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Psychiatric education: state of the art, 1976.

The authors describe an extraordinary review of 527 programs in 205 institutions conducted by the Psychiatry Education Branch of NIMH. Each institution was evaluated by 2 site visitors, whose findings were reviewed by a group of 12 special consultants. These consultants voted on approval of grant applications and assigned priorities to those which were approved. Direct results of the review included approval of 69% of the programs, increased support of programs in medical student education, consultation-liaison psychiatry, and psychiatric investigation, but a decrease in the total number of institutions supported. Indirect results were the encouragement of self-evaluation in each program reviewed, the valuable exchange of ideas among the educators involved in the review process, and implications for future reviews. The authors, who believe that psychiatric education is in good health, discuss the findings of this review in terms of the future of the field.

Behavior

A study of antimicrobial misuse in a university hospital.

We undertook a prospective study to determine patterns and sequelae of antimicrobial misuse and factors associated with inappropriate antimicrobial therapy in a teaching hospital. Over an eight-week period, 144 (26.2%) of 549 hospitalized medical and surgical patients received one or more courses of antimicrobial therapy. An average course comprised 1.4 drugs. Presumptive infection was the reason for 70% of courses and prophylaxis, 30%. Therapy was judged appropriate in 59% of courses overall. Unnecessary therapy, poor drug choice (bacteriologically, pharmacologically, or both), or misguided prophylaxis most frequently underlay inappropriate therapy. Adverse reactions (17% overall) were twice as frequent and the cost of therapy was 55% greater in inappropriate courses. Performance of pretherapy cultures (p less than 0.05), obtaining gram-stained smears of sputum in presumed respiratory tract infections (p 0.001), and notation in the record that antimicrobial therapy had been instituted (p less than 0.001) were strongly associated with appropriate therapy. This study underscores the need for more effective programs of postgraduate education which stress basic principals of infectious disease and antimicrobial pharmacology and guidelines for prophylaxis. Antimicrobial utilization review should figure heavily in hospital programs of medical self-evaluation. Additional measures to upgrade the use of antibiotics are discussed.

Anti-Bacterial Agents

Objective criteria for evaluating occupational health programs.

An objective scoring system is proposed as a single and flexible method of evaluating occupational health programs to appraise the extent to which existing programs approach a basic standard of excellence as defined by a theoretical model based on published and professionally acceptable guidelines and standards. This proposed system emphasizes the importance of an interdependent relationship between four program components: (1) guiding philosophy and policy; (2) organizational structure; (3) resources; (4) occupational health services, and it stresses the importance of long range health commitments to employee health status in contrasts to short range health commitments aimed primarily at an economic payoff to a sponsoring agency, institution, or company. The proposed evaluation scheme should enable self-evaluation by individual programs. Additionally, programs can utilize this evaluative tool to examine their influence on such important questions as employee hospital utilization and other specific elements of employee health in an objective, relatively simple manner.

Evaluation Studies as Topic

Geriatrics and internal medicine.

If medical education is to respond adequately to the growing number of citizens encompassed by the field of geriatric medicine, it must intensify its commitment to the special health and health-related problems of the elderly at every level, from student to certified specialist. This paper discusses the various intellectual, epidemiologic, economic, and attitudinal factors related to the teaching and practice of geriatric medicine. The emergence of a positive philosophy emphasizing coping and possible reversibility of disease is vital. The recent report of the Institute of Medicine on Aging and Medical Education is also reviewed, as well as graduate training opportunities and ways in which the American Board of Internal Medicine could play a leading role in this process by providing increased emphasis on geriatrics in its training programs and certifying examinations. The medical profession must continue its self-evaluation to ascertain how it can most effectively contribute to improving the lives of the elderly, perhaps our greatest national resource.

Attitude of Health Personnel

Family (parental) history and prevalence of hypertension. Results of a nationwide screening program.

In a nationwide screening program, blood pressure measurements, family (parental) histories of hypertension, and self-evaluations of weight class were obtained for more than a half million people. Positive family history was associated with hypertension prevalence double that found in persons with negative history and was independent of weight. When overweight was also present, however, hypertension prevalence was three to four times as high. Hypertension was more likely to have been previously diagnosed in screenees if family history was positive. However, such screenees did not have a higher proportion receiving effective treatment than those with negative family history. When an index case of hypertension is found, other family members should be examined. For persons with positive family history, nutritional-hygienic recommendations to avoid overweight may be important in reducing the risk of becoming hypertensive.

Adult

Attachment learning: a humanistic educational experience. Final practicum in a coordinated undergraduate program.

Throughout the five stages, the student has ample opportunity for expression and self-evaluation in the counseling sessions that accompany each stage. The student experiences progress with increasing responsibility to the ultimate functioning as an administrative dietitian under supervision. It is believed that the experiences of attachment learning will enable the student, on graduation, to enter professional practice with confidence and a strong likelihood of success. Thus far, experiences with attachment learning at the University of Missouri-Columbia have demonstrated superiority over methods used previously. It is believed that this method can be readily adapted to other learning situations in dietetics, such as traineeships and internships. In fact, our enthusiasm for the method prompts the suggestion that it might well be considered for the final stage of education for any profession in which entry-level competencies can be established.

Curriculum

Outcome research on treatment and on the drug abuser: an exploration.

The study of treatment outcome has its own history, and the experience of other service fields in this area may be of considerable interest to researchers concerned with the effectiveness of treatment for drug abusers. Methodological issues that emerged from psychotherapy's efforts at self-evaluation are reviewed and contrasted with work done on treatment outcome in drug programs. An overview is presented of current research on the improvement of drug abusers and on treatment effectiveness.

Age Factors

A cognitive-behavioral versus nondirective group treatment program for opioid-addicted persons: an adjunct to methadone maintenance.

Fourteen methadone maintenance individuals participated in a 10-week program comparing the relative effectiveness of a cognitive-behavioral (CB) versus discussion-type (DISC) group in developing adaptive behavioral skills and self-evaluations. Posttreatment and follow-up results indicated that the CB group was significantly more successful than the DISC group in lowering reported levels of anxiety, depression, and situational non-assertiveness. These data are discussed in terms of a comprehensive, social rehabilitation program that involves multiple treatment techniques and measurement criteria.

Adult

The role of the academic medical center in the PSRO program.

The professional standards review organization (PRSO) program offers both a challenge and an opportunity to the academic medical center. Application by the local PSRO of objective measures of the quality and medical necessity of services challenges the medical center to demonstrate that its self-image of excellence is correct. Educating and training medical students and house staff in methods of self-evaluation and peer review could have a major impact on both the success of the PSRO program and the quality of medical care. Evaluation of the educational programs of the medical center through review of actual practice behavior presents an unparalleled means for improvement in undergraduate, graduate, and continuing medical education.

Attitude

[Formative evaluation of education].

The formative evaluation tries to obtain, analyze and furnish information over the planning and development of a course, which is brought about through a continuous performance of the students during the course. This method allows for the adoption of corrective measures with reference to the course (presentation of other learning opportunities, preparation of instructive materials, revision of curriculum, etc.) and with reference to the student (studies prescribed). The formative evaluation may be fulfilled by means of repeated tests which the student himself will correct and, subsequently, will discuss with the professor; it can also be processed by means of the students self-evaluation, interacting with computer terminals. CLATES/Rio presents its experience employing minicomputers to allow for self-evaluation in bioscience courses.

Computers

Shaping behavior in voice therapy.

This study demonstrates the process of learning and shaping of behavior which occurs during a program of therapy for individuals with hyperfunctional hoarse voice quality. First a therapy program delineating the techniques and criteria to be used was written. The program was presented during 16 individual half-hour sessions over an eight-week period to three clients known to have vocal nodules. The clients' responses were charted at various points from audiotape recordings of each therapy session using a modification of the Boone-Prescott analysis system, to obtain data to demonstrate the learning processes. It was concluded that: (1) the client's behaviors in this vocal rehabilitation program reflected a learning process; (2) facilitating techniques were used to modify or shape behavior through successive approximations to the terminal goal; (3) self-evaluation is an important factor needed to bring about successful changes in behavior; (4) analysis of client's behaviors in relation to the learning process can aid in evaluating the effectiveness of the facilitating techniques; and (5) from such evaluation intraclient and interclient program changes are derived hopefully resulting in a greater success rate and maximum benefits from time spent in therapy.

Behavior Therapy

Competency-based education and creative thinking.

When creativity is considered as an approach to problem-solving, rather than as an innate talent, then education can play an important role in its development. This paper postulates that competency-based education, because of its emphasis on stated objectives, feedback, self-evaluation, and alternative learning experiences, is an approach to curriculum design that should lead students to become more creative thinkers. A description of competency-based-education is given, and research on educational methods and creativity is surveyed. The implications of this type of program for occupational therapy education are considered.

Creativity

Short-term group therapy for people in crisis.

The author describes a short-term group therapy program that he believes is more effective than the traditional one-to-one approach for people in crisis. The group focuses on the problems of one member at a time and helps him examine his role, identity, and value system, the significant people in his community, and his ability to appreciate the positive things that exist within himself. Short-term goal-setting, self-evaluation, and written homework assignments are used to teach the client a new process that can help him look at his life positively and accept defeats and failures as a part of the growth process.

Community Mental Health Services

The development and evaluation of a community mental health education program for seminarians.

Because the clergy stands in an ideal position to serve the mental health needs of the community, seminaries have, for some time, included courses in pastoral counseling and related skills. While valuable, these courses tend to focus on the traditional clinical relationship excluding the broader role of community interventionist. Viewing this need, a course was developed to train seminarians in principles and practices of community mental health. The 28 students were compared to 24 controls at the beginning and end of the term. Evaluative instruments were the Community Mental Health Ideology Scale, two scales adapted from the Theological School Inventory, a self-evaluative competence scale, and a role evaluation scale. Data within a 2 X 2 X 2 design were subjected to an analysis of variance. Experimentals were found to exceed controls on the Community Mental Health Ideology Scale (p less than or equal to .001), the competence scale (p less than or equal to .01), and role evaluation scale (p less than or equal to .01).

Adult

Self-control training in the classroom: a review and critique.

Self-control training in classroom settings is becoming widespread. Establishing effective self- rather than externally controlled behavior modification programs in schools would enable children to control their own academic and social behavior, while enabling teachers to devote more time to teaching. The following components of self-control are reviewed in the present article: self-recording, self-evaluation, self-determination of contingencies, and self-instruction. Self-control strategies designed for the maintenance of appropriate classroom behavior, and issues associated with self-control training, such as the reliability of self-observation, response maintenance, generalization, and the role of external control, are examined. Finally, suggestions for maximizing the potential effectiveness of self-control training in the classroom (e.g., teaching self-observational procedures, teaching students to provide themselves with instructions and praise), as well as future areas for experimental investigation (e.g., social changes that may be associated with self-control procedures), are presented.

Adolescent