Home About us Contact
|
Home About us Contact | ||
|
|
||
Medical Training (medical + training)
Selected AbstractsDr Harold Frederick Shipman: An enigmaCRIMINAL BEHAVIOUR AND MENTAL HEALTH, Issue 3 2010John Gunn Dr. Shipman was the worst known serial killer in British history, at least in terms of numbers of victims, and possibly the worst in world history, if politicians are excluded. He killed at least 215 patients and may have begun his murderous career at the age of 25, within a year of finishing his medical training. His case has had a profound impact on the practice of medicine in the United Kingdom. Was he a special case? What were the origins of this behaviour? Could the behaviour have been prevented? It is necessary to learn what we can from a few personal facts and largely circumstantial evidence. He withheld himself from any useful clinical investigation or treatment once he had been taken into custody. Could he have been treated at any stage? Copyright © 2010 John Wiley & Sons, Ltd. [source] The Accuracy of Predicting Cardiac Arrest by Emergency Medical Services Dispatchers: The Calling Party EffectACADEMIC EMERGENCY MEDICINE, Issue 9 2003Alex G. Garza MD Abstract Objectives: To analyze the accuracy of paramedic emergency medical services (EMS) dispatchers in predicting cardiac arrest and to assess the effect of the caller party on dispatcher accuracy in an advanced life support, public utility model EMS system, with greater than 90,000 calls and greater than 60,000 transports per year. Methods: This was a retrospective analysis from January 1, 2000, through June 30, 2000, of 911 calls with dispatcher-assigned presumptive patient condition (PPC) or field diagnosis of cardiac arrest. Sensitivity and positive predictive value (PPV) of the PPC code for cardiac arrest by calling parties were calculated. Homogeneity of sensitivity and PPV of the PPC code for cardiac arrest by calling parties was studied with chi-square analysis. Relevant proportions, relative risk ratios, and associated 95% confidence intervals (95% CIs) were calculated. Student's t-test was used to compare quality assurance scores between calling parties. Results: There were 506 patients included in the study. Overall sensitivity for dispatcher-assigned PPC of cardiac arrest was 68.3% (95% CI = 63.3% to 73.0%) with a PPV of 65.0% (95% CI = 60.0% to 69.7%). There was a significant difference in the PPV for the EMS dispatcher diagnosis of cardiac arrest depending on the type of caller (,2= 17.34, p < 0.001). Conclusions: A higher level of medical training may improve dispatch accuracy for predicting cardiac arrest. The type of calling party influenced the PPV of dispatcher-assigned condition. [source] Student satisfaction with curriculum modifications in a French dental schoolEUROPEAN JOURNAL OF DENTAL EDUCATION, Issue 3 2000P. Farge Since 1994, important modifications have been implemented in the dental curriculum in France, and an additional year has been included in the dental curriculum. The 1st year has remained unchanged; it is common to both medical and dental schools and leads to a selection procedure of 1 in 10 dental students. In the new curriculum, the dental student is engaged in a 5-year programme in dental school (years 2 to 6), as opposed to 4 years in the former programme (years 2 to 5). Basically, this new curriculum emphasises research initiation, links with medical training and offers broader clinical experience. During the academic year 1998,1999, dental schools had 2 different types of students: the 4th year students belonging to the new programme along with the 5th year students in their final year of the old curriculum. Using a specially devised questionnaire, we investigated the students' perception of their respective training, their motivation and professional plans. At the Faculty of Odontology in Lyon, the new curriculum is perceived as an increased strain by the dental students. [source] Would general practitioners support a population-based colorectal cancer screening programme of faecal-occult blood testing?INTERNAL MEDICINE JOURNAL, Issue 9-10 2004S. Tong Abstract Background:, The success of a population-based screening for colorectal cancer (CRC) is determined to a large extent by general practitioner (GP) attitudes, beliefs and support. The extent to which GPs support population-based CRC screening remains unclear. Aims:, To assess the knowledge, attitudes and practices of GPs in relation to CRC screening, and to identify the determinants of GP support for population-based faecal-occult blood testing (FOBT). Methods:, A cross-sectional postal survey was conducted with a random sample of 692 GPs in Queensland, Australia. We assessed GP knowledge, attitudes and practices concerning CRC screening in relation to their stance on population-based FOBT screening. Results:, Although the response rate was low (41%), participants were representative of Queensland GPs in general. Of 284 participating GPs, 143 (50.5%) indicated that they would support a population-based FOBT screening programme, 42 (14.8%) would not and 98 (34.6%) were unsure. Belief in FOBT test efficacy (P < 0.001), possession of CRC guidelines (P < 0.05) and belief in earlier stage detection (P < 0.05) were major determinants of support for population-based FOBT screening. No significant association was observed for doctor's sex, location of practice, age, year completed medical training, membership of a Division of General Practice, number of weekly consultations, number of patients investigated for CRC per month, size of practice, own family history of CRC, interest in further information on CRC screening or treatment, and current use of FOBT with asymptomatic patients aged ,40 years. Conclusions:, GP support for FOBT population-based screening appears to have increased over recent years. The knowledge and attitudes/beliefs of GPs are key determinants of their support. (Intern Med J 2004; 34: 532,538) [source] Australian Medical Council: a view from the insideINTERNAL MEDICINE JOURNAL, Issue 4 2001K. Breen Abstract Although it has an important role in maintaining medical standards, little is known about the work of the Australian Medical Council (AMC) by members of the medical profession. A non-statutory standards authority, the AMC accredits medical schools in Australia and New Zealand, examines overseas-trained doctors for registration purposes and advises Medical Boards and Health Ministers on registration issues. The AMC, in consultation with Specialist Medical Colleges and others, is currently working on a number of initiatives to ensure standards of medical training and practice, including procedures to recognize new specialties and to accredit externally specialist education and training courses. (Intern Med J 2001; 31: 243,248) [source] Development and Validation of a Geriatric Knowledge Test for Medical StudentsJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 6 2004Ming Lee PhD Objectives: To assesses the reliability and validity of a geriatrics knowledge test designed for medical students. Design: Cross-sectional studies. Setting: An academic medical center. Participants: A total of 343 (86% of those sampled) medical students participated in the initial study, including 137 (76%) first-year, 163 (96%) third-year, and 43 (86% of those sampled) fourth-year students in the 2000,2001 academic year. To cross-validate the instrument, another 165 (92%) third-year and 137 (76%) first-year students participated in the study in the 2001,2002 academic year. Measurements: An 18-item geriatrics knowledge test was developed. The items were selected from a pool of 23 items. An established instrument assessing the clinical skills of medical students was included in the validation procedure. Results: The instrument demonstrated good reliability (Cronbach ,=0.80) and known-groups and concurrent validity. Geriatrics knowledge scores increased progressively with the higher level of medical training (mean percentage correct=31.3, 65.3, and 66.5 for the first-year, third-year, and fourth-year classes, respectively, P<.001). A significant (P<.01) relationship was found between the third-year students' geriatrics knowledge and their clinical skills. Similar results, except the relationship between knowledge and clinical skills, were found in the cross-validation study, supporting the reliability and known-groups validity of the test. Conclusion: The 18-item geriatrics knowledge test demonstrated sound reliability and validity. The average scores of the student groups indicated substantial room for growth. The relationship between geriatrics knowledge and overall clinical skills needs further investigation. [source] Using job analysis to identify core and specific competencies: implications for selection and recruitmentMEDICAL EDUCATION, Issue 12 2008Fiona Patterson Objective, Modern postgraduate medical training requires both accurate and reliable selection procedures. An essential first step is to conduct detailed job analysis studies. This paper reports data on a series of job analyses to develop a competency model for three secondary care specialties (anaesthesia, obstetrics and gynaecology, and paediatrics). Methods, Three independent job analysis studies were conducted. The content validity of the resulting competency domains was tested using a questionnaire-based study with specialty trainees (specialist registrars [SpRs]) and consultants drawn from the three specialties. Job analysis was carried out in the Yorkshire and the Humber region in the UK. The validation study was administered with additional participants from the West Midlands and Trent regions in the UK. This was an exploratory study. The outcome is a set of competency domains with data on their importance at senior house officer, SpR and consultant grade in each specialty. Results, The study produced a model comprising 14 general competency domains that were common to all the three specialties. However, there were significant between-specialty differences in both definitions of domains and the ratings of importance attached to them. Conclusions, The results indicate that a wide range of attributes beyond clinical knowledge and academic achievement need to be considered in order to ensure doctors train and work within a specialty for which they have a particular aptitude. This has significant implications for developing selection criteria for specialty training. Future research should explore the content validity of these competency domains in other secondary care specialties. [source] Factors affecting future choice of specialty among first-year medical students of the University of the West Indies, TrinidadMEDICAL EDUCATION, Issue 1 2007Nelleen S Baboolal Background, This study was conducted to determine factors that influence career choice among 1st-year medical students. Design And Methods, A cross-sectional survey of 170 1st-year medical students from the University of the West Indies, St Augustine Campus was undertaken with a questionnaire designed to assess their perceptions of careers in various specialties. Likert scales were used to quantify the reasons for their preferences. Results, The response rate was 136/170 (80%). The age of respondents ranged from 16 to 36 years, mean 20.45, SD 2.88. Of the generic factors students considered important in their choice of a specialty, students ranked the ability to help patients the highest (rating of 1.44), along with the diagnosis and treatment of disease second (rating of 1.49); 38 (27.9%) cited medicine, 26 (19.1%) surgery, 13 (9.6%) paediatrics, 10 (7.4%) family practice and 4 (2.9%) psychiatry as their chosen career. Students begin their medical training with the view that a career in psychiatry is less attractive than other specialties surveyed. The average attractiveness was estimated as surgery 1.64, medicine, 1.81, paediatrics 1.95 and psychiatry 2.57. The differences between the averages were highly significant (F = 57.6, P < 0.001). Conclusion, The findings suggest that although 1st-year medical students rank the diagnosis and treatment of disease and the ability to help patients as the greatest influence in choosing a specialty, internal medicine was the most popular chosen career, while the surgical specialties were identified as the most attractive. Medical students have serious reservations about psychiatry as a career choice. [source] A qualitative study examining tensions in interdoctor telephone consultationsMEDICAL EDUCATION, Issue 8 2006Anupma Wadhwa Objective, Communication skills have gained increasing attention in medical education. Much of the existing literature and medical curricula addresses issues of doctor,patient communication. The critical importance of communication between health professionals, however, is now coming under the spotlight. The interdoctor telephone consultation is a common health care setting in which health professional communication skills are exercised. Breakdowns in this communication commonly occur and, surprisingly, this skill is not formally addressed in medical training. This study sought to clarify the communication issues that can occur during interdoctor telephone consultations in order to inform future educational initiatives in this domain. Methods, Data were collected and triangulated among 3 sources: documentation of 129 telephone consults received; 51 hours of field observations of consultants, and semi-structured interviews of 12 callers and 12 consultants. Analysis was performed using grounded theory methodology. Results, Overwhelmingly, participants described tensions with telephone consultation communication. Recurrent theme analysis revealed 5 key sources of tension: discursive features; context; fragmented clinical process; reason for call, and responsibility. Often, callers and consultants viewed similar instances in different and opposite manners, contributing to difficulties in the exchange. Further, a vicious cycle in which a participant's strategies to mitigate tension actually increased tension for the other participant was identified. Conclusions, Interdoctor telephone consultation has become an integral part of medical practice; however, tensions within this exchange can undermine its effectiveness. The results of this study provide a preliminary theory upon which an educational intervention to improve this communication skill can be based. [source] General competencies of problem-based learning (PBL) and non-PBL graduatesMEDICAL EDUCATION, Issue 4 2005Katinka J A H Prince Introduction, Junior doctors have reported shortcomings in their general competencies, such as organisational skills and teamwork. We explored graduates' perceptions of how well their training had prepared them for medical practice and in general competencies in particular. We compared the opinions of graduates from problem-based learning (PBL) and non-PBL schools, because PBL is supposed to enhance general competencies. Method, We analysed the responses of 1159 graduates from 1 PBL and 4 non-PBL schools to a questionnaire survey administered 18 months after graduation. Results, Compared with their non-PBL colleagues, the PBL graduates gave higher ratings for the connection between school and work, their medical training and preparation for practice. According to the graduates, the most frequently used competencies with sufficient coverage during medical training were expert knowledge, profession-specific skills and communication skills. The majority of the PBL graduates, but less than half of the non-PBL graduates, indicated that communication skills had been covered sufficiently. All the graduates called for more curriculum attention on working with computers, planning and organisation, and leadership skills. More PBL graduates than non-PBL graduates indicated that they had learned profession-specific methods, communication skills and teamwork in medical school. Discussion, Overall, the graduates appeared to be satisfied with their knowledge and skills. The results suggest that the PBL school provided better preparation with respect to several of the competencies. However, both PBL and non-PBL graduates identified deficits in their general competencies, such as working with computers and planning and organising work. These competencies should feature more prominently in undergraduate medical education. [source] The Utility of Simulation in Medical Education: What Is the Evidence?MOUNT SINAI JOURNAL OF MEDICINE: A JOURNAL OF PERSONALIZED AND TRANSLATIONAL MEDICINE, Issue 4 2009Yasuharu Okuda MD Abstract Medical schools and residencies are currently facing a shift in their teaching paradigm. The increasing amount of medical information and research makes it difficult for medical education to stay current in its curriculum. As patients become increasingly concerned that students and residents are "practicing" on them, clinical medicine is becoming focused more on patient safety and quality than on bedside teaching and education. Educators have faced these challenges by restructuring curricula, developing small-group sessions, and increasing self-directed learning and independent research. Nevertheless, a disconnect still exists between the classroom and the clinical environment. Many students feel that they are inadequately trained in history taking, physical examination, diagnosis, and management. Medical simulation has been proposed as a technique to bridge this educational gap. This article reviews the evidence for the utility of simulation in medical education. We conducted a MEDLINE search of original articles and review articles related to simulation in education with key words such as simulation, mannequin simulator, partial task simulator, graduate medical education, undergraduate medical education, and continuing medical education. Articles, related to undergraduate medical education, graduate medical education, and continuing medical education were used in the review. One hundred thirteen articles were included in this review. Simulation-based training was demonstrated to lead to clinical improvement in 2 areas of simulation research. Residents trained on laparoscopic surgery simulators showed improvement in procedural performance in the operating room. The other study showed that residents trained on simulators were more likely to adhere to the advanced cardiac life support protocol than those who received standard training for cardiac arrest patients. In other areas of medical training, simulation has been demonstrated to lead to improvements in medical knowledge, comfort in procedures, and improvements in performance during retesting in simulated scenarios. Simulation has also been shown to be a reliable tool for assessing learners and for teaching topics such as teamwork and communication. Only a few studies have shown direct improvements in clinical outcomes from the use of simulation for training. Multiple studies have demonstrated the effectiveness of simulation in the teaching of basic science and clinical knowledge, procedural skills, teamwork, and communication as well as assessment at the undergraduate and graduate medical education levels. As simulation becomes increasingly prevalent in medical school and resident education, more studies are needed to see if simulation training improves patient outcomes. Mt Sinai J Med 76:330,343, 2009. © 2008 Mount Sinai School of Medicine [source] Advanced da Vinci surgical system simulator for surgeon training and operation planningTHE INTERNATIONAL JOURNAL OF MEDICAL ROBOTICS AND COMPUTER ASSISTED SURGERY, Issue 3 2007L. W. Sun Abstract Background Although patients benefit considerably from minimally invasive surgery, the use of new instruments such as robotic systems is challenging for surgeons, and extensive training is required. Method We developed a computer-based simulator of the da Vinci Surgical System, modelling the robot and designing a new interface. Results The simulator offers users a two-handed interface to control a realistic model of the da Vinci robot. The simulator can be applied (i) to provide an environment in which to practice simple surgical skills and (ii) to serve as a visualization platform on which to validate port placement and robot pose for operation planning. Conclusions Virtual reality is a useful technique for medical training. The simulator is currently in its early stages, but this preliminary work is promising. Copyright © 2007 John Wiley & Sons, Ltd. [source] Assessment of the practicing physician: Challenges and opportunitiesTHE JOURNAL OF CONTINUING EDUCATION IN THE HEALTH PROFESSIONS, Issue S1 2008Eric S. Holmboe MDArticle first published online: 4 DEC 200 Abstract Despite spending a substantial amount of time in structured educational settings during early medical training, most physicians will spend the majority of their career in clinical practice. In the clinical practice setting, physicians become responsible for determining and implementing their own educational program in order to maintain, at a minimum, competence. Pressure to change the nature of continuing medical education (CME) parallels pressure from patients, payers, and policymakers to hold individual physicians more accountable for the care they provide. How can these two forces be brought together more deliberately and effectively? Comprehensive physician assessment provides such an opportunity with the potential to benefit all parties involved in health care, especially patients and physicians. Many assessment methods and tools exist today that can facilitate the integration of CME and quality. Using a multifaceted physician-level performance assessment system has substantial potential to align the public's need and desire to ensure their physician is competent, at a minimum, with providing the physician with meaningful, actionable information and data to improve performance and engage in transformative learning. CME programs need to incorporate more robust assessment as part of the learning activity to facilitate improvements in health care more directly. [source] Recruiting and Retaining Physicians in Very Rural AreasTHE JOURNAL OF RURAL HEALTH, Issue 2 2010Carolyn M. Pepper PhD Abstract Context: Recruiting and retaining physicians is a challenge in rural areas. Growing up in a rural area and completing medical training in a rural area have been shown to predict decisions to practice in rural areas. Little is known, though, about factors that contribute to physicians' decisions to locate in very sparsely populated areas. Purpose: In this study, we investigated whether variables associated with rural background and training predicted physicians' decisions to practice in very rural areas. We also examined reasons given for plans to leave the study state. Methods: Physicians in the State of Wyoming (N = 693) completed a questionnaire assessing their background, current practice, and future practice plans. Findings: Being raised in a rural area and training in nearby states predicted practicing in very rural areas. High malpractice insurance rates predicted planning to move one's practice out of state rather than within state. Conclusions: Rural backgrounds and training independently predict practice location decisions, but high malpractice rates are the most crucial factor in future plans to leave the state. [source] Monitoring stress levels in postgraduate medical trainingTHE LARYNGOSCOPE, Issue 1 2009Justin D. Hill MD Abstract Objectives: The Accreditation Council for Graduate Medical Education (ACGME) mandates that residency Program Directors (PD) monitor resident well-being, including stress. Burnout, as a measure of work-related stress, is defined by a high degree of emotional exhaustion and depersonalization, and a low degree of personal accomplishment using the Maslach Burnout Inventory-Human Services Survey (MBI-HSS). The purpose of this study is to describe the use of the MBI-HSS as a method of monitoring stress levels in an academic otolaryngology residency training program and introduce this survey as a tool for wider use in meeting ACGME requirements. Methods: The MBI-HSS was administered to residents in an academic otolaryngology residency training program on three separate occasions: at the beginning, middle, and end of different academic years. In addition, at the time of the third administration, the MBI-HSS was completed by faculty and staff in the same department. Surveys were completed and collected anonymously. Responses were scored against normative data from the MBI-HSS overall sample and the medicine subscale. Low, average, and high levels of burnout were identified for the individual categories of emotional exhaustion (EE), depersonalization (DP), and personal accomplishment (PA); average levels for each category were calculated. Results: Twenty-two residents completed the first survey, taken near the end of an academic year; 19 completed the second administration in the middle of the following academic year; and 24 completed the third survey at the beginning of the subsequent academic year. Thirteen faculty and 23 staff also completed the third survey. We found that three, one, and one residents reported high levels of burnout on the first, second, and third surveys, respectively. These figures compare to one faculty member and no staff members in the same department reporting high levels of burnout. Conclusions: The MBI-HSS is an established and validated tool for identifying burnout in resident physicians. Residency PDs may find the MBI-HSS useful as an aid in monitoring resident well-being and stress. In our own department, we found levels of burnout comparable to those previously reported for residents and faculty in this specialty. Laryngoscope, 119:75,78, 2009 [source] Beyond competence: defining and promoting excellence in anaesthesiaANAESTHESIA, Issue 2 2010A. F. Smith Summary Recent trends in medical training have tended to focus on competence, in the sense of adequate performance, rather than excellence. This article reviews published literature and relevant concepts relating to excellence and professionalism from within anaesthesia, from medicine more generally and from outside the profession. A number of conceptual frameworks are presented that could be adapted for the promotion of excellence, and some of the necessary prerequisites for this promotion discussed. [source] Airway incidents in critical care, the NPSA, medical training and capnographyANAESTHESIA, Issue 4 2009D. R. Goldhill First page of article [source] The assessment of frailty in older people in acute careAUSTRALASIAN JOURNAL ON AGEING, Issue 4 2009Sarah N Hilmer Aim:, Develop a measure of frailty for older acute inpatients to be performed by non-geriatricians. Method:, The Reported Edmonton Frail Scale (REFS) was adapted from the Edmonton Frail Scale for use with Australian acute inpatients. With acute patients aged over 70 years admitted to an Australian teaching hospital, we validated REFS against the Geriatrician's Clinical Impression of Frailty (GCIF), measures of cognition, comorbidity and function, and assessed inter-rater reliability. Results:, REFS was moderately correlated with GCIF (n = 105, R = 0.61, P < 0.01), Mini-Mental State Examination impairment (n = 61, R = 0.49, P < 0.001), Charlson Comorbidity Index (n = 59, R = 0.51, P < 0.001) and Katz Daily Living Scale (n = 59, R = 0.51, P < 0.001). Inter-rater reliability of REFS administered by two researchers without medical training was excellent (kappa = 0.84, n = 31). Conclusion:, In this cohort of older acute inpatients, REFS is a valid, reliable test of frailty, and may be a valuable research tool to assess the impact of frailty on prognosis and response to therapy. [source] Training doctors in general practices: A review of the literatureAUSTRALIAN JOURNAL OF RURAL HEALTH, Issue 5 2006Karen Larsen Abstract Objective:,This study was undertaken to assess the evidence of whether new forms of medical training, where substantial training takes place in general practice, will be acceptable to GPs. In particular, we asked the questions: Are GPs willing to act as trainers and supervisors in their practices? Do GPs have the appropriate skills to be trainers? Do practices have the infrastructure and resources to support placements? And, are patients happy to be seen by medical students and General Practice Registrars? Design:,Key Australian and international databases, key Australian journals and key Australian websites were searched for literature on general practice-based training of medical students and General Practice Registrars. Results:,In the international and Australian literature, we found that many GPs consider training medical students and General Practice Registrars to be intrinsically satisfying. They vary in their skills, and most medical schools have made significant investments in training and support activities. Many practices do not have the necessary infrastructure, and investments need to be made if extended placements are to be successful. Many patients are happy to be seen by students and Registrars, but careful thought needs to be given to implementing appropriate models so that students have good learning opportunities, patients are not disadvantaged and general practices can operate efficiently. Conclusion:,The success of this new model of clinical placements is dependent on medical schools having a detailed understanding of the needs and expectations of GPs. [source] | ||||||||||