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PubMed1994

Comparison of three techniques of esophagectomy within a residency training program.

Residency training programs commonly emphasize a single technique of esophagectomy, as the safety and the efficacy of teaching or performing more than one type of esophagectomy are unclear. Between 1986 and 1992, 248 patients were explored for possible esophageal resection. Thoracic surgical residents or fellows performed major components of all resections. Two hundred twenty-one patients (adenocarcinoma, 146; squamous cell carcinoma, 72; and other, 3) underwent transthoracic esophagectomy (n = 134), transhiatal esophagectomy (n = 42), or total thoracic esophagectomy (n = 45), a resectability rate of 89.1% (221/248). Complications occurred in 75% of patients with transthoracic esophagectomy, in 69% with transhiatal esophagectomy, and in 80% with total thoracic esophagectomy. The overall operative mortality rate was 6.8% (15/221). Patients with a cervical anastomosis had a higher leak rate (13%) than those with an intrathoracic anastomosis (6%). Median survival was 22 months (19% 5-year survival) and did not differ by operation type or stage. No patient with unresectable disease (n = 27) survived longer than 10 months. Survival for patients with adenocarcinoma stages 3 and 2a suggested a trend toward improved survival after transthoracic esophagectomy despite similar rates of local and distant recurrence. Transthoracic esophagectomy, transhiatal esophagectomy, and total thoracic esophagectomy performed within a residency training program have similar morbidity, mortality, and recurrence rates as those in other modern series. A specific technique of esophagectomy can be selected for individual patients. Survival and sites of recurrence primarily reflect disease stage, not the technique of esophagectomy used.

Adenocarcinoma↗
PubMedDate not supplied

Evaluating the WEB training program for cancer screening in Native American women.

The Native Women Enjoying the Benefit (WEB) program trains nurses to perform breast and cervical cancer screening examinations for Native American women. Several evaluations have shown that the program improves nurses' knowledge and skills, and nurses value its positive impact on clinic, nurse, and patient behaviors. Beyond effectiveness, program longevity often rests upon equilibrium that results from alignment between a program's values and principles with those of its sponsoring organization and pertinent surrounding environments. We examined how Native WEB values align with those of its 2 most relevant environments-the medical institution (immediate environment) that sponsors it and the broader health care context (distal environment). We found that social justice views articulated in Catholic social teaching served as a convenient synthesis of the 2 environments' values and principles. We used this conception of social justice to determine whether the Native WEB program reflected the perspectives of its immediate and distal environments.

Breast Neoplasms↗
PubMed1994

New concepts in nursing management of the TB patient: a community training program.

This article describes the development and implementation of interventions aimed at improving return rates for reading of Mantoux tuberculosis (TB) injections and subsequent referrals. The TB screening program, sponsored by a midwestern Native-American primary health care service, was initiated in response to an identified Native-American TB case. The return rate of 61% was considered unsatisfactory, and a program training 20 community health care, alcohol and substance, and social-service workers to read TB tests after screening by a community health nurse was implemented. Implementation of an interagency agreement developed to improve referral completion rates is described.

Chicago↗
PubMed2004

[Effect of the Training Program at Occupational Health Training Center (OHTC) on the attitude of occupational health residents].

University of Occupational and Environmental Health (UOEH) conducts three courses in postgraduate education of occupational health (OH). Graduates of UOEH who have already received a basic education in OH can participate in any course and are trained to play an appropriate role as an occupational physician (OP). We operate the training program to provide practical knowledge and skills as well as to encourage interest in occupational health and to promote a further understanding of the role of the OP. In this study we evaluated changes in attitude of participants and the effectiveness of our program by an anonymous questionnaire. The subjects were all 19 participants of the 3-month program conducted between September 2003 and February 2004 as a part of the postgraduate education following several years of clinical experience. They were expected to be occupational physicians with a clinical specialty. The data were collected from questionnaires handed out at the beginning and the end of the program. The questionnaire included 8 items on the attitude toward occupational health. The subjects answered the questions according to a scale of 1 to 7. Data analysis was performed using the unpaired t-test by SPSS. The results suggested that our training program had a positive effect on trainees. Interest in occupational practice (P < 0.05) and willingness to act as a full-time occupational physician in a large company (P < 0.05) increased significantly. When considering the positive correlation between willingness to act as an OP and interest in a field that has some overlap between the speciality and occupational health, it was thought that developing a vision as an OP with respect to their career was important for training. However, in some clinical fields it may be difficult to define a relationship between the clinical speciality and occupational health. Understanding the role of an OP (P < 0.05) and self-confidence in playing an appropriate role as an OP (P < 0.05) also showed significant improvement. On the other hand, fourteen of the trainees (74%) did not have enough confidence to play a role as an OP even after completion of the program. In this study, the questionnaire we used was anonymous and did not include items concerning various attributes of the subjects. Therefore it was not possible to analyze changes of attitude at the individual level. We recognize the need to improve the program and are preparing a new version of the educational program with emphasis on understanding company organization activities and practical skills for problem solving. Opportunities to consider association between clinical speciality and occupational health are also included in this new version. We hope that the new program will further encourage trainees.

Clinical Competence↗
PubMed1986

Career development of residents in university and independent training programs: the influence of special training fellowships, type of practice, specialization, and research.

General surgical chief residents in all approved training programs were surveyed to evaluate the influence of fellowships, specialization, and research. Respondents represented 76% of programs and 60% of residents. Most chief residents plan to take post-residency fellowships. This is most common among those from university training programs and residents planning an academic career. Vascular surgery and cardiothoracic surgery represent half of all fellowships. Sixty-two percent of residents plan to enter private practice compared with 28% who plan to join a medical school faculty. More than one third of university trainees plan an academic career. More than 90% plan fellowships. The practice of general surgery alone or combined with a specialty was more common among trainees from independent training programs. Practice of a subspecialty was more common among university trainees. More than 80% of residents did research during training. Research leading to publication was more common among university trainees planning academic careers and least common among future general surgeons. This survey suggests that general surgery is predominant among residents in independent training programs who then enter private practice. University programs produce subspecialists who are predominant among future academic surgeons. This trend has vital implications for the future of academic general surgery.

Adult↗
PubMed1979

Custodians climb career ladder through intensive training program.

The training program for custodial staff at the University of Houston provides continuing education and opportunities for advancement for minority women, who make up approximately 90 percent of the staff. The training and opportunities offered may be responsible for the low turnover and absenteeism in the custodial services department.

Career Mobility↗
PubMed1981

Child psychiatry education in early child development: description of a training program.

Career training in child psychiatry, though provided from a developmental perspective, often lacks opportunity for directly observing normally developing infants. This paper describes a training program in which child psychiatry fellows, in collaboration with residents in pediatrics, follow a young couple and their first child from the third trimester of pregnancy through infancy and early childhood. Case illustrations and discussion of approximately 10 years' experience demonstrate how the program can enhance understanding of normal child development, development of the nuclear family, liaison between child psychiatrist and pediatrician and early detection of psychopathology in infants.

Adult↗
PubMed2001

Clinician scientist training program: a proposal for training medical students in clinical research.

There is national alarm about a decline in the number of clinician scientists. Most of the proposed solutions have focused on housestaff and junior faculty. We propose a new national program for training medical students in clinical research. This program, coined "Clinician Scientist Training Program" (CSTP), would consist of a combined degree program in medicine (MD) and clinical research (eg, masters in translational research or masters in clinical epidemiology). Students could enroll in the program at any stage during medical school. After 3 years of medical school, students would spend at least 2 years in a combined didactic and mentored clinical research training program and then complete medical school. Students could elect to pursue more prolonged clinical research training toward a combined PhD and MD. The CSTP is designed to meet six critical challenges: 1) engage students early in clinical research training; 2) provide a didactic clinical research curriculum; 3) expose students to several years of mentored clinical research training; 4) promote debt prevention by providing tuition payments during medical education and a stipend during clinical research training; 5) facilitate prolonged exposure to a community of peers and mentors in a program with national and institutional identity and respect; and 6) permit enrollment in the program as students enter medical school or at any stage during medical school. If the success of the Medical Scientist Training Program in training medical students in basic research is a guide, the CSTP could become a linchpin for training future generations of clinician scientists.

Humans↗