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PubMed1993

Surgical services and training in the context of national health care policy: the Malawi experience.

Malawi has a pyramidal health care structure, featuring at its broad base health centres and outreach stations in villages and rural areas; at the middle the district hospitals which receive cases from the villages and outreach health stations, and at its narrow apex the few central hospitals one of which is located in each of the three regions as a referral centre. Primary health care is practised at the health centres mostly by paramedical workers. The district hospitals are manned by general duty doctors and the central hospitals by specialists. Medical auxiliaries (clinical officers and medical assistants) play a vital role in the surgical and anaesthetic services of Malawi. Surgical education is community based and aims at providing staff for the various tiers of the health care pyramid, the surgical training being now jointly supervised by both government and non-government organizations and the new College of Medicine of Malawi. The internship programme is designed to prepare doctors for service in the districts where the bulk of their clinical hospital duties is of a surgical nature.

Allied Health Personnel↗
PubMed1993

Clinical rheumatology training of Australian medical students. A national survey of 1991 graduates.

OBJECTIVE: To describe Australian medical graduates' knowledge, experiences and practical training in rheumatology and their attitudes towards rehabilitation and disability. DESIGN: Cross-sectional survey of all interns at randomly selected hospitals in each State. PARTICIPANTS: 382 Australian interns at 12 hospitals surveyed in the first week of their 1991 internship. RESULTS: New interns demonstrated little experience with soft tissue rheumatism, with only 45% reporting they had examined a patient with bursitis and 22% one with epicondylitis. There was considerable dissatisfaction with the teaching of assessment of low back pain, regardless of the amount of formal rheumatology teaching the graduates had experienced, with only 22% rating it as good or excellent. There was little evidence that students are exposed to the social dimensions of chronic illness; only 32% of students reported that they had been shown how to assess a patient's psychological adjustment to illness. Only 22% felt competent at assessing disability and handicap and less than half of the graduates studied had ever attended a clinic where there was a physiotherapist. Graduates who had never been attached to either a rheumatology ward or an outpatients clinic (17%) were less likely to have examined a patient with gout (P < 0.001), osteoarthritis (P < 0.01), or chronic low back pain (P < 0.05), and were more likely to report dissatisfaction with training in rheumatology. CONCLUSION: This survey suggests that there are significant problems in the training of medical students in musculoskeletal disorders, particularly in relation to the assessment of disability and the appreciation of psychosocial factors.

Adult↗
PubMedDate not supplied

[Curriculum evaluation program of the University of São Paulo Medical School--results for 1993 and a 5-year analysis].

The following report contains the results of the "Curricular Evaluation Program" of University of São Paulo Medical School pertaining to the year of 1993 and to the five-year period between 1989 and 1993. This evaluation of all undergraduate courses was made by students, responding to questionnaires supplied at the end of each program. In 1993, 60.6% of programs were considered as very good programs. In relation to 1989-1993 period, are presented the results of a disciplines group of the 4th year and a internship stages of the 5th year.

Brazil↗
PubMed1996

Family practice training in Estonia.

BACKGROUND AND OBJECTIVES: The collapse of the Communist regime has required many newly independent countries to reform their health care systems. This article presents the unique experience of Estonia's development of family practice training and the introduction of this specialty to the existing health care system. Family practice training programs began in 1991 and include several pathways to certification in family practice. For physicians currently working as district doctors, pediatricians, gynecologists, or emergency doctors, there is the possibility of part-time retraining while continuing their work as primary care physicians. For new graduates of the medical school, there is an internship and residency in family practice or the option of part-time or in-service vocational training while maintaining a clinical practice. An important aim of the programs is to develop the identity of family physicians. The success and the failures of the Estonian experience in launching this project may be useful to other countries facing health care reform.

Education, Medical, Continuing↗
PubMed1996

Management of the early and late presentations of rheumatoid arthritis: a survey of Ontario primary care physicians.

OBJECTIVE: To examine primary care physicians' management of rheumatoid arthritis, ascertain the determinants of management and compare management with that recommended by a current practice panel. DESIGN: Mail survey (self-administered questionnaire). SETTING: Ontario. PARTICIPANTS: A stratified computer-generated random sample of 798 members of the College of Family Physicians of Canada. OUTCOME MEASURES: Proportions of respondents who chose various items in the management of two hypothetical patients, one with early rheumatoid arthritis and one with late rheumatoid arthritis. Scores for investigations, interventions and referrals for each scenario were generated by summing the recommended items chosen by respondents and then dividing by the total number of items recommended in that category. The scores were examined for their association with physician and practice characteristics and physician attitudes. RESULTS: The response rate was 68.3% (529/775 eligible physicians). Recommended investigations were chosen by more than two thirds of the respondents for both scenarios. Referrals to physiotherapy, occupational therapy and rheumatology, all recommended by the panel, were chosen by 206 (38.9%), 72 (13.6%) and 309 (58.4%) physicians respectively for early rheumatoid arthritis. These proportions were significantly higher for late rheumatoid arthritis (p < 0.01). In multiple regression analysis, for early rheumatoid arthritis, internship or residency training in rheumatology was associated with higher investigation and intervention scores, for late rheumatoid arthritis, older physicians had higher intervention scores and female physicians had higher referral scores. CONCLUSIONS: Primary care physicians' investigation of rheumatoid arthritis was in accord with panel recommendations. However, rates of referral to rheumatologists and other health care professionals were very low, especially for the early presentation of rheumatoid arthritis. More exposure to rheumatology and to the role of physiotherapy, occupational therapy and social work during primary care training is strongly recommended.

Adult↗
PubMed1996

[Introduction of molecular biology in respiratory medicine and its perspective].

I reviewed the change of respiratory medicine in the past several decades, overlapping with my own history of medical training and clinical and research works. In the 1950's when I graduated from the medical school and internship, the tuberculosis had been conquered effectively by the development of new antituberculous agents and improvement of nutritional state in Japan. Fibroptic bronchoscopy was introduced in the respiratory medicine in 1968, and computed tomography, in the 1970's, which gave us a good insight into pathological and biological aspects of various lung diseases in vivo. Molecular biology was brought in the respiratory medicine and our laboratory in the last decade, and my colleagues used it for genetic study of hereditary diseases such as alpha-1 antitrypsin deficiency and protein C deficiency, biochemical analysis of lung cancer and other pulmonary diseases, rapid detection of microorganisms, and so on. In the next step, gene therapy will come true in the near future, and I hope many intractable diseases such as lung cancer and interstitial pneumonia will be cured by the new technology and scientific knowledge.

Humans↗
PubMed1996

Transforming the present--discovering the future: the University of Pittsburgh's NLM grant on education and training of health sciences librarians.

BACKGROUND: The University of Pittsburgh was awarded a grant by the National Library of Medicine to study the education and training needs of present and future medical librarians and health information specialists through a collaboration of the university's School of Information Sciences and Health Sciences Library System. Goals and objectives for the year-long project included (1) assessment of education and training needs of medical librarians, (2) development of a master of library science curriculum and an internship program that would prepare graduates to take leadership roles in medical librarianship or information management, (3) development of continuing education programs for medical librarians in different formats, and (4) development of targeted recruitment efforts to attract minority group members and individuals with undergraduate science majors. The importance of this project, present practice, and success factors for programs seeking excellence in the preparation of health sciences information professionals are reviewed. A needs assessment involving a national advisory panel and a follow-up study of individuals who have participated in previous specialized training programs in health sciences information, compared with a peer group of medical librarians who did not participate in such programs, is described. This paper presents the goals and objectives of the project, describes the methods used, and outlines a curriculum, continuing education initiatives, and recruitment activities.

Career Choice↗
PubMed1996

Interdisciplinary multiinstitutional alliances in support of educational programs for health sciences librarians.

This project responds to the need to identify the knowledge, skills, and expertise required by health sciences librarians in the future and to devise mechanisms for providing this requisite training. The approach involves interdisciplinary multiinstitutional alliances with collaborators drawn from two graduate schools of library and information science (University of Illinois at Urbana-Champaign and Indiana University) and two medical schools (University of Illinois at Chicago and Washington University). The project encompasses six specific aims: (1) investigate the evolving role of the health sciences librarian; (2) analyze existing programs of study in library and information science at all levels at Illinois and Indiana; (3) develop opportunities for practicums, internships, and residencies; (4) explore the possibilities of computing and communication technologies to enhance instruction; (5) identify mechanisms to encourage faculty and graduate students to participate in medical informatics research projects; and (6) create recruitment strategies to achieve better representation of currently underrepresented groups. The project can serve as a model for other institutions interested in regional collaboration to enhance graduate education for health sciences librarianship.

Cooperative Behavior↗
PubMedDate not supplied

[Program evaluation Curriculum of the University of São Paulo Medical School. For the year 1994 and the period 1989-1994].

The authors present the results of the Program of Curriculum Evaluation of the University of São Paulo Medical School for the year of 1994, as well as the 1989-1994 period. The academic year of 1994 wasn't a good year to the medical graduation regarding disciplines from the first to the fourth year; only 14.3% of the disciplines achieved 90% or more of "excellent" + "good". The disciplines held at internship continued, on the most, doing well. The analysis of the 1989-1994 period outstands different sequential evaluation.

Brazil↗
PubMed1996

Working with Mexican midwives.

Mavis Smith is a midwife and a Ph. D. (Nursing) student at the University of Wollongong. She was the recipient of a Lions Nurses Scholarship Award for an overseas project, which was an internship in a freestanding Mexican Birthing Clinic on the Texas-Mexico border. Here Mavis shares her experience at the clinic which challenged and enhanced her midwifery skills.

Education, Nursing, Graduate↗
PubMed1996

[The crisis of internal medicine].

The rapid technological progress in medicine has lead to a better physiopathologic and etiological knowledge of adult diseases, producing a fragmentation of internal medicine and a great development of its subspecialties. Furthermore, specialization grants a professional, scientific and academic status. Contrarywise technological enrichment has impoverished the human relationship of clinical practice. The training at the Medical School has a great responsibility towards General Internal Medicine, and the technical capacity of teachers should be revised. The practical tutorial teaching at the hospital should be accomplished by Internists with a general clinical orientation. Outpatient clinics should be incorporated as places where a more clinical and less technological medicine could be taught. Internship should be a period in which General Internal Medicine should be valorized, continuing in post-graduate training and continuous teaching. General Internal Medicine is going through a crisis; Medical Schools and the Medical society have the responsibility to overcome it.

Chile↗
PubMed1997

Training of surgeons for primary health care.

It has been the view of the Association of Surgeons of East Africa (ASEA) that, like primary health care, there is primary surgery. The unit of provision of primary surgery is the district hospital. The training of surgeons for district hospitals starts at the undergraduate level, leading to the attainment of Bachelor of Medicine and Bachelor of Surgery (M.B. Ch.B.) degree. After internship the doctor works in a district or provincial hospital for 2-3 years, then trains for the degree of Master of Medicine (M. Med. (Surg.)) for a period of 3 years. The training involves rotation through all branches of surgery, so that the surgeon should be able to handle all aspects of routine surgery in a district hospital. To equip the surgeon further, a period in an outside setting is considered advisable. There are arrangements for regional surgical colleges to standardise the form of surgical training in the ASEA region. To keep surgeons in touch with the outside world, specialist training is done outside the region, but arrangements are being made for localised specialised units to offer this training.

Africa, Eastern↗
PubMed1997

[Undergraduate curriculum reform at the Pontifical Catholic University Medical School: aims, methodology and advance status].

The Medical School of the Pontifical Catholic University is devoted to a reform process aiming to adequate undergraduate training to scientific, technological, cultural and social changes in medical practice in Chile and to incorporate novel teaching methodology. One of the main modifications is the change of the resulting professional from "a general physician capable of resolving most medical problems of rural or urban populations" to "a physician with a solid general training but qualified for a subsequent specialization". This requires curricular flexibility to obtain different professional profiles. Other important changes are a reduction in curricular contents and their vertical and horizontal integration, modernization of teaching methodologies with the incorporation of computing techniques and problem oriented teaching and the incorporation of new subjects such as molecular biology, clinical genetics, health economics. To achieve these objectives, a semi-flexible curriculum was devised, the curricular mesh has been modified extensively, an outpatient and a nine months elective internship were added. Most modifications have been implemented, remaining changes in 4th and 5th years. These changes required a reorganisation of academic structure, the use of new selection, training and perfecting criteria for teachers, better salaries for outstanding professors and improvement of teaching infrastructure. This reform must be seen as a medium term integral change in the context of an integral academic development plan.

Chile↗
PubMed1997

[Aims and objectives of medical training at the University of Valparaíso].

The Medical School of the University of Valparaíso was founded thirty years ago aiming to produce a physician considering the health needs of the population and with a solid humanitarian training. The epidemiological, demographic and scientific changes of the last decades prompted the introduction of modifications in the curriculum such as using problem oriented active learning, incorporation of new subjects such as geriatrics, labour medicine and trauma and training in communication skills. The curricular mesh will be modified to allow an efficient vertical integration of educational contents, which will be delivered sequentially during the different years of the career. The internship, as a crucial part of the career, has incorporated outpatient clinical practice, has emphasized preventive medicine and has stimulated active learning through research projects and active reviews of specific issues. These changes will require cultural changes of professors and students and more resources that are difficult to obtain.

Chile↗
PubMed1997

[The Universidad Austral de Chile Medical School: a regional commitment].

The Universidad Austral de Chile Medical School was created in 1966. Its general goal was to train a general physician with capacities to integrate biological, psychological and social issues, to deal with prevalent diseases as well as with the non referable casualties, to analyze health situations and to manage health teams. From its beginning, it incorporated anthropological and the public health contents to medical curriculum. Moreover, the formal teaching formation was reduced to 5 years, increasing the internship cycle to 2 years, with an important practice on primary health care in regional hospitals, that included a research project on health administration. A revision of the School curriculum showed the need of a better horizontal and vertical integration of medical education. Consequently, global courses were organized to gather knowledge that, until now, was delivered in a fragmented form. Our Medical School has a major impact in the southern region of the country and over 60% of its graduates have settled in this zone, improving its physician/inhabitant relationship and the number of specialists.

Chile↗