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Resident, faculty, and residency program development. An integrated approach through annual retreats.

Retreats during residency training have evolved as an escape from the daily routine. Recognizing that the retreat format could also be used as a foundation for program design and personal development, we have designed annual retreats for each of the 3 years of pediatric residency training. The sessions vary in length and agenda, but serve as the basis for an ongoing effort fostering growth and maturation of the department and its component participants. The effectiveness of the program (and the morale of the residents) is greatly influenced by this program.

Chicago

Launching a multidisciplinary staff development program for liver transplantation.

This article describes a collaborative effort between specialty areas at a large urban medical center to develop a comprehensive liver transplant educational program. The historical overview, needs assessment, and program planning are discussed. The implementation, planning, and evaluation phases are examined. The process presented here can serve as a framework for clinical educators confronted with major new initiatives.

Curriculum

Accreditation of occupational health programs: development and validation of criteria.

Defined standards and a mechanism for evaluation of performance can help promote new and improve existing occupational health programs. Criteria must be based on sound principles, be comprehensive, discriminating and attainable. They should apply to small and large establishments with varying hazards. A successful program requires a multi-disciplinary effort involving physicians, nurses, industrial hygienists, health physicists, safety professionals, managers, technicians and labor. Assessment by on-site peer review is necessary. The criteria and process for their use must be accepted by the professions, labor and management. The Occupational Health/Safety Programs Accreditation Commission plans to use the document entitled Standards, Interpretations and Audit Criteria for Performance of Occupational Health Programs in its accreditation activities. The development and validation of this document and its use are described.

Accreditation

Improving a community preceptorship through a clinical faculty development program.

A department of family and community medicine has successfully used annual conferences to develop the teaching skills of clinical faculty. The conferences focus on specific topics each year, faculty are required to attend, and experienced preceptors are used as facilitators. These conferences have effectively improved the preceptors' abilities as teachers of medical students. This is dramatically illustrated by the increase in measurable objectives on the negotiated learning contracts.

Community Medicine

[A self-development program for obese female students].

The purpose of this study is to construct and evaluate a self-development programme for obese female students. The important role of psychological factors in the etiology of obesity, affects self-development in the client through methods of growth stimulation, and will promote ego strength to assist in the demands of mass control. A self-development programme is constructed and applied to a group of obese female students. The experimental design comprised a pre, post and post-post evaluation with physical and psychological measuring instruments on an experimental and a control group. No significant changes in body mass occurred. Psychologically the programme promoted self-actualisation in terms of (intrapersonally) increased spontaneity, self-regard, confidence, worthiness and decreased nervousness, and (interpersonally) increased general social adaptation and the capacity for intimate, personal contact. It is recommended that the stimulation of psychological growth be stressed even more in mass control programmes. Also, the contents of this type of programme should be investigated to promote behaviour change over a longer period of time.

Adolescent

Teaching material. Ways to enhance visual aids in staff development programs.

Most nurse educators incorporate some kind of media into their teaching strategies. The widespread availability of professionally developed media resources, however, does not guarantee effectiveness. The ASSURE model was presented as one method of selecting these materials on the basis of their suitability for the subject, the adult learner, and the instructor in achieving the desired educational outcomes. Furthermore, it offers guidelines for modifying or designing materials to be used in settings where media resources may be limited. The ASSURE model can help staff development educators provide effective instruction by making the best use of available media through the use of systematic instructional design principles.

Audiovisual Aids

An intrathoracic left ventricular assist system: utilization of results from a development program.

An intrathoracic, electrohydraulically actuated, left ventricular assist system (LVAS) was subjected to formal device readiness testing. Endurance testing was initiated on eight systems before testing was halted due to failure of four of the systems. Three failed due to environmental leakage. Solutions were straightforward, involving gasket changes and o-ring resizing. The fourth failure involved a magnetic coupling piston swelling and seizing. The failure was attributed, after long investigation, to hydrogen adsorption by the samarium-cobalt magnets. An unknown number of coupling magnets were affected in this fashion, necessitating complete replacement of magnets to resolve the problem. However, this was beyond the scope of the program, and no further endurance testing was accomplished. The test experience of the Nimbus/CCF LVAS has demonstrated all functional aspects of the complete LVAS, both in vitro and in vivo, and the endurance and reliability potential is indicated as well. Although the LVAS program is currently inactive, its legacy of technical innovations continue to drive the development of other medical devices.

Animals

The Commission on Ophthalmic standards--the American Optometric Association's standards development program.

The American Optometric Association has been concerned with ophthalmic standards for over fifty years. This paper describes this involvement and how it has led to the creation of the Commission on Ophthalmic Standards. The commission's scope and function and the responsibilities of the Director of Standards Development are given. The progress of the commission's program has been temporarily delayed due to a proposed FTC rule on voluntary standards setting organizations.

Eyeglasses

Toward program development.

An era of disciplined thinking may result not only in acknowledging but also in addressing those questions that may lead to a consistent examination of existing programs within a profession. This paper is one attemp at encouraging the professional membership to continue to address: 1. the nature and focus of the content and practice environments of the field of Occupational Therapy; 2. two approaches to investigating the distinctive character of the field of Occupational Therapy-the Separate Domain Approach and the Retroductive Approach; 3. and the basic documents developed and/or sponsored by the professional organization-in this case-The Ohio State Study (1), the NIH Study (2), and the Curriculum Guide (3).

Clinical Competence

The Consensus Development Program. Detecting changes in medical practice following a consensus conference on the treatment of prostate cancer.

The treatment of prostate cancer was reviewed at a U.S. National Institutes of Health Consensus Development Conference in June 1987. Data from the U.S. National Cancer Institute's Surveillance, Epidemiology, and End Results tumor registries were analyzed and showed that the proportion of eligible prostate cancer patients receiving the recommended therapies did not increase at a faster rate after the conference than before.

Aged

Programs developed from concerns for women in medicine.

Since the Medical College of Pennsylvania, formerly the Woman's Medical College of Pennsylvania, became coeducational in 1969, there has been a continued effort to maintain the commitment of the institution to its heritage of women in medicine. An office has the role of coordinating and stimulating the establishment and maintenance of programs relevant to women in medicine throughout the institution. These programs are now available to men as well but particularly serve women's needs. They include the Summer Premedical Program, the Summer Health Policy Program, a restraining program for inactive physicians, a demonstration child care project, archives and special collections related to women in medicine, a women in medicine oral history project, and a bibliography of the literature on women physicians. The Medical College of Pennsylvania will continue its interests in the present and future needs of women physicians.

Archives

Changing practice patterns in the management of primary breast cancer: Consensus Development Program.

In the last decade, new knowledge has emerged concerning the efficacy of treatment for breast cancer. For that reason, the National Institutes of Health devoted a consensus conference to this topic. To determine whether the consensus conference had influenced practice patterns, and to evaluate the level of quality of care given to women with breast cancer, the medical records of 573 patients treated in ten hospitals throughout the state of Washington were abstracted and analyzed. Results showed no changes with respect to the consensus conference's recommendations for use of a total mastectomy with axillary dissection or the use of a two-step procedure in which the biopsy is performed first and therapeutic options are discussed before a definitive surgery is undertaken. Analyses of quality of care issues not addressed by the consensus conference revealed that 4 percent of the sample were explicitly staged preoperatively and 29 percent postoperatively and that little changed over time in the use of sentinel laboratory tests. These results also show that consensus recommendations will not necessarily change physicians' behavior even where change is possible, and that quality of care in diagnosis and treatment of breast cancer still needs to be addressed.

Adult