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PubMed1995

A multistate program to educate physicians: successful, economical, but endangered.

The Southern Regional Education Board (SREB) was formed in 1948 to facilitate multistate contracts for education exchange; at present, 15 states participate in this program. West Virginia is one of four states in the SREB that offer training in osteopathic medicine, and the West Virginia School of Osteopathic Medicine (WVSOM) is the only professional school in West Virginia that is a member of the SREB program. The authors describe (1) WVSOM's mission to provide primary care physicians to meet the medical needs of Appalachia, and (2) the success that an WVSOM-SREB partnership has had in training primary care physicians for participating states at a fraction of the effort and cost that would otherwise have been necessary. Concern is expressed for the program's future, and suggestions offered for the establishment of similar multistate programs to foster the production of physicians in a variety of specialties throughout the nation, since the WVSOM has clearly been successful in producing primary care physicians and in motivating graduates to return to their home states. For example, through the WVSOM-SREB osteopathic medicine program, students from states that share parts of Appalachia (Georgia, Mississippi, Alabama, and Maryland) and Florida have received their education at WVSOM. From 1978 until 1994, WVSOM graduated 148 SREB physicians; 122 of these are practicing physicians, 23 are in internships or residencies, and three have died. Of the 122, 53% have returned to practice in their home states; 85% of these graduates and 84% of all the SREB graduates who have returned to their home states or to other Appalachian states are practicing in primary care fields.

Education, Medical↗
PubMed1999

Why students drop out of the pipeline to health professions careers: a follow-up of gifted minority high school students.

PURPOSE: To track gifted underrepresented minority (URM) students who entered the pipeline to health professional school when they were in high school and to determine whether and why students left the pipeline to enter other professions. METHOD: A questionnaire was mailed to 162 students who had participated in the Student Educational Enrichment Program (SEEP) in health sciences at the Medical College of Georgia between 1984 and 1991; 123 (75%) responded. RESULTS: Students in the study population had higher graduation rates than the average state or national student. Fifty-nine (48%) of the students had entered health care careers; 98% had stated that intention when they were in high school. Although some of the students stated trouble with course work and GPA as reasons for their decisions to change career tracks, many students said that their interests in non-medical careers had been fostered by mentors or by opportunities to serve internships. CONCLUSION: Early intervention is important to retaining students in a pipeline that leads to a health care career. Summer programs are successful, but may not be enough to help students with difficult science courses in college, especially chemistry. However, another important conclusion is that much more needs to be done to help students find mentors with whom they can develop relationships and to give them opportunities to work in health care settings.

Career Choice↗
PubMed2002

Education on-demand: the development of a simulator-based medical education service.

OBJECTIVES: Clinical medical education depends on the availability of instructive patient encounters, or "good teaching cases." While all medical students hope to see enough patients of sufficient scope and variety, exposure to good teaching cases has been traditionally limited by time and chance. Students may graduate from medical school without having seen a number of important cases, each of which may represent a knowledge gap they will carry forward into internship and future patient care. Recently, however, the advent of high-fidelity patient simulators has enabled instructors to recreate realistic patient scenarios in a standardized fashion. Using the simulator, we wanted to create a medical education service-like any other clinical teaching service, but designed exclusively to help students fill in the gaps in their own education, on demand. We hoped to mitigate the inherent variability of standard clinical teaching, and to augment areas of deficiency. DESCRIPTION: Using a Human Patient Simulator(TM) (Medical Education Technologies, Inc.), which is equipped with a transmitted voice and reactive eyes, chest movements and breath sounds, heart tones and palpable pulses, a multidisciplinary group of physicians and educators designed a simulator-based medical education service. The premise was that students should have the ability to realistically practice and discuss medicine with a physician-mentor at any time they wish, with full access to simulator-enabled cardiac monitoring, diagnostic resources, pharmacologic agents, and invasive procedures. Students were informed of the program by e-mail and by course instructors. A dedicated pager was established for the on-call physician-educator, and the number disseminated to students. Physician-educators included faculty members scheduled for dedicated teaching time, and senior residents participating in a medical education elective. On-call physicians were responsible for fielding educational requests, developing appropriate scenarios, and scheduling instructional time. Upon arriving at the skills lab for their appointments, students would proceed to interview, evaluate, and treat the mannequin-simulator as if it were a real patient, using the instructor for assistance as needed. All students participated in an educational debriefing after each session. Instructors could also request formal observation and feedback on their teaching style, in collaboration with an existing faculty development program. DISCUSSION: Students enjoy the opportunity to practice medicine on-demand with dedicated clinical mentoring by a practicing physician. Course directors are interested in scheduling simulator time to help bring to life tutorial-based teaching cases and other course material for their students. By offering a medical education elective for residents, we have bolstered the pool of available instructors, provided a valuable learning experience for residents as teachers, and fostered additional opportunities for collaboration between the medical school and clinical training sites. Customized, realistic clinical correlates are now readily available for students and teachers, allowing reliable access to "the good teaching case."

Education, Medical, Continuing↗
PubMed2003

Medical humanities: a new undergraduate teaching program at the University of Geneva School of Medicine, Switzerland.

In 2001, a new program of medical humanities was initiated at the University of Geneva School of Medicine in Switzerland. Four mandatory seminars and one optional 2-week internship are offered to second-through fifth-year medical students. The program has four interdependent goals: contextualizing, developing personal reflection and judgment, encouraging imagination, and offering specific ways to improve the quality of the therapeutic relationship. The program is based on an integrated vision of the humanities and stimulates the students' imagination and reflection in a way that medical students should find useful. Three steps help teachers to build an integrated vision: familiarization, confrontation, and adjustment to the medical culture. The mandatory seminars are taught by a team consisting of a physician and a humanities teacher. All the physicians, department heads, and clinicians involved in each seminar actively collaborated. The medical humanities program is in the Bioethics Unit, which is housed in the Department of Community Health and Medicine with medical history and legal medicine. This intellectual, institutional, and physical proximity encourages informal dialogue and ensures a more coherent and unified vision of the different disciplines. In their assessments of the program, students stated that the seminars gave them food for thought and met their expectations. However, it is premature to draw conclusions from these assessments because the program is still in its infancy. The program strives to provide students with tools specific to the humanities so that they can strengthen their own judgment, listening skills, open-mindedness, creativity, and curiosity, attributes that are needed to ensure that the therapeutic relationship will be satisfying for both physicians and patients.

Curriculum↗
PubMed2005

Viewpoint: teaching professionalism: is medical morality a competency?

The Accreditation Council for Graduate Medical Education (ACGME) has declared medical professionalism to be a competence analogous to competence at medical practice. Medical educators accordingly seek to develop ways in which to teach and assess medical professionalism as they now teach and assess clinical medicine. The author contends that professionalism is medical morality and that while being moral in the world of medical practice can involve skill, morality differs from domain-based skills such as medicine in important respects. The norms of morality are both more exigent and more difficult to live up to than the norms of medical expertise. And any morality we learn in the course of medical education does not simply establish itself in our repertoire as a new skill, but must contend with our preexisting moral outlook. These differences have implications for the inculcation and assessment of professionalism. Professionalism can be taught, but the current model employed by medical education, cognitive engagement followed by supervised practice, will not suffice for its inculcation. Nor will objective cognitive or behavioral testing suffice for its assessment. Medical educators can seek and achieve compliance with professional norms during the formative periods of training (internship and residency). Committed observance of professional norms cannot be coerced but may emerge among trainees through their responsiveness to the lived moral life of virtuous faculty, encouraged by the tacit and explicit invitation of such faculty to imitation over time. To be valid, assessment of professionalism must be subjective, narrative, personal, undertaken during periods of stress, and obtained during routine activity (rather than on special occasions).

Competency-Based Education↗
PubMed2005

The feasibility, reliability, and validity of a program director's (supervisor's) evaluation form for medical school graduates.

PURPOSE: To determine the feasibility, reliability, and validity of the supervisor's evaluation form for first-year residents as an outcome measure for programmatic evaluation. METHOD: Prospective feedback has been sought from supervisors for the Uniformed Services University of the Health Sciences (USUHS) graduates during their internship year. Supervisors are sent yearly evaluation forms with up to three additional mailings. Using a six-point scale, supervisors rate residents on 18 items. The authors used evaluation data from 1993 to 2002. Feasibility was estimated by response rate. Internal consistency was assessed by calculating Cronbach's alpha and analyzing scores on a year-to-year and interrater basis. Validity was determined by exploratory factor analysis with oblique rotations, comparing ratings with end-of-medical school GPA and United States Medical Licensing Examination (USMLE) Step 1 and Step 2 scores (Pearson correlations), and by analyzing the range of scores to include the percentage of scores below acceptable level. RESULTS: A total of 1,247 evaluations were collected for the 1,559 USUHS graduates (80%). Cronbach's alpha was .96 with no significant difference in scores by supervisor specialty or year. Factor analysis found that the evaluation form collapsed into two domains accounting for 68% of the variance: professionalism and expertise. End-of-medical school GPA and USMLE Step 1 and 2 scores correlated with expertise but not with professionalism. Mean scores across items were 3.5-4.31 with a median of 4.0 for all items (SD .80-1.21). Four percent of graduates received less-than-satisfactory ratings. CONCLUSIONS: This evaluation form has high feasibility and internal consistency. Factory analysis revealed two complimentary domains supporting its validity. Correlation with end-of-medical school measurements and analysis of range of scores supports the form's validity.

Education, Medical, Undergraduate↗
PubMedDate not supplied

Rehabilitation engineering education at the University of Virginia.

The graduate rehabilitation engineering program of study at the University of Virginia is the first program of its type in the United States. The first students were admitted to the program in the fall of 1979. The program is designed to train students with engineering and clinical science backgrounds in the field of rehabilitation engineering. Emphasis is placed on practical training through internship activities at the University of Virginia Rehabilitation Engineering Center and Medical School Department of Orthopedics and Rehabilitation. Field experience is received at the Woodrow Wilson Rehabilitation Center and the University of Virginia Children's Rehabilitation Center.

Biomedical Engineering↗
PubMed2003

Harvey Cushing's Canadian connections.

During his surgical career between 1896 and 1934, Harvey Cushing made eight visits to Canada. He had a broad impact on Canadian medicine and neurosurgery. Cushing's students Wilder Penfield and Kenneth McKenzie became outstanding leaders of the two major centers in Canada for neurosurgical treatment and training. On his first trip to Canada, shortly after completing his surgical internship in August 1896, Cushing traveled with members of his family through the Maritime Provinces and visited hospitals in Quebec and Montreal. Eight years later, in February 1904, as a successful young neurosurgeon at the Johns Hopkins Hospital, he reported to the Montreal Medico-Chirurgical Society on his surgical experience in 20 cases of removal of the trigeminal ganglion for neuralgia. In 1922, as the Charles Mickle Lecturer at the University of Toronto, Cushing assigned his honorarium of $1000 to support a neurosurgical fellowship at Harvard. This was awarded to McKenzie, then a general practitioner, for a year's training with Cushing in 1922-1923. McKenzie returned to initiate the neurosurgical services at the Toronto General Hospital, where he developed into a master surgeon and teacher. On Cushing's second visit to McGill University in October 1922, he and Sir Charles Sherrington inaugurated the new Biology Building of McGill's Medical School, marking the first stage of a Rockefeller-McGill program of modernization. In May 1929, Cushing attended the dedication of the Osler Library at McGill. In September 1934, responding to the invitation of Penfield, Cushing presented a Foundation Lecture-one of his finest addresses on the philosophy of neurosurgery-at the opening of the Montreal Neurological Institute. On that same trip, Cushing's revisit to McGill's Osler Library convinced him to turn over his own treasure of historical books to Yale University.

Canada↗
PubMedDate not supplied

Recruiting licensed staff in mental health.

This 4- to 6-month mental health internship program for new graduates vocational nurses (GVNs) involves a 4-month mental health course, a new graduate course, management of assaultive behavior course, and a 1:1 preceptorship in mental health. This successful program has recruited and trained 18 VNs to improve licensed staff/patient ratios in mental health. These new graduates are licensed at the end of 4 months and are working successfully as licensed staff on the psychiatric units. All of these licensed vocational nurses (LVNs) are now completing prerequisites or entering registered nurse (RN) programs to earn an advanced degree. They bring their medical skills, positive attitudes, and therapeutic strategies to contribute to the milieu on the nursing units. They have reduced the facility's licensed staff shortage in mental health.

California↗
PubMedDate not supplied

Supporting academic public health practice: a survey of organizational structures in public health schools.

A survey was conducted at 28 schools of public health to assess how they allocate responsibility for three kinds of academic practice activity: continuing education, student internships, and technical consultation by faculty. Respondents identified whether these responsibilities were in a central practice unit, in another schoolwide unit, dispersed among several units, or dispersed among individual faculty members. Though all respondents engaged in these activities, responsibility tended to be carried out by individual departments or independent faculty members. This typically decentralized approach raises questions about the sustainability of academic public health practice that call for further inquiry.

Data Collection↗
PubMed1989

Reports from research centres--20. Alcohol research at the Hjellestad Clinic.

Treatment and research efforts at the Hjellestad Clinic are based on a biobehavioural model of the addictions. The treatment program encompasses life-style changes and relapse prevention, and extensive assessment for the purpose of the treatment choices. The clinic is treating nearly 1500 patients a year. Psychological and medical research projects have included experimental drinking studies, psychopharmacological and biomedical studies, treatment evaluations, studies of neuropsychological assessment, studies of personality subtypes, studies of violence related to alcohol and drugs, and investigations of women alcoholics. A new research laboratory houses an experimental bar, and state-of-the-art facilities for psychophysiological and neuropsychological testing. The Hjellestad Clinic is the only Norwegian centre for clinical and experimental research on the addictions from a psycho-physiological as well as behavioral and cognitive perspective. In addition, a national educational program offers theoretical and practical training for professionals and paraprofessionals in the addictions in co-operation with the University of Bergen. Training in the addictions and internships for psychology students at the University of Bergen is provided at the Clinic. The centre has established connections with centres in Scandinavia, England, Canada and the U.S., through visiting scholars and study trips. (The centre has an especially strong liaison with the Rutgers Center of Alcohol Studies.)

Alcoholism↗
PubMed1986

Choice of general practice for postgraduate training among medical graduates and undergraduates in Nigeria.

A questionnaire survey of career choices was carried out among 112 medical graduates, after one year's internship (group I), during their National Youth Corps programme in Kaduna, Lagos, Cross River and Oyo states of Nigeria, and 365 final-year medical undergraduates (group 2) in the colleges of medicine in the corresponding states. A total of 13% in group I and 40% in group 2 were undecided as regards their first choice. Obstetrics and gynaecology was the most popular first choice in both groups. General practice ranked fifth among group I, but displaced surgery to rank second among group 2. The differences were statistically significant. A total of 41% of group I and 46% of group 2 preferred to work in a teaching hospital, reflecting the high preference for surgical specialties. Twenty-six per cent and 33.7% of respondents in groups 1 and 2 respectively wished to own their own practice or work in the private sector. General practice is a new specialty and its growth is supported by a national postgraduate training programme. A shift towards general practice is seen compared with previous studies of career preference among Nigerian medical graduates and students. This may be due to a changing balance of supply and demand in the medical work-force, or a better assessment of the nation's health problems and manpower needs.

Career Choice↗
PubMed1989

Lectures and skills workshops as teaching formats in a history-taking skills course for medical students.

The consulting skills acquired by medical students during their training are an important determinant of their ability to conduct adequate and efficient clinical interviews. These skills comprise: the acquisition of medical knowledge and the ability to apply this; and communication skills required to obtain full, accurate clinical histories from patients and to be able to give to patients the information they need to comply with prescribed regimens. Until recently, consulting skills training has certainly not had a high profile in medical curricula, despite evidence that students do not gain sufficient expertise during their medical training. A history-taking skills course within the Austin Hospital Clinical School, utilizing mass lecture and small-group skills workshops is described. Independent evaluation of students' videotaped interviews with patients, completed before training, after mass lectures and following small-group workshops, showed that students trained in consulting skills demonstrated significant improvements in interview skills and techniques, compared with a similar group of students for whom training followed the more traditional model. Whilst there were some improvements after mass lectures, most significant gains in history-taking skills were obtained following skills workshops. Ongoing evaluation of these students will determine if these short-term improvements in consultation skills persist over their clinical training and internship.

Clinical Clerkship↗
PubMed1991

The observed long-case in clinical assessment.

The University of Adelaide has developed a comprehensive approach to final-year clinical assessment through the use of ward ratings during student internships and the administration of an objective examination of clinical competence at the end of the year. The traditional clinical viva has been retained only to make pass-fail decisions on borderline students. Problems in making these decisions prompted a modification of the viva so that each student undertook two long-cases, each being observed by a pair of examiners. Better agreement among examiners and more effective decision-making seemed to ensue. The success of this approach led to the introduction of observed long-cases into the ward setting. This move has been strongly supported by staff and students. The opportunities for remedial action during the course were regarded as particularly valuable. This approach may offer a practical alternative to more sophisticated assessment techniques, such as those involving standardized patients, without the need for additional resources. However, psychometric studies will have to be performed before the approach can be fully recommended.

Attitude of Health Personnel↗
PubMed1993

The teaching of medicine at the University Centre for Health Sciences Yaounde, Cameroon: its concordance with the Edinburgh Declaration on medical education.

The University Centre for Health Sciences (UCHS) or as it is referred to in French 'Centre Universitaire des Sciences de la Santé' (CUSS), became functional in 1969 with the enrollment of the first group of students. The objective of this training programme was to produce a scientifically sound, multipurpose doctor who would be fully operational in a rural setting with minimal equipment and supplies (Monekosso 1970, 1972). The graduate had to be able to adapt readily to new situations and improvise whenever possible, calling for a high degree of competence and initiative. The training strategies adopted by UCHS in 1969 which met this requirement were later found to be in close concordance with the tenets of the World Conference on Medical Education held in Edinburgh in 1988, the Edinburgh Declaration. While some of the terminology may not have been worked out at the time, the programme developed embraced some new concepts hitherto untried or undeveloped: the problem-solving approach in the first to the sixth year; an integrated teaching approach during the first to sixth year of medical training; an integrated medicine internship in district hospitals in the sixth year; a community-based training approach throughout the training; team training of three different health professionals; competency-based training; health services linked research; health services linked training (Monekosso & Quenum 1978). The concordance of this programme to the Edinburgh Declaration is of great interest in realizing the World Federation for Medical Education programme and implementing the Edinburgh Declaration. The involvement of the three innovative medical schools in the planning stage of the curriculum explains this concordance.

Cameroon↗
PubMed1997

Skills of pre-registration house officers: gender differences reported in Norway.

During training pre-registration house officers should acquire skills, practical clinical procedures, and good clinical judgement, in order to be able to practice on their own. This is not always the case (Flaatten et al. 1987). Ten years ago the Norwegian Health Authorities issued a regulation regarding the content of hospital training (6 months internal medicine and surgery, respectively). A number of practical skills to be learned were listed. As part of an assessment of the quality of the internship, a study was carried out into what extent the pre-registration house officers had acquired these clinical skills.

Clinical Competence↗
PubMed2005

Health needs in rural areas and the efficacy and cost-effectiveness of doctors and nurses.

OBJECTIVE: Because of a lack of GPs in rural areas of Greece it is mandatory for junior doctors to offer medical service in those areas for a year. The aim of this study is to determine the possibility of replacement of internships with nurses and to suggest the most cost-effective way of covering health needs in remote areas. DESIGN: Regional survey. SETTING AND PARTICIPANTS: Patients of primary care offices in two remote areas of Crete, Greece within a year. MAIN OUTCOME MEASURES: Comparative analysis of the level of preventive medicine (estimated by questionnaires) and health needs in the two areas. The reasons for visiting medical offices, references rates, percentages of glucose and blood pressure regulation are also studied. RESULTS: Prescription of drugs for chronic diseases and blood pressure counting were the main reasons for office visits (2868/4594). Respiratory track infections (364/4594) follow. Apart from the high percentages of uncontrolled patients with blood pressure (34%) and diabetes mellitus (14%) there is a high percentage of ignorance or wrong opinions concerning preventive medicine, for example only 63% knew the value of a pap test. CONCLUSIONS: More than two-thirds of "medical" visits in rural areas were for acts that nurses could easily do. The easy access to a junior doctor did not promote preventive medicine. Replacement of junior doctors with properly trained nurses cooperating with GPs responsible for greater regions would be more cost-effective than junior doctors improving health in rural areas. Legislation should change, mainly with regard to repeat prescriptions, in order to reduce house visits.

Aged↗
PubMed1981

Knowledge of colorectal cancer and attitude to occult blood testing among recent medical graduates in New South Wales.

The extent to which new information on colorectal cancer (C.C.) is being transmitted to medical undergraduates was assessed in a repeated survey of new interns' knowledge of and attitudes on C.C. A probability sample of 214 graduates of the two Sydney medical schools was drawn as they commenced their internships in 1978. A comparable sample of 186 was drawn in 1980. Interns in each sub-sample completed a questionnaire of 54 pre-coded items of knowledge of C.C. epidemiology, early diagnosis, and followup, and on their attitudes towards C.C. On most topics knowledge was not well developed, and 1980 graduates were not significantly better informed than those of 1978. Almost three-quarters of 1980 interns intend using faecal occult blood testing.

Australia↗