a clinical internship; and 4) 79 percent indicated that this specialty training could be utilized effectively in their respective hospital settings, with 20 percent indicating that hospital administrators would willingly pay salary differentials for this clinical specialty. A clinical Master of Arts degree curriculum design is presented with brief course descriptions currently in progess in the Department of Physical Therapy, New York University School of Education, Health, Nursing, and the Arts, Professions.

Curriculum↗

Obstetrics-gynecology in the physical therapy curriculum: a follow-up study.

This article reports the results of two questionnaire surveys conducted five years apart to evaluate the status and changes in obstetrics-gynecology (Ob-Gyn) units taught in physical therapy education programs. Sixteen new Ob-Gyn units were implemented in the five-year period between 1981 and 1986. Laboratory time for breathing and relaxation exercises decreased 50% between 1981 and 1986, whereas total hours for the Ob-Gyn unit remained the same. Fifteen respondents in the 1986 survey indicated gynecologic topic area content included reproductive anatomy, gynecological disorders, and evaluation techniques. The authors recommend increased laboratory time, development of Ob-Gyn internships, and further research. Threading Ob-Gyn concepts throughout the curriculum as well as having a concentrated Ob-Gyn unit are recommended.

Curriculum↗

Evaluating M.D.-level competence in internal medicine.

The faculty of the Department of Medicine at the University of Hawaii John A. Burns School of Medicine defines M.D.-level competence as the capability of undertaking the first day of a primary care internship. The implementation of a clinical clerkship in internal medicine that was flexible in time required that a new evaluation program be developed to assess the progress of students toward defined end points of competence. The four measures used are an objective test of basic medical knowledge, simulations to assess intellectual skills in problem-solving, a clinical skills examination with written standards to help the evaluator make discriminations between levels of performance, and a criterion-referenced rating scale to assess professional habits and attitudes. The progress of the classes of 1979 and 1980 toward achievement of predetermined levels of mastery is presented.

Clinical Competence↗

Health-related experimental learning for college undergraduates.

Guided service experience commonly enriches medical education at the doctoral and postdoctoral levels but rarely has been offered to premedical students. Internships in health agencies were individually arranged for 198 self-selected college undergraduates in 101 different settings which emphasized the social, economic, and interpersonal factors in health care. Students served as nursing aides, clinical assistants, and health educators and in other nontechnical roles; each wrote an analytical report based upon a study plan and firsthand observations. The expectations of both students and host institutions were usually exceeded. Benefits included help in career decisions, exercise in self-directed learning, and demonstration of noncognitive qualities desired in professional work. The authors conclude that undergraduate students are competent to deal with sensitive ethical and social issues in patient care and to provide needed health services of high quality.

Education, Medical, Undergraduate↗

Beyond Florence Nightingale: the general professional education of the nurse.

The leadership of nursing has been more concerned with the issue of nursing as a profession on a par with medicine than with the development of an education that would lead to professional status. Nurses must leave nursing, the care of the sick, to advance their careers. The author proposes rigorous preprofessional science preparation and nursing education at the baccalaureate level followed by a clinical internship. Nurses would be able to achieve specialty education either by graduate education or through experience and continuing nursing education. Those nurses who elected careers in management, the social or natural sciences, as researchers or faculty, could build on their strong undergraduate science education. This educational model would require the apprenticeship education of nursing assistants, whose training should be planned by and supervised by nurses in the classroom and on the wards.

Career Mobility↗

Osteopathic medicine and primary care practice: plan or serendipity?

General practitioners predominate in osteopathic medicine (57% of all D.O.s), as compared with allopathic medicine. A number of possible reasons are put forth: the student selection process (cloning by admission committee general practitioners); special features of osteopathic education (more required courses, primary care courses, and rotations); training in osteopathic hospitals (mainly community institutions); a required rotating internship; and predominant departments of general practice in osteopathic hospitals and colleges (providing more high-quality general practitioner role models). The author suggests consideration of personality differences, as measured by the Myers-Briggs Type Indicator, as a possible causative factor in differences between the allopathic and osteopathic segments of medicine.

Curriculum↗

A student-centered, problem-based surgery clerkship.

In the academic year 1989-90, the department of surgery at one college of medicine revised its third-year clerkship to focus on students' learning decision-making skills and critical thinking (cognitive skills) and acquiring knowledge about surgery. Learning to perform procedures and tasks (psychomotor skills) would be accomplished in the required fourth-year acting internships. Problem-based learning (PBL) was chosen as the clerkship's primary instructional method. Comprehensive student and program evaluation systems were established. The response by faculty and students has been very positive. Students believe that the new clerkship has helped them increase their abilities in resource use, time management, and retention of knowledge. Faculty have noted students' increased eagerness and enthusiasm for learning.

Clinical Clerkship↗

Attitudes of senior medical students from two Australian schools towards rural training and practice.

Australia, like many other countries, continues to face a perennial shortage of doctors in rural areas. This 1988 study of final-year medical students at the two universities in Victoria, Australia, sought to assess their attitudes towards the choice of location for postgraduate training as well as ultimate practice location. The authors gave a cross-sectional, self-administered questionnaire to 360 students; 314 (87%) responded. The majority of the students expressed a desire to do their internships and postgraduate training in a metropolitan hospital. To identify the students' attitudes that might have influenced their choices, factor analysis was carried out. The "education and training" factor accounted for the highest percentage of the variance observed. As in most other similar studies, a strong relationship was observed between a student's rural background and the student's subsequent intention to train and work in a rural area.

Attitude to Health↗

Long-term follow-up of an alternative medical curriculum.

BACKGROUND: The Alternative Curriculum (AC), an elective program at the University of Virginia School of Medicine that enrolled a total of 48 students in 1973 and 1974, was one of many demonstration and pilot programs conducted during the 1970s. Its principal features were (1) a three-year time span; (2) early, prolonged, and intensive instruction in clinical skills; (3) intensive consideration of behavioral, social, economic, ethical, and legal aspects of medicine in a patient-centered curriculum; (4) an extensive course in sexuality; (5) an independent study format for two preclinical courses; (6) instruction in cardiopulmonary resuscitation; and (7) participation in the activities of the local rescue squad. In view of continuing questions about the structure and content of medical school curricula, it seemed worthwhile to try to determine what effects the program might have had on the participants during medical school and in their subsequent careers. METHODS: In 1991, data on the AC participants were collected, largely by means of a survey but also by examination of the participants' medical school records and determination of their current professional status. RESULTS: Of the 48 participants, 44 were available for the survey, and 37 returned completed questionnaires. The great majority of the respondents had positive opinions about the program's three-year time span, morale during the program, and beneficial effects of the program's special content during their clerkships, postgraduate training programs, and subsequent careers. They thought they had had enough time to make informed specialty choices and did not think that their participation in the AC had been a handicap in getting the internships they wanted. Fewer than half of the students thought that the AC had influenced their career choices, and only 26% were currently in primary care specialties. CONCLUSION: The AC was successful in improving students' morale during the preclinical segment, preparing them for clerkships, and increasing their sensitivity to the patient as a whole. That the program was not effective in inducing students to enter primary care specialties supports the view that curriculum content is not a major factor in students' choices of specialty.

Career Choice↗

Station gender bias in a multiple-station test of clinical skills.

PURPOSE: To apply differential item functioning (DIF) procedures to investigate station gender bias in multiple-station tests of clinical skills, and to compare these results with those obtained by comparing the station-score distributions of men and women examinees. METHOD: The data were from 23 stations used in the selection of seven successive cohorts (1987-1993) of candidates to the Ontario Pre-Internship Program for graduates of foreign medical schools. The stations had been used on at least three occasions, with a minimum sample of about 210 candidates per station. Each station's score was expressed as both a binary score and a continuous score, and DIF was assessed using the Mantel-Haenszel procedure with the binary scores and analysis of covariance with the continuous scores. For each station, DIF effect sizes were calculated and compared with the gender-group mean differences. RESULTS: Using the binary scores, significant DIF was observed for three stations; using the continuous scores, significant DIF was observed for five stations. Significant gender differences were observed in the scores of nine stations. In eight, these differences favored women. Overall, in more stations the direction of DIF favored the men, while the women demonstrated higher levels of ability. CONCLUSION: The results suggest the importance of using a DIF approach for controlling the "ability factor" in studies of this kind: although significant gender differences were observed in the continuous score distributions of nine stations, generally these differences were not indicative of station gender bias.

Analysis of Variance↗