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Residency
Kinds of Residency Terms modified by Residency Selected AbstractsGRATELOUPIA DORYPHORA HAS ESTABLISHED RESIDENCY IN RHODE ISLAND WATERSJOURNAL OF PHYCOLOGY, Issue 2000M. M. Harlin Since 1994, when Grateloupia doryphora (Halymeniaceae, Rhodophyta) was first detected in Rhode Island, the species has spread to the northern portions of Narragansett Bay and onto the open coast of Rhode Island Sound. Specimens collected at 5 m depths off North Prudence Island reached 175 cm in length and establish this alga as the largest member of the Florideophyceae on North Atlantic shores. Percent cover of populations is seasonal: highest in fall (September through November) and lowest in spring (March through May). Monthly measurements at three stations in Narragansett Bay show significant seasonal differences (p < 0.01) over two annual cycles. Artificial substrata placed in the field at known periods allowed measurements of growth rates on individual thalli. Laboratory culture clarified the sequence of life history stages that make this species a successful contender for space. [source] Residencies in Addiction Psychiatry: 1990 to 2000, A Decade of ProgressTHE AMERICAN JOURNAL ON ADDICTIONS, Issue 3 2002Marc Galanter M.D. This article reviews the history and status of addiction psychiatry residencies based on surveys conducted in 1990 and again in 1999. The 19 of 38 approved programs in operation since 1990 filled more positions than those that were more recently accredited, but they were not significantly different in time allocated to respective clinical assignments or in salary support. Altogether, the programs provide a broad array of training sites (inpatient and outpatient, alcohol and other-drug related) suitable for the diverse needs that graduates will encounter. There were, however, differences in the balance of time dedicated to research relative to patient care. Salaries were relatively modest and drawn from federal and local sources. [source] Bioterrorism Training in U.S. Emergency Medicine Residencies: Has It Changed since 9/11?ACADEMIC EMERGENCY MEDICINE, Issue 3 2007MSPH, Philip Kevin Moye MD Objectives: To assess the change in prevalence of bioterrorism training among emergency medicine (EM) residencies from 1998 to 2005, to characterize current training, and to identify characteristics of programs that have implemented more intensive training methods. Methods: This was a national cross sectional survey of the 133 U.S. EM residencies participating in the 2005 National Resident Matching Program; comparison with a baseline survey from 1998 was performed. Types of training provided were assessed, and programs using experiential methods were identified. Results: Of 112 programs (84.2%) responding, 98% reported formal training in bioterrorism, increased from 53% (40/76) responding in 1998. In 2005, most programs with bioterrorism training (65%) used at least three methods of instruction, mostly lectures (95%) and disaster drills (80%). Fewer programs used experiential methods such as field exercises or bioterrorism-specific rotations (35% and 13%, respectively). Compared with other programs, residency programs with more complex, experiential methods were more likely to teach bioterrorism-related topics at least twice a year (83% vs. 59%; p = 0.018), to teach at least three topics (60% vs. 40%; p = 0.02), and to report funding for bioterrorism research and education (74% vs. 45%; p = 0.007). Experiential and nonexperiential programs were similar in program type (university or nonuniversity), length of program, number of residents, geographic location, and urban or rural setting. Conclusions: Training of EM residents in bioterrorism preparedness has increased markedly since 1998. However, training is often of low intensity, relying mainly on nonexperiential instruction such as lectures. Although current recommendations are that training in bioterrorism include experiential learning experiences, the authors found the rate of these experiences to be low. [source] Dermatologic Surgery Training during Residency: Room for ImprovementDERMATOLOGIC SURGERY, Issue 5 2001Murad Alam MD No abstract is available for this article. [source] Should Dermatologic Surgery Training in Residency be Expanded?DERMATOLOGIC SURGERY, Issue 5 2001Jeffrey P. Callen MD No abstract is available for this article. [source] Assessment of residency and movement of the endangered bullhead (Cottus gobio) in two Flemish riversECOLOGY OF FRESHWATER FISH, Issue 4 2004G. Knaepkens Abstract,,, Residency and movement of bullheads (Cottus gobio) were assessed by mark-recapture from November 2001 to June 2002 in two Flemish rivers [Steenputbeek (SPB), Laarse Beek (LB)]. Although the majority of the recaptured bullheads (SPB: 66%; LB: 55%) was found in their initial tagging site before the spawning season, some fish had covered distances between 10,100 m (mean: 17 ± 2 m) and 10,70 m (mean: 18 ± 7 m), respectively. During the spawning season, the proportion of fish that moved (SPB: 58%; LB: 75%) and the distances travelled (SPB: between 10 and 90 m, mean 26 ± 3 m; LB: between 30 and 260 m, mean 133 ± 3 m) were significantly larger. In addition, analysis of individual movement behaviour of multiple recaptured bullheads showed that some fish were either always resident or mobile, while others switched between both behaviours. In general, our results suggest that not all bullheads exhibit sedentary behaviour but that the populations under study consist of both stationary and mobile individuals. Resumen 1. Desde Noviembre del año 2001 hasta Junio del 2002, evaluamos la residencia y los movimientos de Cottus gobio a través de técnicas de marcado-recaptura en dos ríos flamencos: Steenputbeek (SPB) y Laarse Beek (LB). Aunque antes de la estación reproductiva, la mayoría de los individuos re-capturados (66% en SPB y 55% en LB) fueron encontrados en las mismas localidades de marcado, algunos peces habían cubierto distancias entre 10 y 100 metros (media = 17.2 ± 2 m) y entre 10 y 70 m (media = 18.0 ± 7 m) en SPB y LB, respectivamente. Durante la estación reproductiva, tanto la proporción de individuos que se movieron (58% en SPB y 75% en LB), como las distancias recorridas fueron significativamente mayores: en SPB, entre 10 y 90 m, media = 26.0 ± 3 m y en LB entre 30 y 260 m, media = 133.0 ± 3 m. 2. Análisis del comportamiento entre múltiples individuos mostró que algunos individuos fueron o residentes o móviles mientras que otros individuos cambiaron entre ambos comportamientos. En general, nuestros resultados sugieren que no todos los individuos muestran comportamiento sedentario sino que la población incluye individuos estacionarios y móviles. [source] Residency and movement of stream-dwelling Japanese charr, Salvelinus leucomaenis, in a central Japanese mountain streamECOLOGY OF FRESHWATER FISH, Issue 3 2002T. Nakamura Abstract,,,The residency and movement of stream-dwelling adult (2+ and older) Japanese charr, Salvelinus leucomaenis, were studied by mark and recapture experiments in the Jadani Stream, a headwater tributary of the Tedori River, central Japan, from 1986 to 1989. Of the marked fish, 31.3,58.3% were recaptured in the same pools where they had been caught during the study periods of summer (June,August), autumn (August,November) and winter,spring (November to the next June) and no seasonal movement was observed. The mean distances that the fish moved during the study periods ranged from 139.0 to 502.3 m and many movements longer than 1000 m were observed. Between the resident and the moved fish, there was little difference in body length, growth rate or sex. For the fish that had been resident in the same pools and riffles at previous recaptures, most fish were recaptures in the same locations at the next recapture. Conversely, for the fish that moved previously, most fish were recaptured in different locations from previous sites at the next recapture. These results suggest that Japanese charr exhibit relatively high residency throughout the year, but many fish moved longer distance. The results also suggest the presence of static and mobile components in the charr population. [source] Gene-Environment Interaction in Patterns of Adolescent Drinking: Regional Residency Moderates Longitudinal Influences on Alcohol UseALCOHOLISM, Issue 5 2001Richard J. Rose Background: Drinking frequency escalates rapidly during adolescence. Abstinence declines markedly, and drinking monthly or more often becomes normative. Individual differences in adolescent drinking patterns are large, and some patterns are predictive of subsequent drinking problems; little, however, is known of the gene,environment interactions that create them. Methods: Five consecutive and complete birth cohorts of Finnish twins, born 1975,1979, were enrolled sequentially into a longitudinal study and assessed, with postal questionnaires, at ages 16, 17, and 18.5 years. The sample included 1786 same-sex twin pairs, of whom 1240 pairs were concordantly drinking at age 16. Maximum likelihood models were fit in longitudinal analyses of the three waves of drinking data to assess changes in genetic and environmental influences on alcohol use across adolescence. Secondary analyses contrasted twin pairs residing in rural versus those in urban environments to investigate gene,environment interactions. Results: Longitudinal analyses revealed that genetic factors influencing drinking patterns increased in importance across the 30-month period, and effects arising from common environmental influences declined. Distributions of drinking frequencies in twins residing in urban and rural environments were highly similar, but influences on drinking varied between the two environments. Genetic factors assumed a larger role among adolescents residing in urban areas, while common environmental influences were more important in rural settings. Formal modeling of the data established a significant gene,environment interaction. Conclusions: The results document the changing impact of genetic and environmental influences on alcohol use across adolescence. Importantly, the results also reveal a significant gene,environment interaction in patterns of adolescent drinking and invite more detailed analyses of the pathways and mechanisms by which environments modulate genetic effects. [source] Effect of an Integrated Public Health Curriculum in an Emergency Medicine ResidencyACADEMIC EMERGENCY MEDICINE, Issue 2009Marian Betz Background: Emergency departments (EDs) serve as a central point of interaction between the public and the medical system. Emergency physicians need education in public health in order to optimize their clinical care and their ability to evaluate potential public health interventions in the ED. Methods: As part of the Centers for Disease Control and Prevention (CDC) and the Association of American Medical College's (AAMC) national initiative for "Regional Medicine-Public Health Education Centers-Graduate Medical Education", we designed and implemented a new public health curriculum for the emergency medicine residents. Over four sessions during regular didactic time, we used a modular approach to link a basic public health principle, such as environmental hazard assessment, to a relevant clinical topic, such as violent patients and ED safety. Each session emphasized resident involvement, including small group work and role-plays. Journal clubs and quality assurance projects supplemented the curriculum. We sought resident feedback through focus groups and anonymous online pre- and post-tests for each session. Assessment: Both before and after the curriculum, 76% of responders felt it was important for physicians to receive training in public health. The program appeared to have a positive effect on residents' comfort level with various public health topics, and felt the residency program had taught them the skills necessary to implement public health principles in clinical practice (23.8%, versus 11.5% before; p<0.05). Conclusions: Integration of public health principles into existing clinical curricula in emergency medicine may increase resident interest and knowledge. Combining public health and emergency medicine topics in regular didactic conferences facilitates public health education for residents. [source] 18 Graduate Medical Education and Knowledge Translation: One Problem-Specific Approach in ResidencyACADEMIC EMERGENCY MEDICINE, Issue 2008Christopher Carpenter Traditional graduate medical education approaches to improving clinical performance based upon the latest research have included Journal Club and didactic lectures. Unfortunately, these educational interventions have rarely been demonstrated to change practice behavior or improve patient-important outcomes. Using a structured approach to identifying a gap between best-evidence knowledge and clinical practice, an illustrative one-year residency-wide translational research project was developed in a four year emergency medicine training program. Step one (assigned to the second year residents): identify and quantitatively justify a Knowledge Translation (KT) deficit within our institution. They identified steroids in adult bacterial meningitis as an unequivocal therapeutic option. Based upon a structured one-year chart review, they next demonstrated that only 7% of meningitis patients received pre-antimicrobial steroids. The next step (assigned to the first year residents): identify and quantify the physician "leaks" within the pipeline of information from publication to bedside utilization via an online survey. The third year residents hypothesized plugs for these information leaks, including examples of other specialties or institutions which have successfully navigated this specific clinical scenario. Finally, at an end-of-year Journal Club, the fourth year residents formulated a protocol for the appropriate use of steroids in suspected adult meningitis and brought together individuals from within the institution contributing to the best-practice leak. Knowledge Translation involves multiple stages beyond simple evidence awareness and usually involves continuation beyond the emergency department. The Washington University KT project offers a structured, multidisciplinary example of moving beyond contemplation to implementation of an unequivocal therapy. [source] Need for Standardized Sign-out in the Emergency Department: A Survey of Emergency Medicine Residency and Pediatric Emergency Medicine Fellowship Program DirectorsACADEMIC EMERGENCY MEDICINE, Issue 2 2007Madhumita Sinha MD Objectives To determine the existing patterns of sign-out processes prevalent in emergency departments (EDs) nationwide. In addition, to assess whether training programs provide specific guidance to their trainees regarding sign-outs and attitudes of emergency medicine (EM) residency and pediatric EM fellowship program directors toward the need for the development of standardized guidelines relating to sign-outs. Methods A Web-based survey of training program directors of each Accreditation Council for Graduate Medical Education (ACGME),accredited EM residency and pediatric EM fellowship program was conducted in March 2006. Results Overall, 185 (61.1%) program directors responded to the survey. One hundred thirty-six (73.5%) program directors reported that sign-outs at change of shift occurred in a common area within the ED, and 79 (42.7%) respondents indicated combined sign-outs in the presence of both attending and resident physicians. A majority of the programs, 119 (89.5%), stated that there was no uniform written policy regarding patient sign-out in their ED. Half (50.3%) of all those surveyed reported that physicians sign out patient details "verbally only," and 79 (42.9%) noted that transfer of attending responsibility was "rarely documented." Only 34 (25.6%) programs affirmed that they had formal didactic sessions focused on sign-outs. A majority (71.6%) of program directors surveyed agreed that specific practice parameters regarding transfer of care in the ED would improve patient care; 80 (72.3%) agreed that a standardized sign-out system in the ED would improve communication and reduce medical error. Conclusions There is wide variation in the sign-out processes followed by different EDs. A majority of those surveyed expressed the need for standardized sign-out systems. [source] Competence of New Emergency Medicine Residents in the Performance of Lumbar PuncturesACADEMIC EMERGENCY MEDICINE, Issue 7 2005Richard L. Lammers MD Abstract Background: Medical students are taught some procedural skills during medical school, but there is no uniform set of procedures that all students learn before residency. Objective: To determine the level of competence in the performance of a lumbar puncture (LP) by new postgraduate year 1 (PGY1) emergency medicine (EM) residents. Methods: An observational study was conducted at three EM residencies with 42 PGY1 residents who recently graduated from 26 various medical schools. The LP procedure was divided into 26 major and 44 minor steps to create a scoring protocol. The model, procedure, and scoring protocol were validated by experienced emergency physicians. Subjects performed the procedure without interruption or feedback on an LP training model using a standard LP kit. A step was scored as "performed correctly" if two of the three evaluators concurred. Pre- and poststudy questionnaires assessed subjects' prior instruction and clinical experience with LP, self-confidence, sense of relevance, motivation, and fatigue. Results: Subjects completed an average of 14.8 (57%; 95% confidence interval [95% CI] = 53% to 61%) of the major steps (range: 4,26) and 19.1 (43%; 95% CI = 42% to 45%) of the minor steps (range: 7,28) in 14.3 minutes (range: 3,22). Sixty-nine percent failed to obtain cerebrospinal fluid from the model. Subjects' levels of confidence changed slightly on a five-point scale from 2.8 ("little-to-some") before the test to 2.5 after the test. Eighty-three percent of the subjects previously performed LPs on patients during medical school (average attempts = 2.2; range: 0,10), but only 40% of those who did so were supervised by an attending during their first attempt. Conclusions: In the cohort studied, new PGY1 EM residents had not attained competence in performing LPs from training in medical school. Most new PGY1 residents probably require training, practice, and close, direct supervision of this procedure by attending physicians until the residents demonstrate competent performance. [source] Evolution of Academic Emergency Medicine over a Decade (1991-2001)ACADEMIC EMERGENCY MEDICINE, Issue 10 2002E. John Gallagher MD Abstract Objective: To test the hypothesis that emergency medicine (EM) has made significant, quantifiable progress within U.S. academic medicine over the past ten years, 1991-2001. Methods: Baseline (7/1/1991) and comparison (7/1/2001) data sets contained all Liaison Committee on Medical Education (LCME)-accredited schools, Association of Academic Chairs of Emergency Medicine (AACEM)-recognized academic departments of EM, Residency Review Committee (RRC)-accredited EM residencies, and Association of American Medical Colleges (AAMC)-designated academic medical centers. The increase over ten years in the two primary variables of academic departmental status, and EM residencies located at academic medical centers, was examined in the aggregate, then stratified by medical schools grouped by academic rank. Differences over time are expressed as simple proportions, bounded by 95% confidence intervals (95% CIs). Results: Between 1991 and 2001, the proportion of academic departments of EM at medical schools increased from 18% to 48% (95% CI for difference of 30%= 19% to 41%). The proportion of EM residencies at academic medical centers increased from 42% to 66% (95% CI for a difference of 24%= 11% to 36%). The largest increment of 37% (95% CI = 22% to 52%) in academic departments of EM, and of 36% (95% CI = 20% to 52%) in EM residencies located at academic medical centers, occurred within medical schools whose academic rank was above the median. Conclusions: A quantitatively and statistically significant increase in academic departments of EM within medical schools and EM residency programs at academic medical centers has occurred over the past decade. Half of all medical schools now have academic departments of EM, and two-thirds of academic medical centers house EM residency programs. This has taken place largely within institutions whose academic ranking places them among the top half of all U.S. medical schools. [source] Emergency Medicine Resident Patient Care Documentation Using a Hand-held Computerized DeviceACADEMIC EMERGENCY MEDICINE, Issue 12 2001Steven B. Bird MD Abstract Objective: To determine whether emergency medicine (EM) resident documentation of procedures, patient encounters, and patient follow-ups improved after implementation of a personal digital assistant (PDA) hand-held recording system. Methods: All first-year EM residents were provided a PalmV (Palm, Inc., Santa Clara, CA) PDA. A customized patient procedure and encounter program was constructed using Pendragon Forms (Pendragon Software Corporation, Libertyville, IL) and loaded into each PDA. Residents were instructed to enter information on patients who had any of 21 procedures performed or were considered to be clinically unstable. These data were downloaded to the residency coordinator's desktop computer. The mean number of procedures, encounters, and follow-ups performed per resident were then compared with those of a group of 36 historical controls from the three previous first-year resident classes who recorded the same information using a handwritten card system. Data from the historical controls were combined and the means of each group were compared by Student's t-test. Results: Mean documentation of three procedures was significantly increased in the PDA group versus the index card system: conscious sedation 5.8 vs. 0.03 (p < 0.000005), thoracentesis 2.2 vs. 0.0 (p = 0.002), ultrasound 6.3 vs. 0.0 (p = 0.002). The mean numbers of pericardiocenteses and unstable pediatric surgical patient evaluations were significantly decreased in the hand-held group [from 1.2 to 0.4 (p = 0.03) and from 9.1 to 2.2 (p = 0.02), respectively]. Patient follow-up documentations were not statistically different between the two groups. Conclusions: Use of a hand-held PDA was associated with an increase in first-year EM resident documentation in three of 20 procedures and a decrease in one procedure and the number of unstable surgical pediatric patient resuscitations. The overall time savings in constructing a resident procedure database, as well as the other uses of the PDAs, may make transition to a hand-held computer-based procedure log an attractive option for EM residencies. [source] Selection Criteria for Emergency Medicine Residency ApplicantsACADEMIC EMERGENCY MEDICINE, Issue 1 2000Joseph T. Crane MD Abstract: Objectives: To determine the criteria used by emergency medicine (EM) residency selection committees to select their residents, to determine whether there is a consensus among residency programs, to inform programs of areas of possible inconsistency, and to better educate applicants pursuing careers in EM. Methods: A questionnaire consisting of 20 items based on the current Electronic Residency Application Service (ERAS) guidelines was mailed to the program directors of all 118 EM residencies in existence in February 1998. The program directors were instructed to rank each item on a five-point scale (5 = most important, 1 = least important) as to its importance in the selection of residents. Followup was done in the form of e-mail and facsimile. Results: The overall response rate was 79.7%, with 94 of 118 programs responding. Items ranking as most important (4.0-5.0) in the selection process included: EM rotation grade (mean ± SD = 4.79 ± 0.50), interview (4.62 ± 0.63), clinical grades (4.36 ± 0.70), and recommendations (4.11 ± 0.85). Moderate emphasis (3.0-4.0) was placed on: elective done at program director's institution (3.75 ± 1.25), U.S. Medical Licensing Examination (USMLE) step II (3.34 ± 0.93), interest expressed in program director's institution (3.30 ± 1.19), USMLE step I (3.28 ± 0.86), and awards/achievements (3.16 ± 0.88). Less emphasis (<3.0) was placed on Alpha Omega Alpha Honor Society (AOA) status (3.01 ± 1.09), medical school attended (3.00 ± 0.85), extracurricular activities (2.99 ± 0.87), basic science grades (2.88 ± 0.93), publications (2.87 ± 0.99), and personal statement (2.75 ± 0.96). Items most agreed upon by respondents (lowest standard deviation, SD) included EM rotation grade (SD 0.50), interview (SD 0.63), and clinical grades (SD 0.70). Of the 94 respondents, 37 (39.4%) replied they had minimum requirements for USMLE step I (195.11 ± 13.10), while 30 (31.9%) replied they had minimum requirements for USMLE step II (194.27 ± 14.96). Open-ended responses to "other" were related to personal characteristics, career/goals, and medical school performance. Conclusions: The selection criteria with the highest mean values as reported by the program directors were EM rotation grade, interview, clinical grades, and recommendations. Criteria showing the most consistency (lowest SD) included EM rotation grade, interview, and clinical grades. Results are compared with those from previous multispecialty studies. [source] Samples: to use or not to use?JOURNAL OF CLINICAL PHARMACY & THERAPEUTICS, Issue 6 2005K. K. Daugherty PharmD BCPS Summary The United States Prescription Drug Marketing Act makes people think that samples are simply advertisement for the drug companies. However, this is not the only reason that they are used. Samples make up a large part of most drug companies' budgets and are used by many clinics with very little control. We need to ensure that these products are being used appropriately. This is becoming a big issue as reports suggest that over 90% of family practise residency clinics allow personal use of drug samples and 60% of pharmaceutical representatives have either used samples for themselves or have given them to non-physicians. The other disturbing fact is that despite the high use of samples, fewer than 10% of family practise residencies in a Brotzman and Mark study reported having written policies regarding the use of samples. The purpose of this article was to review the literature concerning the reasons for use of drug samples, and the problems associated with such use, and then to discuss possible procedures that offices, especially those that train resident physicians, can implement to ensure good governance, if such use is permitted. [source] Well-being in residency: a time for temporary imbalance?MEDICAL EDUCATION, Issue 3 2007Neda Ratanawongsa Context, Previous quantitative studies about doctor well-being have focused primarily on negative well-being, such as burnout. We conducted this study to understand residents' perspectives on well-being. Methods, We conducted 45-minute interviews with residents from 9 residencies at 2 academic hospitals in Baltimore, Maryland. From February to June 2005, we approached 49 residents through random sampling stratified by programme and gender. The semi-structured instrument elicited descriptions of well-being in residency and factors related to its promotion or reduction. Using an editing analysis style, investigators independently coded transcripts, agreeing on the coding template and its application. Results, The 26 participating residents came from internal medicine (3 programmes), psychiatry, surgery, emergency medicine, anaesthesia, obstetrics and gynaecology, and paediatrics. Six themes emerged: balance among multiple domains; professional development and temporary imbalance; professional satisfaction and accomplishment; maintaining a sense of self; stressors and coping strategies, and the role of residency programmes. Residents described well-being as a balance among multiple domains, including professional development, relationships, and physical and mental health. They viewed residency as a time for temporary imbalance, during which they invested in professional development at the expense of other domains. Some residents described feeling a ,loss of self'. Residents revealed strategies for coping with stressors and endorsed ways in which training programmes helped to enhance their well-being. Conclusions, Resident well-being was closely connected to professional development and required varying degrees of self-sacrifice with a re-balancing of personal priorities. These findings should be considered by training programmes that are interested in enhancing resident well-being. [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] Spinal Cord Stimulation Surgical Technique for the Nonsurgically TrainedNEUROMODULATION, Issue 2009FRCP (C), Marshall D. Bedder MD ABSTRACT The objective of this paper is to educate physicians who implant spinal cord stimulators in current surgical techniques. Many implanters have not gone through formal surgical residencies and learn their surgical techniques during a one year Fellowship or from proctoring experience. This paper utilizes current concepts from the literature to reinforce appropriate surgical practices, which are applicable to surgeons as well as interventional pain physicians. This should be a valuable resource for all Fellows whether they are in surgical programs or pain fellowship programs. In addition, a more detailed presentation is made at the end of this paper on a proposed simple one-incision surgical technique for implantation of small internal pulse generators. This is the first publication in the literature describing such a technique and may be useful for less-experienced implanters, as well as conferring potential advantages in surgical technique. [source] Residencies in Addiction Psychiatry: 1990 to 2000, A Decade of ProgressTHE AMERICAN JOURNAL ON ADDICTIONS, Issue 3 2002Marc Galanter M.D. This article reviews the history and status of addiction psychiatry residencies based on surveys conducted in 1990 and again in 1999. The 19 of 38 approved programs in operation since 1990 filled more positions than those that were more recently accredited, but they were not significantly different in time allocated to respective clinical assignments or in salary support. Altogether, the programs provide a broad array of training sites (inpatient and outpatient, alcohol and other-drug related) suitable for the diverse needs that graduates will encounter. There were, however, differences in the balance of time dedicated to research relative to patient care. Salaries were relatively modest and drawn from federal and local sources. [source] AHEC in West Virginia: A Case StudyTHE JOURNAL OF RURAL HEALTH, Issue 1 2003Lamont D. Nottingham MPH The outcome is an evolving universitycommunity partnership designed to meet changing workforce and community health needs in the heart of rural Appalachia. West Virginia University's (WVU's) application of the original Carnegie Commission AHEC recommendations (1970) resulted in the Charleston AHEC, now part of the Robert C. Byrd Health Sciences Center of WVU. AHEC today trains more than 135 residents and interns, and one-third of the third-year and fourth-year WVU medical students. Charleston offers clinical and continuing education for nurses, dentists, pharmacists, and allied health professionals. A health sciences library, distance learning, and a neiwork of primary care clinics help define Charleston's unique AHEC role. This AHEC hub continues to meet the classic Carnegie goals of recruiting and retaining health professionals, and providing access to care in the original service area and statewide. Based on the Charleston experience, four new federally funded AHECs are being developed to link rural primary care residencies with the state-funded West Virginia rural health education partnerships. These rural consortia AHECs are applying the concept of community competency, a performance-based methodology, to integrate learning while achieving the goals of Healthy People 2010. [source] Combined Residency Training in Emergency Medicine and Internal Medicine: An Update on Career Outcomes and Job SatisfactionACADEMIC EMERGENCY MEDICINE, Issue 9 2009Chad S. Kessler MD Abstract Objectives:, This study was designed to provide an update on the career outcomes and experiences of graduates of combined emergency medicine-internal medicine (EM-IM) residency programs. Methods:, The graduates of the American Board of Emergency Medicine (ABEM) and American Board of Internal Medicine (ABIM)-accredited EM-IM residencies from 1998 to 2008 were contacted and asked to complete a survey concerning demographics, board certification, fellowships completed, practice setting, academic affiliation, and perceptions about EM-IM training and careers. Results:, There were 127 respondents of a possible 163 total graduates for a response rate of 78%. Seventy graduates (55%) practice EM only, 47 graduates (37%) practice both EM and IM, and nine graduates (7%) practice IM or an IM subspecialty only. Thirty-one graduates (24%) pursued formal fellowship training in either EM or IM. Graduates spend the majority of their time practicing clinical EM in an urban (72%) and academic (60%) environment. Eighty-seven graduates (69%) spend at least 10% of their time in an academic setting. Most graduates (64%) believe it practical to practice both EM and IM. A total of 112 graduates (88%) would complete EM-IM training again. Conclusions:, Dual training in EM-IM affords a great deal of career opportunities, particularly in academics and clinical practice, in a number of environments. Graduates hold their training in high esteem and would do it again if given the opportunity. [source] "Sim Wars": A New Edge to Academic Residency CompetitionsACADEMIC EMERGENCY MEDICINE, Issue 2009Yasuharu Okuda Introduction: Simulation training is an educational modality that is increasingly being utilized by emergency medicine programs to train and assess residents in core competencies. During a recent national conference, patient simulators were used in a competition to highlight multitasking, teamwork, and patient care skills. The combination of audience participation and an expert panel provided a creative forum for learning. Methods: the Foundation for Education and Research in Neurological Emergencies (FERNE) and the Emergency Medicine Residents' Association (EMRA) sponsored an innovative competition between emergency medicine residencies during the 2008 Scientific Assembly of the American College of Emergency Physicians (ACEP). This competition used high-fidelity simulations to create scenarios on neurologic emergencies. Six teams were selected to participate in the three-hour single-elimination competition. The three-member resident teams were then randomly paired against another institution. Three separate 10 minute scenarios were created for the initial round, allowing paired teams to compete on the same scenario. An expert panel provided commentary and insight on the management by each team. In addition, the experts provided feedback in the areas of communication and team training. Each round's winners were determined by the audience using an interactive system. Results: Based on the immediate feedback from participants, audience members and the expert panelists, this event was an entertaining and successful learning experience for both residents and faculty. Like the Clinical Pathological Cases (CPC) competitions, "Sim Wars" provides a showcase for residencies to demonstrate practice philosophies while providing a unique emphasis on teamwork and communication skills. The ability to expand this program to include regional competitions that lead to a national contest could be the framework for future exciting and educational events. [source] Use of Simulation Technology in Forensic Medical EducationACADEMIC EMERGENCY MEDICINE, Issue 2009Heather Rozzi Although the emergency department often provides the first and only opportunity to collect forensic evidence, very few emergency medicine residencies have a forensic medicine curriculum in place. Most of the existing curricula are composed only of traditional didactics. However, as with any lecture-based education, there may be a significant delay between the didactic session and clinical application. In addition, traditional curricula lack the opportunity for residents to practice skills including evidence collection, documentation, and use of a colposcope. At York Hospital, we have developed a forensic curriculum which consists of both traditional lectures and practical experience in our Medical Simulation Center. As part of their educational conference series, residents receive presentations on domestic violence, child abuse, elder abuse, evidence collection, sexual assault, ballistics, pattern injuries, documentation, forensic photography, and court testimony. Following these presentations, residents have the opportunity to apply their knowledge of forensic medicine in the Simulation Center. First, they interview a standardized patient. They then utilize the mannequins in the Simulation Center to practice evidence collection, photo documentation, and use of our specialized forensic medicine charts. After evidence collection and documentation, the residents provide safety planning for the standardized patients. Each portion is videotaped, and each resident is debriefed by victim advocates, experienced sexual assault nurse examiners, and emergency department faculty. The use of simulation technology in resident education provides the opportunity to practice the skills of forensic medicine, ultimately benefiting patients, residents, and law enforcement, and permitting teaching and evaluation in all six core competency areas. [source] 19 A Novel Approach to Residency Education in EMS: The MD-PM AmbulanceACADEMIC EMERGENCY MEDICINE, Issue 2008Angela Fiege Challenge:, Indiana University EM residents have actively provided prehospital care as crew members on a hospital-based air ambulance service. This service functions as a secondary responder for high acuity patients who have already had first tier evaluation and care. First response, ground EMS experiences have been observational only as residents have ridden along with a two-paramedic team on an urban ambulance service for 24 hours during their residency careers. Resident understanding of first response care and challenges faced by initial EMS providers has been limited to that gleaned during their observational period. Solution:, Most EM residencies do not provide opportunities for residents to function as first response providers. Therefore, we developed a Physician-Paramedic team to provide first response care within a busy metropolitan area. This two-member team operates within a "geozone" that includes a diverse patient population with both medical and trauma complaints. Unlike other residency ground EMS programs, the MD-PM truck responds primarily to all ambulance requests within their designated geozone and assists outside their designated geozone for multi-patient casualties in which a physician response would benefit patient care (fires, motor vehicle accidents, multiple gunshot victims). Residents on the MD-PM truck not only provide care equivalent to that expected of a nationally certified paramedic (IVs, drug administration, splinting, packaging), but also perform advanced skills such as RSI which is outside the scope of a traditional two-paramedic team. Immersion into the first response ground EMS system will provide valuable insight into the challenges of providing care outside of the hospital. [source] A Longitudinal Study of Emergency Medicine Residents' Malpractice Fear and Defensive MedicineACADEMIC EMERGENCY MEDICINE, Issue 6 2007Robert M. Rodriguez MD Objectives:To determine the baseline level and evolution of defensive medicine and malpractice concern (MC) of emergency medicine (EM) residents. Methods:Using a validated instrument consisting of case scenarios and Likert-type scale questions, the authors performed a prospective, longitudinal (June 2001 to June 2005) study of EM residents at five 4-year California residency programs. Results:All 51 EM interns of these residencies were evaluated; four residents left their programs and one took medical leave, resulting in 46 graduating residents evaluated. MC did not affect the residency choice of interns. Although perceived likelihood of serious disease increased in case scenarios over time, defensive medicine decreased in 27% of cases and increased in 20%. On a scale with 1 representing extremely influential and 5 representing not at all influential, the mean (±SD) influence of MC on interns' and graduates' case evaluation and management was 2.5 (±1.1) and 2.7 (±1.0), respectively. Comparing interns and graduates, there was no significant difference in the percentages of respondents who declared MC (mean difference in proportions, 3.3%; 95% CI =,8.4% to 15%) or refused procedures because of MC (11.5%; 95% CI =,1.3% to 24.3%). More interns, however, declared substantial loss of enjoyment of medicine than graduates (48%; 95% CI = 30.3% to 65.5%). Conclusions:Physicians enter four-year EM residencies in California with moderate MC and defensive medicine, which do not change significantly over time and do not markedly impact their decisions to perform emergency department procedures. Malpractice fear markedly decreases interns' enjoyment of medicine, but this effect decreases by residency completion. [source] Bioterrorism Training in U.S. Emergency Medicine Residencies: Has It Changed since 9/11?ACADEMIC EMERGENCY MEDICINE, Issue 3 2007MSPH, Philip Kevin Moye MD Objectives: To assess the change in prevalence of bioterrorism training among emergency medicine (EM) residencies from 1998 to 2005, to characterize current training, and to identify characteristics of programs that have implemented more intensive training methods. Methods: This was a national cross sectional survey of the 133 U.S. EM residencies participating in the 2005 National Resident Matching Program; comparison with a baseline survey from 1998 was performed. Types of training provided were assessed, and programs using experiential methods were identified. Results: Of 112 programs (84.2%) responding, 98% reported formal training in bioterrorism, increased from 53% (40/76) responding in 1998. In 2005, most programs with bioterrorism training (65%) used at least three methods of instruction, mostly lectures (95%) and disaster drills (80%). Fewer programs used experiential methods such as field exercises or bioterrorism-specific rotations (35% and 13%, respectively). Compared with other programs, residency programs with more complex, experiential methods were more likely to teach bioterrorism-related topics at least twice a year (83% vs. 59%; p = 0.018), to teach at least three topics (60% vs. 40%; p = 0.02), and to report funding for bioterrorism research and education (74% vs. 45%; p = 0.007). Experiential and nonexperiential programs were similar in program type (university or nonuniversity), length of program, number of residents, geographic location, and urban or rural setting. Conclusions: Training of EM residents in bioterrorism preparedness has increased markedly since 1998. However, training is often of low intensity, relying mainly on nonexperiential instruction such as lectures. Although current recommendations are that training in bioterrorism include experiential learning experiences, the authors found the rate of these experiences to be low. [source] Integrating the Core Competencies: Proceedings from the 2005 Academic Assembly ConsortiumACADEMIC EMERGENCY MEDICINE, Issue 1 2007Sarah A. Stahmer MD Abstract The Accreditation Council for Graduate Medical Education mandated the integration of the core competencies into residency training in 2001. To this end, educators in emergency medicine (EM) have been proactive in their approach, using collaborative efforts to develop methods that teach and assess the competencies. The first steps toward a collaborative approach occurred during the proceedings of the Council of Emergency Medicine Residency Directors (CORD-EM) academic assembly in 2002. Three years later, the competencies were revisited by working groups of EM program directors and educators at the 2005 Academic Assembly. This report provides a summary discussion of the status of integration of the competencies into EM training programs in 2005. [source] High-level distribution for the rapid production of robust telecoms software: comparing C++ and ERLANGCONCURRENCY AND COMPUTATION: PRACTICE & EXPERIENCE, Issue 8 2008J. H. Nyström Abstract Currently most distributed telecoms software is engineered using low- and mid-level distributed technologies, but there is a drive to use high-level distribution. This paper reports the first systematic comparison of a high-level distributed programming language in the context of substantial commercial products. Our research strategy is to reengineer some C++/CORBA telecoms applications in ERLANG, a high-level distributed language, and make comparative measurements. Investigating the potential advantages of the high-level ERLANG technology shows that two significant benefits are realized. Firstly, robust configurable systems are easily developed using the high-level constructs for fault tolerance and distribution. The ERLANG code exhibits resilience: sustaining throughput at extreme loads and automatically recovering when load drops; availability: remaining available despite repeated and multiple failures; dynamic reconfigurability: with throughput scaling near-linearly when resources are added or removed. Secondly, ERLANG delivers significant productivity and maintainability benefits: the ERLANG components are less than one-third of the size of their C++ counterparts. The productivity gains are attributed to specific language features, for example, high-level communication saves 22%, and automatic memory management saves 11%,compared with the C++ implementation. Investigating the feasibility of the high-level ERLANG technology demonstrates that it fulfils several essential requirements. The requisite distributed functionality is readily specified, even although control of low-level distributed coordination aspects is abrogated to the ERLANG implementation. At the expense of additional memory residency, excellent time performance is achieved, e.g. three times faster than the C++ implementation, due to ERLANG's lightweight processes. ERLANG interoperates at low cost with conventional technologies, allowing incremental reengineering of large distributed systems. The technology is available on the required hardware/operating system platforms, and is well supported. Copyright © 2007 John Wiley & Sons, Ltd. [source] The development of a specialist hostel for the community management of personality disordered offendersCRIMINAL BEHAVIOUR AND MENTAL HEALTH, Issue 1 2009Stephen Blumenthal Background,Since the late 1990s, in England and in Wales, there has been increasing interest in the particular challenges of managing offenders with personality disorder (PD). In 1999, a specialist hostel, managed by the probation service but with a high level of forensic mental health service input, was opened to high-risk PD offenders. Aims,To describe the first 93 high-risk residents with PD who were completing sentences under life licence, parole or probation, and their outcome. Methods,We investigated the nature of the offences residents had previously committed, their psychological profile in terms of personality patterns on the Millon Clinical Multiaxial Inventory (MCMI-III) and the Psychopathy Checklist-Revised (PCL-R), as well as staff commentary on their progress, to establish whether these factors related to outcome in terms of completion of stay in the hostel or premature discharge. Curfew failures and rearrest rates were also measured. Results,Of the 80 men who completed their residency within the two years of the study, the majority (50) left the hostel for positive reasons under mutual agreement. One-fifth were rearrested while resident, which is a lower rate than would be expected for such a group of offenders. PCL-R scores were predictive of outcome, but so was previous offending history. Self-defeating traits on the MCMI-III and negative comments written by hostel staff were also associated with failure. Conclusions,The hostel development demonstrated that probation and health services can work together to manage violent offenders with high levels of psychological dysfunction, and the evaluation provided some indications of how such arrangements might be enhanced. Copyright © 2009 John Wiley & Sons, Ltd. [source] | |||||||||||||||||||||||||||||||||||||