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PubMed2001

Minimum instructional and program-specific administrative costs of educating residents in internal medicine.

BACKGROUND: The cost associated with education of residents is of interest from an educational as well as a political perspective. Most studies report a single institution's actual incurred costs, based on traditional cost accounting methods. We quantified the minimum instructional and program-specific administrative costs for residency training in internal medicine. METHODS: Using the Accreditation Council for Graduate Medical Education program requirements for internal medicine as minimum standards for teaching and administrative effort, we quantified the minimum instructional and administrative costs for sponsorship of an accredited residency program in internal medicine. We also analyzed the impact of resident complement and program curricular emphasis (outpatient, inpatient, or traditional) on the per-resident cost. The main outcome measure was the minimum annual per-resident cost of instruction and program-specific administration. RESULTS: Using the assumptions in this model, we estimated the annual cost per resident of implementing the program requirements to be $50,648, $35,477, $28,517, and $26,197 for inpatient intensive residency programs with resident complements of 21, 42, 84, and 126, respectively. For outpatient intensive residency programs of identical resident complements, we estimated the annual per-resident cost to be $58,025, $42,853, $35,894, and $33,574 for similar resident complements. Fixed costs mandated by the program requirements, which did not vary across program size or configuration, were estimated to be $640,737. CONCLUSIONS: There are fixed and variable costs associated with sponsorship of accredited internal medicine residency programs. The minimum cost per resident of education and departmental administration varies inversely with program size within the sizes examined.

Administrative Personnel↗
PubMed2000

Actions without consequences: injury-related messages in children's programs.

OBJECTIVE: To characterize children's television programs in terms of their unintentional injury-related messages. DESIGN: Content analysis. Episodes representing a total of 216 unique television programs were coded for the presence of imitable unsafe behaviors without consequences. SETTING: A census of all children's programming airing in a northeastern city during the first week of December 1996. RESULTS: Exactly 47.0% of children's programming depicted at least 1 instance of unsafe, imitable behavior without consequences; one third had more than 3 instances. Exactly 51.0% of the programs targeted to school-age children and 33.4% of the programs targeted to preschoolers contained these unsafe behaviors. The majority (56.8%) of children's programs on basic cable television depicted unsafe behavior as compared with 23.1% of programs shown on public television. Cartoon programs depicted the most unsafe behaviors (60.3%), as compared with live-action programs (33.4%) and other genres (23.3%). CONCLUSIONS: Children's television programs depict too many unsafe behaviors without consequences. Future work should explore the role of these programs in the development of unsafe behaviors in children.

Adolescent↗
PubMed2006

Comprehensive long-term follow-up programs for pediatric cancer survivors.

BACKGROUND: The objective of this study was to provide a detailed description of comprehensive long-term follow-up (LTFU) programs for pediatric cancer survivors. METHODS: Program directors from 24 comprehensive LTFU programs in the U.S. and Canada completed a 6-page survey that provided details in 5 categories: description of the program, perceived benefits and strengths of the program, barriers to the development and use of the program, methods to improve the program, and an ideal model of care for pediatric cancer survivors. RESULTS: Participants identified the following primary benefits to health care delivered to survivors through LTFU programs: health care delivered by clinicians familiar with long-term risks of survivors, provision of risk-based screening and surveillance for late effects, and targeted education for risk reduction and healthy lifestyles. Key barriers to the functioning of LTFU programs included system-driven and patient/survivor-driven factors. System-driven factors included inadequate resources and finances to sustain programs, low institutional commitment toward the provision of survivorship care, lack of capacity to care for the growing population of survivors, and difficulties with ongoing communication with community physicians. Survivor-driven barriers included lack of interest and lack of awareness of cancer-related risks. CONCLUSIONS: This report describes the frequency, content, and setting of follow-up care delivered by pediatric comprehensive LTFU programs. Critical challenges as survivorship care evolves will include integrating a structured process of program evaluation and building capacity for care.

Adolescent↗
PubMedDate not supplied

Survey of medicine/pediatrics residency training programs.

The American Board of Internal Medicine and the American Board of Pediatrics agreed in 1967 to create combined medicine/pediatrics residency training programs. These programs span four years and provide 24 months of training in each discipline, leading to Board eligibility in both. Little is known about their curricula because there is no separate residency review committee to critique the current programs. The directors of the 65 current programs were surveyed by mail. Fifty-seven (88%) responded to questions about: lengths of time programs had been in operation, attitudes toward quality of residents, program structures and curricula, and performances of graduates taking the Boards. More than half of the programs were established after 1980. Forty of the programs' graduates have passed the Medicine Boards, and 48 have passed the Pediatrics written Boards. Most programs were structured to have residents switch specialties every six months. Program Directors, both in Medicine and in Pediatrics, rated the quality of combined program residents the same as or slightly better than that of residents in non-combined programs. Medicine/pediatrics residencies have become a successful and important source of training for generalists' careers in and outside of academe, and in both primary and specialty care.

Humans↗
PubMed2004

[A structured treatment and educational program for patients with type 2 diabetes mellitus, insulin therapy and impaired cognitive function (DikoL)].

BACKGROUND AND PURPOSE: More than 50% of patients with type-2 diabetes mellitus and impaired cognitive function are overtaxed with some topics of established structured treatment and teaching programs for patients with insulin therapy. This leads to substantial deficits in respect of the patients' ability of diabetes self-management (insulin injections, self-monitoring) and the need for help by relatives and social workers. The consequences are an impaired quality of life and a great deal of expense in the welfare system. Since 1996, a specialized structured treatment and teaching program for patients with type-2 diabetes mellitus, insulin therapy, and impaired cognitive function (DikoL) has been developed. Main differences in comparison to established programs were less theoretical topics (no pathophysiology, no insulin action, no complicated calculation of carbohydrate pounds) and more time for practical exercise. In a randomized prospective study, the effectiveness of the DikoL program was evaluated. PATIENTS AND METHODS: All patients with type-2 diabetes mellitus (n = 106, age 68.6 +/- 8.7 years, median diabetes duration 10.3 [0.03-35.4] years, HbAlC 10.3+ 1.7% [HPLC, Diamat, normal range 4.5-6.3%], cognitive function 87.7 +12.3 IQ points), admitted to hospital to participate in a structured treatment and teaching program between April 1999 and June 2000, were studied. Patients with impaired cognitive function (< 91 IQ points) were randomized: they participated either in an established structured treatment and teaching program according to Berger et al. (standard group: n = 35) or in the DikoL program(DikoL group: n = 33). Immediately after participation and 0.5 years later, the quality of diabetes control, patients' knowledge of diabetes, their ability for diabetes self-management, and their satisfaction with the program were evaluated. RESULTS: Patients of the DikoL group had a comparable quality of diabetes control (HbAlc: DikoL vs. standard group: 8.5 + 1.3 vs. 8.3 +/- 1.4%; p = 0.62)and diabetes-related knowledge (DikoL vs. standard group: 9.6 +/- 4.4 vs.10.3 + 3.8 points; p = 0.52), but significantly better results in respect of their ability for diabetes self-management (DikoL vs. standard group: 15.9 +/- 3.1 vs. 12.5 +/- 4.1 points; p = 0.001) than patients of the standard group. Moreover, in the DikoL group there was a tendency to a lower number of patients needing third-party assistance (n = 1 patient of the DikoL group vs. n = 5 patients of the standard group; p = 0.13). There were no acute complications (hypoglycemia, comata, and foot ulcers) in neither group. Following participation in the DikoL program, patients reached a better score in the questionnaire evaluating satisfaction with the treatment and teaching program (DikoL vs. standard group:52.5 + 4.5 vs. 44.7 + 76 points; p < 0,001). CONCLUSION: Following the wishes of the majority of diabetes educators as well as diabetologists but also patients' wishes, a specially designed structured treatment and teaching program for patients with type-2 diabetes mellitus, insulin therapy, and impaired cognitive function was designed. DikoL is the first program evaluated in a randomized, prospective trial. It clearly demonstrated a bet-ter outcome for patients with impaired cognitive function in respect of diabetes self-management and satisfaction. With its implementation, patients' quality of diabetes care can be improved in a substantial manner.

Aged↗
PubMed2001

The role of multimedia interactive programs in training for laparoscopic procedures.

BACKGROUND: The application of minimally invasive techniques to the performance of abdominal surgery by general surgeons has been perhaps the greatest advance in the history of general surgery. The safe adoption of many of these procedures, however, has been hampered by significant obstacles, mainly due to the problem of providing adequate training for surgeons. Outside of animal and cadaver labs, most training has been didactic in nature, and adoption rates after completion of these courses are discouraging. Multimedia interactive training has been used in a number of high-tech industries with great success. A >60% improvement in the learning curve after multimedia interactive training, as compared to traditional didactic training, has been reported. Multimedia interactive training programs for surgeons that use content and input from multiple experts in laparoscopic procedures have now been developed. METHODS: Residents from a general surgery residency program who used these programs were asked to rate their effectiveness in increasing their knowledge and comfort level prior to their participation in a real procedure as the primary surgeon or first assistant. A comparison to other traditional training techniques was also made. Eleven residents completed 41 programs designed to teach one of five different laparoscopic procedures-cholecystectomy, fundoplication, appendectomy, colon resection, or hernia repair. RESULTS: On a scale of 1 to 10, with 10 being the highest, the residents reported that the multimedia interactive training programs raised their knowledge level of the procedure from 6.0 to 8.7 (+2.7 point value increase after using the multimedia interactive program). The programs increased their comfort level when actually called on to perform or assist with the procedure from 5.3 to 8.1 (+2.8 point value increase after using the multimedia interactive program). In comparing the value of training methods for learning laparoscopic procedures, the residents rated text, lectures, videos, and animal labs at 4.7, 5.1, 6.0 and 7.3, respectively. By comparison, the residents rated the multimedia interactive training program at 8.8. CONCLUSION: The use of multimedia interactive training programs in addition to current laparoscopic training courses may help to increase the safe adoption of laparoscopic procedures. These programs may be a beneficial adjunct to residency training programs.

Adult↗
PubMed1996

[Multidisciplinary treatment program for chronic low back pain, part 1. Overview].

UNLABELLED: A multimodal treatment program is presented in cases of functional restoration for chronic low back pain. The study comprises four parts. Part I gives an overview of the different results of the study. Part II focuses on the medical and functional examination in comparison with persons who do not suffer from back pain. Part III describes psychosocial aspects (depression, complaints, ways of coping, disability) and psychotherapy. In part IV prognostic factors and their reliability for predicting treatment outcome (return to work, pain intensity, self-assessment of success by patients) are examined. In addition the relevant effects of the program on social and health care systems are also addressed. PROBLEM: The incidence of low back pain is continuously increasing, causing tremendous costs for the health insurance system. Therefore effective treatment methods are needed that take into account somatic, psychological and social factors. Chronic low back pain is conceptualized as a complex phenomenon including biological, social and psychological aspects, all of which should be addressed in a treatment program. A multimodal treatment program for chronic low back pain is presented, in which physical activity and cooperation of the patient are the primary targets. Therapeutic aims focus less on pain reduction and emphasize instead pain control, individual responsibility of the patient, and early reintegration into the working environment. The specific goals of the program are to increase the physical abilities of the patients (i. e., flexibility, strength and endurance), to increase patients' knowledge and the use of body mechanics and back protection techniques, to decrease medication-intake, to decrease dependency on the medical community, to improve patients' own positive coping skills and levels of emotional control, to increase the patient's activity level at home and to facilitate a return to work. METHODS: A total of 90 disabled patients with chronic low back pain were admitted to an 8-week program of functional restoration and behavioral support. The program consisted of a pre-program (3 weeks: education, stretching and calisthenic exercises) and an intensive treatment period (aerobics, functional strength and endurance exercises, back exercises, cognitive behavioral group therapy, relaxation training, socioeconomic and vocational counseling) which took place for 5 weeks, 7 h a day, on an outpatient basis. Apart from a medical examination and a personal interview, the patients' physical impairment, pain descriptions, and psychological distress (according to different criteria for evaluation) were also measured. This includes variables such as depression, psychovegetative complaints, quality of life and workplace satisfaction, disability, and coping with disease. Measurements were repeated at the end of the 8-week program, and after 6 and 12 months. RESULTS: In total 84 patients (94 %) were examined following treatment. There was a statistically significant improvement in flexibility, strength, lifting capacity, and endurance measurements ( p < 0.001) at the end of the treatment. In addition, significant reductions in pain, disability, depression, and psychovegetative signs were demonstrated ( p < 0.001). There was a decreased use of medical treatment for back pain following the program, with 42 % of the patients refraining from the intake of analgesics, followed by a significant reduction in physiotherapy and the consultation of physicians. Assessment of the patients' reported increased activity levels at home also supported findings that statistical improvements were significant. Sixty-three percent of the patients were found to have returned to active, productive work following discharge from the program. Most of the improvements remained stable at the 6- and 12-month follow-up examinations. CONCLUSION: The results demonstrate the effectiveness of the multimodal program of functional restoration, not only concerning positive changes in somatic, psychological and physical variables, but also with respect to the number of patients who returned to work. Our methods are also compared with the discrepant results of multimodal treatment in the United States and Scandinavia.

English Abstract↗
PubMed1989

The television, school and family smoking prevention/cessation project. IV. Controlling for program success expectancies across experimental and control conditions.

A major issue in smoking prevention research is that no study has tried to equate program success expectancies across experimental and placebo control conditions. Equivalent overall program success expectancies should be established to help rule out the effects of extra-theoretical variables which influence program outcomes. The present study tested whether an attention-placebo (information based) smoking prevention program would produce equivalent expectancies about the likelihood of program success in comparison to an experimental social influences program. To try to equate program success expectancies, the design of the two programs differed in content but was similar in procedure. Fourteen middle schools were randomly assigned to the two conditions. As hypothesized, baseline expectancies were found to predict outcome measures, even after controlling for baseline smoking intentions, ethnic group, and gender. Second, the equivalence of program expectancies at posttest was tested. Youths held equivalent overall expectancies for success across conditions. This study suggested the need to control for program expectancies in prevention research, and showed that program expectancies could be controlled for by equating process of program delivery.

Adolescent↗
PubMed1985

A review of hospital-based health promotion programs in Michigan non-governmental hospitals.

In 1983, the 217 hospitals of the Michigan Hospital Association (MHA) were surveyed to learn more about their efforts in health promotion programming. Eighty percent (174 hospitals) responded to the survey, with 48% reporting on 532 programs. Those programs included 216 in health promotion as defined by the survey instructions, 110 in disease management, 66 in first aid and safety, 87 screening, and 53 miscellaneous education programs. Further particulars about the programs are presented, including information regarding program audience, times offered per year, median enrollment, median participant hours, program age, number and type of educational methods used, follow-up methods, and fees charged. Hospital administrators' perceptions regarding health promotion programs were also surveyed. They indicated a higher level of interest in providing such programs because they viewed them as a needed community service. Conversely, they did not see them as a revenue generator. Seventy-two percent of the responding administrators indicated they currently offered health promotion programs, although only 48% submitted information regarding them. Seventy percent said they planned to begin new health promotion programs within the next 12 months, while only 6% planned to discontinue programs in the new year.

Data Collection↗
PubMedDate not supplied

Residency reform: anticipated effects of ACGME guidelines on general surgery and internal medicine residency programs.

INTRODUCTION: The Accreditation Council for Graduate Medical Education (ACGME) has recently amended guidelines for resident work environment. This study was conducted to evaluate opinions of program directors regarding the impact of the changes on residents and residency programs. METHODS: General surgery and internal medicine program directors were sent a 19-question survey. Questions were asked regarding anticipated effects on patient safety, resident well-being, education, medical errors, implementation costs, and methods needed for compliance. Data were analyzed using the chi-square test, the Mann-Whitney method, and the independent samples t-test where appropriate. RESULTS: Responses were received from 153 surgery program directors and 126 medicine program directors. Differences noted were hours worked (surgery 84.2 hours vs medicine 68.7 hours, p < 0.0005), current compliance (49% vs 73%, p < 0.0005), and allowance of internal (13% vs 54%, p < 0.0005) and external (24% vs 58%, p < 0.0005) moonlighting. CONCLUSIONS: Program directors anticipate improved resident safety and well-being. However, education, continuity of care, and board certification success are not expected to improve. Increased cost to institutions is anticipated. Surgery program directors feel medical errors will not decrease; medicine program directors are neutral. To facilitate compliance, surgery program directors anticipate employing physicians' assistants and technology, whereas medicine program directors may implement night float. Neither surgery nor medicine program directors expects increased quantity or quality of applicants. Program directors agree resident work hour reform is essential; however, varied methodology and outcomes are expected.

Faculty, Medical↗
PubMed2006

Differential use of adolescent reproductive health programs in Addis Ababa, Ethiopia.

PURPOSE: Adolescent reproductive health programs in Africa have largely remained as small-scale pilot programs, however, there is increasing interest in bringing programs to scale. Evaluations have focused on individual programs and few have gathered population-based information on the reach of program models and the profile of adolescents who utilize services, versus those who do not. This study examines the coverage and utilization of existing adolescent programs in Addis Ababa, Ethiopia. METHODS: Population-based surveys were undertaken among over 1000 adolescents aged 10 to 19 years in slum areas of Addis Ababa, Ethiopia. An inventory of youth programs including youth centers and peer education programs was compiled in the study area. RESULTS: Eight peer education programs and six youth centers were operating in the study area. Twenty percent of boys and only 7% of girls had visited a youth center in the last year; 27% of boys and 15% of girls had had contact with a peer educator. Older adolescents, especially boys, were more likely to utilize programs. Girls who work long hours and who are isolated are less likely to access and benefit from programs. CONCLUSIONS: Greater segmentation of the adolescent population is needed in the design and content of adolescent reproductive health programs. In addition, programmers should pay attention to the specific circumstances of young people in local settings, particularly vulnerable, hard-to-reach sub-groups of adolescents, including girls.

Adolescent↗
PubMed2004

Development and evaluation of digital subtraction radiography computer program.

OBJECTIVE: We developed a new program for digital subtraction radiography (DSR) having useful functions to get the DSR image more accurately and efficiently. The purpose of this study was to evaluate the accuracy of the DSR image acquired using the new program as compared with the ready-made program. STUDY DESIGN: Four observers performed the DSR process using our program and the ready-made program for digital intraoral radiographs taken from incisor, premolar, and molar regions. The statistical difference was evaluated between the programs, between the observers, and between the regions. RESULTS: The DSR image using our program was superior to that with the ready-made program in all the observers and all the radiographed regions. Also, there was the statistical difference among the observers, especially in our program. CONCLUSION: The DSR image using the new program was very accurate compared with ready-made program, so the program was useful to get an accurate DSR image.

Humans↗
PubMed2006

famoses: a modular educational program for children with epilepsy and their parents.

BACKGROUND: It is known that most adult patients with epilepsy often have poor knowledge of their disorder, treatment options, and social and vocational consequences, despite the huge amount of information available. Being pressed for time, health care professionals often are not able to provide the repetitive counseling and instruction necessary to address epilepsy care adequately. Therefore educational programs are considered extremely important in filling the gap. METHOD: For German-speaking countries, two educational programs called famoses, modulares Schulungsprogramm Epilepsie fur Familien [modular service package epilepsy for families], were developed by a multidisciplinary group of neuropediatricians, psychologists, social workers, and educators. The aims of the famoses programs are to improve children's and parents' knowledge about epilepsy and to help patients of childhood age and their parents achieve a better understanding of their disease, gain more self-confidence, and reduce specific fears regarding epilepsy. famoses comprises two different educational programs: famoses for kids with epilepsy within the developmental period of ages 7 to 13, and famoses for parents or caretakers. The programs are designed for interactive small-group education. RESULTS: The child-centered educational program is based on a fictional story: The children are sailors on a virtual cruise, sailing from island to island, accompanied by educated trainers. On each island there is something new to discover about epilepsy. The parent (and caretaker)-centered educational program covers different topics-overview and content of the program, basic knowledge, diagnostics, therapy, prognosis and development, and living with epilepsy-within six modules. The program was implemented in Germany and Switzerland in the spring of 2005 and is now operating in different epilepsy centers. CONCLUSION: Within comprehensive therapeutic management of epilepsy, educational programs for patients, and for parents (caretakers) of children with epilepsy, are considered to be extremely important. Such educational programs have two main goals: to increase knowledge about the disorder, and to strengthen the patients' responsibility for themselves, with the consequence of living with as few limitations as possible. famoses is an effective component of this comprehensive care. The program has been operating successfully in different epilepsy centers in Germany and Switzerland since the spring of 2005.

Adolescent↗
PubMed2001

Determinants of acceptance of a community-based program for the prevention of falls and fractures among the elderly.

BACKGROUND: Low-energy fractures among the elderly may be prevented by measures aimed at reducing the risk of falling or increasing the strength of the skeleton. Acceptance of these interventions in the target population is necessary for their success. METHODS: The total elderly population in a Danish municipality 7,543 community-dwelling persons aged 66+ years, were offered participation in one of three intervention programs: 2,550 persons were offered a home safety inspection, evaluation of prescribed medicine, and identification of possible health and food problems (Program I); 2,445 persons were offered 1000 mg of elemental calcium and 400 IU (10 microg) of vitamin D(3) per day in combination with evaluation of prescribed medicine (Program II); and 2,548 persons were offered a combination of the two programs (Program III). Acceptance was defined as willingness to receive an introductory visit by a nurse. RESULTS: Acceptance of Program I was 50%; of Program II, 56% (P < 0.00005 as contrasted with Program I); and of Program III, 46% (P < 0.005). Acceptance was associated with gender (females, 53%; males, 47%) and did not change from ages 66 to 84 but decreased significantly after the age of 85. Widows aged 66-84 had the highest acceptance (57%) and never married males aged 66-84 the lowest (30%). An important determinant, however, was the individual social service center that communicated the specific program. Acceptance varied from 39 to 66% between the social centers. CONCLUSIONS: Acceptance of a fall and fracture prevention program varies with intervention type; with gender, age, and social status of the target population; and with the motivation and attitude of the health workers involved in the implementation of the program.

Accidental Falls↗
PubMed1997

Agricultural policy and social returns to eradication programs: the case of Aujeszky's disease in Sweden.

Economic-welfare analysis of animal disease prevention programs frequently ignore the constraints of the agricultural policy environment. Prevention programs affect producers, consumers and the government. The policy environment to a large extent determines the magnitude as well as the distribution of benefits of the program among these groups. The Swedish hog industry has been exposed to three major policy changes during the 1990-1995 period. These scenarios involve various degrees of government intervention in the agricultural sector including internal market deregulation and EU-membership. Aujeszky's disease is a virus disease with swine as the natural infection reservoir. Piglets are the most fragile and an outbreak of the disease results in symptoms such as shaking, cramps and convulsions with an increase in the mortality rate. Slaughter hogs suffer from coughing, fever and reduce their feed consumption. During the last 20-25 years the incidence of Aujeszky's disease (AD) has been increasing in Sweden. In 1989 an eradication program was undertaken. A model is developed to analyze social benefits of an eradication program given variations in agricultural policy. The model refers to the specifics of the AD-program implemented in Sweden. The expected benefits of the program are evaluated using a welfare-economic analysis applying cost-benefit analysis. Total benefits of the program are evaluated across herd and size categories and different regions. Data concerning the frequency of the virus among various categories of herds prior to enacting the program were used (Wahlström et al., 1990). In addition, data from an agricultural insurance company were used to estimate the conditional probability of an outbreak given that the herd is infected. Biological and technical parameter values were collected from a variety of sources. The results of the analysis indicate that the program is economically viable given a social rate of discount in the range of 3-5% without considering non-monetary aspects such as animal ethics. A scenario where the Swedish agricultural sector is deregulated provides the maximum benefits of the program. Consumers obtain about 50% of the benefits excluding program costs. The deregulation scenario would correspond closely to a case where a reformed Common Agricultural Policy (CAP) is applied across member countries. In the current case where Sweden is a member of the EU, the benefits are reduced mainly due to lower prices of inputs and pork.

Agriculture↗
PubMed1992

Academic emergency medicine: a national profile with and without emergency medicine residency programs.

STUDY OBJECTIVE: Formal data are lacking regarding emergency departments in academic medical centers, particularly those without an emergency medicine residency program. The Education Committee of the Society for Academic Emergency Medicine conducted a survey to define a national profile of academic emergency medicine. DESIGN: Prospective survey with telephone follow-up. SETTING: Academic medical centers. PARTICIPANTS: One hundred twenty-three academic medical centers as defined by the Association of American Medical Colleges. RESULTS: Results were obtained from 94 (78%) institutions: 27 (29%) had an emergency medicine residency program and 67 (71%) had no emergency medicine residency program. Significant differences were found between those with and without emergency medicine residency programs regarding 24-hour attending coverage (96% versus 73%), mean weekly clinical faculty hours (26 versus 33), the number of emergency medicine board-certified faculty, faculty recruitment difficulties (25% versus 75%), and the presence of a curriculum for housestaff (96% versus 38%). No significant differences were noted regarding the presence of a curriculum for medical students (78% versus 64%). Of the 67 institutions with no emergency medicine residency programs, 42% were actively planning a program, and 42% would consider future development of a program. CONCLUSION: This article provides the first comprehensive profile of emergency medicine in the Association of American Medical Colleges academic medical centers. Programs with emergency medicine residency programs provided more 24-hour attending coverage, had more emergency medicine board-certified faculty, and reported less difficulty recruiting additional faculty than institutions with no emergency medicine residency program. Both need to expand their undergraduate educational activities. Many institutions with no emergency medicine residency program are attempting to develop emergency medicine residency programs.

Academic Medical Centers↗
PubMed1997

Implementing a comprehensive program for the prevention of conduct problems in rural communities: the Fast Track experience. The Conduct Problems Prevention Research Group.

Childhood conduct problems are predictive of a number of serious long-term difficulties (e.g., school failure, delinquent behavior, and mental health problems), making the design of effective prevention programs a priority. The Fast Track Program is a demonstration project currently underway in four demographically diverse areas of the United States, testing the feasibility and effectiveness of a comprehensive, multicomponent prevention program targeting children at risk for conduct disorders. This paper describes some lessons learned about the implementation of this program in a rural area. Although there are many areas of commonality in terms of program needs, program design, and implementation issues in rural and urban sites, rural areas differ from urban areas along the dimensions of geographical dispersion and regionalism, and community stability and insularity. Rural programs must cover a broad geographical area and must be sensitive to the multiple, small and regional communities that constitute their service area. Small schools, homogeneous populations, traditional values, limited recreational, educational and mental health services, and politically conservative climates are all more likely to emerge as characteristics of rural rather than urban sites (Sherman, 1992). These characteristics may both pose particular challenges to the implementation of prevention programs in rural areas, as well as offer particular benefits. Three aspects of program implementation are described in detail: (a) community entry and program initiation in rural areas, (b) the adaptation of program components and service delivery to meet the needs of rural families and schools, and (c) issues in administrative organization of a broadly dispersed tricounty rural prevention program.

Child↗
PubMed2003

Applicants' opinions about the selection process for oral and maxillofacial surgery programs.

PURPOSE: This study was conducted to investigate the characteristics of and opinions about the selection process of applicants to residency programs in oral and maxillofacial surgery (OMS) in the year 2000. The current investigation paralleled a survey completed in the 1970s, with additional questions to assess contemporary curriculum and surgical training evolution. Differences from the previous (1976) survey, a profile of applicants in 2000, and characteristics of OMS residency programs that applicants view as attractive are discussed. SUBJECTS AND METHODS: Questionnaires were sent to 307 applicants to OMS residency programs registered in the dental matching program. To provide a more direct comparison of the study completed in 1977, the current questionnaire used the original survey as a model. It was divided into 6 sections: general information, information from the formal application and letters of recommendation, the interview, the selection process, the characteristics applicants were seeking in a program, and a retrospective review of programs visited. RESULTS: In this study, 118 responses were received, representing 38% of the total. Respondents were predominately men (86%) and single, and attended dental school in all regions of the United States and the world. Respondents listed geographic location (65%) and national reputation (58%) as important factors for selecting programs to which to apply. Many respondents felt that a previous dental internship (85%), national board scores (83%), and class rank (79%) would be considered important in screening applicants for interview. A program's reputation, personalities of residents and attending staff, and clinical material were ranked as important factors contributing to program selection. Fifty-three of the 79 successful applicants reported that they were matched with their first-choice institution. Sixty percent of programs were considered worthy of revisiting by the respondents. CONCLUSIONS: Respondents in 2000 had more knowledge of the selection process before interviewing and submitted 2 times the number of applications than applicants in 1977. When selecting programs to which to apply, current applicants were less influenced by geographic location and the recommendations of other dentists. Applicants were attracted to programs that they perceive to have a good reputation and abundant clinical material. Residencies that convey a friendly atmosphere, favorable interpersonal skills of enrolled residents, and appealing personalities of the faculty were more attractive to candidates.

Adult↗