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Foster and Boerstler look at the challenge of bringing integration into nursing service programs that combine nursing and business content. They examine capstone courses and internships among other strategies. They also give an interesting criterion of comparative advantage to judge where various content should be acquired.
Over recent months, various medical societies have held sessions about this delicate subject which have focussed more on information than discussion, reflecting a certain degree of concern. Professionals, i.e. legal or private experts have always met in specialized societies, occasionally inviting jurists, magistrates or insurance company legal advisers to participate in their discussions. However, the debates between specialists largely escape the non-specialist doctor. In general medical societies, any discussion which follows a basic presentation is too often diverted towards particular details and personal cases. Some meetings present "informal chats" which give the listener the erroneous impression of having being informed. It is very difficult to practically and usefully inform colleagues, but the author nevertheless attempts this task. The first part of the article presents the classical internship questions in the form of "management of a case of ...". The second, legal part concisely defines the situations of various types of doctors in relation to medical responsibility and briefly deals with the general problem involved. The author has a limited experience. Despite certain encouragement to apply for inscription on the list of expert surgeons as well as that of expert urologists, the author only applied to be an expert urologist, a role he has filled for the last 28 years. He has seen slightly more than 40 cases of urological medical responsibility. The doctors concerned were essentially urologists, gynaecologists, "gastrointestinal" surgeons and even orthopaedic surgeons. However, general practitioners have also been implicated for failing to take urgent and necessary measures required by the patient's condition.
During the 1980s, the two major influences in osteopathic medical education were the increasingly large number of new DOs seeking internships and residencies and the loss of training sites as a result of the shrinking osteopathic hospital network. Owing mainly to a declining interest in primary care by young MDs, allopathic postdoctoral program directors, particularly in primary care specialties, began to actively recruit osteopathic physicians. An oversupply of positions on the allopathic postdoctoral side and an undersupply of residency positions in osteopathic postdoctoral programs contributed to a crossover trend. The programs approved by the Accreditation Council for Graduate Medical Education have made significant inroads in attracting DOs. It has reached the point where two out of every three DOs currently training in a primary care residency can be found in an allopathic program. If it continues, this pattern will have a significant impact on the character of osteopathic medical education.
Recruitment and retention of critical care nurses to care for increasing numbers of complex patients is a challenge in the midst of a national nursing shortage. Strategies to address the shortage begin with implementation of a professional practice model that builds on a meaningful nursing philosophy. This model becomes the basis for development and implementation of multiple strategies that "proactively" involve staff nurses. Critical care new graduate internships, patient care assistant programs, creative care delivery models, and unit clinical committees are some of the strategies that have resulted in positive outcomes.
PL 99-457 mandates nutrition as one of eight disciplines to be included on the team providing services to handicapped infants (up to age 3) and their families. A case-managed range of services is required to enable the child to benefit from early interventions. Findings from a survey of a sample of entry-level Plan IV/V Programs, Coordinated Programs in Dietetics, and dietetic internships randomly selected from The American Dietetic Association's 1988 Directory of Dietetic Programs indicate that the growth and development of handicapped infants and their nutrition care are underexposed in most didactic and experiential components of the education of entry-level dietitians. A working group of nine nutritionists with expertise in both dietetic education and nutrition care of handicapped children met at a national conference and recommended competencies that they thought would enable entry-level registered dietitians to join interdisciplinary teams working with handicapped infants and their families. Registered dietitians on the team that prepares the Individualized Family Service Plan (IFSP) can strive to ensure that infants are well nourished and therefore more responsive to the other therapies proposed in the plan.
Lately the role of internship and primary specialization courses in postgraduate medical training of phthisiologists has decreased. Only 8 per cent of 576 physicians at the courses in advanced phthisiological training at the Vinnitsa Medical Institute had primary specialization. The majority of physicians are usually referred to courses in advanced general and thematic medical training without previous sufficient specialization. This brings about marked difficulties in the work of the departments of advanced medical training and lowers the potentialities of high quality training. To individualize education, it is necessary that medical institutions had more rights in defining the programs for every course proceeding from the students age, professional level and previous training. A system is needed for centralized supply of methodical and instructive materials, as well as training and diagnostic equipment to educational departments.
A questionnaire regarding perceived training and practice goals was distributed to 185 consecutive medical students interviewing for a 1986-87 internship at a community hospital in Southern California. Students were asked to estimate the dollar cost of professional liability insurance for a hypothetical family physician in the first year in practice performing low-risk obstetrics in Southern California. Family physician applicants who planned to do obstetrics estimated an initial average yearly premium cost of $16,406, whereas those not planning to do obstetrics estimated costs of $25,710 per year. Non-OB directed family practice applicants had a statistically significant (P = .0018) higher estimate of professional liability insurance costs. Average premium costs were obtained from three separate professional liability insurance carriers. Cost estimates of mature rates were not necessarily unrealistic, but student ignorance of significantly lower initial rates was widespread. The broad ranges of estimates suggested that subsets of students may be dramatically overestimating these costs. The data and direct questioning of students suggest that perceived insurance costs may affect training goals and career choices of medical students.
The author provides a brief historical review of the education of health services administrators in Latin America. Subsequent to the Conference of Alma Ata (1978), great emphasis was placed on actions to extend coverage of services, primary health care, community participation, appropriate primary health care technology, and development of health personnel to deal with the demands ensuing from such actions. The health policies of the countries of the Region of the Americas have most recently been directed toward horizontal integration of services--including the most complex hospitals--in a specific geographical area, by encouraging the setting up of local health systems (SILOS). In such systems, the new health administrator must be able to manage a hospital or peripheral health center, organize the community, and above all, to ensure that the health institution, regardless of the source of financing, functions harmoniously, possesses fluid mechanisms for case referral and counter-referral, and input distribution. Thus, the health administrator in a given geographical area should be capable of managing more than one institution, as well as its financial, human, and material resources. In order to carry out this mission, in the last quarter of this century the Regional Program for Training in Health Services Administration (PROASA) and the public health schools in the Region will be asked to make a sustained effort to train teaching personnel, introduce new disciplines, and institute supervised internships for in-service training in keeping with these new social requirements.
The evolution and development of institutional pharmacy and its pathfinders are discussed, and future directions for the profession are suggested. From the Bulletin of the American Society of Hospital Pharmacists to the American Journal of Hospital Pharmacy, hospital pharmacy literature has helped the profession evolve by providing specialized information while continuing to meet practitioners' changing needs over time. Editorials help to establish unity of purpose among members by encouraging consensus development. Other publications and programs of ASHP extend its mission into institutions nationwide. To achieve unity of purpose, the profession relies on the formal organization (ASHP and its chapters) for providing order and the informal organization (meetings) for exchanging information and providing motivation. Pharmacy "trains its own" via residency programs, whose prototypes, nonacademic internships, were designed by pathfinder preceptors like Harvey A. K. Whitney. These programs have ensured continuity in improving practice standards and a source of skilled professionals. Women have been leaders in the history and development of hospital pharmacy. The sound economic management of the Society has led to accelerated developments for institutional pharmacy. In the future, ASHP should seek to become more involved in public policy issues concerning health care in general; develop a written set of ethical standards to guide institutional practitioners; and prepare an updated history of ASHP and the hospital pharmacy movement, including an interpretation of events, or a cultural perspective. ASHP has established a strong foundation for hospital pharmacy as envisioned by the early pathfinders; young pharmacists are the pathfinders for future progress.
The subject of the article is medical education in Mexico, particularly in the area of preventive and social medicine. It emphasizes the impact on this instruction of the country's economic and cultural dependence. It then presents some important qualitative data such as those on the existence of the administrative academic body responsible for the area, the names of the academic subjects in the area of preventive and social medicine, the educational objectives and study plan of this area; its connection with undergraduate internship and social service; agreements with other institutions for instructions; the semester in which the subjects in the area are taught and the faculty members teaching them. Finally, on the basis of the information presented, several conclusions are reached which make it possible to asseverate that the teaching of preventive and social medicine is not given the importance it merits, in the study plan of any medical school in the country.
In briefly reviewing the history of veterinary education, particularly that in England, the enduring influence education has on the achievements and status of the profession is emphasised. The sound influence of the first teachers in South Africa, under the guidance of men like Theiler and subsequently du Toit, on veterinary education is outlined. The changes that have taken place in the face of altered demands, from that required by a predominantly State-employed profession to one consisting mainly of private practitioners but with ever-expanding fields of activity, necessitates continual attention to thorough teaching in the basic subjects, to the discipline as against the species approach--the latter being of value, however, when applying preventive medicine to herds/flocks, to a uniform undergraduate curriculum, and to foreseeing and providing adequate, specialised post-graduate education. The present under-graduate course has been extended from five to five-and-a-half years and the South African student enrollment to 90/a. Furthermore, more time will be found by already starting the teaching of Anatomy in the first year, thus providing for a final year of "student-internship". A completely newly planned faculty complex at a more favourable site is a necessity; clinical assistants will haevto be employed. More attention must be given to Public Health and Food Hygiene. Facilities for training Black studnets is a first priority in providing for additional student enrollment. Despite all modern teaching aids, the teacher must always play a vital key role.
Traditional bioethical codes have been unable to cope with the results of modern technology and the drastic changes in life patterns. The medical profession can reestablish bioethical order and reassert leadership through a new and urgently needed medical specialty, which the author tentatively calls bioethiatrics or bioethiatry. Bioethiatrics embodies a unique combination of ethical action and moral judgment.Training for the specialty would start with a residency program, consisting of thorough training in philosophy and religion coupled with continued experience in clinical medicine and indoctrination in contemporary research. Requirements would include the practice of general medicine for at least two years after internship, the passing of oral and written examinations after four years of residency, board certification, and subsequent periodic evaluations.Bioethiatricians would assume all the usual privileges, obligations, and risks associated with the practice of any medical specialty, thereby averting unnecessary ethical crises and ensuring a more rational response to present and future moral challenges.
This paper summarizes the experience acquired under the first university-level program for the basic training of nurses in Peru. It describes the gradual refining of the academic curriculum, which was designed not only to train people as competent professionals, but also to acquaint them with the country's basic social problems. Four levels of teaching-learning were defined in wide-ranging discussions in which various academic and professional sectors connected with the health field participated. Establishing a process of steps of increasing complexity has considerably facilitated the integration of community health, the scientific method, and mental health into the structure of the curriculum. The practice of community nursing was heavily emphasized, and it was endeavored to strike a balance between hospital experience and work in communities themselves. The program includes specific studies community groups spanning such aspects as control of the more common disease, epidemiologic surveillance, and accident and disaster prevention. Practical work in community health care earns the same credit as hospital internship. The paper closes with a description of the experience of a specific program conducted in the self-managed city of Villa El Salvador under an agreement between the community and the university. The writer also notes that the intense campaign to publicize the program is having an effect because most nurse-training institutions in Peru are tending to add community nursing to their curricula.
The results of a survey of Canadian primary care physicians for the Canadian Medical Association (CMA's) Task Force on Education for the Provision of Primary Care Services are reported. Recent Canadian medical school graduates in primary care practice reported that the three major training routes (rotating and mixed internships and family medicine residencies) each prepared them differently for practice. The graduates of 2-year family medicine residencies were more satisfied with their preparation than were the graduates of the other major training routes. A 2- or 3-year family medicine residency was preferred by 50% of the respondents, although only 33% of them had actually taken one of these routes. There was considerable agreement in the respondents' assessments of the types of postgraduate education needed for primary care practice. The results of this survey were consistent with the recommendations in the final report of the CMA's task force.
During the past two years a pilot project was conducted in which 19 inactive physicians were retrained in preparation for resumption of active practice. The initial program consisted of a flexible training program of six months to one year patterned after conventional internship-residency concepts. During the second year the program was modified by providing an initial condensed indoctrination period of two months' duration especially designed for this purpose, followed by a preceptorship type of training. The project was considered successful in permitting trainees to enter some form of active medical work, or to enroll in formal specialty training. The observations made by the faculty of the program and its accomplishments are discussed in the light of the effort expended and the cost of the project.
THE PRESENT SYSTEM OF EDUCATION FOR MEDICAL LIBRARY PRACTICE IN THE UNITED STATES CONSISTS OF FOUR MAJOR COMPONENTS: graduate degree programs in library science with specialization in medical librarianship; graduate degree programs in library science with no such specialization; postgraduate internships in medical libraries; continuing education programs. Data are presented illustrating the flow of graduates along these several educational pathways into medical library practice.The relevance of these educational components to the current medical library work force is discussed with reference to manpower data compiled for Ohio. The total number of medical library personnel in Ohio in 1968 is 316. Of this total, only forty-two (approximately 14 percent) have received any formal library training. Seventy persons have only a high school education. From these figures, it is concluded that there is no standard or essential qualification which is universally accepted as educational preparation for work in medical libraries; that the comparative sophistication of the educational programs in medical librarianship has yet to be reflected widely in general medical library practice; that an increasingly large number of non-professional or ancillary personnel are being, and will continue to be, utilized in medical libraries; that large numbers of untrained persons have sole responsibility for medical libraries; and that appropriate educational programs will have to be designed specifically for this type of personnel.
A two-year program in Medical Library Technology leading to the Associate in Applied Science degree was developed and approved by the State University of New York and the New York State Board of Regents as a joint endeavor of the Upstate Medical Center and the Onondaga Community College, with classes scheduled to begin in September 1969. The curriculum is designed to allow continuation of study towards the Bachelor of Science degree and includes a summer internship at one of several participating medical libraries. An increasing number of library technology programs are being offered by junior colleges in the U. S. and Canada. However, this represents a first attempt at a technician education program designed specifically for medical libraries.
Linkages between psychiatry and other medical specialties have become increasingly evident over the past decade. Reinstatement of the medical internship for psychiatric trainees, expansion of psychiatric liaison services, growth of general hospital psychiatric units, determination of the extensive role served by nonpsychiatric physicians in providing mental health care, and research evidence of the economic benefits of incorporating mental health services in general health settings all have served to break down artificial boundaries between mental health and general health concerns. The psychiatric consultation-liaison service initiated in 1981 by the NIMH at the NIH Clinical Center in Bethesda has afforded opportunity for numerous collaborative research projects with clinical investigators of various categorical disease programs. In addition to offering new etiological insights into psychiatric and general medical illnesses, the work described in this symposium promises to move clinical practice closer toward the Engel model of biopsychosocial medicine.