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PubMed1998

[Validation of an instrument for identifying styles of the professional practice of the primary care doctor].

OBJECTIVE: To elaborate and validate a questionnaire for identifying common styles of Primary Care doctors' practice. SETTING: Primary Health Care. Public sector in Spain. DESIGN: This was a study to validate a questionnaire administered in two phases with different samples. In the first phase, the items (item-total correlation, using Alpha on eliminating item), validity of construction, empirical validity and internal consistency, were analysed. In the second, discriminatory validity and reliability of the questionnaire (test-retest) were calculated. MEASUREMENTS AND MAIN RESULTS: 81.5% of the doctors replied in the first phase; and 100% in the second. Two factors were isolated with the Principal Components procedure, which confirmed the validity of the questionnaire's construction (52% variance explained). Internal consistency (Alphas ranged between 0.55 and 0.75) and reliability (ranging between 0.50 and 0.95 in function of the time elapsed) were also demonstrated. CONCLUSIONS: This instrument could be used to differentiate two styles in practice, characterised by focusing on the physical illness vs the psycho-social aspects of the disease process. The instrument is also useful because it gives the feeling of control over the task.

Family Practice↗
PubMed1996

[Operating room assistance: an innovative practice].

Professional practice changes in the operating room have led to the development of a new role for nurses--as surgical assistants. Essentially, the surgical assistant nurse helps ensure the patient's safety while providing technical and clinical assistance to the surgeon in such areas as exposing and manipulating tissues, suturing fascia and using various specialized instruments. The surgical assistant nurse function is being implemented through a pilot project at the Institut de cardiologie de Montréal. Developed by representatives of the nursing and surgical departments there, the project was approved by the Collège des médecins du Québec in April 1995 and subsequently by the institute's council of physicians, dentists and pharmacists. It has also gained recognition from the Ordre des infirmières et infirmiers du Québec (OIIQ). The pilot project incorporated a 186-hour training program, which was delivered from May to September 1995 according to three distinct learning modules: maintenance of a safe environment for the patient, clinical assistance and technical assistance. A tutorial approach to learning included individual and team work, simulation exercises, technical courses, lab work and practical training in the operating room. At the end of the training program, two surgical assistant nurses began practising in their new role. An evaluation of the project will be performed in September 1996.

Curriculum↗
PubMed2003

The Vanderbilt Professional Nursing Practice Program: part 1: Growing and supporting professional nursing practice.

Professional practice programs are designed to attract, retain, and reward nurses. This three-part series will describe Vanderbilt's performance-based career advancement system, the Vanderbilt Professional Nursing Practice Program (VPNPP). Part 1 outlines the overall program's foundation, philosophical background, and basic structure. The VPNPP is built upon Benner's work, distinguishing among four levels of practice: novice, competent, proficient, and expert. Work by many in the organization identified the expected behaviors for nurses at each level, which were then used to develop clear process evaluation criteria. Part 2 will examine the performance measurement and evaluation system created to support the program. The process of advancing within the program will be described in part 3.

Academic Medical Centers↗
PubMed2002

National Academy of Neuropsychology/Division 40 of the American Psychological Association practice survey of clinical neuropsychology in the United States, Part I: practitioner and practice characteristics, professional activities, and time requirements.

Leaders of the National Academy of Neuropsychology and Division 40 (Clinical Neuropsychology) of the American Psychological Association determined that current information on the professional practice of clinical neuropsychology within the United States (U.S.) was needed. These two organizations co-sponsored a national survey of U.S. clinical neuropsychologists that was conducted in September 2000. The primary goal of the survey was to gather information on such topics as: practitioner and practice characteristics, economic variables (e.g., experience with major third party payors, such as Medicare and managed care), practice expenses, billing methods, experiences with Current Procedural Terminology (CPT) codes, time spent on various clinical tasks, use of assistants, and income. The adjusted return rate of 33.5% (n = 1,406) reflects the number of surveys returned with sufficient data by licensed doctoral level clinicians with membership in one or both sponsoring organizations. In this first of two articles describing the survey results, characteristics of practitioners and practices, various types of professional activities, and time requirements for clinical tasks are presented and discussed. It was noted that the proportion of women in the field is increasing rapidly. Private practice is the predominant employment setting. Findings also document that members of the two sponsoring organizations are very similar with regard to employment setting, professional characteristics, and weekly activities. That is, involvement in clinical practice and research, as well as private practice versus institutional employment, was very similar between organizations. However, across organizations, work setting (private practice vs. institution) was associated with significant and meaningful differences. Private practitioners have a more diverse set of weekly clinical activities, are less likely to use assistants, and engage in more forensic activities. Across work setting, with the exception of forensic evaluations, those using assistants invest a greater number of hours per evaluation, but bill approximately the same numbers of hours per evaluation.

Academies and Institutes↗
PubMed2006

Assessing professionalism: theory and practice*.

Professional attitudes and behaviours have only recently been explicitly recognized by medical educators as legitimate and necessary components of global competence, although the idea of Fitness to Practice has always presupposed acceptable professional behaviour. Medical schools have recently begun to introduce teaching and assessment of professionalism, including attitudes and behaviours. Partly as a result of the difficulty of assessment in this area, selection of students is receiving greater attention, in the pursuit of globally competent graduates. However, selection processes may be overrated for this purpose. Assessing actual attitudes and behaviour during the course is arguably a better way of ensuring that medical graduates are competent in these areas. I argue that judgments about attitudinal and behavioural competence are legitimate, and need be no more arbitrary than those made about scientific or clinical knowledge and skills, but also that these judgments should be restricted to what is agreed to be unacceptable behaviour, rather than attempting to rate attitudes and behaviour positively. This model introduces students to the way in which their behaviours will be judged in their professional lives by registration authorities. These theoretical positions are illustrated by a recent case of academic failure based on inadequate attitudes and behaviours.

Attitude of Health Personnel↗
PubMed2006

Teaching professionalism: theory, principles, and practices.

Professionalism as a subject must be taught explicitly. This requires an institutionally accepted definition which then must be learned by both students and faculty. This directs what will be taught, expected, and evaluated. Of equal importance, and more difficult to achieve, is the incorporation of the values and attitudes of professionalism into the tacit knowledge base of physicians in training and in practice. This requires learning experiences which encourage self-reflection on professionalism throughout the continuum of medical education. Because of the great influence of role models and because most physicians do not fully understand professionalism and the obligations required to sustain it, faculty development is essential to the success of any program on professionalism. Also important are strong institutional support including adequate resources, the presence of a longitudinal program which ensures repeated exposure throughout the educational process, a supportive environment, and a system of evaluation which reinforces teaching.

Education, Medical↗