Humane qualities to meet human needs and technical skills to meet technical needs: how can we bridge the gap in primary care?
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Allied Health Personnel↗
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The improvement of technical skills in preclinical courses.
One hundred fifty-four freshmen dental students were administered a fine motor ability test prior to and at the completion of a series of preclinical technique courses. The pre- and posttest performances were compared for each student to determine whether an improvement of technical skill had occurred. The pre- and posttests were also graded using the rank ordered method. The number of students who demonstrated improvement in technical skill was compared to the number of students who improved in grades to establish whether the change in grades was indicative of the observed change in technical skill. Most students improved in technical skill; however, grades did not reflect this improvement.
Curriculum↗
A study of cognitive and technical skill deterioration among trained paramedics.
Thirty trained paramedics were studied to measure cognitive and technical skill deterioration 6 to 30 months after completion of their individual training programs. The group of 30 paramedics included those with six months and those with one year of training. The purpose of the study was to identify areas in need of continuing education and to see if the rate of skill deterioration correlated with the time from completion of the training program. The trained paramedics were given the same final written and technical skill examination they had taken at the end of their training and the individuals' two scores were compared. The skills requiring the most technical knowledge deteriorated the fastest. Also, basic skills, despite frequent use in the field, had deteriorated. The amount of skill deterioration was greatest among the group of trained paramedics that had completed their training 30 months prior to this study.
Allied Health Personnel↗
An attempt to identify frequency of use of technical skills and procedures by the primary care physician.
Some technical skills required and learned during residency training are not often used in primary care. Pediatricians who practice primary care in rural settings for smaller communities) tend to perform a greater variety of procedures than those who practice in urban settings. Family practitioners report that they perform more of these procedures than either rural or urban practicing pediatricians. Training programs should define the skills and procedures which residents must learn to perform and should differentiate between those needed during the training period and those which will be used in primary care practice.
Family Practice↗
Neurovascular microsurgery: a model for laboratory investigation and the development of technical skills.
An inexpensive and reproducible model to help in developing the technical skills for, and to investigate experimentally, a microvascular anastomosis resembling the superficial temporal-middle cerebral artery bypass is described. The model is used to illustrate the important principles of microvascular surgery. Using a standardized operative technique, we evaluated 50 successive preparations by perfusion; the patency rate was 100%.
Anesthesia, General↗
Performance of technical skills of diabetes management: increased independence after a camp experience.
This study examines some educational effects of a camp experience on independent performance of tasks in the management of diabetes mellitus. One hundred and eleven children were studied with regard to insulin administration, urine glucose testing, recognition of hypoglycemic reactions, adherence to diet, and over-all independence. There was a significant increase in independent measurement of insulin dose, administration of insulin injections, and urine glucose testing. No significant differences were seen in dietary adherence of ability to recognize hypoglycemic reactions. Precamp data indicated that returning campers demonstrated greater independence in insulin administration prior to camp than did new campers. After camp, both new and returning campers showed significant increases in independent performance of dose measurement and injection. It is concluded that a camp educational experience contributes to both the knowledge and performance of self-care techniques required in the management of diabetes mellitus.
Adolescent↗
Certain select variables as predictors of goal achievement in speech therapy.
A previous factor-analytic investigation indicated that 18 variables, structured within interpersonal and technical skill dimensions, contribute most significantly to supervisor's evaluations of student clinicians engaged in speech therapy. The present study was designed to extend that investigation by determining the relative contribution of the variables to the clinicians' accomplishment of the goals of the therapy session. Using the previously collected data, 17 of the resultant variables were regressed in stepwise fashion against the clinicians' accomplishment of the session's goals. The regression solution yielded a three-variable prediction system, which accounted for approximately two-thirds of the criterion variance. All three variables were related to clinicians' technical skills. The "schedule of reinforcement" variable was the single most valid predictor and accounted for half of the criterion variance. The other two technical skill variables were "implements carryover procedures in therapy" and "changes therapeutic procedure to meet client needs." Implications for inclusion of these variables in interactive and microtherapy methodologies of clinical training are discussed.
Achievement↗
The use of instructor-patients to teach physical examination techniques.
The increasing difficulty in obtaining appropriate hospitalized patients to give enlarging classes of medical students their first exposure to abnormal physical findings has led to the development of an instructor-patient program. Sixteen community residents with relatively stable respiratory, cardiovascular, musculoskeletal, or neurological findings were recruited and trained as instructor-patients to teach the technical elements of the examination of the affected organ system. Evaluation of the technical skills of 46 second-year students trained by instructor-patients and those of 41 randomly selected students trained in these skills by physician instructors demonstrated that the two have comparable technical skills five to eight weeks after the training sessions. Faculty recruitment, instructor-patient recruitment and training, and evaluation are discussed.
Education, Medical, Undergraduate↗
A factor-analytic study of criteria for evaluating student clinicians in speech pathology.
This study was designed to determine the most significant criteria used in university training programs to evaluate the therapeutic effectiveness of student clinicians enrolled in clinical practicum. A total of 152 supervisors in 53 ASHA accredited training programs used 40 criteria to evaluate 207 clinicians engaged in speech and language therapy. Factor analysis yielded two distinct dimensions, Technical Skills and Interpersonal Relationship Factors, and indicated that 18 variables contributed most significantly to the evaluative process. Student clinicians were consistently rated higher on variables related to the interpersonal dimension than on those related to technical skills. The identification and structure of the 18 variables suggests that both technical and interpersonal skills are widely regarded as essential to therapeutic effectiveness. The results provide insight into the nature of clinical evaluation and behavior and suggest a restructuring of criteria for evaluating the process of therapeutic treatment.
Clinical Competence↗
Clinical competence in internal medicine.
To describe more explicitly the components of competence required of the internist, The American Board of Internal Medicine has analyzed the medical encounter and defined the major variables involved: the abilities required of the internist, the tasks that must be performed to solve a medical problem, the medical illness, and the patient. The abilities of the internist have been categorized into attitudes and habits, interpersonal skills, motor and technical skills, and intellectual abilities. The latter have been further subdivided into the abilities to acquire and use knowledge, to organize, to synthesize information, and to apply clinical judgment. For each of these abilities statements of clinical competence that relate to the tasks required have been developed. The Board is publishing this paper, an excerpt of a longer document, with the hope that it will be useful to residents, faculty, and practicing internists.
Attitude of Health Personnel↗
The Effectiveness of Passive Half-Time Interventions on Simulated Second-Half Performance in Elite Youth Soccer Players.
The half-time period in soccer provides a potentially important window to implement short-duration interventions aimed at maintaining second-half performance. However, passive rest has been associated with a decline in subsequent physical and technical performance. While re-warm-up strategies are well studied, little is known about the efficacy of technology-based, passive recovery modalities, device-supported interventions that require minimal active movement or physical exertion from the athlete, during half-time intervals. This study examined whether percussive therapy, electrical muscle stimulation, and pneumatic compression can mitigate second-half performance decline in male adolescent soccer players. Forty-three academy-level players (17.5 ± 0.6 years) completed a simulated soccer protocol including the Loughborough Soccer Pass Test (LSPT), repeated 20-meter sprints, and completed Total Quality of Recovery (TQR) assessments before and after half-time. Participants were randomized into one of four intervention groups during the 15-minute half-time interval: Passive Rest (CON), Percussive Therapy (Theragun Pro; TG), EMS (PowerDot; PD), and Pneumatic Compression (RecoveryAir; COMP). Linear mixed-effects models assessed Time × Condition interactions for performance and recovery outcomes. Passive half-time rest led to significant deterioration in technical skill, sprint performance, and perceived recovery (p < .05) for the control group. TG and PD significantly improved technical performance (LSPT scores) compared to the control group (d = 0.65 and 0.72, respectively; p < .01). Furthermore, TG and COMP were effective at maintaining 20-meter sprint times (d = 0.58 and 0.49; p < .01), whereas the control group experienced significant slowing. Perceived recovery (TQR) scores significantly declined in the CON group from First Half to Second Half (16.5 ± 2.2 to 11.1 ± 2.3. However, this decline was significantly attenuated in all intervention groups: TG (17.5 ± 1.9 to 14.2 ± 1.9), PD (17.3 ± 1.9 to 15.1 ± 1.9), and COMP (17.6 ± 1.9 to 15.9 ± 2.0). Short-duration passive interventions during half-time can mitigate performance decline in adolescent soccer players. TG and EMS appear most effective for preserving technical skills, while COMP may support perceived recovery. These findings highlight practical strategies for optimizing in-game performance and inform evidence-based half-time protocols.
Humans↗
Creative potential in schizophrenia.
The purpose of this paper is to demonstrate the presence of creative potential in a group of hospitalized persons who have been categorized as schizophrenic. Previous work (Buck and Kramer, 1973, 1974) has made it obvious that considerable poetic skill exists in this group of people. While creative potential was apparent in large numbers of those we have worked with, it is unnecessary to claim that our present data represent all (or even a majority) of the hospital population. However, we are concerned with providing a more balanced perspective on the ego strength and creativity which are retained in people who are labeled schizophrenic-even those considered to be regressed. In the following selections, we will attempt to demonstrate, first, an openness to fantasy and an access to primary-process thought which is molded by sufficient technical skill to warrant being labeled poetry, and second, an active, reconstructive capacity which includes a clear intention of communicating with an audience. The technical skill and the reconstructive capacity are critical in substantiating the retention of ego strength necessary for the mobilization of secondary-process cognition. We are interested, therefore, in exploring poetry written with clarity, intelligibility, and cohesiveness, where the visual can be translated into the verbal, where the effort is directed toward communication rather than sorcery, and where sponteneity replacesstereotypy. In the case of originality of style-that is, artistic license-these distinctions may not always be clear; but where questions arise, the artist's ability to justify his own intentions becomes critical.
Cognition↗
Magement education for health services.
This paper examines the implications of the recent emergence in the United States of three major factors for management education in health services. The factors are: new organizational forms for delivery of services, increased emphasis on public accountability, and the proliferation of agencies intended to monitor and coordinate health services providers. Several questions are considered, including the degree to which training for various managerial careers within health services should be differentiated; the degree to which professional education should occur in the academic setting as distinct from the work setting; and, most importantly, the appropriate content of graduate education. It is argued that formal education for health services management should place substantial emphasis on the development of a student's analytic skills, with particular reference to quantitative methods. While these technical skills are not likely to become the dominant ingredient of successful and effective management, they do provide the manager with the ability to identify courses of action which will benefit the organization, and strengthen his hand in dealing with groups that are necessarily in conflict with its goals. It is stressed that training in this area should be oriented toward the needs of the prospective manager rather than the quantitative methods specialist.
Administrative Personnel↗
The utilization of dental skills in non-dental situations.
The development of electronic control systems has enabled severely physically handicapped people to revolutionize their lives by using any minimal residual movements they may have to operate micro-switches linking them with typewriters and other environmetal controls. Technical skills of a high order are required in making the unique splint or interface which links the switches with these residual movements whether of the tongue, lips, chin, eyebrow, finger or toe. Through the initiative of the Cordent Trust and generous financial support from the Leverhulme Trust a mobile laboratory was designed and built and a dental technician appointed for a three-year development project in the use of these switches as it was felt that his experience was particularly appropriate to the work and would also demonstrate how dental skills can be used to bring about a degree of rehabilitation far beyond the oral environment.
Electronics, Medical↗
Vascular trauma observed at an urban hospital center.
The records of 50 patients with 67 major civilian type vascular injuries treated in a large urban center from 1967 to 1975 were reviewed in terms of nature of the injury, form of surgical management and early and late results. Civilian injuries differ in many aspects from those of their military counterparts and often require different treatment. In both, however, treatment protocols should be periodically re-evaluated for a number of reasons, chiefly among which are changing patterns of delivery of the injured patient to the medical center and advances in technical skills. Notable in the presently reported series were the low mortality and the absence of a need for amputation, with a limb salvage rate of 100 per cent. Despite modern advances in technical proficiency in vascular reconstruction, there is still a place for careful vascular ligation in the definitive surgical management of major vascular trauma.
Abdominal Injuries↗
[Experimental lung transplantation at the Research Institute for Lung Diseases and Tuberculosis Berlin-Buch. Technical standard and quality].
Report on the technical standard of unilateral orthotopic allogenic lung transplantation (allo- or homotransplantation) which has been developed and tried on animals since years at The Institute for Research on Pulmonary Diseases and Tuberculosis in Berlin-Buch. Technical insufficiencies which are crucial for essential alterations of the graft in autogenous lung transplantation (replantation) can not be excluded in allogenic transplantations also. By means of certain direct and indirect criteria the authors examined the development of quality of the technical standard between the years 1973 and 1976. Only based on optimal technique the results from examinations of recipient and graft can be correctly valued. On the other hand, optimal technique is an indispensable presupposition for optimal efficiency of several immunosuppressive methods. Duration of anesthesis, operation, ischemia of the transplantate, and of atrial, arterial, and bronchial anastomosis are considered for the assessment of the quality of technical standard. Thrombosis of pulmonary vein and of atrium was the most frequent complication in 71 allogenic pulmonary graftings. Their frequency decreased with improved technical skill, but some circumstances suggest that their formation is favored also by other factors. The duration of survival after unilateral allogenic lung transplantation is reported, although this is no direct scale for the technical performance.
Animals↗
The new graduate in the operating room.
New graduate nurses today come to their first positions in nursing with varying knowledge bases and minimal clinical nursing skills. Gone are the days when new graduates begin functioning fully in a budgeted position on day one of employment. Mastery of psychomotor, cognitive, and affective skills necessary for nursing practice must be acquired through experience in the work situation. The more complex the clinical setting, the more stressful is the period of learning. The O.R. can be a highly stressful place. The need for anticipation, planning and organization to provide efficient care with meticulous attention to detail is coupled with the need to perform smoothly numerous technical skills. Safe, humanistic care cannot be implemented unless the nurse is also able to assess each patient's individual biopsychosocial status, and identify his unique nursing care needs. In order to learn to cope with this level of complexity, the neophyte nurse must be provided with a planned, supportive experiential learning situation that also provides the time necessary to achieve a beginning level of mastery. The program in Basic O.R. Nursing described here was one attempt to provide such an experience for new graduates.
California↗
The role of house staff in undergraduate surgical education.
An analysis of the contribution made by house officers in fulfilling the objectives for a comprehensive clerkship experience was undertaken by questioning members of the 1975 medical class. The objectives examined over a broad spectrum of surgical disease and are applicable to any general surgical clerkship. In addition, the instruction received in technical skills was analyzed and deficiencies were noted. Major subject areas related to surgical disease were examined for adequacy of house staff instruction, and an estimation of hours per week devoted to the clerkship experience by house and staff was derived. The university-private hospital training program at this institution permitted a comparison of instruction between these clerkship settings. Some deficiencies did appear in intellectual and technical instruction in both clerkship environments. These deficiencies, however, usually were related to a paucity of patient material and to the lack of opportunity for clinical instruction which ensues from these cases. With few exceptions, the house staff provided nearly one third of the knowledge base acquired during the junior medical student experience. The results indicate that very little difference exists between the didactic role of the house officer in either the university or community hospital environment.
Education, Medical, Undergraduate↗