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Interactive videodisk training programs offer a new instructional approach to demands for technical skills training. This article highlights the demands for staff development providers to address technical skills training through interactive videodisk modalities.
Concern regarding the quality of surgical treatment performed within resident training programs and the need for direct, active involvement of the attending surgeon have been issues of interest to surgeons and the public. To provide specialized training in the diagnosis and treatment of vascular disease, vascular surgical fellowships have been established. In institutions with established vascular fellowships, one may question whether general surgical residents or vascular surgical fellows should perform carotid endarterectomies. The majority of carotid reconstructive procedures are performed at our institution by the chief general surgical resident under direct supervision. We elected to review our experience with surgical treatment of the carotid artery in an effort to examine the safety of this practice. The record of all patients who underwent carotid endarterectomy or reconstruction from April 1980 to July 1984 were reviewed. One hundred and twenty-nine patients who underwent 153 reconstructions of the carotid artery constituted the study group. The indication for operation was symptomatic carotid atheromatous disease in 96 and asymptomatic disease in 57. Ninety-three per cent of the procedures were performed by the chief general surgical resident under the supervision of one attending surgeon. Although the incidence of associated systemic problems (hypertension, diabetes and coronary artery disease) was significant in the study group, postoperative cardiovascular and cranial nerve and central neurologic deficits were 1.3 per cent, respectively, with no operative mortality. At our institution, the performance of carotid endarterectomy under close supervision provides an excellent context in which the resident in training may learn precise and careful dissection of the tissue and arterial repair. The need for formal vascular surgical fellowships to develop proficiency in judgment, technique and management of vascular disease is not questioned. However, as a learning experience for the general surgical resident, we believe this practice is both safe and effective, and a high standard of patient care is not compromised.
Factors causing predisposition to knee exertion injuries were sought by means of a questionnaire and detailed anthropometric measurements in 39 Finnish Army conscripts picked from a random sample of 56 army conscripts. The subjects consisted of two groups of 18- to 23-year-old conscripts; Group A comprised 29 subjects without knee exertion injuries and Group B 10 subjects who had experienced knee exertion injuries during the physical training program of the first eight weeks of military service. In Group A the physical activity level preceding the military service was somewhat higher than in Group B. In Group B the skeletal dimensions were longer and the body fat percentage was higher than in Group A. We conclude that big size of the subjects predisposed to knee exertion injuries during the training program.
We describe a laboratory medicine residency training program that includes ongoing interaction with both clinical laboratories and clinical services as well as significant research experience. Laboratory medicine residents serve as on-call consultants in the interpretation of test results, design of testing strategies, and assurance of test quality. The consultative on-call beeper system was evaluated and is presented as an effective method of clinical pathology training that is well accepted by the clinical staff. The research component of the residency program is also described. Together, these components provide training in real-time clinical problem solving and prepare residents for the changing technological environment of the clinical laboratory. At the completion of the residency, the majority of the residents are qualified laboratory subspecialists and are also capable of running an independent research program.
This study examined the long-term effects of participation in a self-taught memory training program. In all, 27 memory training and 13 nontraining participants were assessed at approximately 3-year follow-ups. Assessment of these groups prior to the introduction of training had revealed nonsignificant differences in memory performance but marked differences in level of memory complaints, with training participants evidencing higher levels of complaints. The current assessment again demonstrated overall nonsignificant differences in memory performance but significant differences in memory complaints between the two groups. More specifically, the training group evidenced significant decreases in memory performance over the 3-year interval, but no significant changes in memory complaints were observed for either group. Thus, memory training appeared to have little long-term effect on memory functioning. Future research should explore long-term maintenance strategies in memory training with older adults.
As more graduates of colleges of osteopathic medicine enroll in allopathic training programs and specialty programs, medical directors of osteopathic medical institutions are faced with the challenge of maintaining a well-trained housestaff. More important, perhaps, this exodus threatens the very core of osteopathic medicine, namely, its ability to produce well-trained primary care physicians. A recruitment plan used at the Chicago College of Osteopathic Medicine and its affiliates is presented here. The plan emphasizes the importance of trainee involvement in their own education as well as the use of residents in recruiting interns and specialty residents.
This study investigated the implications of pregnancy on residents and their training programs and how programs have planned for pregnancy disruptions compared to other employers. We received questionnaires from 236 male and female residents and their families who had experienced at least one pregnancy during their training. Results for female residents were compared with working spouses of male residents. Approximately half of the female residents reported that their programs had formal leave policies compared to 70% of the working spouses. The average amount of leave taken by residents was considerably less than that taken by the spouse group. For both groups, 35% of all pregnancies were unplanned; 19% of these without benefit of birth control. Approximately 30% of both groups said they should have timed their pregnancies differently. Female residents were more likely to perceive their pregnancies as a stressful time. Despite this greater stress, female residents were equally as unlikely as spouses of male residents to miss work for pregnancy-related causes. This study supports the need for better planning for pregnancy during residency training.
A survey of 127 neurology residency training programs (124 approved by the Accreditation Council for Graduate Medical Education; 3 by the American Osteopathic Association) in the United States indicated that 80% were sponsored by medical schools. Of the 2,700 MD neurology faculty in 1982, 3/5 were full-time. As of 1982, there were 1,300 neurology trainees, including 334 fourth-year postgraduates (PG4s); 21% were women, and 3% held DO degrees. From 1960 through 1983, about 5,000 PG4s were produced, and for 1984 through 1990 the program directors estimated that this number will be about 3,000; our own projection, however, was only 2,400.
The existing Canadian training programs prepare the majority of the trainees adequately for the final examination. The standards of the examination and the passing rate are realistic and compare favourably with those of the general internal medicine speciality examination.
In this article three simple applications for microcomputers in the training program setting are explained. All three are also useful in a private practice setting. The ability to conduct a literature search from your own office and the ability to manage lists of clinical cases have important research as well as educational advantages. The computerized in-service examination takes an already useful educational tool and adds a new dimension.
Participants in the Mammacheck breast self-examination (BSE) training program were surveyed to assess the characteristics of women choosing to attend BSE training sessions, as well as to assess the factors that related to their BSE practice prior to attending the session. In all, 5,673 women completed questionnaires. In comparison with the general population, women who attended Mammacheck tended to be younger, married, and more highly educated, but did not differ in relation to prior experience of breast problems. Previous BSE practice related predominantly to the amount of knowledge about BSE the women reported that they had acquired before attending a training session. The findings highlight the importance of education and raised the important question of how to teach women with lower education levels and little or no knowledge about BSE. Recommendations are made.
This is a report on the clinical component of physician's assistant (PA) training programs. Given the significant role physicians played in establishing the new profession, it is not surprising many PA programs are built on the traditional model of medical education, with clinical training occurring after didactic and laboratory-based courses in the basic sciences. It is also not unexpected that programs rely heavily on physicians as clinical instructors. This situation, however, is changing. An increasing number of PA graduates are serving as role models and as instructors in patient care settings. These graduates are also assuming positions of leadership in PA programs. Like their counterparts in medical schools, the PA faculty members surveyed in this project are not adequately prepared for their work as teachers, but they do demonstrate an eagerness to enhance their skills and to continue to upgrade the quality of teaching in their programs. Two areas in which PA faculty would particularly like help are evaluation and faculty development.
To determine the effects of exercise training programs on psychosocial improvement in uncomplicated postmyocardial infarction patients, 210 male patients hospitalized for an acute myocardial infarction (MI) were randomized to three week symptom limited treadmill (TM) plus home exercise training, TM plus medically supervised gym training, TM without formal exercise program or control, where patients were seen only at six months post MI. Patients in this sample were at low risk for psychosocial disturbance (13% were moderate to severely depressed, 23% reported marital disturbance and 3% were extremely anxious). Patients in the training groups improved from 3 to 26 weeks post MI on all depression and anxiety measures. The gym training group showed a significant reduction on one depression measure compared to no training and on one anxiety measure compared to controls.
The article presents the outlines of training programs in subspecialties in gynecology and obstetrics as gynaecological oncology, reproductivity and gynaecological endocrinology, maternal-fetal medicine and gynaecological urology. The program should be discussed and evaluated by scientific gynaecological associations, the Centre for Postgraduate Training and approved of by the ministry.
An evaluation of the two-year experience since the institution of the postdoctoral pharmacy fellowship in family practice has revealed the program to be a valuable one not only for the fellows completing the program but to the departments cosponsoring this experimental training program. The two individuals who have completed the program have gone to clinical practice positions. In both academic and hospital settings, the fellow gains an understanding of the philosophical basis of family medicine while at the same time gaining specialized experience in an area of interest as well as research design and implementation. The department of family practice has benefited by the provision of additional clinical pharmacy services and education. It has also enabled the department to expand its involvement in research activities.
Modeling, self-verbalization, and self-reinforcement techniques were used to train hyperactive children in more effective and less impulsive strategies for approaching cognitive tasks, academic problems, and social situations. Eighteen hyperactive children took part in the training program. The control group, which received no training, consisted of 11 children, matched with the experimental group on age, IQ, and measures of hyperactivity and impulsivity. Several tests and measures, some of which have been shown to differentiate between hyperactive and normal children, were administered prior to training at the end of the 3-month training period, and after a further 3-month period in which no training took place. The trained group showed significantly greater improvement on several of the measures, both at the time of posttesting and on the follow-up evaluation.
22 subjects seeking psychological help for problems of insomnia were trained to use a self-administered treatment package which contained a booklet explaining the problem and outlining the training program in detail and a tape with three versions of progressive relaxation training. A follow-up study one year later indicated that 90% of the subjects had trained according to the instructions and that 82% experienced a positive effect on sleep both with respect to falling asleep, staying asleep, and consumption of sleeping pills. It was concluded that self-administered relaxation training seems a cheap, convenient, and effective means of treating insomnia.
Semi-supervised physical training for 12 weeks was performed on 60 patients with coronary heart disease including 48 patients with myocardial infarction and 12 with angina pectoris. The training program consisted of medically-supervised training at the institute once a week and unsupervised training at home at least twice a week with an intensity of 70 to 85% of the maximum heart rate which had been attained by a symptom-limited multiphasic treadmill stress testing according to Bruce's protocol. The results showed an average increase of maximum oxygen consumption from 27.0 +/- 5.7 to 31.0 +/- 7.8 ml/min X kg (p less than 0.01) and of treadmill time from 507 +/- 120 to 673 +/- 140 sec (p less than 0.0001). Cardiovascular responses reduced at a submaximal level of exercise and remained unchanged at the maximal level of exercise. No detrimental events were encountered during the program. The left heart catheterization and coronary angiogram were performed on 35 out of 60 patients. The trainability was higher in patients with single-vessel disease than in those with multi-vessel disease. Based on these results, supervised training should be required mostly for patients with low physical fitness, and patients with high physical fitness can probably improve their physical abilities by self-training at home following a proper exercise program.