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PubMed1992

Changing the curriculum for internal medicine residency training.

The academic leadership of internal medicine is considering fundamental changes in the curriculum for internal medicine residency training. The impetus to change the curriculum is derived from various socioeconomic changes during the past 10 years. These changes have resulted in a drastically shortened length of stay of patients in hospitals, an emphasis on outpatient care by reimbursement agencies, and a sharp decline in the numbers of U.S. medical graduates selecting careers in internal medicine. Curriculum change will mandate that we define the roles of general internists and subspecialists in the delivery of primary care and that we re-define how we train these two groups of internists. We must focus attention on the issue of service compared with education and must confront the issue of how best to train foreign medical graduates. Any curriculum change will also have to accommodate residents selecting careers in research in order to ensure an adequate supply of physician-scientists. Before implementing any change in curriculum, we must put into place a rigorous, prospective evaluation system. We must be able to accurately assess both positive and negative outcomes of these changes and make necessary midcourse corrections. The impetus for curriculum change in internal medicine will, it is hoped, ultimately benefit the public, the trainees, and the practice of internal medicine.

Ambulatory Care Facilities↗

PubMed1978

An evaluation of undergraduate family care programs.

Evaluation of the many new family care programs (FCP), and others of similar intent, however defined, is as essential as determining the value of any other curriculum change. Replies to a questionnaire from 101 U.S. and 15 Canadian medical schools indicated that 80% of the former and 93% of the latter had FCPs; 35% and 29%, respectively, were not evaluating their program by any method. No single evaluative technique was used by more than 42% of the American medical schools. A review of the literature on FCPs frequently indicated that the conclusions that could be drawn about the programs were ambiguous. Students in the University of Cincinnati Medical Center FCPs elected family practice or pediatric internships significantly more often than did the FCP nonparticipants, but they indicated that the program had little effect on this choice, despite almost uniformly favorable testimonials. We discuss the possibility that FCPs may be educating the wrong students, that FCPs, if not reinforced in other clinical areas, may have few lasting effects on student attitudes or career choice, and that we may be asking the wrong questions, and with inadequate methods.

Adult↗

PubMed1989

Ten-year study of trends in removable prosthodontic service.

To gain an overview of where the field of removable prosthodontics may be heading, an ex post facto research project was completed that randomly sampled the charts of patients screened for removable prosthodontics during 1977-1979 and 1985-1987. The information showed that, overall, the number of complete dentures was declining whereas the number of removable partial dentures was increasing. The fastest growing prosthodontic service was the combination of the maxillary complete denture opposing the mandibular removable partial denture. Curriculum changes based on the results of the research were made.

Denture, Partial, Removable↗

PubMed1991

Librarian or educator: into the classroom.

There is a traditional view of librarians as keepers of information. This paper reports on the development of a post of Tutor Librarian who is actively involved in nurse education and inservice training. Project 2000 and its accompanying curriculum changes provide an opportunity to develop the Tutor Librarian's role.

Education, Nursing↗

PubMedDate not supplied

Clinical procedures performed by emergency medicine resident physicians: a computer-based model for documentation.

To facilitate documentation and assess the number and types of clinical procedures actually performed by resident physicians, we developed a microcomputer-based recording process. After completing a procedure, including resuscitations, residents recorded in a precoded book issued for each monthly rotation. At the end of each rotation, the books were collected and the information was transferred to a database program by the clerical staff. During 1989, 17 emergency medicine resident physicians at PGY levels 1 through 3 utilized this system. Completed procedure record books were submitted for 124 of 148 clinically active months for a compliance rate of 84%. Of 1,857 procedures recorded, the most frequent were resuscitation (20%), orotrachael intubation (12%), and percutaneous central vein cannulation (12%). Commonly recorded were lumbar puncture (7%), diagnostic peritoneal lavage (5%), nasotrachael intubation (4%), and newborn delivery (4%). The high compliance rate suggests resident physicians acceptance. This system enables residency directors to closely monitor individual and group procedure experiences and to make curriculum changes based on objective findings. It also provides a means of storing and retrieving data for review organizations and credentials committees.

Documentation↗

PubMed1990

Implementing nutrition into the medical curriculum: a user's guide.

The medical profession is facing the challenges of the 1990s with a shift to outpatient care and preventive services. Medical schools will need to respond to these forces by reevaluating their curricula and setting new objectives. Nutrition is an essential element in the process of curriculum change. The nutrition educator will be expected to take a leading role in integrating nutrition into the medical school curriculum. This report presents steps and strategies to initiate the process.

Curriculum↗

PubMed1991

Integrating substance abuse education in the medical student curriculum.

Physicians miss the diagnosis of substance abuse in significant numbers of patients, partly because of a lack of education about identifying and treating those patients. This article describes an attempt to integrate substance abuse into the curriculum of a traditionally organized medical school. Faculty selection, determination of the skills and knowledge needed, and methods for enriching the curriculum to include substance abuse are described. Problems encountered during the project, benefits of implementing the curriculum changes, and recommendations for other medical schools choosing to implement such a program also are provided.

Curriculum↗

PubMed1990

Implementing the Roy model: challenges for nurse educators.

The experience of selecting and implementing a nursing model appropriate to the nursing course in the first year of the generic baccalaureate programme of the University of Ottawa School of Nursing is described. Many challenges surfaced for the professors in year one as this curriculum change was implemented. Four challenges: (1) adapting the course to be congruent with the Roy model, (2) developing teaching tools suitable for student learning, (3) sequencing of content for student learning, and (4) obtaining competent role models, and how they were met, are discussed.

Adaptation, Psychological↗

PubMed1991

Social class, gay men and AIDS prevention.

The relationship between sexuality, gay communities and class is potentially a very large problem for AIDS prevention. Class is a historical process which interacts with sexuality in ways still little understood. The complexities of modern class structures need full acknowledgement; labour market groupings are internally divided, and cultural privilege and exclusion are important. A community survey in New South Wales of men who have sex with men shows the class selectiveness usual in such research. An exploration of correlates of labour market position, income and education finds few relationships with attachment to milieu except for involvement with gay organisations, and minor differences in broad measures of sexuality but some class differences in HIV risk-taking and some differences in exposure to information and in attitude. An exploration of several cases from a life-history study of working-class gay men shows the impact of class circumstance on the formation of sexual relationships and points to the accessibility of unlabelled homosexual activity in working-class milieux. Research on working-class education points to the importance of curriculum change in overcoming class exclusion, and is moving towards empowerment models of great relevance in AIDS education.

Acquired Immunodeficiency Syndrome↗

PubMed1989

[The indicators for a restructuring of the nursing degree curriculum: the expectations of professionals and a curriculum assessment by former students].

Two kinds of evidence were used to guide curriculum changes in the Nursing School of Ribeirão Preto (University of São Paulo): 1) a survey of nurses' expectations on their profession, their functions, the other members of the team and on the Nursing School teachers; 2) graduates' (ex-students) curriculum evaluation. We inquired 115 nurses working in 5 general hospitals of Ribeirão Preto, and had a return of 49 questionnaires (42.6%). This questionnary was delivered by the authors personally to the nurses, along with guidances on answering and date for return, and had 9 opened questions. The classification of answers makes possible to assert: the assistance function is the most emphasized by nurses; the student's expectations change during the professional practice; 60% of the informants considered the content of the curriculum disciplines adequate; 69.4% considered the habilitations dispensable.

Attitude of Health Personnel↗

PubMed1992

Alternative pathways for training the general internist and the medical subspecialist.

Considerable attention is being directed from within the discipline of internal medicine to a perceived need for changes in the curriculum for postgraduate training of the internist. Much of this attention has been focused on the training required to properly prepare the general internist for the evolving system of health care. A proposal is presented to change the pattern of training of both the general internist and the medical subspecialist. After 2 years of core training, the general internist would enter 2 additional years of training that would include new material and additional experience in areas such as ambulatory and continuity care. After the core experience, the subspecialist would begin training in the subspecialty. The general internist would be certified as such, and the subspecialist would be certified only in the subspecialty. The proposal is based on the assumptions that 1) more general physicians are needed to meet the nation's health care needs; 2) more time will be required to properly train the general internist; 3) all of the additional and expanded training experiences for the generalist are not essential for training the subspecialist; and 4) the generalists of the future will not come from the ranks of subspecialists. The training needs of the general internist and the subspecialist should be viewed as separate, and curriculum changes should be considered without the restrictions of current patterns of training.

Curriculum↗

PubMed1975

Attitudes of graduates toward occupational therapy education.

Recently graduated occupational therapists were surveyed to determine their perceptions of the adequacy of their professional training. Through a mailed questionnaire, therapists evaluated their undergraduate professional preparation based upon their clinical experiences since graduation. Additional suggestions were solicited regarding possible areas of curriculum change, and the survey gave special attention to the area of interpersonal skill development. Responses were examined for areas of commonality and possible use in curriculum planning and modification. Results indicated that recent graduates see a need for more and earlier patient contact, increased attention to the development of administrative and managerial skills, and courses designed to facilitate skills necessary for effective interpersonal relationships.

Attitude of Health Personnel↗

PubMed1991

The impact of a resident-directed survey on the education curriculum of a university surgical training program.

Surgical training programs use various objective and subjective means to evaluate housestaff performance. However it is less clear how to assess the quality of the educational experience the program itself provides. This study examines the use of a resident-directed survey as a means of identifying and rectifying weakness in a surgical training curriculum. Multiple choice questionnaires covering each of 14 senior rotations were prepared by chief residents and distributed to all senior surgical residents in April 1989 (year I). The survey covered factors considered vital to resident education, including operative experience, input into preoperative and postoperative decisions, autonomy, and time demands, and an overall rating (OR) of the educational quality of the rotations. Responses were numerically graded: 1, appropriate; 0, fair; -1, inadequate (or "excessive" for the variable "time demands"). The results, which were presented and discussed at a departmental retreat that spring, prompted specific curriculum changes for the 1989-1990 academic year. An identical survey was conducted the next spring (year II). Major reorganizational changes were made in three of the four negatively rated rotations from year I. The OR for each of the rotations improved dramatically in year II (average increase of 0.64/rotation; p less than 0.05). None of the eight favorably rated rotations in year I suffered a reduction in OR as a result of the changes. Case load, intraoperative involvement, and input in both preoperative and postoperative decisions correlated most frequently with favorable ORs in both years. This study shows that a resident survey is an effective tool for critically assessing the education curriculum of a surgical training program.

Curriculum↗

PubMed1991

Changes in demographics at the University of Oklahoma College of Medicine.

Efforts in recruitment and retention of students by the University of Oklahoma College of Medicine have resulted in an increased size of applicant pool to the college over the past three years. Curriculum changes and programmatic innovations have provided new opportunities for students and incentives to remain in the State of Oklahoma. Continuing and expanding recruitment efforts can be enhanced by the active participation and support of the physicians of the state.

Education, Medical↗

PubMed1990

Tobacco use cessation curricula in the U.S. dental schools and dental hygiene programs.

Tobacco-related health problems are the most preventable forms of illness in the United States. By assuming proactive tobacco use cessation counseling roles, dentists and dental hygienists can help reduce the number of people who currently use tobacco. The literature reports that many oral health professionals feel unprepared to assume such roles. To help combat the problem of tobacco-related illness and to help prepare dentists and dental hygienists to assume tobacco use cessation counseling roles, dental schools and dental hygiene programs need to develop appropriate didactic and clinical tobacco use cessation curriculum content. To date, there are limited national data addressing the extent of tobacco use cessation education in dental schools and dental hygiene programs. Studies of medical schools have revealed a need for increased curriculum content on tobacco use prevention and cessation. Further, tobacco use cessation training programs for medical students, practicing dentists, and dental hygienists have resulted in increased student and provider confidence when tobacco use cessation counseling roles were assumed. This study surveyed all dental schools and dental hygiene programs in the U.S. to determine if tobacco-related curriculum content exists, and if so, to what extent. Variables addressed included allocated hours, subject content, scope, department responsible, workplace smoking policy, importance, and future curricular directions. Questionnaires were mailed to all dental hygiene program directors and dental school academic deans. Study findings suggest that dental and dental hygiene students receive limited tobacco use cessation education, and respondent schools have no immediate plans for curriculum change in this area.(ABSTRACT TRUNCATED AT 250 WORDS)

Chi-Square Distribution↗

PubMedDate not supplied

[Dentists and the prevention of oral cancer].

The authors, after participating on the European Conference on Dentists and Cancer Prevention, part of the program Europe Against Cancer, describe the main conclusions of the working groups, namelly on epidemiology and etiology of oral cancer, participation of dentists on community based programs for primary and secondary prevention of pré-cancer and cancer, as well as the curriculum changes proposed for Dental degree and the role of continuous education and of dental societies in this field.

Curriculum↗

PubMed1990

General practice residency training and the osteopathic profession: trends and issues for the 1990s.

With the 1989-1990 training year, the length of postinternship residency training in osteopathic general practice will increase from 1 to 2 years. The longer residency is expected to give trainees a more complete and more competitive education and to protect them against discrimination regarding hospital privileges. With this change comes the opportunity to evaluate the current status of residency training in the field and to use the data as the basis for making rational predictions and recommendations for the future of the specialty. The author considers the effect of curriculum changes on the operation of training residents in osteopathic general practice. He examines the structure of the new training program and discusses issues pertaining to osteopathic general practice.

Education, Medical↗

PubMed1977

Extramural training of medical students: lessons from Southeast Asia.

Several medical schools in Southeast Asia have identified deficiencies in their undergraduate medical education that result in inappropriate training of students for the health-care problems that exist in their respective countries. Curriculum changes have been made that take students out of the laboratory and the subspecialty-oriented university hospital and place them in extramural programs in the community. Both the deficiencies identified and the solutions developed merit study by North American medical educators, especially those teaching primary care in family practice.

Community Health Services↗