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PubMed2006

Implementing a surgical skills training program.

Significant change is underway in surgical training programs. Many educators believe that an outcomes-based approach to surgical education best addresses the need for greater public accountability and patient safety in surgical education. To achieve this end, surgical educators need to understand the basic principles of curriculum design and demonstrate a willingness to apply these educational methods within their training programs.

Clinical Competence↗

PubMed2004

Faculty and finances of United States anesthesiology training programs: 2002-2003.

Between February, 2000 and August, 2002 three surveys have been submitted to the program directors of the anesthesiology training programs in the United States (U.S.) to assess the departments' needs for faculty and financial support from their institutions. In this article we present the results of a fourth follow-up survey. This survey also asked questions regarding the need for additional support to meet the new 80-h workweek resident requirement and asked the average academic time offered to faculty. The average department has 40 faculty members with 3.7 open faculty positions in the 78% of departments with open positions. Only 25% of the departments planned to add personnel to comply with the 80-h resident workweek. Fifty-one percent of the departments had a positive financial margin of 15,908 dollars/full-time equivalent (FTE) faculty anesthesiologist (faculty FTE), whereas 34% had a negative margin of 42,603 dollars/faculty FTE. The overall institutional support was 85,607 dollars/faculty FTE, which is a 43% increase over the previous year. The average academic time provided to faculty was 13.8%, a decline from 20% in 2000. Twenty-five percent of departments have closed an anesthetizing location as a result of a lack of faculty in 2003. Open faculty positions in U.S. training programs have remained fairly constant at 8% to 10% from 2000 to 2003. Institutional support for training departments has more than doubled since 2000, reaching approximately 85,000 dollars/faculty in 2003.

Academic Medical Centers↗

PubMed1980

Improving physical fitness by exercise training programs.

Thirteen young men completed a ten-week exercise training program on bicycle ergometers. Training sessions were conducted five days per week, with eight men randomly assigned to low-effort (LE) and five to high-effort (HE) regimens. LE participants worked continuously at 50% of their maximal oxygen intake (exercise HR congruent to 135 BPM); HE participants performed two minutes alternating work-rest intervals at 80% of their maximal oxygen intake (exercise HR congruent to 170 BPM). Total work done was held constant for the two groups. LE and HE participants increased maximal oxygen intake (P < .01), but there was no difference in changes between the two groups. LE exercise training programs are more comfortable for participants and perhaps should be recommended over HE programs for most individuals, since improvements in physical fitness appear to be comparable.

Adolescent↗

PubMed2005

Evaluation of a Skilled Birth Attendant pilot training program in Bangladesh.

OBJECTIVES: An evaluation of the pilot project of the Skilled Birth Attendant (SBA) training program has been undertaken to assess the strengths and weaknesses of the training program, the after training performances of the selected SBAs and to ascertain the sustainability of the program. METHODS: The study was conducted in three phases adopting both qualitative and quantitative methods: assessment of training program; evaluation of after training performances of SBAs; and evaluation of performance of providers in non-SBA areas. RESULTS: During the post-training period it was observed that on an average the SBAs performed 3-4 deliveries per month. They were able to perform different life saving skills. In the areas served by the SBAs, they performed 29% deliveries and 47% were performed by the TBAs. In control areas TBAs performed 61% deliveries. CONCLUSION: Overall, the study points to the efficacy of SBAs over traditional hands and the societal need for SBAs.

Adult↗

PubMed2004

Development of a valid, cost-effective laparoscopic training program.

BACKGROUND: Practical programs for training and evaluating surgeons in laparoscopy are needed to keep pace with demand for minimally invasive surgery. METHODS: At the University of Kentucky five inexpensive simulations have been developed to train and assess surgical residents. Residents are videotaped performing laparoscopic procedures on models. Five surgeons assess the taped performances on 4 global skills. RESULTS: Creating mechanical models reduces training costs. Trainees agreed procedures were well represented by the simulations. Blinded assessment of performances showed high interrater agreement and correlated with the trainees' level of experience. Nonclinician evaluations on checklists correlated with evaluations by surgeons. CONCLUSIONS: Inexpensive simulations of laparoscopic appendectomy, cholecystectomy, inguinal herniorrhaphy, bowel enterotomy, and splenectomy enable surgical residents to practice laparoscopic skills safely. Obtaining masked, objective, and independent evaluations of basic skills in laparoscopic surgery can assist in reliable assessment of surgical trainees. The simulations described can anchor an innovative educational program during residency for training and assessment.

Education, Medical↗

PubMed2004

PhD graduate training programs in pathology: 2003 report from the American Society for Investigative Pathology workshop on pathology graduate education.

Graduate training is one of the most important activities in which we engage. Through PhD training programs in pathology, we continually renew the intellectual vigor of our discipline and assure its position as a vibrant force in the life sciences. To focus on this important issue, the Education Committee of the American Society for Investigative Pathology (ASIP) organized a workshop on April 11, 2003 for pathology graduate program directors from across the United States and Canada. The goals of this workshop were to better define the current models of pathology graduate training programs, to identify key issues pertaining to the curriculum of pathology training programs and strategies to better market pathology graduate training opportunities, and to identify challenges for the future. Twenty-three program directors and other faculty interested in pathology graduate education, as well as 2 invited PhD students, attended the workshop. Workshop participants concluded that the integration of more and better disease-related education into graduate training programs would attract more and better-qualified students into pathology career pathways that will ultimately fulfill important societal needs and train future leaders of the biomedical research community. The ASIP is facilitating this goal by taking a leadership role in publicizing educational efforts in pathology and by making systematic use of its Website for sharing information about curriculum ideas and materials, as well as course syllabi.

Biomedical Research↗

PubMed2000

The role of government in postgraduate training programs in women's health.

This paper examines the role of the federal government in postgraduate training programs in women's health. Health care professional education has long been an interest of many agencies within the Department of Health and Human Services. Although federal agencies have not been directly involved in the creation of curriculum or funding of training programs in women's health, they have helped to catalyze wide public and private support of these programs. The Office on Women's Health within the Department of Health and Human Services, the National Institutes of Health Office of Research on Women's Health, and the Health Resources and Services Administration have each provided recommendations for the inclusion of women's health in the medical school curriculum. Additionally, the Council on Graduate Medical Education, an advisory body to the Secretary of Health and Human Services and Congress, has recommended that physicians develop a broad understanding of health conditions specific to women. Although federal funding is not available for the development of training programs in women's health, continued public and private interest will foster the development of post-graduate training programs that will improve the delivery of health care for women in the United States.

Curriculum↗

PubMed1998

The impact of health care reform on gastroenterology fellows: are training programs preparing them for the future? American College of Gastroenterology Educational Affairs Subcommittee on Training.

OBJECTIVE: Health care reform is dramatically changing the practice and delivery of medical care. The goal of this investigation was to examine gastroenterology trainees' outlook on the impact of health care reform on training programs. METHODS: A 24-question survey was mailed in February 1996 to 780 GI fellows obtained from the comprehensive American College of Gastroenterology (ACG) database. RESULTS: A total of 362 fellows responded (46%): 85% were male, 57% Caucasian, 75% married, and 86% were university-based. Ninety-six percent of fellows believed that health care reform is adversely affecting the quality of health care and 94.1% felt that it was adversely affecting fellowship training. Eighty-eight percent expressed concern over the impact of health care reform on practice opportunities. Only 9% of fellows reported that their training program had established a specific educational program addressing health care reform, whereas 83% of fellows felt that their program should do so. CONCLUSION: Gastroenterology fellows are concerned about the impact of health care reform on the quality of care and the quality of their fellowship training. Trainees believe that programs are not providing sufficient education to help them respond to the changes in health care.

Education, Medical, Graduate↗

PubMed1981

A review of training programs for providers of foster family care to mentally retarded persons.

The training needs of foster care providers serving mentally retarded persons have been acknowledged for some time. This review of specific training programs demonstrates that a variety of excellent materials and strategies for meeting these needs are now available. A number of important tasks remain. First, existing training programs need to be implemented more widely. Second, new programs and training materials need to be developed to address needs not adequately met by existing programs. Finally, there is a need to conduct systematic evaluations of care provider training on a more regular basis. The results of these evaluations must then be used to guide refinements in future training efforts. This is an essential step if these programs are to be effective in meeting their goal of improving the quality of care offered to mentally retarded persons by foster family care providers.

Education↗

PubMed1975

A behavior modification training program for staff working with drug addicts.

This paper described a Behavior Modification Training Program, emphasizing self-control, for staff working with drug addicts. The program, which is primarily geared toward the training of paraprofessionals, takes place in ten 1-1/2 hour sessions and includes an overview of behavior modification as well as instruction in techniques of relaxation, desensitization, self-image improvement, behavior analysis, behavior control, assertive training, rational thinking, and how to set up and run similar behavior modification training programs for staff and patients. Since this training began at the New Jersey Neuropsychiatric Institute in November 1971, a total of 898 staff members, mostly paraprofessionals working with addicts, alcoholics, mentally ill patients, and inmates, including 53 from our own institution, 576 persons from other facilities in New Jersey, and 269 from facilities in other states, have been trained, while 2,021 patients have been trained in similar programs. Most of this training has been accomplished by paraprofessionals. Preliminary evaluation data have been promising and the response of participants enthusiastic.

Allied Health Personnel↗

PubMed1989

Occurrence of running injuries in adults following a supervised training program.

To study the occurrence of running-related injuries, a group of 115 volunteers were supervised in a training program. These subjects who had limited or no running experience were asked to keep a diary in which they registered information on the training program and injuries. Ultimately, 63% of the diaries fulfilled the criteria for inclusion into longitudinal analysis. The training program (18-20 months) consisted of three phases, each phase finished with a contest (15 km, 25 km, and a marathon, respectively). The participants were individually supervised by an experienced coach with special attention to physiologic training and injury-preventive aspects. Eighty-five percent (n = 62) of the research population sustained at least one injury during the experiment. They reported in total 174 injuries. The number of injury cases per week increased gradually over the experimental period; however, when expressed per unit of exposure time (i.e., 1000 training hours), it showed a decline. There was a significant correlation between the number of injured volunteers and the distance covered during the training at the start of the training program. The anatomic distribution of the injuries is in agreement with findings in the literature. There was also a possible preference for the localization of injuries to the lower leg and Achilles tendon on the left side of the body.

Adult↗

PubMed2002

The effect of a 3-month low-intensity endurance training program on fat oxidation and acetyl-CoA carboxylase-2 expression.

Endurance training has been shown to increase fat oxidation both at rest and during exercise. However, most exercise training studies have been performed at high exercise intensity in well-trained athletes, and not much is known about the effect of a low-intensity training program on fat oxidation capacity in lean sedentary humans. Here, we examine the effect of 3-month low-intensity training program on total and intramuscular triglyceride (IMTG)- and/or VLDL-derived fat oxidation capacity and skeletal muscle mRNA expression. Six healthy untrained subjects (aged 43 +/- 2 years, BMI 22.7 +/- 1.1 kg/ m(2), V(O)(2max) 3.2 +/- 0.2 l/min) participated in a supervised 12-week training program at 40% V(O)(2max) three times weekly. Total and plasma-derived fatty acid oxidation at rest and during 1 h exercise was measured using [(13)C]palmitate, and in a separate test, [(13)C]acetate recovery was determined. Muscle biopsies were taken after an overnight fast. Total fat oxidation during exercise increased from 1,241 +/- 93 to 1,591 +/- 130 micromol/min (P = 0.06), and IMTG- and/or VLDL-derived fatty acid oxidation increased from 236 +/- 84 to 639 +/- 172 micromol/min (P = 0.09). Acetyl-CoA carboxylase-2 mRNA expression was significantly decreased after training (P = 0.005), whereas lipoprotein lipase mRNA expression tended to increase (P = 0.07). In conclusion, a minimal amount of physical activity tends to increase fat oxidation and leads to marked changes in the expression of genes encoding for key enzymes in fat metabolism.

Acetyl-CoA Carboxylase↗

PubMed2005

Cognitive functions in severe congestive heart failure before and after an exercise training program.

BACKGROUND: Congestive heart failure is associated with cognitive impairment, particularly of attentional skills. We assessed, in a hypothesis-generating study, the effect of an exercise training program on cognitive functions among patients with severe congestive heart failure. METHODS: Patients with severe congestive heart failure (n=20; New York Heart Association functional class III; left ventricular ejection fraction < or =35%) were evaluated before and following a standardized and supervised exercise training program (x2/week for 18 weeks; exercise group), while 5 additional patients did not undergo an exercise training program (control group). A battery of cognitive tests was used to assess cognitive functions. Physical performance was assessed by the 6-min walk test and the modified Bruce exercise test, cardiac index and systemic vascular resistance using thoracic electrical bioimpedance, and cerebral vasomotor reactivity to hypercapnia by means of the breath-holding index using transcranial Doppler. RESULTS: Time of completion of the trail making A (105+/-116 to 75+/-52; p=0.02) and B (169+/-100 to 119+/-65; p=0.002) tests, and of the Stroop part A (40+/-13 to 37+/-13; p=0.04) was shorter in patients completing the exercise training program, but not in control patients, while the other neuropsychological measures remained unchanged in both groups. Cerebral vasomotor reactivity to hypercapnia remained diminished (breath-holding index 0.64+/-0.27 vs. 0.68+/-0.37) despite significant improvements in exercise capacity (6-min walk test 308+/-87 to 423+/-91 m, p<0.001; modified Bruce exercise test 5.6+/-3.8 to 9.8+/-3.4 min, p<0.001). CONCLUSIONS: Patients with severe congestive heart failure undergoing an exercise training program improve in some measures of cognitive functions that are limited to general attention and psychomotor speed. Based on these preliminary findings, further evaluations are designed within the framework of a larger controlled clinical trial.

Adult↗

PubMed2002

[Postgraduate trainings program in pathology and laboratory medicine at teaching hospitals of Japan].

It is meaningful to propose a postgraduate training program in pathology and laboratory medicine to select the course after graduation and promote recognition of the roles of pathologists(AP) and laboratory physicians(CP). It is desirable that the training program be common to both AP and CP, although this would be difficult in practice. So author proposes a practical training program that should involve making rounds with AP and CP. The desirable period of training is 3 or 4 years. In the program of laboratory medicine for AP, conferences and CPC are essential and other courses are elective. In the selective program, laboratory management is very important because it will be useful when the graduate becomes a laboratory manager. In the pathology program for CP, autopsy and CPC(as a pathologist) are essential. Training in surgical pathology and cytology are desirable to set limits in materials, for example, liver, kidney, bone marrow, and other tissues. Key points of successful training are good relationships chiefs of AP and CP, high level performance and give-and-take in routine work. It is very difficult to study and maintain the knowledge and technique necessary in all fields of pathology and laboratory medicine. So the author emphasizes that the training program should be constructed to focus on useful issues in routine work and management of laboratory.

Curriculum↗

PubMed2004

Comparison of a high-intensity and a low-intensity lumbar extensor training program as minimal intervention treatment in low back pain: a randomized trial.

In a randomized, observer-blinded trial, the effectiveness of 3-month high-intensity training (HIT) of the isolated lumbar extensors was compared to low-intensity training (LIT). Eighty-one workers with nonspecific low back pain longer than 12 weeks were randomly assigned to either of the two training programs. Training sessions were performed on a modified training device that isolated the lower back extensors. Total intervention time was limited to 5-10 min (one or two training sessions) per week. Training effects were assessed in terms of changes in self-rated degree of back complaints, functional disability, and general, physical and mental health. Secondary outcomes in this study were muscle strength and fear of moving the back (kinesiophobia). Outcomes were evaluated at 1,2, 3, 6, and 9 months after randomization. The results showed that the two treatment programs led to comparable improvements in all outcome measures, except for mean isometric strength at 1, 2, 3, 6, and 9 months and kinesiophobia score at 2 and 9 months of follow-up. The high-intensity training group showed a higher strength gain (24 to 48 Nm) but a smaller decline in kinesiophobia (2.5 and 3.4 points, respectively), compared to the low-intensity training group. It can be concluded that high-intensity training of the isolated back extensors was not superior to a non-progressive, low-intensity variant in restoring back function in nonspecific (chronic) low back pain. In further research, emphasis should be put on identifying subgroups of patients that will have the highest success rate with either of these training approaches.

Adult↗

PubMedDate not supplied

The effectiveness of empowering in-service training programs for foreign nurse aides in community-based long-term care facilities.

The objective of the study was to examine the effectiveness of empowering in-service training programs for foreign nurse aides working in community-based long-term care (LTC) facilities. The design was a pretest and post-test design with experiment and control groups. The sample consisted of purposeful sampling from 10 LTC facilities in the Shihlin and Peitou areas of Taipei. A total of 35 foreign nurse aides participated in this study; 16 in the experimental group and 19 in the control group. The experimental group attended the training program for a 3-month period, whereas the control group did not receive any training. The research findings reveal that the training program was effective in increasing the work stress of workload/scheduling (Z = 2.01, p </= 0.05), meaning that the training program has raised the awareness of work stress for foreign nurse aides. The results could be used as a reference when considering the development of in-service training programs in LTC facilities.

Adult↗

PubMed2001

Source of improvement in balance control after a training program for ankle proprioception.

Previous research on healthy individuals reported improvements in balance control following a purported ankle proprioception-training program. The training may have resulted in a general rather than a specific enhancement of ankle proprioception. To test this hypothesis, subjects were constrained at the hips and trunk with a custom-made thoracolumbosacral orthosis and performed a one-leg standing test with eyes closed and head tilted back, so that they had to rely primarily on their ankle musculature to keep their balance. Subjects were retested after training on the BAPS three times a week for 4 weeks, following the training recommendations of the manual. Subjects' bodies were not constrained during the training. Analysis showed that subjects made improvements during training in performing more difficult tasks on the board. On the one-leg test, however, there were no improvements in sway velocity, number of touchdowns, or falls relative to pretest scores. Improvements observed during training likely resulted from diffuse enhancement of proprioception in other body segments such as the knees, hips, spine, and upper extremities. A training program in control of general balance does not specifically target ankle proprioception.

Adult↗

PubMed2005

Development and analysis of the effects of caregiver training program on aggressive behavior in elders with cognitive impairment.

PURPOSE: The purposes of this study were to 1) describe the type and frequency of aggressive behavior of cognitively impaired nursing home resident, 2) develop a caregiver training program on prevention and management of aggressive behavior, 3) examine the effects of caregiver training program on the incidence of aggressive behavior of cognitively impaired nursing home resident, and 4) examine the effects of caregiver training program on nursing staff's aggressive behavior management skills. METHODS: One-group, time series, quasi-experimental design with a pre-test and two post-tests was used. Data were collected from cognitively impaired home residents (N=32) and nursing staff (N=36) in a proprietary nursing home using Ryden Aggression Scale I, II, and Aggressive Behavior Management Scale. Data were entered and analyzed by descriptive statistics and repeated measures ANOVA. RESULTS: Incidence of aggressive behavior was high with a mean score of 3.09 (SD=3.11) at baseline. Caregiver training program was developed based on Progressively Lowered Stress Threshold (PLST) model and gerontological and psychiatric literature. The mean scores of aggressive behavior at baseline, Post I, and II did not differ significantly although the difference approached to the significant level (F=2.925, p=.066). Nursing staff's aggressive behavior management skills increased at Post I, and at Post II when compared to baseline, and the difference was significant (F=12.736, p=<.001). CONCLUSION: Caregiver training program showed potential impact on reduction of aggressive behavior in elders with cognitive impairment and was effective in increasing nursing staff's aggressive behavior management skills.

Adult↗