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PubMed1975

A group training program in behavior modification for mothers of children with birth defects: an exploratory study.

This paper explores the impact of a group approach to teaching behavior modification principles and techniques to mothers of physically handicapped children. Five sessions involving presentations, discussions, and application of operant reinforcement techniques were followed by five sessions focusing on the importance of communication about the handicap, and applying the previously learned operant tecniques to opening communication in this sensitive, secretive area. Clinical and statistical findings suggest that this approach can effectively train mothers to apply the techniques, and increase their attempts to communicate with their handicapped children. Moreover, mothers' participation appeared to facilitate their children's readiness to communicate, as well as improve their children's self-esteem, enthusiasm, and likability.

Adolescent↗
PubMed1978

[The effect of an on the job training program -- stairclimbing -- on the physical working capacity of employees (author's transl)].

Following medical screening and physical fitness testing (W170) 52 voltuntary employees in a 31-story administration building were formed into matched pairs and randomly allocated into intervention (stairclimbing) and control (lift) groups. The intervention group was asked to climb at least 25 floors/workday or 125 floors/week. the control group was asked to use only the lift. The intervention time was 10 weeks. The physiological measurements were made before and after the intervention. The number of stairs climbed was recorded daily in a diary. The heart rate was recorded continuously over one workday before and during the interventions. The average quantity of training in the final intervention group (n = 19) was 29.9 floors/workday or 36,790 kpm/week and in the control group 4.6 and 5980 correspondingly. The average training frequency was 4.3 in intervention and 1.4 climbs/workday in the control group. The average number of continuous floors used during climbing was 7.0 in intervention and 3.4 in control group. The average number of minutes on heart rate level of 130-159 beats/min during one workday was 7.8 in intervention and 1.6 in control group. The W170 (W/kg) increased 17.8% and the predicted VO2max (ml/min/kg) 15.1% in intervention group. The difference between the intervention group and the control group was significant (p less than 0.01). It was concluded, that stairclimbing is a suitable on the job physical activity program for middle-aged, untrained men.

Employment↗
PubMed1995

A perinatal cross-training program.

A comprehensive program involving the orientation of perinatal staff to a secondary clinical area has led to a flexible staffing plan. After one year, the perinatal department has improved financially, while staff have improved their marketability.

Competency-Based Education↗
PubMed2006

The effects of a specific speech and language training program on students of a radio announcing course.

The purpose of this study was to determine whether individuals show differences in speech and voice during reading of the same news before and after attending a radio announcing course. Twenty-five students of a Radio Announcing Course in Sao Paulo city, 17 men and 8 women, aged 19 to 55 years, participated in this study. The readings were recorded in a professional audio studio, and the speech samples were submitted to perceptual and acoustic analysis. For the perceptual analysis, the samples were randomly presented in pairs and five trained speech pathologists identified each recording as pre- and posttraining, and also justified their choices by indicating what parameters better based their judgment: type of voice, articulation and pronunciation, loudness, pitch, resonance, speech rate, respiratory coordination, and use of emphasis. The acoustic parameters analyzed were mean, minimum, and maximum fundamental frequency, frequency range, text duration, and pause duration. The perceptual analysis showed that the posttraining speech samples were considered the best productions in 80% of the evaluations. Emphasis characterized the readings (70.4%), followed by type of voice (44.8%) and pitch (40.8%). Acoustic analysis showed higher mean fundamental frequency and increase of frequency range posttraining. These results indicated richer modulation in the posttraining readings. There are differences in the readings of the same news pre- and posttraining in a radio announcing course, and the posttraining reading was considered the best production, indicating the positive effect of the training.

Adult↗
PubMed2000

An outcome survey of psychology residency training program graduates of the University of Texas Houston Medical School.

A survey of 71 graduates of the psychology residency program at The University of Texas Houston Medical School and the Texas Research Institute of Mental Science indicated that two-thirds of the respondents were involved in private practice, conducting primarily individual therapy, with assessment also playing a major role in their practice. Managed care had the effect of placing limits on the numbers of sessions available to patients, reducing income, and increasing paperwork associated with practice. Implications for training during residency are that individual therapy, using focused short-term approaches, and assessment should continue to be the primary clinical experiences for trainees, and that there should also be training in the business aspect of practice, including marketing.

Adult↗
PubMed1997

Complications of surgical endoscopy. A decade of experience from a surgical residency training program.

BACKGROUND: This study examines the notion that gastrointestinal endoscopy performed by supervised surgical residents is safe. METHODS: We reviewed all gastrointestinal endoscopic procedures performed by surgical residents with faculty supervision for complications and deaths occurring up to 30 days following the procedures. RESULTS: The overall complication rate for 9,201 upper and lower endoscopy procedures was 1.4% and 0.42%, respectively. Overall mortality rate was 0.76% for upper endoscopy and 0.6% for lower endoscopy. No mortality was a direct result of a procedure-related complication. Intestinal perforation, drug overdose, bleeding, and aspiration were the most common procedure-related complications. Each resident completed an average of 75 upper endoscopies and 79 lower endoscopies during their training period. CONCLUSIONS: Gastrointestinal endoscopy can be performed safely by surgical residents with appropriate supervision. The higher morbidity and mortality of upper endoscopy are most likely related to the underlying disease rather than the procedure. Awareness of common complications and application of appropriate precautions and instruction are critical for minimizing complications.

Adult↗
PubMed1997

[Re-education and new education. Evaluation of a training program for occupational health services' personnel aimed for employees with chronic musculoskeletal pain].

Chronic musculoskeletal pain can be perceived as resulting from lack of control and coping in relation to both internal and external demands. Persons with chronic musculoskeletal pain are repetitive users of the occupational and primary health care services, and it seems that traditional medical treatment and physiotherapy are of little help. Health personnel may gain from learning teaching and counselling methods that might enable them to deal with the complexity of the patient's pain. 23 occupational personnel from different professions we invited to participate in a 150 hour training programme based on experience- and process-oriented teaching and counselling methods. After the training programme the participants counselled groups of employees with chronic musculoskeletal pain. Four left the programme after the first workshop. The remaining group felt more competent in meeting persons with chronic pain. When, in stead of giving traditional advice, they used counselling methods and focused on interaction and communication, and on helping the person in pain to find her/his own solutions, they also experienced a change of role in their relationship with these persons.

Chronic Disease↗
PubMed2006

Tutorial on maximum inspiratory and expiratory mouth pressures in individuals with idiopathic Parkinson disease (IPD) and the preliminary results of an expiratory muscle strength training program.

Respiratory symptoms are recognized as sequelae of motor dysfunction in idiopathic Parkinson's disease (IPD) and these symptoms have the potential to cause problems with swallow, cough, voice and speech. Specifically, maneuvers that require rapid activation and coordination of upper airway and chest wall musculature become progressively impaired as motor dysfunction progresses during the natural course of the disease. This study reports on the maximum inspiratory and expiratory pressures produced by 28 participants (average age 64) diagnosed with moderate to severe IPD (average stage 2.5 with a range of 2.0-3.0). All measures were collected during the "medication on" state. Outcomes of a specific respiratory muscle strength training technique for improving maximum expiratory pressure are reported for three of the patients in this study. Techniques that focus on strengthening the respiratory muscles in patients with IPD (other than with low load breathing exercises), have not been previously reported. The results of this pilot study demonstrate that respiratory muscle weakness may be an important factor in the respiratory complications in IPD and that respiratory muscle strength training has the potential to improve expiratory muscle strength for this population. This improvement has the potential to positively impact high forced respiratory activities, such as forced breathing maneuvers, swallow, cough and speech functions that require greater magnitude and duration of expiration.

Adult↗
PubMed2004

Feedback from operative performance to improve training program of laparoscopic radical prostatectomy.

PURPOSE: We report our preliminary experience identifying factors that contribute to differences in operative performance in laparoscopic radical prostatectomy (LRP) between trainees and experienced laparoscopic urologists based on objective and subjective feedback. MATERIALS AND METHODS: Between December 2001 and May 2002, six trainees at the Institut Montsouris and Ecole Européenne de Chirurgie, Paris, were evaluated to identify the factors contributing to differences in operative performance in LRP between them and experienced laparoscopic urologists, both objectively and subjectively. Objective evaluation was done by an independent observer who was well versed in laparoscopic surgery, while all the trainees evaluated themselves subjectively. All the trainees had in vitro, in vivo, and didactic training sessions during the evaluation period. RESULTS: The following deficiencies were noted objectively in the trainees compared with experienced laparoscopic urologists: (1) lack of perfect knowledge of each step, (2) lack of synchronized movements of the nondominant hand; and (3) easy physical fatigue. The trainees took a long time to dissect the vas deferens, seminal vesicles, and bladder neck because they did not have perfect knowledge of each step. It was difficult for them to pass the needle for ligation of dorsal venous complex because they tried to hold the needle far away from the needle tip at the wrong angle, and the direction of movement was not correct. For the urethrovesical anastomosis, they struggled to find the right angle to pass the needle on the urethral side. CONCLUSION: Lack of synchronized movement of the nondominant hand, easy physical fatigue, and lack of perfect knowledge of operative steps are crucial limitations for live operative performance of trainees in LRP. Incorporation of intensive well-planned in vitro training into the curriculum to correct these deficiencies and feedback from the operative performance can make a significant contribute to shortening the learning curve.

Adult↗
PubMed1998

Medical practices of past graduates from one obstetric/gynecologic training program.

BACKGROUND: We sought to assess the practice patterns of former obstetric-gynecologic residents and to solicit their opinions regarding their educational experience and its clinical relevance to primary care. METHOD: In response to a Residency Review Committee mandate regarding past residents, a questionnaire was sent to all graduates from our residency program over a 17-year period (1979 to 1995). RESULTS: Of the 90 subjects who received the survey, 86 responded. Their ages ranged from 29 years to 49 years; 79 were married and 7 were single. Of the 75 in clinical practice, 71 practiced both obstetrics and gynecology and 13 had subspecialized. Most of the respondents (77/80) practiced in the mid-South. Of all graduates, 93% routinely provided primary care. In rating 20 major resident education categories, respondents gave high grades to training in surgically related areas. Only 4% rated their experience as fair or poor in the operative categories. CONCLUSION: Our graduates indicate satisfaction with their training, and their practices include primary care.

Adult↗
PubMed1994

A comparison of rural and non rural RACGP training program trainees. Royal Australian College of General Practice.

OBJECTIVE: To obtain demographic data about Royal Australian College of General Practice (RACGP) trainees, and identify differences between rural and non rural RACGP trainees. DESIGN: A postal survey of 211 RACGP trainee doctors in South Australia (SA) and the Northern Territory (NT) from 1992 to 1993. Statistical tests used were chi 2 or Fisher's exact test, with P < or = 0.05. RESULTS: The questionnaire was completed by 154 doctors, 41 of whom planned on rural general practice. The sex distribution of rural trainees was equal. Almost all of the trainees planning on rural general practice were born in Australia; all spoke English as their first language and all did their undergraduate training in Australia. There were very few part time rural trainees. Most trainees who planned to settle in rural areas were raised in a capital city. Contrary to widely accepted opinion, trainees with a rural background were no more likely to enter rural practice than trainees with an urban background; with the possible exception of trainees raised in towns with a population of less than 5000 people.

Adult↗
PubMed1975

A training program in bioanalytical toxicology.

Students of diversified backgrounds are taught methods used in bioanalytical toxicology such as TLC, GLC, RIA, EMIT, UV, and spectrofluorometry. Major emphasis is placed on the detection of abused drugs in biologic specimens. It was found that the students with more advanced formal education have learned the lecture theory and instrumentation quicker and in greater detail. However, as far as the ability to work rapidly and accurately, many of the trainees who have had less formal education have shown better ability. Perhaps it could be said that the theory is a science, whereas the work is an art. This art through practice can be better developed by some people regardless of education. On completion of this training, they will be able to help fill the great need for toxicologic technicians.

Allied Health Personnel↗
PubMed1999

Substance use disorders in physician training programs.

Physician impairment due to substance use occurs in all age groups of physicians. Risk factors are similar for age-matched controls, but choice of substance may be influenced by specialty and narcotic permit. Alcohol is by far the most commonly abused drug involved. One of the last areas of performance affected is work. Other areas may provide earlier clues. Intervention and referral to appropriate treatment centers is important. Death rates are relatively high in this disease. We report a favorable outcome of 75 percent at The University of Oklahoma Health Sciences Center, Tulsa (OUHSC-T), but a death rate of 16.7 percent in our small sample. Aftercare and monitoring are essential to a successful outcome. The vast majority of physicians in training can complete their training with appropriate treatment and monitoring and go on to successful careers.

Alcoholism↗
PubMed2003

Office preparedness for pediatric emergencies: a randomized, controlled trial of an office-based training program.

OBJECTIVE: Many children enter the emergency medical system through primary care offices, yet these offices may not be adequately prepared to stabilize severely ill children. We conducted this study to evaluate the effectiveness of an office-based educational program designed to improve the preparation of primary care practices for pediatric emergencies. METHODS: A prospective, randomized, controlled trial was conducted of primary care practices (pediatric, family practice, and health departments) that were recruited from an existing database of North Carolina practices. Practices that agreed to participate were randomly assigned to either the intervention or the control group. Unannounced mock codes were conducted in the intervention practices by 2 emergency medicine clinicians (medical doctor and/or registered nurse). Practices were expected to respond to the mock code using their own staff, equipment, and local emergency medical system. After the exercise, the emergency medicine clinicians and the local emergency medical system team led a structured debriefing session providing constructive feedback to the staff on their performance, a review of the office's equipment, and a resource manual designed for the project. The primary outcome measures were obtained by survey 3 to 6 months postintervention and included 1) purchase of new pediatric emergency equipment and medications, 2) receipt or updating of basic life support/pediatric advanced life support/advanced life support training by staff members, and 3) development of written emergency pediatric protocols. The control practices received no interventions during the trial and completed a similar outcome survey. RESULTS: Thirty-nine practices (20 intervention, 19 control) completed the trial. There were no significant differences in practice characteristics between the 2 groups. Intervention practices were more likely to develop written office protocols (60% vs 21%); more staff in the intervention practices received additional basic life support/pediatric advanced life support/advanced life support training 3 to 6 months after the intervention (118 vs 54). There were no significant differences in the purchase of new equipment or medications. Ninety percent of the intervention practices rated the intervention as useful for their practice, and 95% believed that the program should be continued. CONCLUSIONS: The findings suggest that the intervention was well received and motivated practices to take concrete actions to prepare for pediatric emergencies.

Child↗
PubMed2005

Effects of a twenty-four hour call period on resident performance during simulated endoscopic sinus surgery in an accreditation council for graduate medical education-compliant training program.

OBJECTIVES/HYPOTHESIS: Since the early 1990s, extended resident work hours have undergone increasing scrutiny. Although previous studies have demonstrated conflicting results regarding cognitive decline secondary to fatigue, few studies have specifically examined the effects of fatigue on surgical performance. No previous studies have examined resident performance under current Accreditation Council for Graduate Medical Education (ACGME) work-hour guidelines that limit residents to an average number of work hours of 80 hours per week. The study sought to determine whether an endoscopic sinus surgery simulator (ES3) measured performance changes before and after a 24-hour on-call period in residents following mandated work-hour limitations. STUDY DESIGN: Case control, crossover trial at a Level I trauma center. METHODS: Eight general surgical residents were trained on the novice mode of the ES3. These residents were then tested twice both before and after on-call duties. Performance and hazard scores were compared using a paired t test. RESULTS: No statistically significant change in the number of errors, time to task completion, or overall performance was identified in the study between the precall and postcall groups. There was a trend toward improved speed at the expense of accuracy in the postcall group. Postcall score between the two trials improved, on average, by 3.3 (P = .045). CONCLUSION: In the study of residents following current ACGME work-hour mandates, there was no diminution in performance before and after a 24-hour on-call period. There was a trend toward improved speed at the expense of accuracy. Furthermore, repetition on the ES3 in the postcall period can result in improved ES3 proficiency.

Accreditation↗
PubMed1997

One-on-one mentor-resident rotation for improving continuity of care in a surgical training program.

The modern resident team, staffed by multiple attendings, often makes sacrifices on continuity of care due to scheduling conflicts. We investigated a one-on-one mentor-resident rotation where all clinical activities were synchronized to produce near-perfect continuity of care, and we compared the objective and subjective outcome measures to those of control rotations of the same resident during the same year. The results showed that continuity of care close to 100% was possible in such rotations, but work hours were increased by 25%. Also, the number of patients seen was decreased by over 50%. The rotation was well-received by both mentors and residents. Continuity of care per se can be improved by this rotation. However, theoretical disadvantages, mainly narrow training due to exposure to only one mentor and fewer patients, make it unsuitable for extended use.

General Surgery↗
PubMedDate not supplied

Substance use and alcohol abuse in emergency medicine training programs, by resident report. SAEM Residency Survey Task Force.

OBJECTIVE: To determine the prevalence of substance use and alcohol abuse among emergency medicine residents. METHOD: The study instrument was an anonymous, self-report survey that assessed the use of 13 substances and included the CAGE questions for measuring alcohol abuse. The survey was administered to emergency medicine residents at the time of the American Board of Emergency Medicine's annual In-Service Examination. RESULTS: Alcohol was the substance most commonly used by emergency medicine residents for nonmedical reasons. Using the CAGE score, 4.9% of residents were classified as alcoholic and another 7.6% as suspect for alcoholism, rates similar to those for housestaff of all specialties as reported in earlier studies. Instruction related to physician impairment during training in their emergency medicine residency was reported by only 36% of the respondents. CONCLUSIONS: Emergency medicine residents report a low rate of illicit substance use and do not appear to misuse alcohol differently than other housestaff. Interpretation of these results must be tempered with the potential for underreporting that may occur with a voluntary self-report survey of a sensitive nature.

Adult↗