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Biomedical subjects

A S Robbins

Publications and source records attributed to A S Robbins.

50 records · Page 3Linked to original sources
PubMed1982

A study of geriatric training programs in the United States.

Training physicians in geriatrics is essential to improving health care for the elderly. The study reported here provides a detailed analysis of geriatric education at the undergraduate, graduate, and fellowship levels. The number of programs for medical students and residents has increased but is still relatively few; most are elective, and they are of variable quality. Both the number of fellowship programs (36) and positions (87) and the current number of yearly graduates (40) are quite small. Few of these programs have been thoroughly evaluated. Data are presented on the type of training sites, educational activities, and clinical interaction at different levels of training. Overall, the nursing home is most frequently used as a training site, and trainees have contact with many care providers. Information of this kind may be of value to those planning or conducting geriatric programs. The results suggest that there is a persistent need for high quality programs at all levels of educational continuum and that such efforts should be evaluated to ensure and improve quality.

Aged↗
PubMed1982

Guidelines for graduate medical education in geriatrics.

There has been a substantial increase in training programs in geriatrics over the past several years. In this paper the authors propose guidelines for geriatric training at the graduate medical educational level, both for specialized training (geriatric fellowship) and training in geriatrics as part of other specialty training (internal medicine, family practice, psychiatry, and neurology). Experts from relevant specialty boards and societies, an advisory group in geriatrics, and the faculty of the University of California-Los Angeles Multicampus Division of Geriatrics participated in a modified Delphi study which provided the information used to formulate the guidelines. Performance objectives, core content, training experiences, and clinical exposure and program evaluations are described for geriatric fellows and house staff members in internal medicine, family practice, neurology, and psychiatry. Recommendations included here may be of use to deans, faculty members, and educators responsible for the development of the many new geriatric training programs.

Aged↗
PubMed1982

Studies in geriatric education: II. educational materials and programs.

There has recently been an increase in educational programs and materials in geriatrics, but their quality and content have not been adequately assessed. This study concerns important objectives and core contents in geriatric education, with a review of training programs, books, and audiovisual materials. Specific areas of need for printed and audiovisual materials are identified. Medical student and graduate level programs were found to address relatively few objectives. Geriatric fellowship programs, although having more extensive coverage, had some notable deficiencies. This information may be of use to those conducting training programs or preparing educational material in geriatrics.

Aged↗
PubMed1982

Studies in geriatric education: I Developing educational objectives.

This study reports on the development of a comprehensive set of objectives for the education of undergraduates, graduates, and fellows in geriatric medicine. The objectives were derived from reviews of available educational materials and programs, and their significance was validated through consensus techniques that included over 100 workers with special expertise in geriatrics and gerontology from the United States. Canada, and the United Kingdom. A related and supplementary investigation, which also used consensus methods, uncovered ten general and disease-specific objectives considered to be essential outcomes of the education of geriatric fellows. Academic departments and specialty and subspecialty organizations should find the total set of objectives useful for planning and evaluating educational programs in geriatrics.

Canada↗
PubMed1980

The long-term effectiveness of interpersonal skills training in medical schools.

To determine the effectiveness of teaching interpersonal skills (IPS) in medical school, the authors evaluated interview behaviors of 46 general internal medicine interns and residents from 24 schools. Measures of interview skills included three independent videotape ratings of actual patient interviews. Telephone and mail interview forms assessed the quality of interpersonal skills training provided by each medical school. House officers receiving IPS training did not perform significantly better than nontrained colleagues on any of 12 parameters. However, when IPS training was divided into high and low categories based on comprehensiveness of training, house officers receiving the more comprehensive courses demonstrated greater use of openended questions and emotion-related responses. Implications of these findings are discussed.

Adult↗
PubMed1979

Interpersonal skills training: evaluation in an internal medicine residency.

To determine the effectiveness of teaching interpersonal skills in a general internal medicine residency, a program was developed utilizing videotape feedback of house-staff/patient interactions, a modification of Interpersonal Process Recall (IPR). Fifty-one randomly selected house officers at different levels of training were included in a controlled, pretest-posttest study design. The major pre-post measures were three independent ratings of videotapes of actual first-visit interviews between resident and patient. House officers in the experimental group significantly increased the proportion of each interview devoted to psychosocial issues compared with controls, although the interviews remained predominantly medical; increased the use of effective responses; and improved their level of empathy with patients. Personality and attitude measures were found not to correlate with observed interpersonal skills on pretest or posttest videotapes. House officers rated the training program as being interesting, valuable, relevant, and nonthreatening. The data suggest that interpersonal skills can be effectively taught to internal medicine residents utilizing a videotape feedback training program.

Feedback↗
PubMedDate not supplied

Evaluating humanistic attributes of internal medicine residents.

OBJECTIVE: Methods of assessing humanism in internal medicine residents have not been completely designed or evaluated. This study used patient satisfaction as a measure of humanism, and assessed the validity of using faculty physicians to evaluate residents' humanistic behavior. Residents' ability to assess themselves was also evaluated. SETTING: A university-affiliated internal medicine training program. SUBJECTS: Forty-seven internal medicine residents were evaluated by patients, faculty, and themselves. DESIGN: Faculty physicians were given standard faculty evaluation and patient satisfaction forms, and were asked to evaluate residents. These evaluations were compared with the patients' responses on the same satisfaction forms. Residents performed self-assessment using identical forms; these responses were compared with those of the faculty and patients. RESULTS: There was no correlation between patients' responses and those of the faculty or residents. There was a significant inverse correlation between resident and faculty responses, especially for the female residents (r = 0.71). CONCLUSION: These findings suggest the need for further study of the evaluation process, including what factors influence individuals to respond as they do. It appears that the use of one rating group is not sufficient to achieve an accurate assessment of residents' humanistic skills. The present status of the process of evaluating humanism is discussed.

Adolescent↗
PubMedDate not supplied

The reliability and validity of an obstacle course as a measure of gait and balance in older adults.

The use of an obstacle course to quantify gait, balance and functional mobility in elderly persons, particularly to assess objectively changes following exercise and rehabilitation interventions, has not been extensively developed or tested. In this study, we describe an 18-item obstacle course developed as an outcome measure for an exercise intervention among fall-prone elderly men. Reliability and validity of the obstacle course was tested in a group of 58 community-living elderly men (mean age = 75 years). Each subject's performance was videotaped and timed. The videotapes were scored by a physical therapist and a physician. Inter-rater reliability between the raters was high (Kappa = 0.96, p < 0.0001). Both the obstacle course score and time correlated significantly with gait velocity, a 6-minute walk test, and a performance-oriented instrument of gait and balance. Obstacle course scores showed significant improvement among the most impaired subjects, but not among higher functioning subjects following a 3-month exercise intervention. These results suggest that an obstacle course may be a useful and valid method for measuring outcomes related to mobility tasks in selected elderly populations. Further work is needed to determine in which populations, and for which outcomes, an obstacle course is better than simpler performance-based measures.

Aged↗
PubMedDate not supplied

Weight gain as a barrier to smoking cessation among military personnel.

PURPOSE: To assess the relationships between active-duty military status, military weight standards, concern about weight gain, and anticipated relapse after smoking cessation. DESIGN: Cross-sectional study. SETTING: Hospital-based tobacco cessation program. SUBJECTS: Two hundred fifty-two enrollees, of 253 eligible, to a tobacco cessation program in 1999 (135 men, 117 women; 43% on active duty in the military). MEASURES: Independent variables included gender, body mass index (weight/height2), and military status. Dependent variables included about weight gain with smoking cessation and anticipated relapse. RESULTS: In multivariate regression analyses that controlled for gender and body mass index, active-duty military status was associated with an elevated level of concern about weight gain (1.9-point increase on a 10-point scale; 95% confidence interval [CI], 1.0- to 2.8-point increase), as well as higher anticipated relapse (odds ratio [OR] = 3.6; 95% CI, 1.3 to 9.8). Among subjects who were close to or over the U.S. Air Force maximum allowable weight for height, the analogous OR for active-duty military status was 6.9 (p = .02). CONCLUSIONS: Occupational weight standards or expectations may pose additional barriers for individuals contemplating or attempting smoking cessation, as they do among active-duty military personnel. These barriers are likely to hinder efforts to decrease smoking prevalence in certain groups.

Adult↗
PubMedDate not supplied

Pharmacological approaches to smoking cessation.

Currently, 28% of U.S. adults smoke, and this percentage is declining by 0.5% per year; however, this rate of decline must double if the goal in Healthy People 2000 (smoking prevalence of no more than 15% among adults) is to be reached. To help decrease physiological barriers to smoking cessation, numerous pharmacological approaches have been used. I review the effectiveness of these approaches, including interventions reported in the relatively older literature as well as more recent approaches, such as nicotine replacement, clonidine, antianxiety agents, and antidepressants. I also discuss the results and design of clinical trials.

Administration, Cutaneous↗