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Biomedical subjects

D A Bertram

Publications and source records attributed to D A Bertram.

18 recordsLinked to original sources
PubMed1996

Implementation of an inpatient case management program in rural hospitals.

The objective of the study was to identify factors that affected the implementation of an inpatient case management program in rural hospitals. The hospitals studied were from the Western New York Rural Health Care Cooperative. Five of the hospitals implemented the program in 1992. A qualitative evaluation was conducted by analyzing tape-recorded interviews with nurses and chief executive officers to identify obstacles to and facilitators of program implementation. Many obstacles to implementation could be traced to workload and time constraints, physician autonomy concerns, and limited nursing staff and physician participation. Implementation was facilitated foremost by the effort and supportive attitudes of nursing leaders and hospital chief executive officers. This study concluded that it should be possible to successfully implement conceptually sound managed care and case management programs in rural hospitals, but it will require a relatively long period of support, especially from hospital administration and nursing leaders.

Case Management↗
PubMed1995

Predictors of young physicians practicing specialties without prior graduate medical education.

OBJECTIVE: This study identifies predictors of young physicians practicing specialties for which they did not report having graduate medical education. DATA SOURCE: A secondary analysis was conducted using a nationally representative survey of young physicians, Practice Patterns of Young Physicians, 1987 (United States). Physicians were under 40 years of age and in uninterrupted practice more than one but fewer than six complete years. STUDY DESIGN: Young physicians who practiced specialties without prior graduate medical education (GME) in these specialties were compared to young physicians who practiced only the specialties for which they reported GME. Comparisons were made on sociodemographic characteristics, international medical graduate status, number and types of GME specialties, year completed GME, and preference for a practice position that was not offered. DATA EXTRACTION METHODS: Sample size was 4,440, including 345 (7.8 percent) physicians who practiced specialties without prior GME. Logistic regression analysis was used to identify predictors of young physicians practicing specialties without prior GME. PRINCIPAL FINDINGS: Physicians who practiced specialties without prior GME more likely were younger, members of minorities other than Black, and with a physician father, high medical school educational debt, and GME in the more generalist specialties. Interaction effects occurred among sex, marital status, and having had GME in internal medicine. Goodness-of-fit analyses indicated that the predictors were useful, but classification table results indicated that at best two out of three cases could be correctly classified. CONCLUSIONS: Practicing specialties without prior graduate medical education in those specialties was related to sociodemographic characteristics and type of specialty training, but a fuller understanding of the circumstances affecting physician specialty changes will require querying physicians directly about their practice choices.

Adult↗
PubMed1994

Culture shock in a university health service: a case and commentaries.

The detailed experience of one international student provides a case history in the use of college health services. His journey through the campus health center and outside referrals reveals important facets of student healthcare. It also offers some insights into foreign students' feelings as they contrast their health encounters with expectations carried from home. Four commentaries on the case attempt to draw inferences and to explain from various points of view what the student found in the course of seeking a diagnosis for rectal bleeding.

Adult↗
PubMed1992

Measuring physician mental workload: reliability and validity assessment of a brief instrument.

This study examined the reliability and validity of a brief six-item instrument to measure the mental workload experienced by residents for specific patient visits to an ambulatory care clinic. Participating in the study were twenty-two residents in postgraduate years 1 through 3 who were working in the general outpatient clinic of an inner city, private, nonprofit community hospital. Cronbach's alpha coefficient for the instrument was 0.80. Findings supported several theory-based hypotheses on determinants and performance consequences of mental workload. Mental workload was positively correlated with fatigue (r = 0.42, P = 0.03) and inversely correlated with residents' self-rated experience with patients' problems (r = -0.65, P less than 0.001). Residents' performance was measured through self-ratings and faculty physicians' ratings. Mental workload was inversely correlated with self-rated performance (r = -0.67, P less than 0.001). The correlation of mental workload with faculty physician ratings that reflected the technical dimension of patient care (physician examination, medications, and procedures) was r = -0.38 (P = 0.04). With mental workload squared, the correlation was r = -0.45 (P = 0.02) and the form of the relationship, consistent with the hypothesis, was a slightly downward sloping curve. Limitations of this research are discussed as well as suggestions for further research.

Adult↗
PubMed1990

A measure of physician mental work load in internal medicine ambulatory care clinics.

Physician mental work load is an important variable intervening between work demands imposed on physicians and physician performance. A brief instrument was developed to measure the mental work load experienced during a clinic session in internal medicine ambulatory care hospital clinics. The instrument covered six dimensions of mental work load: performance, time load, mental effort, physical effort, psychologic stress, and difficulty. Cronbach's alpha reliability coefficient for the instrument was 0.83. The instrument exhibited construct validity. As hypothesized, mental work load was found to be positively associated with number of patients seen and with fatigue, and mental work load was inversely associated with physician satisfaction with the patient care they provided and with their self-rating of the quality of care they provided. The importance of measuring physician mental work load is discussed.

Adult↗
PubMed1989

The new medical practice environment. Internists' view of the future.

There have been many changes in the environment in which internal medicine is practiced in recent years. This has been coupled with reports of internists becoming frustrated and of internists leaving primary care practice. We conducted a survey of 219 internists in academic and private practice in western New York. While internists were generally positive regarding the training of residents, there was a pervasive feeling of frustration and demoralization among practicing internists. This demoralization may affect recruitment of new physicians to internal medicine and cause early retirement of practicing internists. The study demonstrated some of the causes of the demoralization.

Adult↗
PubMed1988

Career paths of physicians who received an American Cancer Society Regular Clinical Fellowship.

The authors conducted a survey of American Cancer Society Regular Clinical Fellowship recipients from 1975 to 1976 and 1985 to 1986 and directors whose programs were awarded fellowships in 1985 to 1986. The survey ascertained the career paths taken or planned by the surveyed fellows, program directors' estimates of the career paths chosen by their programs' fellows from the last 5 years, and to elicit opinions on the role of the fellowship program. Response rates exceeded 70% across the three groups. The survey found that there has been a shift toward full-time academic oncologic practice and away from community oncologic practice by fellows. Program directors indicated the fellowship program afforded more benefits to fellows than fellows perceived, with the exception of the contribution to fellows' salaries. Program directors and fellows agreed on the most important aspects of a fellowship program (support a year of otherwise unavailable training and require exposure to research) but were in less agreement on other characteristics.

American Cancer Society↗
PubMed1988

Obstacles to effective professional education programming by a voluntary health association: findings from a national survey.

The American Cancer Society (ACS) conducted a nationally representative survey of ACS professional education committee volunteer chairpersons and ACS staff responsible for professional education programs in Divisions and Units of the Society. The survey questionnaire included a set of 25 items (15 in the chairperson questionnaires) representing potential obstacles to effective professional education programming. Subjects rated these obstacles on a four-point scale indicating the extent to which they were perceived as problems in professional education. The survey identified which potential obstacles to professional education programming by a voluntary health association were considered to be most problematic. These included competition from other providers of oncology professional education, outdated audiovisuals and publications, and the recruitment and retention of physician volunteers. The survey verified that there were differences within the organizational structure of the association. In particular, small Units of the Society faced more problems than did Divisions and large Units. The survey found differences in perceived problems between volunteers and staff, particularly in that staff found outdated audiovisuals and publications to be more of a problem than did chairpersons. In general, however, there was a commonality of opinion among all respondents as to which obstacles posed more of a problem than others in professional education.

American Cancer Society↗
PubMed1986

The professional education program of the American Cancer Society.

The American Cancer Society is the major organization that provides cancer education to health professionals in the United States. This is implemented not only by the National Office but through 58 Divisions and over 3000 local Units. Objectives for professional education emphasize informing physicians and the multiple disciplines of health professionals engaged in primary care about cancer detection and prevention, particularly for breast, lung, colon, rectal, and cervical cancers. A plan is now being developed for a professional education program to the year 2000. Cancer control programs sponsored or planned by the Society include the Colorectal Health CHECK program, Smoke Free Young America, Breast Cancer Detection Awareness, and Cancer Risk Reduction. These programs demonstrate an effective partnership between professionals and lay volunteers. The Society also offers Clinical Fellowships, Medical and Nursing Professorships, and Nursing Scholarships to further professional education. National conferences are sponsored by the Society, as are special graduate courses for physicians from foreign countries. In addition, numerous publications and audiovisuals are available through Units to supplement professional, as well as lay, education.

American Cancer Society↗
PubMed1977

The evaluation of continuing medical education: a literature review.

The literature of continuing medical education (CME) program evaluation was reviewed and analyzed. The "State-of-the-art" of CME evaluation is depicted in a series of tables which indicate evaluation methods and results. Evaluation designs providing strong assurances of valid results were not often found. The weakness of most published evaluations limit possible conclusions about the effectiveness of CME.

Education, Medical, Continuing↗