Mayans, David; Schneider, Logan; Adams, Nellie; Khawaja, Ayaz M.; Engstrom, John
Objective: To survey US-trained graduating neurology residents who are American Academy of Neurology members, in an effort to trend perceived quality and completeness of graduate neurology education. Methods: An electronic survey was sent to all American Academy of Neurology members graduating from US neurology residency programs in the Spring of 2014. Results: Of 805 eligible respondents, 24% completed the survey. Ninety-three percent of adult neurology residents and 56% of child neurology residents reported plans to pursue fellowship training after residency. Respondents reported a desire for additional training in neurocritical care, neuro-oncology, neuromuscular diseases, botulinum toxin injection, and nerve blocks. There remains a clear deficit in business training of neurology residents, although there was notable improvement in knowledge of coding and office management compared to previous surveys. Discussion: Although there are still areas of perceived weakness in neurology training, graduating neurology residents feel generally well prepared for their chosen careers. However, most still pursue fellowship training for reasons that are little understood. In addition to certain subspecialties and procedures, practice management remains deficient in neurology training and is a point of future insecurity for most residents. Future curriculum changes should consider resident-reported gaps in knowledge, with careful consideration of improving business training. PMID:26976522
Biomedical or clinical informatics is the transdisciplinary field that studies and develops effective uses of biomedical data, information technology innovations, and medical knowledge for scientific inquiry, problem solving, and decision making, with an emphasis on improving human health. Given the ongoing advances in information technology, the field of informatics is becoming important to clinical practice and to residency education. This article will discuss how informatics is specifically relevant to residency education and the different ways to incorporate informatics into residency education, and will highlight applications of current technology in the context of residency education. How informatics can optimize communication for residents, promote information technology use, refine documentation techniques, reduce medical errors, and improve clinical decision making will be reviewed. It is hoped that this article will increase faculty and trainees' knowledge of the field of informatics, awareness of available technology, and will assist practitioners to maximize their ability to provide quality care to their patients. This article will also introduce the idea of incorporating informatics specialists into residency programs to help practitioners deliver more evidenced-based care and to further improve their efficiency. Copyright © 2017 American Academy of Physical Medicine and Rehabilitation. Published by Elsevier Inc. All rights reserved.
Kansagra, Akash P
The revised ABR board certification process has updated the method by which diagnostic radiology residents are evaluated for competency in clinical radiologic physics. In this work, the author reports the successful design and implementation of a resident-taught physics course consisting of 5 weekly, hour-long lectures intended for incoming first-year radiology residents in their first month of training. To the author's knowledge, this is the first description of a course designed to provide a very early framework for ongoing physics education throughout residency without increasing the didactic burden on faculty members. Twenty-six first-year residents spanning 2 academic years took the course and reported subjective improvement in their knowledge (90%) and interest (75%) in imaging physics and a high level of satisfaction with the use of senior residents as physics educators. Based on the success of this course and the minimal resources required for implementation, this work may serve as a blueprint for other radiology residency programs seeking to develop revised physics curricula. Copyright © 2014 American College of Radiology. Published by Elsevier Inc. All rights reserved.
Waineo, Eva; Arfken, Cynthia L.; Morreale, Mary K.
Objective: This report discusses psychiatric residents' perceptions of sexual health education and their opinions regarding curricular improvements. Methods: An anonymous, web-based survey was sent to residents in one general psychiatry program (N = 33). The response rate was 69.7%. Results: Residents reported inadequate experience in multiple…
Creating new library services through collaboration with resident groups : Aimimg at human resource development and information literacy education in ways only libraries can do : Study on activities of an NPO called Ueda Library Club
Creating new library services through collaboration with resident groups : Aimimg at human resource development and information literacy education in ways only libraries can do : Study on activities of an NPO called Ueda Library Club
Karlen, Naomi; Cruz, Brian; Leigh, A E
Despite the growth of palliative medicine, 39% of hospitals do not have palliative care teams for consultation or to provide resident education. We examined the impact of resident-led education in palliative care principles on attitudes toward and comfort with palliative medicine and end-of-life care among internal medicine residents. An educational module designed by the authors was presented to other internal medicine residents in the program. Pre- and post-intervention survey data measuring residents' agreement with various statements regarding palliative medicine and end-of-life care were analyzed. Residents' agreement with various statements regarding palliative medicine and end-of-life care on a 5-point Likert scale was analyzed. Following the intervention, participants reported improved comfort with general knowledge of palliative medicine (p palliative care and end-of-life care (p curriculum in palliative medicine can improve resident comfort within this still-under-represented area of medicine.
Bohm, Parker E; Arnold, Paul M
A host of factors have contributed to the increasing use of simulation in neurosurgical resident education. Although the number of simulation-related publications has increased exponentially over the past two decades, no studies have specifically examined the role of simulation in resident education in spinal neurosurgery. We performed a structured search of several databases to identify articles detailing the use of simulation in spinal neurosurgery education in an attempt to catalogue potential applications for its use. A brief history of simulation in medicine is given, followed by current trends of spinal simulation utilization in residency programs. General themes from the literature are identified that are integral for implementing simulation into neurosurgical residency curriculum. Finally, various applications are reported. The use of simulation in spinal neurosurgery education is not as ubiquitous in comparison to other neurosurgical subspecialties, but many promising methods of simulation are available for augmenting resident education.
Albert, Dara V F; Patel, Anup D; Behnam-Terneus, Maria; Sautu, Beatriz Cunill-De; Verbeck, Nicole; McQueen, Alisa; Fromme, H Barrett; Mahan, John D
The aim of this study was to evaluate whether the current state of child neurology education during pediatric residency provides adequate preparation for pediatric practice. A survey was sent to recent graduates from 3 pediatric residency programs to assess graduate experience, perceived level of competence, and desire for further education in child neurology. Responses from generalists versus subspecialists were compared. The response rate was 32%, half in general pediatric practice. Only 22% feel very confident in approaching patients with neurologic problems. This may represent the best-case scenario as graduates from these programs had required neurology experiences, whereas review of Accreditation Council of Graduate Medical Education-accredited residency curricula revealed that the majority of residencies do not. Pediatric neurologic problems are common, and pediatric residency graduates do encounter such problems in practice. The majority of pediatricians report some degree of confidence; however, some clear areas for improvement are apparent.
Drogan, O.; Manno, E.; Geocadin, R.G.; Ziai, W.
Objective: Limited information is available regarding the current state of neurocritical care education for neurology residents. The goal of our survey was to assess the need and current state of neurocritical care training for neurology residents. Methods: A survey instrument was developed and, with the support of the American Academy of Neurology, distributed to residency program directors of 132 accredited neurology programs in the United States in 2011. Results: A response rate of 74% (98 of 132) was achieved. A dedicated neuroscience intensive care unit (neuro-ICU) existed in 64%. Fifty-six percent of residency programs offer a dedicated rotation in the neuro-ICU, lasting 4 weeks on average. Where available, the neuro-ICU rotation was required in the vast majority (91%) of programs. Neurology residents' exposure to the fundamental principles of neurocritical care was obtained through a variety of mechanisms. Of program directors, 37% indicated that residents would be interested in performing away rotations in a neuro-ICU. From 2005 to 2010, the number of programs sending at least one resident into a neuro-ICU fellowship increased from 14% to 35%. Conclusions: Despite the expansion of neurocritical care, large proportions of US neurology residents have limited exposure to a neuro-ICU and neurointensivists. Formal training in the principles of neurocritical care may be highly variable. The results of this survey suggest a charge to address the variability of resident education and to develop standardized curricula in neurocritical care for neurology residents. PMID:22573636
Calhoon, John H; Baisden, Clint; Holler, Ben; Hicks, George L; Bove, Ed L; Wright, Cameron D; Merrill, Walter H; Fullerton, Dave A
We sought to define an accurate measure of thoracic surgical education costs. Program directors from six distinct and differently sized and geographically located thoracic surgical training programs used a common template to provide estimates of resident educational costs. These data were reviewed, clarifying questions or discrepancies when noted and using best estimates when exact data were unavailable. Subsequently, a composite of previously published cost-estimation products was used to capture accurate cost data. Data were then compiled and averaged to provide an accurate picture of all costs associated with thoracic surgical education. Before formal accounting was performed, the estimated average for all programs was approximately $250,000 per year per resident. However, when formal evaluations by the six programs were performed, the annual cost of resident education ranged from $330,000 to $667,000 per year per resident. The average cost of $483,000 per year was almost double the initial estimates. Variability was noted by region and size of program. Faculty teaching costs varied from $208,000 to $346,000 per year. Simulation costs ranged from $0 to $80,000 per year. Resident savings to program ranged from $0 to $135,000 per year and averaged $37,000 per year per resident. Thoracic surgical education costs are considerably higher than initial estimates from program directors and probably represent an unappreciated source of financial burden for cardiothoracic surgical educational programs. Copyright © 2014 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.
MDW/SGVU SUBJECT: Professional Presentation Approval 27 JULY 2017 Your paper, entitled Resident Research Fundamentals Course - "Human Research ...Curves in the Road" (27 Sep 2017) presented at/published to Resident Research Fundamentals Course - JBSA Lackland, San Antonio, TX - 27 Sep 2017 in...are a Graduate Health Sciences Education student and your department has told you they cannot fund your publication, the 59th Clinical Research
Mahood, S.; Rojas, R.; Andres, D.; Zagozeski, C.; White, G.; Bradel, T.
An educational contract for family medicine residency training and evaluation addresses many of the difficulties and challenges of current postgraduate medical education. This article identifies important principles for developing a contractual approach; describes the contract used in one program and its implementation; and discusses its theory, advantages, and limitations.
Oliveira, Aparecido Ferreira de; Lederman, Henrique Manoel; Batista, Nildo Alves
Objective: to investigate the process of learning on human resource management in the radiology residency program at Escola Paulista de Medicina - Universidade Federal de Sao Paulo, aiming at improving radiologists' education. Materials and methods: exploratory study with a quantitative and qualitative approach developed with the faculty staff, preceptors and residents of the program, utilizing a Likert questionnaire (46), taped interviews (18), and categorization based on thematic analysis. Results: According to 71% of the participants, residents have clarity about their role in the development of their activities, and 48% said that residents have no opportunity to learn how to manage their work in a multidisciplinary team. Conclusion: Isolation at medical records room, little interactivity between sectors with diversified and fixed activities, absence of a previous culture and lack of a training program on human resources management may interfere in the development of skills for the residents' practice. There is a need to review objectives of the medical residency in the field of radiology, incorporating, whenever possible, the commitment to the training of skills related to human resources management thus widening the scope of abilities of the future radiologists. (author)
Oliveira, Aparecido Ferreira de; Lederman, Henrique Manoel; Batista, Nildo Alves, E-mail: email@example.com [Universidade Federal de Sao Paulo (EPM/UNIFESP), Sao Paulo, SP (Brazil). Escola Paulista de Medicina
Objective: to investigate the process of learning on human resource management in the radiology residency program at Escola Paulista de Medicina - Universidade Federal de Sao Paulo, aiming at improving radiologists' education. Materials and methods: exploratory study with a quantitative and qualitative approach developed with the faculty staff, preceptors and residents of the program, utilizing a Likert questionnaire (46), taped interviews (18), and categorization based on thematic analysis. Results: According to 71% of the participants, residents have clarity about their role in the development of their activities, and 48% said that residents have no opportunity to learn how to manage their work in a multidisciplinary team. Conclusion: Isolation at medical records room, little interactivity between sectors with diversified and fixed activities, absence of a previous culture and lack of a training program on human resources management may interfere in the development of skills for the residents' practice. There is a need to review objectives of the medical residency in the field of radiology, incorporating, whenever possible, the commitment to the training of skills related to human resources management thus widening the scope of abilities of the future radiologists. (author)
Aparecido Ferreira de Oliveira
Full Text Available Objective To investigate the process of learning on human resource management in the radiology residency program at Escola Paulista de Medicina – Universidade Federal de São Paulo, aiming at improving radiologists' education. Materials and Methods Exploratory study with a quantitative and qualitative approach developed with the faculty staff, preceptors and residents of the program, utilizing a Likert questionnaire (46, taped interviews (18, and categorization based on thematic analysis. Results According to 71% of the participants, residents have clarity about their role in the development of their activities, and 48% said that residents have no opportunity to learn how to manage their work in a multidisciplinary team. Conclusion Isolation at medical records room, little interactivity between sectors with diversified and fixed activities, absence of a previous culture and lack of a training program on human resources management may interfere in the development of skills for the residents' practice. There is a need to review objectives of the medical residency in the field of radiology, incorporating, whenever possible, the commitment to the training of skills related to human resources management thus widening the scope of abilities of the future radiologists.
Full Text Available Julie A Croley,1 C Helen Malone,1 Brandon P Goodwin,1 Linda G Phillips,2 Eric L Cole,2 Richard F Wagner1 1Department of Dermatology, 2Division of Plastic Surgery, Department of Surgery, The University of Texas Medical Branch, Galveston, TX, USA Background: Surgical reconstructive planning following Mohs surgery can be a difficult subject for dermatology residents to master. Prior research demonstrates that active learning is preferred and more effective compared to passive learning models and that dermatology residents desire greater complexity and volume in surgical training. We present a novel, active, problem-based learning tool for the education of Mohs reconstruction with the goal of improving residents’ ability to plan surgical reconstructions.Materials and methods: The Mohs Surgical Reconstruction Educational Activity is an active, problem-based learning activity in which residents designed repairs for planned Mohs defects prior to surgery on an iPad application or on a printed photograph. The attending Mohs surgeon reviewed the reconstructive designs, provided feedback, guided discussion, and facilitated insight into additional issues requiring further review. Residents performed or observed the Mohs and reconstructive surgical procedures for respective repairs. Surveys were administered to participants before and after participating in the Mohs Surgical Reconstruction Educational Activity to assess the educational value of the activity. Survey responses were recorded on a 5-point Likert scale.Results: Mean participant-reported confidence in flap and graft knowledge, flap and graft planning, and flap and graft performance increased 1.50–2.50 Likert scale points upon completion of the Mohs surgery rotation by residents participating in the educational activity. The observed trend was larger in the dermatology resident subset, with increases of 2.00–3.50 Likert scale points reported for these questions. Mean participant
Nausheen Jamal MD
Full Text Available Since publication of the Institute of Medicine’s report To Err Is Human in 1999, patient safety and health care quality have become hot topics in the parlance of modern medical care. The Accreditation Council for Graduate Medical Education now requires integration of these topics into resident education, with evidence of trainee involvement in Patient Safety and Quality Improvement (PSQI projects. Research in other disciplines indicates that interactive, experiential learning leads to the highest quality PSQI education. Otolaryngology as a field has been slow to adopt these changes into its residency curricula due to competing educational demands and lack of faculty expertise. The author reports preliminary experience with integration of an online module-based curriculum that addresses both of these issues.
Silk, Hugh; Shields, Sara
Humanities in medicine (HIM) is an important aspect of medical education intended to help preserve humanism and a focus on patients. At the University of Massachusetts Family Medicine Residency Program, we have been expanding our HIM curriculum for our residents including orientation, home visit reflective writing, didactics and a department-wide…
Backes, Carl H; Reber, Kris M; Trittmann, Jennifer K B; Huang, Hong; Tomblin, Jordanna; Moorehead, Pamela A; Bauer, John A; Smith, Charles V; Mahan, John D
Pressures on academic faculty to perform beyond their role as educators has stimulated interest in complementary approaches in resident medical education. While fellows are often believed to detract from resident learning and experience, we describe our preliminary investigations utilizing clinical fellows as a positive force in pediatric resident education. Our objectives were to implement a practical approach to engage fellows in resident education, evaluate the impact of a fellow-led education program on pediatric resident and fellow experience, and investigate if growth of a fellowship program detracts from resident procedural experience. This study was conducted in a neonatal intensive care unit (NICU) where fellows designed and implemented an education program consisting of daily didactic teaching sessions before morning clinical rounds. The impact of a fellow-led education program on resident satisfaction with their NICU experience was assessed via anonymous student evaluations. The potential value of the program for participating fellows was also evaluated using an anonymous survey. The online evaluation was completed by 105 residents. Scores were markedly higher after the program was implemented in areas of teaching excellence (4.44 out of 5 versus 4.67, pteaching skills and enhanced knowledge of neonatal pathophysiology as the most valuable aspects of their participation in the education program. The anonymous survey revealed that 87.5% of participating residents believed that NICU fellows were very important to their overall training and education. While fellows are often believed to be a detracting factor to residency training, we found that pediatric resident attitudes toward the fellows were generally positive. In our experience, in the specialty of neonatology a fellow-led education program can positively contribute to both resident and fellow learning and satisfaction. Further investigation into the value of utilizing fellows as a positive force in
Swing, Susan R; Clyman, Stephen G; Holmboe, Eric S; Williams, Reed G
The Outcome Project requires high-quality assessment approaches to provide reliable and valid judgments of the attainment of competencies deemed important for physician practice. The Accreditation Council for Graduate Medical Education (ACGME) convened the Advisory Committee on Educational Outcome Assessment in 2007-2008 to identify high-quality assessment methods. The assessments selected by this body would form a core set that could be used by all programs in a specialty to assess resident performance and enable initial steps toward establishing national specialty databases of program performance. The committee identified a small set of methods for provisional use and further evaluation. It also developed frameworks and processes to support the ongoing evaluation of methods and the longer-term enhancement of assessment in graduate medical education. The committee constructed a set of standards, a methodology for applying the standards, and grading rules for their review of assessment method quality. It developed a simple report card for displaying grades on each standard and an overall grade for each method reviewed. It also described an assessment system of factors that influence assessment quality. The committee proposed a coordinated, national-level infrastructure to support enhancements to assessment, including method development and assessor training. It recommended the establishment of a new assessment review group to continue its work of evaluating assessment methods. The committee delivered a report summarizing its activities and 5 related recommendations for implementation to the ACGME Board in September 2008.
Yunoki, Kazuma; Sakai, Tetsuro
An increasing number of reports indicate the efficacy of simulation training in anesthesiology resident education. Simulation education helps learners to acquire clinical skills in a safe learning environment without putting real patients at risk. This useful tool allows anesthesiology residents to obtain medical knowledge and both technical and non-technical skills. For faculty members, simulation-based settings provide the valuable opportunity to evaluate residents' performance in scenarios including airway management and regional, cardiac, and obstetric anesthesiology. However, it is still unclear what types of simulators should be used or how to incorporate simulation education effectively into education curriculums. Whether simulation training improves patient outcomes has not been fully determined. The goal of this review is to provide an overview of the status of simulation in anesthesiology resident education, encourage more anesthesiologists to get involved in simulation education to propagate its influence, and stimulate future research directed toward improving resident education and patient outcomes.
Rodriguez, Abigail; Ho, Trung; Verheyden, Charles
There is a significant need for basic surgical care worldwide. In recent years, modest improvement in fulfilling this demand has been achieved through international medical mission trips from various organizations. These humanitarian endeavors and global health experiences have generated increasing interest in participating in international missions from surgical residents. However, many academic institutions currently do not have the infrastructure or desire to support surgical residents participating in medical missions. This paper aims to illustrate that careful, planned integration of medical mission trips into the residency curriculum will develop and enhance resident education and experience by fulfilling all six Accreditation Council for Graduate Medical Education (ACGME) core competencies and by benefitting the native program.
Girgis, Fady; Miller, Jonathan P
Engaging residents across a multiyear training spectrum is challenging given the heterogeneity of experience and limited time available for educational activities. A "flipped classroom" model, in which residents prepare ahead of time for mentored topic discussions, has potential advantages. We implemented a curriculum consisting of topics distributed across the specialty. Weekly, each resident was randomly assigned to research a specific aspect of an assigned topic appropriate to his or her level of experience: junior residents about what characterizes each clinical entity, midlevel residents about when to intervene, and chief residents about how to administer treatment. Residents completed an anonymous survey 6 months after implementation. Board examination performance was assessed before and after implementation. A total of 12 residents participated in the program. Weekly, 1.75±0.40 hours were spent in preparation, with senior residents reporting less time than junior residents. All residents indicated that the accumulation of experience across 7 years of residency was a major advantage of this program, and all preferred it to lectures. Performance on the board examination significantly increased after implementation (from 316±36 to 468±45, pflipped classroom is a viable approach to resident education and is associated with increased engagement and improved performance using validated knowledge-assessment tools.
Dokuzlar, Uğur; Miman, Murat Cem; Denizoğlu, İsmail İlter; Eğrilmez, Murat
Our study was planned to get the views of residents about the Otorhinolaryngology (ORL) education process and to enlighten the studies to make this process more effective. A questionnaire was sent to the residents who were still in the residency program in all education clinics via "Google Drive". Seventy-four of 354 residents responded and the answers were evaluated electronically. Fifty residents (67.56%) gave an affirmative answer to the question about the use of "Resident Log Book" and no difference was seen among the clinics. While 9 residents (12.16%) were reporting that they did not read any scientific papers, 43 (58.1%) reported they read less than three per month. Forty-one residents thougt that they were having a good and sufficient education. Seventeen residents (51.51%) who thought they were not having a sufficient education reported that the education period should be longer. When they were wanted to evaluate the education process, while 66 of them (89.18%) said "Exhausting", 52 (70.27%) said "Stressful", it was seen that the ones who said "Instructive" and "Rewarding" were 26 (35.13%) and 17 (22.97%) respectively. Further, 43 of 48 residents (89.58%) who were over the third year of their residency program indicated that they were unable to perform at least one procedure listed in the questionnaire after finishing their education. This study is important because it is the first study about the opinion of ORL residents and will help determine the current status in Turkey. This study will be useful for the preparation of educational programs and guides in the future.
Morreale, Mary K.; Arfken, Cynthia L.; Balon, Richard
Objective: This study aims to determine how residents are being educated regarding sexual health, and it assesses attitudes toward sexual education and barriers to evaluating patients' sexuality. Methods: An anonymous Internet survey was sent to 195 residents in family practice, internal medicine, obstetrics and gynecology, and psychiatry at a…
Charles V. Smith
Full Text Available Pressures on academic faculty to perform beyond their role as educators has stimulated interest in complementary approaches in resident medical education. While fellows are often believed to detract from resident learning and experience, we describe our preliminary investigations utilizing clinical fellows as a positive force in pediatric resident education. Our objectives were to implement a practical approach to engage fellows in resident education, evaluate the impact of a fellow-led education program on pediatric resident and fellow experience, and investigate if growth of a fellowship program detracts from resident procedural experience.This study was conducted in a neonatal intensive care unit (NICU where fellows designed and implemented an education program consisting of daily didactic teaching sessions before morning clinical rounds. The impact of a fellow-led education program on resident satisfaction with their NICU experience was assessed via anonymous student evaluations. The potential value of the program for participating fellows was also evaluated using an anonymous survey.The online evaluation was completed by 105 residents. Scores were markedly higher after the program was implemented in areas of teaching excellence (4.44 out of 5 versus 4.67, p<0.05 and overall resident learning (3.60 out of 5 versus 4.61, p<0.001. Fellows rated the acquisition of teaching skills and enhanced knowledge of neonatal pathophysiology as the most valuable aspects of their participation in the education program. The anonymous survey revealed that 87.5% of participating residents believed that NICU fellows were very important to their overall training and education.While fellows are often believed to be a detracting factor to residency training, we found that pediatric resident attitudes toward the fellows were generally positive. In our experience, in the specialty of neonatology a fellow-led education program can positively contribute to both
Heckerling, P S; Gerber, B S; Weiner, S J
Medical residents engage in formal and informal education interactions with fellow residents during the working day, and can choose whether to spend time and effort on such interactions. Time and effort spent on such interactions can bring learning and personal satisfaction to residents, but may also delay completion of clinical work. Using hypothetical cases, we assessed the values and strategies of internal medicine residents at one hospital for both cooperative and non-cooperative education interactions with fellow residents. We then used these data and cellular automata models of two-person games to simulate repeated interactions between residents, and to determine which strategies resulted in greatest accrued value. We conducted sensitivity analyses on several model parameters, to test the robustness of dominant strategies to model assumptions. Twenty-nine of the 57 residents (50.9%) valued cooperation more than non-cooperation no matter what the other resident did during the current interaction. Similarly, thirty-six residents (63.2%) endorsed an unconditional always-cooperate strategy no matter what the other resident had done during their previous interaction. In simulations, an always-cooperate strategy accrued more value (776.42 value units) than an aggregate of strategies containing non-cooperation components (675.0 value units, p = 0.052). Only when the probability of strategy errors reached 50%, or when values were re-ordered to match those of a Prisoner's Dilemma, did non-cooperation-based strategies accrue the most value. Cooperation-based values and strategies were most frequent among our residents, and dominated in simulations of repeated education interactions between them.
Havryliuk, Tatiana; Bentley, Suzanne; Hahn, Sigrid
Interest in global health and international electives is growing among Emergency Medicine (EM) residents in the United States (US). The majority of EM residency programs offer opportunities for international electives. The degree of participation among residents and type of support provided by the residency program, however, remains unclear. To explore the current state of global health education among EM residents who participate in international electives. A 12-question survey was e-mailed to the program directors of the 192 EM residency programs in the US. The survey included questions about the number of residents participating in international electives and the types of preparation, project requirements, supervision, and feedback participating residents receive. The response rate was 53% with 102 responses. Seventy-five of 102 (74%) programs reported that at least one resident participated in an international elective in the 2010-2011 academic year. Forty-three programs (42%) report no available funding to support any resident on an international elective. Residents receive no preparation for international work in 41 programs (40%). Only 25 programs (26%) required their residents to conduct a project while abroad. Forty-nine programs (48%) reported no formal debriefing session, and no formal feedback was collected from returning residents in 57 of 102 (59%) programs. The majority of EM residencies have residents participating in international electives. However, the programs report variable preparation, requirements, and resident supervision. These results suggest a need for an expanded and more structured approach to international electives undertaken by EM residents. Copyright © 2014 Elsevier Inc. All rights reserved.
Das, Indra J; Moskvin, Vadim
The aim of this study was to compare the quality of medical physics education for radiation oncology medical residents. An independent survey regarding physics education was carried out using e-mail. The survey contained 12 questions addressing the duration, length, and quality of education. Responses were tabulated and compared with the recommended educational scheme. Nearly 56% of institutions participated in this survey. Educational patterns were found to be significantly variable among institutions. Some have minimum physics education (10 lectures), and some have 90 lectures per year. In general, two-thirds of the institutions require residents to attend classes up to the third year. Significant variability of physics education for radiation oncology medical residents was observed, contrary to the national recommendations. With advanced treatment techniques, physics education should be given more importance, and the number of lectures should be increased to accommodate every aspect of radiation oncology practice. Copyright © 2012 American College of Radiology. Published by Elsevier Inc. All rights reserved.
Kiesau, Carter D; Heim, Kathryn A; Parekh, Selene G
Leadership and business challenges have become increasingly present in the practice of medicine. Orthopaedic residency programs are at the forefront of educating and preparing orthopaedic surgeons. This study attempts to quantify the number of orthopaedic residency programs in the United States that include leadership or business topics in resident education program and to determine which topics are being taught and rate the importance of various leadership characteristics and business topics. A survey was sent to all orthopaedic department chairpersons and residency program directors in the United States via e-mail. The survey responses were collected using a survey collection website. The respondents rated the importance of leadership training for residents as somewhat important. The quality of character, integrity, and honesty received the highest average rating among 19 different qualities of good leaders in orthopaedics. The inclusion of business training in resident education was also rated as somewhat important. The topic of billing and coding received the highest average rating among 14 different orthopaedically relevant business topics. A variety of topics beyond the scope of clinical practice must be included in orthopaedic residency educational curricula. The decreased participation of newly trained orthopaedic surgeons in leadership positions and national and state orthopaedic organizations is concerning for the future of orthopaedic surgery. Increased inclusion of leadership and business training in resident education is important to better prepare trainees for the future.
Daniels, Alan H; Bariteau, Jason T; Grabel, Zachary; DiGiovanni, Christopher W
Future physician leaders must be able to critically assess health care policy and patient advocacy issues. Currently, no nationally accepted, standardized curriculum to provide advocacy education during orthopedic residency training exists. We therefore developed an "Advocacy" curriculum for our orthopedic residents designed to direct particular attention to patient advocacy, specialty advocacy, and healthcare policy. Residents were given pre- and post-curriculum questionnaires to gauge their perception of the importance, strengths, and weaknesses of this curriculum. A paired t-test was used to compare pre- and post-curriculum responses. Twenty-one of 24 orthopedic residents completed the pre-curriculum and post-curriculum questionnaire regarding the importance of advocacy education (87.5% response rate). Overall, 85.7% (18/21) of responders ranked the curriculum on orthopedic advocacy as good or excellent. Prior to the advocacy curriculum, 33.3% (7/21) of residents felt that learning about orthopedic advocacy was important to their education, while following the curriculum 100% (21/21) felt so (padvocacy curriculum, 90.5% (19/21) of responders would be interested in getting involved in orthopedic advocacy. This curriculum significantly increased residents' belief in the importance of advocacy issues. Following the curriculum, 100% of responding residents considered orthopedic advocacy education as important. An advocacy curriculum may serve as an integral preparatory educational core component to residency training.
Elias, Joseph Abraham; Morgenroth, David Crespi
The aim of this study was to assess amputee care-related educational offerings and barriers to further educational opportunities in United States physical medicine and rehabilitation residency programs. A two-part survey was distributed to all United States physical medicine and rehabilitation residency program directors. Part 1 assessed the use of educational tools in amputee education. Part 2 assessed the potential barriers to amputee care-related education. Sixty-nine percent of the program directors responded. Seventy-five percent or more of the programs that responded have didactic lectures; grand rounds; reading lists; self-assessment exam review; gait analysis training; training with prosthetists; faculty with amputee expertise; and amputee care during inpatient, outpatient, and consult rotations. Less than 25% of the programs use intranet resources. No more than 14% of the programs said any one factor was a major barrier. However, some of the most prominent major barriers were limited faculty number, finances, and patient volume. The factors many of the programs considered somewhat of a barrier included lack of national standardized resources for curriculum, resident time, and faculty time. This study identified the most commonly used amputee educational opportunities and methods in physical medicine and rehabilitation residencies as well as the barriers to furthering resident amputee education. Developing Web-based resources on amputee care and increasing awareness of physiatrists as perioperative consultants could improve resident amputee education and have important implications toward optimizing care of individuals with amputation.
Faucett, Erynne A; Barry, Jonnae Y; McCrary, Hilary C; Saleh, Ahlam A; Erman, Audrey B; Ishman, Stacey L
To date, there have been no reports in the current literature regarding the use of the Accreditation Council for Graduate Medical Education (ACGME) core competencies in otolaryngology residency training. An evaluation may help educators address these core competencies in the training curriculum. To examine the quantity and nature of otolaryngology residency training literature through a systematic review and to evaluate whether this literature aligns with the 6 core competencies. A medical librarian assisted in a search of all indexed years of the PubMed, Embase, Education Resources Information Center (via EBSCOhost), Cochrane Library (Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, and Cochrane Methodology Register), Thomson Reuters Web of Science (Science Citation Index Expanded, Social Sciences Citation Index Expanded, Conference Proceedings Citation Index-Science, and Conference Proceedings Citation Index-Social Science and Humanities), Elsevier Scopus, and ClinicalTrials.gov databases to identify relevant English-language studies. Included studies contained original human data and focused on otolaryngology resident education. Data regarding study design, setting, and ACGME core competencies addressed were extracted from each article. Initial searches were performed on May 20, 2015, and updated on October 4, 2016. In this systematic review of 104 unique studies, interpersonal communication skills were reported 15 times; medical knowledge, 48 times; patient care, 44 times; practice-based learning and improvement, 31 times; professionalism, 15 times; and systems-based practices, 10 times. Multiple studies addressed more than 1 core competency at once, and 6 addressed all 6 core competencies. Increased emphasis on nonclinical core competencies is needed, including professionalism, interpersonal and communication skills, and systems-based practices in the otolaryngology residency training curriculum. A formal curriculum
Dy, Geolani W; Osbun, Nathan C; Morrison, Shane D; Grant, David W; Merguerian, Paul A
Transgender individuals are underserved within the health care system but might increasingly seek urologic care as insurers expand coverage for medical and surgical gender transition. To evaluate urology residents' exposure to transgender patient care and their perceived importance of transgender surgical education. Urology residents from a representative sample of U.S. training programs were asked to complete a cross-sectional survey from January through March 2016. Respondents were queried regarding demographics, transgender curricular exposure (didactic vs clinical), and perceived importance of training opportunities in transgender patient care. In total, 289 urology residents completed the survey (72% response rate). Fifty-four percent of residents reported exposure to transgender patient care, with more residents from Western (74%) and North Central (72%) sections reporting exposure (P ≤ .01). Exposure occurred more frequently through direct patient interaction rather than through didactic education (psychiatric, 23% vs 7%, P importance on gender-confirming surgical training than did their male colleagues (91% vs 70%, P important. Most residents (77%) stated transgender-related surgical training should be offered in fellowships. Urology resident exposure to transgender patient care is regionally dependent. Perceived importance of gender-confirming surgical training varies by sex and geography. A gap exists between the direct transgender patient care urology residencies provide and the didactic transgender education they receive. Copyright © 2016 International Society for Sexual Medicine. Published by Elsevier Inc. All rights reserved.
Mochizuki, Takashi; Tsuboi, Ryoji; Sei, Yoshihiro; Hiruma, Masataro; Watanabe, Shinichi; Makimura, Koichi
To improve the ability of dermatologists to diagnose cutaneous mycoses, we have proposed a list of the minimum mycological knowledge and skills required by senior residents of dermatology. The list includes ability to select the most appropriate sampling method, knowledge of the basic method of potassium hydroxide (KOH) examination and skill in performing fungal cultures and identifying the most prevalent fungal species isolated from skin lesions. It is not possible for the Japanese Society of Medical Mycology to train every senior resident directly, and it is difficult for them to acquire sufficient expertise independently. Consequently, training and advice given by instructors in residents' home institutes is essential. A project of an advanced course for instructors, who are in charge of educating senior residents in their own institute, may be possible. Therefore, we have proposed here a list for instructors of the knowledge and skills required to educate senior residents. Employing this list should realize improved skill in dermatologists.
Ford, Eric C; Nyflot, Matthew; Spraker, Matthew B; Kane, Gabrielle; Hendrickson, Kristi R G
Education in patient safety and quality of care is a requirement for radiation oncology residency programs according to accrediting agencies. However, recent surveys indicate that most programs lack a formal program to support this learning. The aim of this report was to address this gap and share experiences with a structured educational program on quality and safety designed specifically for medical physics therapy residencies. Five key topic areas were identified, drawn from published recommendations on safety and quality. A didactic component was developed, which includes an extensive reading list supported by a series of lectures. This was coupled with practice-based learning which includes one project, for example, failure modes and effect analysis exercise, and also continued participation in the departmental incident learning system including a root-cause analysis exercise. Performance was evaluated through quizzes, presentations, and reports. Over the period of 2014-2016, five medical physics residents successfully completed the program. Evaluations indicated that the residents had a positive experience. In addition to educating physics residents this program may be adapted for medical physics graduate programs or certificate programs, radiation oncology residencies, or as a self-directed educational project for practicing physicists. Future directions might include a system that coordinates between medical training centers such as a resident exchange program. © 2017 The Authors. Journal of Applied Clinical Medical Physics published by Wiley Periodicals, Inc. on behalf of American Association of Physicists in Medicine.
Arora, Gitanjli; Ripp, Jonathan; Evert, Jessica; Rabin, Tracy; Tupesis, Janis P; Hudspeth, James
To meet the demand by residents and to provide knowledge and skills important to the developing physician, global health (GH) training opportunities are increasingly being developed by United States (U.S.) residency training programs. However, many residency programs face common challenges of developing GH curricula, offering safe and mentored international rotations, and creating GH experiences that are of service to resource-limiting settings. Academic GH partnerships allow for the opportunity to collaborate on education and research and improve health care and health systems, but must ensure mutual benefit to U.S. and international partners. This article provides guidance for incorporating GH education into U.S. residency programs in an ethically sound and sustainable manner, and gives examples and solutions for common challenges encountered when developing GH education programs.
Fung, Lawrence K; Akil, Mayada; Widge, Alik; Roberts, Laura Weiss; Etkin, Amit
The purpose of this study is to assess the attitudes of psychiatry trainees toward neuroscience education in psychiatry residency and subsequent training in order to inform neuroscience education approaches in the future. This online survey was designed to capture demographic information, self-assessed neuroscience knowledge, attitudes toward neuroscience education, preferences in learning modalities, and interest in specific neuroscience topics. Volunteers were identified through the American Psychiatric Association, which invited 2,563 psychiatry trainees among their members. Four hundred thirty-six trainees completed the survey. Nearly all agreed that there is a need for more neuroscience education in psychiatry residency training (94%) and that neuroscience education could help destigmatize mental illness (91%). Nearly all (94%) expressed interest in attending a 3-day course on neuroscience. Many neuroscience topics and modes of learning were viewed favorably by participants. Residents in their first 2 years of training expressed attitudes similar to those of more advanced residents and fellows. Some differences were found based on the level of interest in a future academic role. This web-based study demonstrates that psychiatry residents see neuroscience education as important in their training and worthy of greater attention. Our results suggest potential opportunities for advancing neuroscience education.
Smalley, Hannah K; Keskinocak, Pinar
At academic teaching hospitals around the country, the majority of clinical care is provided by resident physicians. During their training, medical residents often rotate through various hospitals and/or medical services to maximize their education. Depending on the size of the training program, manually constructing such a rotation schedule can be cumbersome and time consuming. Further, rules governing allowable duty hours for residents have grown more restrictive in recent years (ACGME 2011), making day-to-day shift scheduling of residents more difficult (Connors et al., J Thorac Cardiovasc Surg 137:710-713, 2009; McCoy et al., May Clin Proc 86(3):192, 2011; Willis et al., J Surg Edu 66(4):216-221, 2009). These rules limit lengths of duty periods, allowable duty hours in a week, and rest periods, to name a few. In this paper, we present two integer programming models (IPs) with the goals of (1) creating feasible assignments of residents to rotations over a one-year period, and (2) constructing night and weekend call-shift schedules for the individual rotations. These models capture various duty-hour rules and constraints, provide the ability to test multiple what-if scenarios, and largely automate the process of schedule generation, solving these scheduling problems more effectively and efficiently compared to manual methods. Applying our models on data from a surgical residency program, we highlight the infeasibilities created by increased duty-hour restrictions placed on residents in conjunction with current scheduling paradigms.
Soones, Tacara N; O'Brien, Bridget C; Julian, Katherine A
In order to teach residents how to work in interprofessional teams, educators in graduate medical education are implementing team-based care models in resident continuity clinics. However, little is known about the impact of interprofessional teams on residents' education in the ambulatory setting. To identify factors affecting residents' experience of team-based care within continuity clinics and the impact of these teams on residents' education. This was a qualitative study of focus groups with internal medicine residents. Seventy-seven internal medicine residents at the University of California San Francisco at three continuity clinic sites participated in the study. Qualitative interviews were audiotaped and transcribed. The authors used a general inductive approach with sensitizing concepts in four frames (structural, human resources, political and symbolic) to develop codes and identify themes. Residents believed that team-based care improves continuity and quality of care. Factors in four frames affected their ability to achieve these goals. Structural factors included communication through the electronic medical record, consistent schedules and regular team meetings. Human resources factors included the presence of stable teams and clear roles. Political and symbolic factors negatively impacted team-based care, and included low staffing ratios and a culture of ultimate resident responsibility, respectively. Regardless of the presence of these factors or resident perceptions of their teams, residents did not see the practice of interprofessional team-based care as intrinsically educational. Residents' experiences practicing team-based care are influenced by many principles described in the interprofessional teamwork literature, including understanding team members' roles, good communication and sufficient staffing. However, these attributes are not correlated with residents' perceptions of the educational value of team-based care. Including residents in
To demonstrate the effect of ethics education on a resident's ability to answer questions that relate to moral dilemmas and on the clinical evaluations of residents by faculty. The curriculum for the ethics education that was used for this study was designed by the author and consisted of 10 lectures of 1.5 hours each. Five residencies were included in the project. One residency received one lecture, two residencies received three lectures, and two residencies received 10 lectures. To evaluate the moral skills of the residents at the beginning of the course and at the end, the residents were given the Defining Issues Test (DIT-2) developed by James Rest, which involves answering standardized questions about four moral dilemmas. Faculty evaluations were completed before and after the ethics lectures were given. At the beginning of the ethics course, each resident was given a social survey that was designed to assess participation in community, religious, political, and societal activities as well as attitudes about these activities. All residents were also asked demographic information, including their age, gender, and year of residency. The results of the DIT-2 taken before and after the ethics lectures were compared. No correlations were found in faculty evaluations of clinical performance of the residents before and after the course (P = .052). Associations between DIT-2 scores and questions on community and religion in the social survey were noted. The finding that the effect of an ethics course on residents' ability to answer moral dilemmas did not achieve statistical significance should be accepted with the understanding that this was a first attempt at standardization of many variables, especially the format of the curriculum and materials used. The use of faculty evaluations to assess clinical performance needs to be standardized, and the faculty members need additional training to ensure validity of the results. The social survey was also the first attempt
Bass, Ellen J; DeVoge, Justin Michael; Waggoner-Fountain, Linda A; Borowitz, Stephen M
To characterize question types that residents received on overnight shifts and what information sources were used to answer them. Across 30 overnight shifts, questions asked of on-call senior residents, question askers' roles, and residents' responses were documented. External sources were noted. 158 of 397 questions (39.8%) related to the plan of care, 53 (13.4%) to medical knowledge, 48 (12.1%) to taskwork knowledge, and 44 (11.1%) to the current condition of patients. For 351 (88.4%) questions residents provided specific, direct answers or visited the patient. For 16 of these, residents modeled or completed the task. For 216 questions, residents used previous knowledge or their own clinical judgment. Residents solicited external information sources for 118 questions and only a single source for 77 (65.3%) of them. For the 118, most questions concerned either the plan of care or the patient's current condition and were asked by interns and nurses (those with direct patient care responsibilities). Resident physicians serve as an information system and they often specifically answer the question using previous knowledge or their own clinical judgment, suggesting that askers are contacting an appropriately knowledgeable person. However, they do need to access patient information such as the plan of care. They also serve an educator role and answer many knowledge-related questions. As synchronous verbal communications continue to be important pathways for information flow, informaticians need to consider the relationship between such communications and workflow in the development of healthcare support tools.
Bega, Danny; Krainc, Dimitri
Residency training has had to adapt to higher patient volumes, increased complexity of medical care, and the commercialized system of health care. These changes have led to a concerning culture shift in neurology. We review the relationship between the emerging health care delivery system and residency training, highlighting issues related to duty hours and work-life balance, the changing technological landscape, high patient volumes, and complex service obligations. We propose that the current challenges in health care delivery offer the opportunity to improve neurology residency through faculty development programs, bringing teaching back to the bedside, increasing resident autonomy, utilizing near-peer teaching, and rewarding educators who facilitate an environment of inquiry and scholarship, with the ultimate goal of better alignment between education and patient care. Ann Neurol 2016;80:315-320. © 2016 American Neurological Association.
Patow, Carl; Bryan, Debra; Johnson, Gail; Canaan, Eugenia; Oyewo, Adetolu; Panda, Mukta; Walsh, Eric; Zaidan, James
Residents and fellows frequently care for patients from diverse populations but often have limited familiarity with the cultural preferences and social determinants that contribute to the health of their patients and communities. Faculty physicians at academic health centers are increasingly interested in incorporating the topics of cultural diversity and healthcare disparities into experiential education activities; however, examples have not been readily available. In this report, we describe a variety of experiential education models that were developed to improve resident and fellow physician understanding of cultural diversity and healthcare disparities. Experiential education, an educational philosophy that infuses direct experience with the learning environment and content, is an effective adult learning method. This report summarizes the experiences of multiple sponsors of Accreditation Council for Graduate Medical Education-accredited residency and fellowship programs that used experiential education to inform residents about cultural diversity and healthcare disparities. The 9 innovative experiential education activities described were selected to demonstrate a wide range of complexity, resource requirements, and community engagement and to stimulate further creativity and innovation in educational design. Each of the 9 models is characterized by residents' active participation and varies in length from minutes to months. In general, the communities in which these models were deployed were urban centers with diverse populations. Various formats were used to introduce targeted learners to the populations and communities they serve. Measures of educational and clinical outcomes for these early innovations and pilot programs are not available. The breadth of the types of activities described suggests that a wide latitude is available to organizations in creating experiential education programs that reflect their individual program and institutional needs and
Full Text Available Abstract Background Residents are one of the key stakeholders of specialty training. The Turkish Board of Family Medicine wanted to pursue a realistic and structured approach in the design of the specialty training programme. This approach required the development of a needs-based core curriculum built on evidence obtained from residents about their needs for specialty training and their needs in the current infrastructure. The aim of this study was to obtain evidence on residents' opinions and views about Family Medicine specialty training. Methods This is a descriptive, cross-sectional study. The board prepared a questionnaire to investigate residents' views about some aspects of the education programme such as duration and content, to assess the residents' learning needs as well as their need for a training infrastructure. The questionnaire was distributed to the Family Medicine Departments (n = 27 and to the coordinators of Family Medicine residency programmes in state hospitals (n = 11 by e-mail and by personal contact. Results A total of 191 questionnaires were returned. The female/male ratio was 58.6%/41.4%. Nine state hospitals and 10 university departments participated in the study. The response rate was 29%. Forty-five percent of the participants proposed over three years for the residency duration with either extensions of the standard rotation periods in pediatrics and internal medicine or reductions in general surgery. Residents expressed the need for extra rotations (dermatology 61.8%; otolaryngology 58.6%; radiology 52.4%. Fifty-nine percent of the residents deemed a rotation in a private primary care centre necessary, 62.8% in a state primary care centre with a proposed median duration of three months. Forty-seven percent of the participants advocated subspecialties for Family Medicine, especially geriatrics. The residents were open to new educational methods such as debates, training with models, workshops and e
Uzuner, Arzu; Topsever, Pinar; Unluoglu, Ilhami; Caylan, Ayse; Dagdeviren, Nezih; Uncu, Yesim; Mazicioğlu, Mumtaz; Ozçakir, Alis; Ozdemir, Hakan; Ersoy, Fusun
Residents are one of the key stakeholders of specialty training. The Turkish Board of Family Medicine wanted to pursue a realistic and structured approach in the design of the specialty training programme. This approach required the development of a needs-based core curriculum built on evidence obtained from residents about their needs for specialty training and their needs in the current infrastructure. The aim of this study was to obtain evidence on residents' opinions and views about Family Medicine specialty training. This is a descriptive, cross-sectional study. The board prepared a questionnaire to investigate residents' views about some aspects of the education programme such as duration and content, to assess the residents' learning needs as well as their need for a training infrastructure. The questionnaire was distributed to the Family Medicine Departments (n = 27) and to the coordinators of Family Medicine residency programmes in state hospitals (n = 11) by e-mail and by personal contact. A total of 191 questionnaires were returned. The female/male ratio was 58.6%/41.4%. Nine state hospitals and 10 university departments participated in the study. The response rate was 29%. Forty-five percent of the participants proposed over three years for the residency duration with either extensions of the standard rotation periods in pediatrics and internal medicine or reductions in general surgery. Residents expressed the need for extra rotations (dermatology 61.8%; otolaryngology 58.6%; radiology 52.4%). Fifty-nine percent of the residents deemed a rotation in a private primary care centre necessary, 62.8% in a state primary care centre with a proposed median duration of three months. Forty-seven percent of the participants advocated subspecialties for Family Medicine, especially geriatrics. The residents were open to new educational methods such as debates, training with models, workshops and e-learning. Participation in courses and congresses was considered
Hope, W W; O'Dwyer, B; Adams, A; Hooks, W B; Kotwall, C A; Clancy, T V
The purpose of this study was to evaluate surgical residents' educational experience related to ventral hernias. A 16-question survey was sent to all program coordinators to distribute to their residents. Consent was obtained following a short introduction of the purpose of the survey. Comparisons based on training level were made using χ(2) test of independence, Fisher's exact, and Fisher's exact with Monte Carlo estimate as appropriate. A p value techniques for open ventral hernia varied; the most common (32 %) was intra-abdominal placement of mesh with defect closure. Twenty-two percent of residents had not heard of the retrorectus technique for hernia repair, 48 % had not performed the operation, and 60 % were somewhat comfortable with and knew the general categories of mesh prosthetics products. Mesh choices, biologic and synthetic, varied among the different products. The most common type of hernia education was teaching in the operating room in 87 %, didactic lecture 69 %, and discussion at journal club 45 %. Number of procedures, comfort level with open and laparoscopic techniques, indications for mesh use and technique, familiarity and use of retrorectus repair, and type of hernia education varied significantly based on resident level (p techniques and mesh prosthetics in surgical residency programs appears to vary. Further evaluation is needed and may help in standardizing curriculums for hernia repair for surgical residents.
Full Text Available Background: Ethics education and research on medical residents is needed because, unlike medical students or experienced doctors, medical residents have to perform multiple roles simultaneously – student, teacher and clinician – thus exposing them to unique ethical stressors. In this paper we reviewed the literature concerning ethics education in postgraduate pediatrics training programs. Our goal was not to simply describe educational strategies and programs, but also to explore measurements and experiences of current practices to address gaps in ethics education during residency. Method: We conducted a structured literature review to explore the extent of ethics education in pediatric residency programs. Results: Twelve relevant studies were found. The studies suggest that existing training regimens are insufficient to meet the real life ethical challenges experienced in actual practice, particularly with respect to palliative care and the commission of clinical errors. Conclusions: The increasing diversity of culture and beliefs in the clinical workplace is also serving to complicate educational needs. An interdisciplinary approach, spread over the entirety of a physician’s training, is a proposed solution worthy of more attention.
Ghareeb, Allen; Han, Heeyoung; Delfino, Kristin; Taylor, Funminiyi
Effects of residents' blended learning on their clinical performance have rarely been reported. A blended learning pilot program was instituted at Southern Illinois University School of Medicine's Obstetrics and Gynecology program. One of the modules was chronic hypertension in pregnancy. We sought to evaluate if the resident blended learning was transferred to their clinical performance six months after the module. A review of patient charts demonstrated inadequate documentation of history, evaluation, and counseling of patients with chronic hypertension at the first prenatal visit by Obstetrics and Gynecology (OB/GYN) residents. A blended learning module on chronic hypertension in pregnancy was then provided to the residents. A retrospective chart review was then performed to assess behavioral changes in the OB/GYN residents. This intervention was carried out at the Department of Obstetrics and Gynecology, Southern Illinois University. All 16 OB/GYN residents were enrolled in this module as part of their educational curriculum. A query of all prenatal patients diagnosed with chronic hypertension presenting to the OB/GYN resident clinics four months prior to the implementation of the blended learning module (March 2015-June 2015) and six months after (July 20, 2015-February 2016) was performed. Data were collected from outpatient charts utilizing the electronic medical record. Data were abstracted from resident documentation at the first prenatal visit. The residents thought that the blended learning module was applicable to performance improvement in the real-world setting. Patients evaluated before ( n = 10) and after ( n = 7) the intervention were compared. After the intervention, there was an increase in assessment of baseline liver enzymes, referral for electrocardiogram, and early assessment for diabetes in the obese patients. More patients were provided a blood pressure cuff after the module (71.4% vs. 20%). Data were provided to the residents in an
Christianson, Mindy S; Ducie, Jennifer A; Altman, Kristiina; Khafagy, Ayatallah M; Shen, Wen
This study aims to understand the current teaching of menopause medicine in American obstetrics and gynecology residency programs. A Web-based survey was e-mailed to all American obstetrics and gynecology residency directors, with a request that they forward it to their residents. Of 258 residency program directors contacted, 79 (30.6%) confirmed forwarding the survey. In all, 1,799 people received the survey, with 510 completions, for a response rate of 28.3%. Most residents reported that they had limited knowledge and needed to learn more about these aspects of menopause medicine: pathophysiology of menopause symptoms (67.1%), hormone therapy (68.1%), nonhormone therapy (79.0%), bone health (66.1%), cardiovascular disease (71.7%), and metabolic syndrome (69.5%). Among fourth-year residents who will be entering clinical practice soon, a large proportion also reported a need to learn more in these areas: pathophysiology of menopause symptoms (45.9%), hormone therapy (54.2%), nonhormone therapy (69.4%), bone health (54.2%), cardiovascular disease (64.3%), and metabolic syndrome (63.8%). When asked to rate the most preferred modalities for learning about menopause, the top choice was supervised clinics (53.2%), followed by case presentations (22.2%), formal lectures (21.3%), small groups (14.7%), Web-based learning (7.8%), and independent reading (5.2%). Only 20.8% of residents reported that their program had a formal menopause medicine learning curriculum, and 16.3% had a defined menopause clinic as part of their residency. It seems that some American residency programs do not fulfill the educational goals of their residents in menopause medicine. A curriculum would be beneficial for increasing knowledge and clinical experience on menopause issues.
Pascual, T.N.; San Luis, T.O.L.; Leus, M.
Full text: The comprehensive evaluation of medical residents in a residency-training program includes the use of educational tools to measure the attainment of competencies in the cognitive, psychomotor and affective domains as prescribed in the training curriculum. Attention is almost always focused on the testing of cognitive domain of the learners with limited attention given on the psychomotor and affective parameters, which are in fact, together with the cognitive domain, integral to the students' learning behaviour. This paper aims to review the principles of test construction, including the perspectives on the roles, types and purpose of tests in the domains of learning (cognitive, psychomotor and affective) as well as the use of Non-Test materials for measuring affective learning outcomes and the construction of Performance Tests and Portfolio Assessment tools which are all essential for the effective and efficient evaluation of residents in a Nuclear Medicine Training Program. (author)
Lapid, Maria; Moutier, Christine; Dunn, Laura; Hammond, Katherine Green; Roberts, Laura Weiss
Objective: Awareness of the privileges and limits of one's role as physician, as well as recognition and respect for the patient as a human being, are central to ethical medical practice. The authors were particularly interested in examining the attitudes and perceived needs of psychiatric residents toward education on professional boundaries and…
Albrecht, Martina; Kupfer, Ramona; Reissmann, Daniel R; Mühlhauser, Ingrid; Köpke, Sascha
Associations between nursing home residents' oral health status and quality of life, respiratory tract infections, and nutritional status have been reported. Educational interventions for nurses or residents, or both, focusing on knowledge and skills related to oral health management may have the potential to improve residents' oral health. To assess the effects of oral health educational interventions for nursing home staff or residents, or both, to maintain or improve the oral health of nursing home residents. We searched the Cochrane Oral Health Trials Register (to 18 January 2016), the Cochrane Central Register of Controlled Trials (CENTRAL) (the Cochrane Library, 2015, Issue 12), MEDLINE Ovid (1946 to 18 January 2016), Embase Ovid (1980 to 18 January 2016), CINAHL EBSCO (1937 to 18 January 2016), and Web of Science Conference Proceedings (1990 to 18 January 2016). We searched ClinicalTrials.gov and the World Health Organization International Clinical Trials Registry Platform for ongoing trials to 18 January 2016. In addition, we searched reference lists of identified articles and contacted experts in the field. We placed no restrictions on language or date of publication when searching the electronic databases. Randomised controlled trials (RCTs) and cluster-RCTs comparing oral health educational programmes for nursing staff or residents, or both with usual care or any other oral healthcare intervention. Two review authors independently screened articles retrieved from the searches for relevance, extracted data from included studies, assessed risk of bias for each included study, and evaluated the overall quality of the evidence. We retrieved data about the development and evaluation processes of complex interventions on the basis of the Criteria for Reporting the Development and Evaluation of Complex Interventions in healthcare: revised guideline (CReDECI 2). We contacted authors of relevant studies for additional information. We included nine RCTs involving
Butteris, Sabrina M; Schubert, Charles J; Batra, Maneesh; Coller, Ryan J; Garfunkel, Lynn C; Monticalvo, David; Moore, Molly; Arora, Gitanjli; Moore, Melissa A; Condurache, Tania; Sweet, Leigh R; Hoyos, Catalina; Suchdev, Parminder S
Despite the growing importance of global health (GH) training for pediatric residents, few mechanisms have cataloged GH educational opportunities offered by US pediatric residency programs. We sought to characterize GH education opportunities across pediatric residency programs and identify program characteristics associated with key GH education elements. Data on program and GH training characteristics were sought from program directors or their delegates of all US pediatric residency programs during 2013 to 2014. These data were used to compare programs with and without a GH track as well as across small, medium, and large programs. Program characteristics associated with the presence of key educational elements were identified by using bivariate logistic regression. Data were collected from 198 of 199 active US pediatric residency programs (99.5%). Seven percent of pediatric trainees went abroad during 2013 to 2014. Forty-nine programs (24.7%) reported having a GH track, 66.1% had a faculty lead, 58.1% offered international field experiences, and 48.5% offered domestic field experiences. Forty-two percent of programs reported international partnerships across 153 countries. Larger programs, those with lead faculty, GH tracks, or partnerships had significantly increased odds of having each GH educational element, including pretravel preparation. The number of pediatric residency programs offering GH training opportunities continues to rise. However, smaller programs and those without tracks, lead faculty, or formal partnerships lag behind with organized GH curricula. As GH becomes an integral component of pediatric training, a heightened commitment is needed to ensure consistency of training experiences that encompass best practices in all programs. Copyright © 2015 by the American Academy of Pediatrics.
Mahler, Simon A; McCartney, Jeannie R; Swoboda, Thomas K; Yorek, Lauren; Arnold, Thomas C
Few studies have evaluated the effect of Emergency Department (ED) overcrowding on resident education. To determine the impact of ED overcrowding on Emergency Medicine (EM) resident education. A prospective cross-sectional study was performed from March to May 2009. Second- and third-year EM residents, blinded to the research objective, completed a questionnaire at the end of each shift. Residents were asked to evaluate the educational quality of each shift using a 10-point Likert scale. Number of patients seen and procedures completed were recorded. Responses were divided into ED overcrowding (group O) and non-ED overcrowding (group N) groups. ED overcrowding was defined as >2 h of ambulance diversion per shift. Questionnaire responses were compared using Mann-Whitney U tests. Number of patients and procedures were compared using unpaired T-tests. During the study period, 125 questionnaires were completed; 54 in group O and 71 in group N. For group O, the median educational value score was 8 (interquartile range [IQR] 7-10), compared to 8 (IQR 8-10) for group N (p = 0.24). Mean number of patients seen in group O was 12.3 (95% confidence interval [CI] 11.4-13.2), compared to 13.9 (95% CI 12.7-15) in group N (p = 0.034). In group O, mean number of procedures was 0.9 (95% CI 0.6-1.2), compared to 1.3 (95% CI 1-1.6) in group N (p = 0.047). During overcrowding, EM residents saw fewer patients and performed fewer procedures. However, there was no significant difference in resident perception of educational value during times of overcrowding vs. non-overcrowding. Copyright © 2012 Elsevier Inc. All rights reserved.
Byrne, John; Straub, Heather; DiGiovanni, Laura; Chor, Julie
The objective of the study was to assess the current status of ethics education in obstetrics-gynecology residency programs. A cross-sectional, web-based survey was designed in conjunction with a professional survey laboratory at the University of Chicago. The survey was piloted with a convenience sample of clinical medical ethics fellows to assess question content and clarity. The survey was deployed by e-mail to all obstetrics-gynecology residency program directors. Descriptive statistics were used to analyze participant responses. The University of Chicago's Institutional Review Board deemed this study exempt from institutional review board formal review. Of 242 eligible obstetrics-gynecology residency program directors, 118 (49%) completed the survey. Most respondents were from university-based programs (n = 78, 66%) that were not religiously affiliated (n = 98, 83%) and trained 4-6 residents per postgraduate year (n = 64, 70%). Although 50% of program directors (n = 60) reported having ethics as part of their core curriculum, most programs teach ethics in an unstructured manner. Fifty-seven percent of respondents (n = 66) stated their program dedicated 5 or fewer hours per year to ethics. The majority of program directors (n = 80, 73%) responded they would like more to a lot more ethics education and believed that ethics education should be required (n = 93, 85%) for residents to complete their training. Respondents identified that crowding in the curriculum was a significant barrier to increased ethics training (n = 50, 45%) and two-thirds (n = 74, 67%) reported a lack of faculty expertise as a moderate barrier to providing ethics education in the residency curriculum. This study found that a lack of structured curricula, inadequate faculty expertise, and limited time were important barriers for ethics education in obstetrics-gynecology programs across the nation. Despite these existing challenges, program directors have a strong interest in increasing ethics
Full Text Available Problem Effects of residents’ blended learning on their clinical performance have rarely been reported. A blended learning pilot program was instituted at Southern Illinois University School of Medicine's Obstetrics and Gynecology program. One of the modules was chronic hypertension in pregnancy. We sought to evaluate if the resident blended learning was transferred to their clinical performance six months after the module. Intervention A review of patient charts demonstrated inadequate documentation of history, evaluation, and counseling of patients with chronic hypertension at the first prenatal visit by Obstetrics and Gynecology (OB/GYN residents. A blended learning module on chronic hypertension in pregnancy was then provided to the residents. A retrospective chart review was then performed to assess behavioral changes in the OB/GYN residents. Context This intervention was carried out at the Department of Obstetrics and Gynecology, Southern Illinois University. All 16 OB/GYN residents were enrolled in this module as part of their educational curriculum. A query of all prenatal patients diagnosed with chronic hypertension presenting to the OB/GYN resident clinics four months prior to the implementation of the blended learning module (March 2015–June 2015 and six months after (July 20, 2015–February 2016 was performed. Data were collected from outpatient charts utilizing the electronic medical record. Data were abstracted from resident documentation at the first prenatal visit. Outcome The residents thought that the blended learning module was applicable to performance improvement in the real-world setting. Patients evaluated before ( n = 10 and after ( n = 7 the intervention were compared. After the intervention, there was an increase in assessment of baseline liver enzymes, referral for electrocardiogram, and early assessment for diabetes in the obese patients. More patients were provided a blood pressure cuff after the module (71
Putnam, Luke R; Levy, Shauna M; Kellagher, Caroline M; Etchegaray, Jason M; Thomas, Eric J; Kao, Lillian S; Lally, Kevin P; Tsao, KuoJen
Effective communication and patient safety practices are paramount in health care. Surgical residents play an integral role in the perioperative team, yet their perceptions of patient safety remain unclear. We hypothesized that surgical residents perceive the perioperative environment as more unsafe than their faculty and operating room staff despite completing a required safety curriculum. Surgeons, anesthesiologists, and perioperative nurses in a large academic children's hospital participated in multifaceted, physician-led workshops aimed at enhancing communication and safety culture over a 3-y period. All general surgery residents from the same academic center completed a hospital-based online safety curriculum only. All groups subsequently completed the psychometrically validated safety attitudes questionnaire to evaluate three domains: safety culture, teamwork, and speaking up. Results reflect the percent of respondents who slightly or strongly agreed. Chi-square analysis was performed. Sixty-three of 84 perioperative personnel (75%) and 48 of 52 surgical residents (92%) completed the safety attitudes questionnaire. A higher percentage of perioperative personnel perceived a safer environment than the surgical residents in all three domains, which was significantly higher for safety culture (68% versus 46%, P = 0.03). When stratified into two groups, junior residents (postgraduate years 1-2) and senior residents (postgraduate years 3-5) had lower scores for all three domains, but the differences were not statistically significant. Surgical residents' perceptions of perioperative safety remain suboptimal. With an enhanced safety curriculum, perioperative staff demonstrated higher perceptions of safety compared with residents who participated in an online-only curriculum. Optimal surgical education on patient safety remains unknown but should require a dedicated, systematic approach. Copyright © 2015 Elsevier Inc. All rights reserved.
Maniate, Jerry M; Karimuddin, Ahmer
With so much invested in the clinical competency of physicians, adequate and appropriate mechanisms are needed to ensure that educational systems provide the highest-quality training possible and are responsive both to the changing demands of the patient population and to changing technologies and research. After a literature review, the authors concluded that there are no established criteria or principles, from a learners' perspective, that set out goals for the delivery and evaluation in Canada of quality postgraduate medical education. The authors initiated the process of developing a set of principles of medical education based on residents' perspectives by compiling a list of issues and concepts that were felt to be important to creating the "ideal" postgraduate medical education system. This list of issues was divided into broad categories before presentation by the authors for Canada-wide discussion, reflection, and further refinement of concepts and issues across a nine-month period. The process eventually resulted in the final consensus-driven and iterative development of the main categories and the final principles that were adopted by the Canadian Association of Internes and Residents (CAIR). The authors present this set of principles and propose that they be used as a template to guide postgraduate medical education and against which changes to the system can be evaluated. CAIR will use these principles in a number of ways, including evaluation, education, and quality assurance.
Hamza, S; Anderson, P; Reddy, V V; Siegal, G P
The Internet has revolutionized the computer and communications world. It has grown to become a worldwide mechanism for information exchange without regard for geographic boundaries. The tremendous growth in this wealth of information poses several questions regarding the utility of this powerful tool in pathology practice and education. This article reviews the advantages and disadvantages of using the Internet in pathology resident education, in general, and how it has impacted the repertoire of educational opportunities at our own institution. The various Internet resources of educational value for pathology trainees are outlined. Basic Internet concepts are also elucidated.
Jansen, Kate L; Rosenbaum, Marcy E
Communication skills are essential to medical training and have lasting effects on patient satisfaction and adherence rates. However, relatively little is reported in the literature identifying how communication is taught in the context of residency education. Our goal was to determine current practices in communication curricula across family medicine residency programs. Behavioral scientists and program directors in US family medicine residencies were surveyed via email and professional organization listservs. Questions included whether programs use a standardized communication model, methods used for teaching communication, hours devoted to teaching communication, as well as strengths and areas for improvement in their program. Analysis identified response frequencies and ranges complemented by analysis of narrative comments. A total of 204 programs out of 458 family medicine residency training sites responded (45%), with 48 out of 50 US states represented. The majority of respondents were behavioral scientists. Seventy-five percent of programs identified using a standard communication model; Mauksch's patient-centered observation model (34%) was most often used. Training programs generally dedicated more time to experiential teaching methods (video review, work with simulated patients, role plays, small groups, and direct observation of patient encounters) than to lectures (62% of time and 24% of time, respectively). The amount of time dedicated to communication education varied across programs (average of 25 hours per year). Respondent comments suggest that time dedicated to communication education and having a formal curriculum in place are most valued by educators. This study provides a picture of how communication skills teaching is conducted in US family medicine residency programs. These findings can provide a comparative reference and rationale for residency programs seeking to evaluate their current approaches to communication skills teaching and
Kelly, Aine Marie; Gruppen, Larry D; Mullan, Patricia B
Radiologists in teaching hospitals and in practices with residents rotating through are involved in the education of their residents. The Accreditation Council for Graduate Medical Education requires evidence that trainees are taught and demonstrate competency not only in medical knowledge and in patient care-the historic focus of radiology education-but also in the so-called non-interpretative core competencies, which include professionalism and interpersonal skills. In addition to accreditation agencies, the prominent assessment practices represented by the American Board of Radiology core and certifying examinations for trainees, as well as Maintenance of Certification for practitioners, are planning to feature more non-interpretative competency assessment, including professionalism to a greater extent. Because professionalism was incorporated as a required competency in medical education as a whole, more clarity about the justification and expected content for teaching about competence in professionalism, as well as greater understanding and evidence about appropriate and effective teaching and assessment methods, have emerged. This article summarizes justifications and expectations for teaching and assessing professionalism in radiology residents and best practices on how to teach and evaluate professionalism that can be used by busy radiology faculty in their everyday practice supervising radiology residents. Copyright © 2017 The Association of University Radiologists. Published by Elsevier Inc. All rights reserved.
Objective: This article provides a brief overview of the history of psychiatry residency training in Canada,and outlines the rationale for the current training requirements, changes to the final certification examination,and factors influencing future trends in psychiatry education and training. Method: The author compiled findings and reports on…
Cronholm, Peter F; Singh, Vijay; Fogarty, Colleen T; Ambuel, Bruce
Violence is a significant public health issue with far-reaching implications for the health of individuals and their communities. Our objective was to describe trends in violence-related training in family medicine residency programs since the last national survey was conducted in 1997. Surveys were sent to 337 US family medicine residency programs with the program director having active Society of Teachers of Family Medicine (STFM) membership. Measures included residency setting and characteristics, violence-related curricular content, teaching techniques and personnel, timing of content, and impact of changes in Residency Review Committee (RRC) and Accreditation Council for Graduate Medical Education (ACGME) requirements. Descriptive statistics and bivariate analyses comparing measures across time were used. A total of 201 (60%) surveys were completed. The most common violence curricula was child (83%) and elder abuse (76%), and the most common teachers of violence-related content were family physicians, psychologists, and social workers. The most common teaching methods were clinical precepting (94%), lectures (90%), case vignettes (71%), and intimate partner violence (IPV) shelter experiences (67%). ACGME and RRC changes were not reflected in self-reported measures of curricular emphasis or time. Violence curricular content and number of hours has been constant in family medicine residencies over time. An increase in the reported use of active learning strategies was identified as a trend across surveys. Next steps for violence curricula involve assessment of residents' competency to identify and intervene in violence.
Le, Phu; Dempster, Laura; Limeback, Hardy; Locker, David
This study assessed the efficacy of oral care education among nursing home staff members to improve the oral health of residents. Nursing home support staff members (NHSSMs) in the study group received oral care education at baseline between a pretest and posttest. NHSSMs' oral care knowledge was measured using a 20-item knowledge test at baseline, posteducation, and at a 6-month follow-up. Residents' oral health was assessed at baseline and again at a 6-month follow-up using the Modified Plaque Index (PI) and Modified Gingival Index (GI). Among staff members who received the oral care education (n = 32), posttest knowledge statistically significantly increased from the pretest level (p Care Dentistry Association and Wiley Periodicals, Inc.
Junior League of Ogden, UT.
This handbook was developed to promote interest in humane education and to encourage the adoption of humane education projects. Although specifically designed to assist Junior Leagues in developing such projects, the content should prove valuable to animal welfare organizations, zoos, aquariums, nature centers, and other project-oriented groups…
Kirby, Joslyn S; Adgerson, Cheri N; Anderson, Bryan E
The demands for cosmetic procedures are increasing. Dermatologists perform many of these procedures, therefore adequate education and training during residency is important. Surveys demonstrate dermatology residents desire more training even while faculty members believe this has already become a more prominent feature of resident education. We sought to assess the time and methods dedicated to education and training of cosmetic procedures in dermatology residency. A 26-question survey was developed and electronically distributed in May 2010 to dermatology program directors via the Association of Professors of Dermatology list-serve with their approval. Program directors were asked to forward the e-mail to their instructors of cosmetic/procedural dermatology, and chief residents. Responses were anonymous. A total of 86 responses were collected. In all, 67% (n = 54) of respondents had formal lectures focusing on cosmetic dermatology. Lecture topics reported by more than 50% of respondents included botulinum toxin injection, lasers, soft tissue augmentation, chemical peels, and sclerotherapy. Topics such as dermabrasion, liposuction, and scar revision were less commonly taught. The most commonly encountered and performed procedures were botulinum toxin injection and lasers (100%, n = 86); 98.8% (n = 85) encounter soft tissue augmentation and 95.4% (n = 82) encounter both chemical peels and sclerotherapy. Resident experience performing procedures as the first assistant or as the first surgeon varied widely. The limitations of this study are that the data were subjectively reported so results may differ from the true amount of time spent in any activity. The data may be biased by the population that responded as they may have strong opinions supporting or opposing training in cosmetic procedures. The data also may have been skewed by the small percentage of participants who were instructors of cosmetic dermatology (21%), chief residents (20%), and others respondents (8
Hsueh, Wayne D; Bent, John P; Moskowitz, Howard S
Technological change is leading to an evolution in medical education. The objective of our study was to assess the impact of a medical knowledge app, called PulseQD, on resident education within our otolaryngology-head and neck surgery department at Montefiore Medical Center, Albert Einstein College of Medicine (Bronx, NY). A prospective cohort study was conducted within the Department of Otolaryngology-Head and Neck Surgery from July 2016 to June 2017. All faculty attendings and residents were asked to participate in the study and were included. A Web and mobile-based app, PulseQD, that allowed for collaborative learning was implemented. Questionnaires were given at the beginning and end of the academic year. Otolaryngology Training Exam (OTE) scores were collected RESULTS: A total of 20 residents and 13 faculty members participated in the study. Residents used online sources of medical information significantly more often than faculty (90% and 54%, respectively, P = 0.0179). Residents and faculty felt that PulseQD offered a valuable perspective on clinically relevant medical information (P = 0.0003), was a great way to test clinical and medical knowledge (P = 0.0001), and improved the sharing and discussing of medical knowledge (P academic year. The implementation of a novel mobile app, PulseQD, was well received by residents and faculty in the Department of Otolaryngology-Head and Neck Surgery. Preliminary data suggest that app-based learning may lead to improved performance on knowledge-based assessments. NA. Laryngoscope, 2017. © 2017 The American Laryngological, Rhinological and Otological Society, Inc.
Zhang, Jie; Hardy, Peter A; DiSantis, David J; Oates, M Elizabeth
The American Board of Radiology Core Examination integrates assessment of physics knowledge into its overall testing of clinical radiology, with an emphasis on understanding image quality and artifacts, radiation dose, and patient safety for each modality or subspecialty organ system. Accordingly, achieving a holistic approach to physics education of radiology residents is a huge challenge. The traditional teaching of radiological physics-simply through didactic lectures-was not designed for such a holistic approach. Admittedly, time constraints and clinical demands can make incorporation of physics teaching into clinical practice problematic. We created and implemented a week-long, intensive physics rotation for fledgling radiology residents and evaluated its effectiveness. The dedicated physics rotation is held for 1 week during the first month of radiology residency. It comprises three components: introductory lectures, hands-on practical clinical physics operations, and observation of clinical image production. A brief introduction of the physics pertinent to each modality is given at the beginning of each session. Hands-on experimental demonstrations are emphasized, receiving the greatest allotment of time. The residents perform experiments such as measuring radiation dose, studying the relationship between patient dose and clinical practice (eg, fluoroscopy technique), investigating the influence of acquisition parameters (kV, mAs) on radiographs, and evaluating image quality using computed tomography, magnetic resonance imaging, ultrasound, and gamma camera/single-photon emission computed tomography/positron emission tomography phantoms. Quantitative assessment of the effectiveness of the rotation is based on an examination that tests the residents' grasp of basic medical physics concepts along with written course evaluations provided by each resident. The pre- and post-rotation tests show that after the physics rotation, the average correct score of 25
Millar, Heather C; Randle, Elizabeth A; Scott, Heather M; Shaw, Dorothy; Kent, Nancy; Nakajima, Amy K; Spitzer, Rachel F
To become culturally competent practitioners with the ability to care and advocate for vulnerable populations, residents must be educated in global health priorities. In the field of obstetrics and gynaecology, there is minimal information about global women's health (GWH) education and interest within residency programs. We wished to determine within obstetrics and gynaecology residency programs across Canada: (1) current GWH teaching and support, (2) the importance of GWH to residents and program directors, and (3) the level of interest in a national postgraduate GWH curriculum. We conducted an online survey across Canada of obstetrics and gynaecology residency program directors and senior obstetrics and gynaecology residents. Of 297 residents, 101 (34.0%) responded to the survey and 76 (26%) completed the full survey. Eleven of 16 program directors (68.8%) responded and 10/16 (62.5%) provided complete responses. Four of 11 programs (36.4%) had a GWH curriculum, 2/11 (18.2%) had a GWH budget, and 4/11 (36.4%) had a GWH chairperson. Nine of 10 program directors (90%) and 68/79 residents (86.1%) felt that an understanding of GWH issues is important for all Canadian obstetrics and gynaecology trainees. Only 1/10 program directors (10%) and 11/79 residents (13.9%) felt that their program offered sufficient education in these issues. Of residents in programs with a GWH curriculum, 12/19 (63.2%) felt that residents in their program who did not undertake an international elective would still learn about GWH, versus only 9/50 residents (18.0%) in programs without a curriculum (P education is important for all trainees and is currently insufficient. There is a high level of interest in a national postgraduate GWH educational module.
Corral, Irma; Johnson, Toni L; Shelton, Pheston G; Glass, Oliver
Resident physicians training in psychiatry in the U.S. are required to master a body of knowledge related to cultural psychiatry; are expected to adopt attitudes that endorse the principles of cultural competence; and finally are expected to acquire specific cultural competence skills that facilitate working effectively with diverse patients. This article first provides an overview of the Accreditation Council for Graduate Medical Education (ACGME) competencies related to cultural competence, as well as the American Academy of Child and Adolescent Psychiatry's (AACAP) recommendations for the cultural competence training of child/adolescent fellows. Next, numerous print and electronic resources that can be used in cultural competence education in psychiatry are reviewed and discussed. Finally, we conclude by providing recommendations for psychiatry residency programs that we culled from model cultural competence curricula.
Wouda, Jan C.; van de Wiel, Harry B. M.
Objectives: We compared supervisors' and residents' patient-education competency in challenging consultations in order to establish whether supervisors demonstrate sufficient patient-education competency to act credibly as role models and coaches for residents. Methods: All consultations conducted
Bhattarai, M D
The learners have to take active parts in the teaching learning activities. To make them aware and to help them develop the skills required, the need of the study skills course in medical education early in the part of their training has been realized for the postgraduate residents. The important areas of the study skills course focusing in the requirement of clinical components of the postgraduate residents are 1) Interpersonal and communications skills, 2) Teaching, learning and presentation skills, 3) Language, reading and computer use, 4) Evidence based medicine and diagnosis and management, 5) Assessment principles and strategies, 6) Time management strategies to get the best out of the training, 7) Reflection, portfolio and self-directed lifelong learning, and 8) Follow-up presentation. The methodologies that could be used in such study skills course are interactive lectures, brainstorming, presentations by the trainees, demonstration to and by the trainees, small group discussion, group work and presentation, group and individual feedback, practice sessions, role play, short relevant video movies, video recording of the trainees and viewing with feedback. With their already tight training schedule and posting and other similar other mandatory courses required for the postgraduate residents, much time cannot be allocated for the study skills course in medical education alone. Similar study skills course in medical education may need to be arranged for the undergraduate medical students as well.
Roberts, Susanne M; Jarvis-Selinger, Sandra; Pratt, Daniel D; Polonijo, Andrea; Polinijo, Andrea; Stacy, Elizabeth; Wisener, Katherine; Black, Kevin P
Despite advances in understanding the "systems-based practice" competency in resident education, this topic has remained difficult to teach, assess, and document. The goal of this study was to perform a needs assessment and an analysis of the current state of systems-based practice education in orthopaedic residency programs across the U.S. and within our own institution. A sample of orthopaedic educators and residents from across the U.S. who were attending the 2010 American Orthopaedic Association (AOA) Effective Orthopaedic Educator Course, AOA Resident Leadership Forum, and AOA Council of Residency Directors meeting were surveyed to determine (1) which aspects of systems-based practice, if any, were being taught; (2) how systems-based practice is being taught; and (3) how residency programs are assessing systems-based practice. In addition, an in-depth case study of these issues was performed by means of seven semi-structured focus group sessions with diverse stakeholders who participated in the care of musculoskeletal patients at the authors' institution. A quantitative approach was used to analyze the survey data. The focus group data were analyzed with procedures associated with grounded theory, relying on a constant comparative method to develop salient themes arising from the discussion. "Clinical observation" (33%) and "didactic case-based learning" (23%) were reported by the survey respondents as the most commonly used teaching methods, but specific topics were taught inconsistently. Competency assessment was reported to occur infrequently, and 36% of respondents reported that systems-based practice areas were not being assessed by any methods. The focus group discussions emphasized the need for standardized experiential learning that was closely linked to the patient's perspective. Orthopaedic faculty members were uncomfortable with their knowledge of this competency and their ability to teach and assess it. Teaching the systems-based practice
Vieira, Teresa Cristina Souza Barroso; Nakamura, Mary Uchiyama; Silva, Ivaldo da; Torloni, Maria Regina; Ribeiro, Meireluci Costa; Souza, Eduardo de
Purpose To describe the experience of a distance education course on sexual issues during pregnancy and after birth for residents. Methods This prospective educational intervention study was conducted by investigators from the Universidade Federal de São Paulo, Brazil, between April and September 2014. The participants were 219 physicians (residents from the 1st to the 6th years). The duration of the course was of 24 hours (10 video lectures and online chats). At baseline, the participants answered questions about their training, attitude and experience regarding sexual issues during pregnancy and after birth; before and after the course, they answered questions to assess their knowledge about the topic; at the end of the course, they answered questions on the quality of the course. The Student t -test was used to compare the before and after scores of the knowledge tests; values of p < 0.05 were considered statistically significant. Results A total of 143 residents concluded the course; most were in their 1st (27.2%) or 3rd (29.4%) years of residency. There was a significant increase in the mean scores of the questionnaires that assessed the knowledge of the topic: 4.4 (±1.6) versus 6.0 (±1.3; maximum score: 10), before and after the course respectively ( p < 0.0001). Most of the participants (74.1%) declared that the quality of the course as a whole reached their expectations, and 81.1% would recommend the course to a friend. Conclusions The online Sexology course for Obstetrics and Gynecology residents increased their knowledge about the sexual issues during pregnancy and after birth, and fulfilled the participants' expectations. The experience described here may serve as a model for other sexuality courses targeting similar audiences. Thieme Revinter Publicações Ltda Rio de Janeiro, Brazil.
Singer, Benjamin D.; Corbridge, Thomas C.; Schroedl, Clara J.; Wilcox, Jane E.; Cohen, Elaine R.; McGaghie, William C.; Wayne, Diane B.
Introduction Prior research shows that gaps exist in internal medicine residents’ critical care knowledge and skills. The purpose of this study was to compare the bedside critical care competency of first-year residents who received a simulation-based educational intervention plus clinical training to third-year residents who received clinical training alone. Methods During their first three months of residency, a group of first-year residents completed a simulation-based educational intervention. A group of traditionally-trained third-year residents who did not receive simulation-based training served as a comparison group. Both groups were evaluated using a 20-item clinical skills assessment at the bedside of a patient receiving mechanical ventilation at the end of their medical intensive care unit rotation. Scores on the skills assessment were compared between groups. Results Simulator-trained first-year residents (n=40) scored significantly higher compared to traditionally-trained third-year residents (n=27) on the bedside assessment, 91.3% (95% CI 88.2% to 94.3%) vs. 80.9% (95% CI 76.8% to 85.0%), P = simulation-based educational intervention demonstrated higher clinical competency than third-year residents who did not undergo simulation training. Critical care competency cannot be assumed after clinical ICU rotations; simulation-based curricula can help ensure residents are proficient to care for critically ill patients. PMID:23222546
Craddock, Megan F; Blondin, Heather M; Youssef, Molly J; Tollefson, Megha M; Hill, Lauren F; Hanson, Janice L; Bruckner, Anna L
Pediatricians manage skin conditions such as atopic dermatitis (AD) but report that their dermatologic training is inadequate. Online modules may enhance medical education when sufficient didactic or clinical teaching experiences are lacking. We assessed whether an online module about AD improved pediatric residents' knowledge and changed their clinical management of AD. Target and control cohorts of pediatric residents from two institutions were recruited. Target subjects took a 30-question test about AD early in their residency, reviewed the online module, and repeated the test 6 months and 1 year later. The control subjects, who had 1 year of clinical experience but had not reviewed the online module, also took the test. The mean percentage of correct answers was calculated and compared using two-sided, two-sample independent t tests and repeated-measures analysis of variance. For a subset of participants, clinical documentation from AD encounters was reviewed and 13 practice behaviors were compared using the Fisher exact test. Twenty-five subjects in the target cohort and 29 subjects in the control cohort completed the study. The target cohort improved from 18.0 ± 3.2 to 23.4 ± 3.4 correctly answered questions over 1 year (P online module about AD demonstrated statistically significant improvement in disease-specific knowledge over time and had statistically significantly higher scores than controls. Online dermatology education may effectively supplement traditional clinical teaching. © 2017 Wiley Periodicals, Inc.
Kuo, Kelly; Zhu, Tao Y; Raidoo, Shandhini; Zhao, Lulu X; Sammarco, Anne; Ashby, Karen
To assess the impact of a resident-driven sexual health educational initiative in an inner-city Cleveland middle school. 10 resident physicians and 57 students in 7(th) and 8(th) grade participated in this prospective cohort study. Residents taught 3 sessions on the topics of basic anatomy and physiology, pregnancy, sexually transmitted infections (STI), contraception, and safe relationships. Outcome measures included the percentages of students able to name at least 3 different STIs and contraceptive methods; to name potential complications of STIs; and to correctly identify condoms and abstinence as the only contraceptive methods also protective against STI transmission. Significant improvements were noted in students' baseline knowledge of human anatomy, contraception, and safe sex practices after completion of the curriculum. The percentage of students able to name at least 3 forms of birth control increased from 1.7% to 70.7% (P curriculum demonstrated significant knowledge retention. All residents and medical students surveyed described a perceived need for comprehensive-rather than abstinence-based-reproductive health education in schools. The socioeconomic burden of teen pregnancy justifies comprehensive efforts to improve reproductive health education. Copyright © 2014 North American Society for Pediatric and Adolescent Gynecology. Published by Elsevier Inc. All rights reserved.
Dwyer, Tim; Wright, Sara; Kulasegaram, Kulamakan M; Theodoropoulos, John; Chahal, Jaskarndip; Wasserstein, David; Ringsted, Charlotte; Hodges, Brian; Ogilvie-Harris, Darrell
Competency-based medical education as a resident-training format will move postgraduate training away from time-based training, to a model based on observable outcomes. The purpose of this study was to determine whether junior residents and senior residents could demonstrate clinical skills to a similar level, after a sports medicine rotation. All residents undertaking a three-month sports medicine rotation had to pass an Objective Structured Clinical Examination. The stations tested the fundamentals of history-taking, examination, image interpretation, differential diagnosis, informed consent, and clinical decision-making. Performance at each station was assessed with a binary station-specific checklist and an overall global rating scale, in which 1 indicated novice, 2 indicated advanced beginner, 3 indicated competent, 4 indicated proficient, and 5 indicated expert. A global rating scale was also given for each domain of knowledge. Over eighteen months, thirty-nine residents (twenty-one junior residents and eighteen senior residents) and six fellows (for a total of forty-five participants) completed the examination. With regard to junior residents and senior residents, analysis using a two-tailed t test demonstrated a significant difference (p < 0.01) in both total checklist score and overall global rating scale; the mean total checklist score (and standard deviation) was 56.15% ± 10.99% for junior residents and 71.87% ± 8.94% for senior residents, and the mean global rating scale was 2.44 ± 0.55 for junior residents and 3.79 ± 0.49 for senior residents. There was a significant difference between junior residents and senior residents for each knowledge domain, with a significance of p < 0.05 for history-taking and p < 0.01 for the remainder of the domains. Despite intensive teaching within a competency-based medical education model, junior residents were not able to demonstrate knowledge as well as senior residents, suggesting that overall clinical experience
Le Grange, L.
In this article I initiate a debate into the (de)merits of human capital theory and human capability theory and discuss implications of the debate for higher education. Human capital theory holds that economic growth depends on investment in education and that economic growth is the basis for improving the quality of human life. Human capable…
Jordan, Justin T; Mayans, David; Schneider, Logan; Adams, Nellie; Khawaja, Ayaz M; Engstrom, John
To survey US-trained graduating neurology residents who are American Academy of Neurology members, in an effort to trend perceived quality and completeness of graduate neurology education. An electronic survey was sent to all American Academy of Neurology members graduating from US neurology residency programs in the Spring of 2014. Of 805 eligible respondents, 24% completed the survey. Ninety-three percent of adult neurology residents and 56% of child neurology residents reported plans to pursue fellowship training after residency. Respondents reported a desire for additional training in neurocritical care, neuro-oncology, neuromuscular diseases, botulinum toxin injection, and nerve blocks. There remains a clear deficit in business training of neurology residents, although there was notable improvement in knowledge of coding and office management compared to previous surveys. Although there are still areas of perceived weakness in neurology training, graduating neurology residents feel generally well prepared for their chosen careers. However, most still pursue fellowship training for reasons that are little understood. In addition to certain subspecialties and procedures, practice management remains deficient in neurology training and is a point of future insecurity for most residents. Future curriculum changes should consider resident-reported gaps in knowledge, with careful consideration of improving business training. © 2016 American Academy of Neurology.
Pisani, Anthony R; leRoux, Pieter; Siegel, David M
Pediatric residency practices face the challenge of providing both behavioral health (BH) training for pediatricians and psychosocial care for children. The University of Rochester School of Medicine and Dentistry and Rochester General Hospital developed a joint training program and continuity clinic infrastructure in which pediatric residents and postdoctoral psychology fellows train and practice together. The integrated program provides children access to BH care in a primary care setting and gives trainees the opportunity to integrate collaborative BH care into their regular practice routines. During 1998-2008, 48 pediatric residents and 8 psychology fellows trained in this integrated clinical environment. The program's accomplishments include longevity, faculty and fiscal stability, sustained support from pediatric leadership and community payers, the development in residents and faculty of greater comfort in addressing BH problems and collaborating with BH specialists, and replication of the model in two other primary care settings. In addition to quantitative program outcomes data, the authors present a case example that illustrates how the integrated program works and achieves its goals. They propose that educating residents and psychology trainees side by side in collaborative BH care is clinically and educationally valuable and potentially applicable to other settings. A companion report published in this issue provides results from a study comparing the perceptions of pediatric residents whose primary care continuity clinic took place in this integrated setting with those of residents from the same pediatric residency who had their continuity clinic training in a nonintegrated setting.
Suzana Miovska Spaseva
Full Text Available The article examines the complex role and great responsibility of the education today in development of the moral strength and human values of the children and youth. At the beginning of the article the author reconsiders the pedagogical ideas of Maria Montessori and her concept of education for peace as an instrument for reconstruction of the society and for improvement of the human living. Than the analysis of the moral values in the contemporary society is made and several issues and dilemmas are discussed referring the value disorientation of the youth and the importance of the models of adult’s moral behavior in their search for personal identity. On the basis of this analysis, the human dimension of the education is elaborated enhancing the need for its understanding as support of development, which is based on several crucial elements: love, freedom and spirit of community.
Johnson, Nicholas E; Maas, Matthew B; Coleman, Mary; Jozefowicz, Ralph; Engstrom, John
To assess the strengths and weaknesses of neurology resident education using survey methodology. A 27-question survey was sent to all neurology residents completing residency training in the United States in 2011. Of eligible respondents, 49.8% of residents returned the survey. Most residents believed previously instituted duty hour restrictions had a positive impact on resident quality of life without impacting patient care. Most residents rated their faculty and clinical didactics favorably. However, many residents reported suboptimal preparation in basic neuroscience and practice management issues. Most residents (71%) noted that the Residency In-service Training Examination (RITE) assisted in self-study. A minority of residents (14%) reported that the RITE scores were used for reasons other than self-study. The vast majority (86%) of residents will enter fellowship training following residency and were satisfied with the fellowship offers they received. Graduating residents had largely favorable neurology training experiences. Several common deficiencies include education in basic neuroscience and clinical practice management. Importantly, prior changes to duty hours did not negatively affect the resident perception of neurology residency training.
Rodriguez Lien, Elizabeth; Shattuck, Karen
Breastfeeding education is known to be insufficient in pediatric (PEDS) training and is, in part, responsible for suboptimal rates of breastfeeding. No recent studies about the level of education provided to family medicine (FM) and obstetrics-gynecology (OB) residency trainees are available. This study was conducted to investigate breastfeeding education and support services provided to FM and OB residents in the United States. The results were compared with a 2011 study of PEDS residents. A cross-sectional study was conducted using a web-based survey emailed to program directors (PDs) of FM and OB residency programs in the United States. Eighteen percent of PDs (95 of 515) completed the survey. Of these, 88% answered questions regarding education and support services provided. A median of 23 hours of breastfeeding education is provided to OB residents (4-year program) and 8 hours provided to FM residents (3-year program). In comparison, PEDS programs reported a median of 9 hours. The most commonly used settings included lectures with faculty and lactation consultants, similar to the PEDS study. Approximately 75% of respondents cited barriers to educating residents, with limited resident time being the most common. Eighty-one percent of respondents identified breastfeeding rooms as the service most frequently provided to residents who breastfeed. FM and PEDS residents are provided similar amounts of breastfeeding education, while OB programs provide more education, but in different settings. Reported barriers to this education are similar in all specialties. Support services are more commonly provided in PEDS programs.
Cabrera, Alvin R; Lee, W Robert; Madden, Richard; Sims, Ershela; Hoang, Jenny K; White, Leonard E; Marks, Lawrence B; Chino, Junzo P
Radiation oncologists require a thorough understanding of anatomy, but gross anatomy is not part of the standard residency curriculum. "Oncoanatomy" is an educational program for radiation oncology residents at Duke University that integrates cadaver dissection into the instruction of oncologic anatomy, imaging, and treatment planning. In this report, the authors document their experience with a 2-year curriculum. Nineteen radiation oncology residents from Duke University and the University of North Carolina participated during academic years 2008-2009 and 2009-2010. Monthly modules, based on anatomic site, consisted of one or two clinically oriented hour-long lectures, followed by a 1-hour gross anatomy session. Clinical lectures were case based and focused on radiographic anatomy, image segmentation, and field design. Gross anatomy sessions centered on cadaver prosections, with small groups rotating through stations at which anatomists led cadaver exploration. Adjacent monitors featured radiologic imaging to facilitate synthesis of gross anatomy with imaging anatomy. Satisfaction was assessed on a 10-point scale via anonymous survey. Twenty modules were held over the 2-year period. Participants gave the course a median rating of 8 (interquartile range, 7-9), with 1 signifying "as effective as the worst educational activities" and 10 "as effective as the best educational activities." High resident satisfaction was seen with all module components. Incorporating a structured, 2-year gross anatomy-based curriculum into radiation oncology residency is feasible and associated with high resident satisfaction. Copyright © 2011 American College of Radiology. Published by Elsevier Inc. All rights reserved.
Fitchett, George; Tartaglia, Alexander; Dodd-McCue, Diane; Murphy, Patricia
There is growing evidence that leaders in professional health care chaplaincy recognize the important role of research. The Standards of Practice recently approved by the Association of Professional Chaplains (APC), and especially the standard about research (Standard 12), provide strong evidence that the profession sees research, and research-literate chaplains, as important for its future. The aim of this study was to identify the extent to which Association for Clinical Pastoral Education, Inc (ACPE) accredited clinical pastoral education (CPE) residency programs are preparing their graduates to be the kind of research-literate chaplains described in these Standards. We interviewed CPE supervisors from 26 randomly-selected CPE residency programs. We found 12% of the programs had intentional and substantive research-related curricula, 27% of the programs offered some limited exposure to research, and 62% of the programs provided no education about research. We found also that supervisors often defined "research education" in terms of actually conducting research projects. CPE residency programs potentially play a central role in educating research-literate chaplains. Future research should examine the incentives and barriers that influence the inclusion of research education in CPE residency programs.
Kim, Curi; Fetters, Michael D; Gorenflo, Daniel W
The value of the morbidity and mortality conference (M&MC) has received little examination in the primary care literature. We sought to understand the educational content of M&MCs by examining data from a family medicine training program. Archived morbidity and mortality conference data (July 2001-July 2003) were retrieved from two University of Michigan family medicine adult inpatient services (one community based and one university based). We used chi-square and t test to compare demographic variables and adverse events between hospital sites. We qualitatively analyzed written comments about adverse events. Both family medicine services shared similar diagnoses, patient volume, length of stay, and gender distribution of patients, but the community hospital had an older average patient age (67.9 years versus 52.9 years) and a higher outpatient complication rate. Analysis of the qualitative data revealed patterns of adverse events, such as an association between avoidable admissions and inadequate pain control, that could be improved through educational intervention. Although family medicine residents' experiences in university and community hospitals were comparable, there were differences in patient populations and case complexity. Modifying the M&MC format could enhance its effectiveness as an educational tool about adverse events.
Full Text Available Staphylococcus aureus is a part of the microbiota flora in many animal species. The clonal spread of S. aureus among animals and personnel in a Zoological Park was investigated. Samples were collected from colonized and infected sites among 32 mammals, 11 birds and eight humans. The genes mecA, mecC, lukF/lukS-PV (encoding Panton-Valentine leukocidin, PVL and tst (toxic shock syndrome toxin-1 were investigated by PCR. Clones were defined by Multilocus Sequence Typing (MLST, spa type and Pulsed-Field Gel Electrophoresis (PFGE. Seven S. aureus isolates were recovered from four animals and one from an employee. All were mecA, mecC and tst–negative, whereas, one carried the PVL genes and was isolated from an infected Squirrel monkey. Clonal analysis revealed the occurrence of seven STs, eight PFGE and five spa types including ones of human origin. Even though a variety of genotypes were identified among S. aureus strains colonizing zoo park residents, our results indicate that colonization with human lineages has indeed occurred.
Salem, Johannes; Borgmann, Hendrik; MacNeily, Andrew; Boehm, Katharina; Schmid, Marianne; Groeben, Christer; Baunacke, Martin; Huber, Johannes
To investigate the usage and perceived usefulness of new media for educating urology residents in Canada and Germany. We designed an 11-item online survey to assess the use and perceived usefulness of new media for education. We performed a comparative analysis. The survey was distributed via e-mail to 143 Canadian and 721 German urology residents. The survey included 58 urology residents from Canada and 170 from Germany. A total of 58 residents from Canada (41% response rate) and 170 from Germany (24% response rate) responded to this survey. Residents spent 45% of their education time on new media. The Internet was used by 91% (n = 208) of the residents for professional education purposes, with a median time of 270 minutes (interquartile range [IQR]: 114-540) per month. Apps were used by 54% (n = 118) of the residents, with a median time of 101 minutes (IQR: 45-293) per month. A total of 23% (n = 47) of the residents used social media (SoMe) for education, with a median time of 90 minutes (IQR: 53-80) per month. In all, 100% (n = 228) rated the Internet, 76% (n = 173) apps, and 43% (n = 97) SoMe as being useful for professional education purposes. A total of 90% (n = 205) watched medical videos for education, and 89% (n = 203) of these videos were on surgical procedures. Canadian urology residents used more new media sources for professional education than did the Germans (58% vs. 41%, p media was higher among Canadian residents for the Internet (p media play a dominant role in the education of urology residents. The primary source for personal education in urology is the Internet. Future studies and technological developments should investigate and improve new media tools to optimize education during residency. Copyright © 2017 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.
Narang, Akhil; Arora, Vineet M
Background Residency programs face many challenges in educating learners. The millennial generation’s learning preferences also force us to reconsider how to reach physicians in training. Social media is emerging as a viable tool for advancing curricula in graduate medical education. Objective The authors sought to understand how social media enhances a residency program’s educational mission. Methods While chief residents in the 2013-2014 academic year, two of the authors (PB, AN) maintained a Twitter feed for their academic internal medicine residency program. Participants included the chief residents and categorical internal medicine house staff. Results At the year’s end, the authors surveyed residents about uses and attitudes toward this initiative. Residents generally found the chief residents’ tweets informative, and most residents (42/61, 69%) agreed that Twitter enhanced their overall education in residency. Conclusions Data from this single-site intervention corroborate that Twitter can strengthen a residency program’s educational mission. The program’s robust following on Twitter outside of the home program also suggests a need for wider adoption of social media in graduate medical education. Improved use of data analytics and dissemination of these practices to other programs would lend additional insight into social media’s role in improving residents’ educational experiences. PMID:27731845
Tait, Glendon R.; Hodges, Brian D.
Objective: The authors examined psychiatric residents' attitudes, perceived preparedness, experiences, and needs in end-of-life care education. They also examined how residents conceptualized good end-of-life care and dignity. Methods: The authors conducted an electronic survey of 116 psychiatric residents at the University of Toronto. The survey…
O'Heron, Colette T; Jarman, Benjamin T
To outline a structured approach for general surgery resident integration into institutional quality improvement and patient safety education and development. A strategic plan to address Accreditation Council for Graduate Medical Education (ACGME) Clinical Learning Environment Review assessments for resident integration into Quality Improvement and Patient Safety initiatives is described. Gundersen Lutheran Medical Foundation is an independent academic medical center graduating three categorical residents per year within an integrated multi-specialty health system serving 19 counties over 3 states. The quality improvement and patient safety education program includes a formal lecture series, online didactic sessions, mandatory quality improvement or patient safety projects, institutional committee membership, an opportunity to serve as a designated American College of Surgeons National Surgical Quality Improvement Project and Quality in Training representative, mandatory morbidity and mortality conference attendance and clinical electives in rural surgery and international settings. Structured education regarding and participation in quality improvement and patient safety programs are able to be accomplished during general surgery residency. The long-term outcomes and benefits of these strategies are unknown at this time and will be difficult to measure with objective data. © 2013 Published by Association of Program Directors in Surgery on behalf of Association of Program Directors in Surgery.
Cohen, Elaine R.; Caprio, Timothy; McGaghie, William C.; Simuni, Tanya; Wayne, Diane B.
Objective: To evaluate the effect of simulation-based mastery learning (SBML) on internal medicine residents' lumbar puncture (LP) skills, assess neurology residents' acquired LP skills from traditional clinical education, and compare the results of SBML to traditional clinical education. Methods: This study was a pretest-posttest design with a comparison group. Fifty-eight postgraduate year (PGY) 1 internal medicine residents received an SBML intervention in LP. Residents completed a baseline skill assessment (pretest) using a 21-item LP checklist. After a 3-hour session featuring deliberate practice and feedback, residents completed a posttest and were expected to meet or exceed a minimum passing score (MPS) set by an expert panel. Simulator-trained residents' pretest and posttest scores were compared to assess the impact of the intervention. Thirty-six PGY2, 3, and 4 neurology residents from 3 medical centers completed the same simulated LP assessment without SBML. SBML posttest scores were compared to neurology residents' baseline scores. Results: PGY1 internal medicine residents improved from a mean of 46.3% to 95.7% after SBML (p < 0.001) and all met the MPS at final posttest. The performance of traditionally trained neurology residents was significantly lower than simulator-trained residents (mean 65.4%, p < 0.001) and only 6% met the MPS. Conclusions: Residents who completed SBML showed significant improvement in LP procedural skills. Few neurology residents were competent to perform a simulated LP despite clinical experience with the procedure. PMID:22675080
Tolan, Amy M; Kaji, Amy H; Quach, Chi; Hines, O Joe; de Virgilio, Christian
Program directors often struggle to determine which factors in the Electronic Residency Application Service (ERAS) application are important in the residency selection process. With the establishment of the Accreditation Council for Graduate Medical Education (ACGME) competencies, it would be important to know whether information available in the ERAS application can predict subsequent competency-based performance of general surgery residents. This study is a retrospective correlation of data points found in the ERAS application with core competency-based clinical rotation evaluations. ACGME competency-based evaluations as well as technical skills assessment from all rotations during residency were collected. The overall competency score was defined as an average of all 6 competencies and technical skills. A total of77 residents from two (one university and one community based university-affiliate) general surgery residency programs were included in the analysis. Receiving honors for many of the third year clerkships and AOA membership were associated with a number of the individual competencies. USMLE scores were predictive only of Medical Knowledge (p = 0.004). Factors associated with higher overall competency were female gender (p = 0.02), AOA (p = 0.06), overall number of honors received (p = 0.04), and honors in Ob/Gyn (p = 0.03) and Pediatrics (p = 0.05). Multivariable analysis showed honors in Ob/Gyn, female gender, older age, and total number of honors to be predictive of a number of individual core competencies. USMLE scores were only predictive of Medical Knowledge. The ERAS application is useful for predicting subsequent competency based performance in surgical residents. Receiving honors in the surgery clerkship, which has traditionally carried weight when evaluating a potential surgery resident, may not be as strong a predictor of future success. Copyright © 2010 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights
Tan, Charlene; Ibrahim, Azhar
This article explores and compares the salient characteristics and educational influences of humanism in both Islam and Confucianism. It is argued that the humanist tradition in both belief systems upholds the development and transforming ability of human beings. A common aim of education is to nurture God/Way-conscious and virtuous individuals…
Lepiller, Quentin; Solis, Morgane; Velay, Aurélie; Gantner, Pierre; Sueur, Charlotte; Stoll-Keller, Françoise; Barth, Heidi; Fafi-Kremer, Samira
Theoretical knowledge in biology and medicine plays a substantial role in laboratory medicine resident education. In this study, we assessed the contribution of problem-based learning (PBL) to improve the training of laboratory medicine residents during their internship in the department of virology, Strasbourg University Hospital, France. We compared the residents' satisfaction regarding an educational program based on PBL and a program based on lectures and presentations. PBL induced a high level of satisfaction (100%) among residents compared to lectures and presentations (53%). The main advantages of this technique were to create a situational interest regarding virological problems, to boost the residents' motivation and to help them identify the most relevant learning objectives in virology. However, it appears pertinent to educate the residents in appropriate bibliographic research techniques prior to PBL use and to monitor their learning by regular formative assessment sessions.
Turner, Simon R; Lai, Hollis; Bédard, Eric L R
Cigarette smoking is the leading cause of preventable death in North America and a major contributor to surgically treated diseases and operative complications. Counseling by residents can be an effective means of helping patients to quit smoking, and with the introduction of the Accreditation Council for Graduate Medical Education and CanMEDS competency frameworks, health promotion is a required component of residency training. However, past studies have found that smoking cessation counseling by residents, and in particular surgical residents, is lacking. In light of the introduction of health promotion as a core competency in residency training, this study was designed to examine the attitudes and practices of residents at our institution regarding smoking cessation counseling, comparing surgical and nonsurgical residents and seeking to identify barriers to resident counseling. An internet-based questionnaire was distributed to all residents at the University of Alberta in the fall of 2012. Items examined residents׳ attitudes and practices related to smoking cessation counseling and barriers to counseling. Although almost all residents believed that smoking cessation was important and that counseling was part of their job as a resident, far fewer routinely practiced the counseling behaviors examined. Surgical residents were less likely to perform counseling and more likely to think that counseling was not part of their job. Surgical residents were also more likely to identify obstacles to counseling such as a lack of time and formal training. Residents, and surgical residents in particular, are missing opportunities to help their patients quit smoking and improve their health. Given their positive attitudes toward counseling, it may be possible to improve their counseling practices through simple means. By identifying obstacles to counseling and tools that may increase residents׳ tendency to perform counseling, this study can help to guide training programs
Mai, Mark V; Luo, Brooke T; Orenstein, Evan W; Luberti, Anthony A
Opportunities for education in clinical informatics exist throughout the spectrum of formal education extending from high school to postgraduate training. However, physicians in residency represent an underdeveloped source of potential informaticians. Despite the rapid growth of accredited fellowship programs since clinical informatics became a board-eligible subspecialty in 2011, few resident physicians are aware of their role at the intersection of clinical medicine and health information technology or associated opportunities. In an effort to educate and engage residents in clinical informatics, Children's Hospital of Philadelphia has developed a three-pronged model: (1) an elective rotation with hands-on project experience; (2) a longitudinal experience that offers increased exposure and mentorship; and (3) a resident founded and led working group in clinical informatics. We describe resident participation in these initiatives and lessons learned, as well as resident perceptions of how these components have positively influenced informatics knowledge and career choices. Since inception of this model, five residents have pursued the clinical informatics fellowship. This educational model supports resident involvement in hospital-wide informatics efforts with tangible projects and promotes wider engagement through educational opportunities commensurate with the resident's level of interest. Schattauer GmbH Stuttgart.
Blash, Anthony; Saltsman, Connie L; Steil, Condit
Upon completion of their post-graduate training, pharmacy informatics residents need to be prepared to interact with clinical and technology experts in the new healthcare environment. This study describes pharmacy informatics residency programs within the United States. Preliminary information for all pharmacy informatics residency programs was accessed from program webpages. An email was sent out to programs asking them to respond to a six-item questionnaire. This questionnaire was designed to elicit information on attributes of the program, behaviors of the preceptors and residents, and attitudes of the residency directors. Of 22 pharmacy informatics residencies identified, nineteen (86%) participated. Twenty (91%) were second post-graduate year (PGY2) residencies. Ten (45%) were accredited by the American Society of Health-System Pharmacists (ASHP), while eight (36%) were candidates for accreditation. Hospital (17/22, 77%) and administrative offices (3/22, 14%) were the predominant training sites for pharmacy informatics residents. Large institutions were the predominant training environment for the pharmacy informatics resident, with 19 of 22 (86%) institutions reporting a licensed bed count of 500 or more. The median (range) number of informatics preceptors at a site was six to eight. Regarding barriers to pharmacy informatics residency education, residency directors reported that residents did not feel prepared based on the limited availability of curricular offerings. In the United States, relatively few residencies are explicitly focused on pharmacy informatics. Most of these are accredited and hospital affiliated, especially with large institutions (>500 beds). Copyright © 2017 Elsevier Inc. All rights reserved.
Galiatsatos, Panagis; Porto-Carreiro, Fernanda; Hayashi, Jennifer; Zakaria, Sammy; Christmas, Colleen
Background Residents work at variable times and are often unable to attend all scheduled educational sessions. Therefore, new asynchronistic approaches to learning are essential in ensuring exposure to a comprehensive education. Social media tools may be especially useful, because they are accessed at times convenient for the learner. Objective Assess if the use of Twitter for medical education impacts the attitude and behavior of residents toward using social media for medical education. Design Preintervention and postintervention surveys. Internal medicine resident physicians were surveyed before the launch of a residency-specific Twitter webpage on August 1, 2013, and again 135 days later, to determine their use of the Twitter application and web page, as well as other social media for medical education. Participants Residents at an internal medicine urban academic training program. Main Measures All residents within our training program were administered web-based surveys. The surveys assessed resident views and their frequency of use of social media for medical education purposes, and consisted of 10 Likert scale questions. Each answer consisted of a datapoint on a 1-5 scale (1=not useful, 3=useful, 5=very useful). The final survey question was open-ended and asked for general comments. Key Results Thirty-five of 50 residents (70%) completed the presurvey and 40 (80%) participated in the postsurvey. At baseline, 34 out of 35 residents used social media and nine specifically used Twitter. Twenty-seven (77%) used social media for medical education; however, only three used Twitter for educational purposes. After the establishment of the Twitter page, the percentage of residents using social media for educational purposes increased (34 of 40 residents, 85%), and 22 used Twitter for this purpose (psocial media could be useful as a medical education tool, which slightly increased from 30 out of 35 in the preintervention survey (p=0.01). Conclusion Residents believe
Martha, Carlough; Sylvia, Becker-Dreps; Samuel, Hawes; Bethany, Hodge; Ian, Martin; Denniston, Clark
Following a similar trend among United States (US) medical students, US resident physicians are increasingly interested in pursuing global health education. Largely, residency education has lagged behind in addressing this demand. Time and curriculum requirements make meeting this need challenging. The Office of International Activities (OIA) at University of North Carolina-Chapel Hill (UNC-CH) was founded to provide support to students and residents in the area global health. In order to more fully understand resident physicians' attitudes and educational needs, a survey of incoming residents was undertaken. The OIA administered a survey for incoming first-year residents of all specialties in July 2012. The survey was administered over one month using Qualtrics® and the response rate was 60%. Although 42% of residents had had an international experience during medical school, only 36% reported they felt prepared to address issues of international public health, including travel medicine and immigrant health. Significant barriers to involvement in global health opportunities in residency education were identified, including lack of time, finances and mentorship. As has been previously documented for global health education for medical students, this study's residents saw significant barriers to international electives during residency, including lack of elective time, finances and family responsibilities. In response to the survey results, an interdisciplinary educational initiative was developed at our school. This included obtaining buy-in from core residency leadership, establishing a pathway to arrange experiences, competitive scholarships for travel, and initiation of interdisciplinary educational opportunities. Results may serve as a useful model for other academic centers in developed countries.
Brand, Eske; Fridberg, Marie; Knudsen, Ulrik Kragegaard
OBJECTIVE: The objective of the study was to examine the educational exposure during residency in Danish orthopedic departments. DESIGN: Questionnaire-based cross-sectional study. SETTING: Data were gathered from January 1, 2014 to April 30, 2014 through a nationwide web-based questionnaire....... CONCLUSIONS: A large variation in the educational exposure was found among the Danish orthopedic departments. Numbers indicate that Danish residents, compared with their US counterparts, operate considerably less during residency. Most residents work overtime and many of them work for free to participate...
Schoenfeld, Elizabeth M; Goff, Sarah L; Elia, Tala R; Khordipour, Errel R; Poronsky, Kye E; Nault, Kelly A; Lindenauer, Peter K; Mazor, Kathleen M
Physicians need to rapidly and effectively facilitate patient-centered, shared decision-making (SDM) conversations, but little is known about how residents or attending physicians acquire this skill. We explored emergency medicine (EM) attending physicians' use of SDM in the context of their experience as former residents and current educators and assessed the implications of these findings on learning opportunities for residents. We used semistructured interviews with a purposeful sample of EM physicians. Interviews were transcribed verbatim, and 3 research team members performed iterative, open coding of transcripts, building a provisional codebook as work progressed. We analyzed the data with a focus on participants' acquisition and use of skills required for SDM and their use of SDM in the context of resident education. Fifteen EM physicians from academic and community practices were interviewed. All reported using SDM techniques to some degree. Multiple themes noted had negative implications for resident acquisition of this skill: (1) the complex relationships among patients, residents, and attending physicians; (2) residents' skill levels; (3) the setting of busy emergency departments; and (4) individual attending factors. One theme was noted to facilitate resident education: the changing culture-with a cultural shift toward patient-centered care. A constellation of factors may diminish opportunities for residents to acquire and practice SDM skills. Further research should explore residents' perspectives, address the modifiable obstacles identified, and examine whether these issues generalize to other specialties.
Hochberg, Mark S; Berman, Russell S; Kalet, Adina L; Zabar, Sondra R; Gillespie, Colleen; Pachter, H Leon
Teaching professionalism effectively to fully engaged residents is a significant challenge. A key question is whether the integration of professionalism into residency education leads to a change in resident culture. The goal of this study was to assess whether professionalism has taken root in the surgical resident culture 3 years after implementing our professionalism curriculum. Evidence was derived from 3 studies: (1) annual self-assessments of the residents' perceived professionalism abilities to perform 20 defined tasks representing core Accrediting Council on Graduate Medical Education professionalism domains, (2) objective metrics of their demonstrated professionalism skills as rated by standardized patients annually using the objective structure clinical examination tool, and (3) a national survey of the Surgical Professionalism and Interpersonal Communications Education Study Group. Study 1: aggregate perceived professionalism among surgical residents shows a statistically significant positive trend over time (P = .016). Improvements were seen in all 6 domains: accountability, ethics, altruism, excellence, patient sensitivity, and respect. Study 2: the cohort of residents followed up over 3 years showed a marked improvement in their professionalism skills as rated by standardized patients using the objective structure clinical examination tool. Study 3: 41 members of the national Surgical Professionalism and Interpersonal Communications Education Study Group rated their residents' skills in admitting mistakes, delivering bad news, communication, interdisciplinary respect, cultural competence, and handling stress. Twenty-nine of the 41 responses rated their residents as "slightly better" or "much better" compared with 5 years ago (P = .001). Thirty-four of the 41 programs characterized their department's leadership view toward professionalism as "much better" compared with 5 years ago. All 3 assessment methods suggest that residents feel increasingly
Bradley, Corey K; Fischer, Melissa A; Walsh, Kathleen E
The Institute of Medicine has called for physician education as a key step in medical error prevention. In our 2002 national survey, pediatric resident education about medical error prevention was sporadic. We sought to describe the amount and type of pediatric resident training about medical errors and to assess the change in training since 2002. We surveyed a national sample of 50 pediatric chief residents randomly selected from the 198 Accreditation Council for Graduate Medical Education-accredited residency programs from August to November 2010. The 31-item telephone survey was developed from the 2002 survey, with the addition of 10 items about electronic learning and resident quality improvement projects. The survey included 4 domains: current patient safety curriculum, chief resident knowledge, learning from medical errors, and demographics. We phoned 55 chief residents and contacted 51. Fifty participated (90% participation rate). Ninety-four percent of chief residents stated that their program had a formalized curriculum to discuss medical errors, compared to only 50% (P medical error should be systemic change. The primary method for educating residents about medical error reported was informal teaching. Ninety-two percent reported never or rarely discussing medical error in an outpatient setting. Seventy-four percent of chief residents reported that they never or rarely learn from an error made by an attending physician, and 50% never or rarely learned from an error made by a fellow resident. Although resident education about medical errors has improved since 2002, opportunities to model learning from mistakes are frequently missed. Copyright © 2013 Academic Pediatric Association. Published by Elsevier Inc. All rights reserved.
Susanto, Novie; Putranto, Thomas Triadi; Prastawa, Heru; Ulfa, Ema Amalia
Semarang city has the potential landslides were quite high in almost all regions. The previous research shows that the Manyaran and Kembang Arum is classified as "not ready" with vulnerability-prone of landslide areas. Therefore, design and implementation of cognitive interventions in human are needed to educate and improve the preparedness of the residents against landslide. This study aims to implement the various cognitive interventions to the residents in landslide areas and analysis of the different interventions toward the preparedness index. The study is conducted on 40 respondents from Kembang Arum and 40 respondents from Manyaran. They are aged ≥ 17 years, illiteracy and a RT/RW/PKK cadres. The independent variables in this study are Knowledge and Attitude, Emergency Planning, Warning System, and Resources Mobilization. The dependent variable is the preparedness index. The design of cognitive interventions is generated according to the demographic characteristics of the respondent and the result of Fault Tree Analysis. The preparedness index of the residents against landslides in Kembang Arum increases about 71.71% and in Manyaran up to 90.06%. Implementation of cognitive interventions with module, video and discussion in the Manyaran is more effective than using posters, videos and discussions in Kembang Arum.
Greene, James G
Neurology residency training programs have been profoundly impacted by recent changes in resident duty hours, workloads, and supervisory requirements. In response, many programs have adopted a night float coverage system to minimize the requirements for overnight call. The majority involves residents working a block of night shifts in what is typically a service-oriented rotation. Recently, concerns have arisen regarding the impact of this design on resident education and patient care. We have developed a novel on-site nighttime neurohospitalist model for the explicit purpose of steepening the initial learning curve for neurology residents in an effort to rapidly improve their neurological skills and, in conjunction, overnight patient care. We surveyed residents after the initiation of this system to assess their perception of the impact of direct overnight supervision on education and patient care. As part of ongoing quality improvement efforts, surveys were administered to neurology house staff at a tertiary academic medical center after they had completed service on the night float rotation both with and without an attending in the hospital using a retrospective pre/postdesign. There was a robust positive impact on resident's perception of overall quality, educational value, and clinical quality on the night float rotation with an attending on-site. Despite an overall perception that their autonomy was maintained, residents believed barriers to contact the attending were lower, and attending interaction during critical decision making was more frequent. Direct overnight supervision by a neurohospitalist enhances the educational value and care quality on overnight resident rotations.
Brian Dawson, MD
Full Text Available Objective: The healthcare chart is becoming ever more complex, serving clinicians, patients, third party payers, regulators, and even medicolegal parties. The purpose of this study was to identify our emergency medicine (EM resident and attending physicians’ current knowledge and attitudes about billing and documentation practices. We hypothesized that resident and attending physicians would identify billing and documentation as an area in which residents need further education.Methods: We gave a 15-question Likert survey to resident and attending physicians regarding charting practices, knowledge of billing and documentation, and opinions regarding need for further education.Results: We achieved a 100% response rate, with 47% (16/34 of resident physicians disagreeing or strongly disagreeing that they have adequate training in billing and documentation, while 91% (31/34 of residents and 95% (21/22 of attending physicians identified this skill as important to a resident’s future practice. Eighty-two percent (28/34 of resident physicians and 100% of attending physicians recommended further education for residents.Conclusion: Residents in this academic EM department identified a need for further education in billing and documentation practices. [West J Emerg Med. 2010;11(2: 116-119.
Chen, H Carrie; Wamsley, Maria A; Azzam, Amin; Julian, Katherine; Irby, David M; O'Sullivan, Patricia S
Training the next generation of health professionals requires leaders, innovators, and scholars in education. Although many medical schools and residencies offer education electives or tracks focused on developing teaching skills, these programs often omit educational innovation, scholarship, and leadership and are narrowly targeted to one level of learner. The University of California San Francisco created the Health Professions Education Pathway for medical students, residents, and fellows as well as learners from other health professional schools. The Pathway applies the theoretical framework of communities of practice in its curricular design to promote learner identity formation as future health professions educators. It employs the strategies of engagement, imagination, and alignment for identity formation. Through course requirements, learners engage and work with members of the educator community of practice to develop the knowledge and skills required to participate in the community. Pathway instructors are faculty members who model a breadth of educator careers to help learners imagine personal trajectories. Last, learners complete mentored education projects, adopting scholarly methods and ethics to align with the broader educator community of practice. From 2009 to 2014, 117 learners participated in the Pathway. Program evaluations, graduate surveys, and web-based searches revealed positive impacts on learner career development. Learners gained knowledge and skills for continued engagement with the educator community of practice, confirmed their career aspirations (imagination), joined an educator-in-training community (engagement/imagination), and disseminated via scholarly meetings and peer-reviewed publications (alignment). Learners identified engagement with the learner community as the most powerful aspect of the Pathway; it provided peer support for imagining and navigating the development of their dual identities in the clinician and educator
Kim, Hyun; Malatesta, Theresa M; Anné, Pramila R; McAna, John; Bar-Ad, Voichita; Dicker, Adam P; Den, Robert B
Board certified radiation oncologists and medical physicists are required to earn self-assessment module (SAM) continuing medical education (CME) credit, which may require travel costs or usage fees. Data indicate that faculty participation in resident teaching activities is beneficial to resident education. Our hypothesis was that providing the opportunity to earn SAM credit in resident didactics would increase faculty participation in and improve resident education. SAM applications, comprising CME certified category 1 resident didactic lectures and faculty-generated questions with respective answers, rationales, and references, were submitted to the American Board of Radiology for formal review. Surveys were distributed to assess main academic campus physician, affiliate campus physician, physicist, and radiation oncology resident impressions regarding the quality of the lectures. Survey responses were designed in Likert-scale format. Sign-test was performed with P < .05 considered statistically different from neutral. First submission SAM approval was obtained for 9 of 9 lectures to date. A total of 52 SAM credits have been awarded to 4 physicists and 7 attending physicians. Main academic campus physician and affiliate campus physician attendance increased from 20% and 0%, respectively, over the 12 months preceding CME/SAM lectures, to 55.6% and 20%, respectively. Survey results indicated that the change to SAM lectures increased the quality of resident lectures (P = .001), attending physician participation in resident education (P < .0001), physicist involvement in medical resident education (P = .0006), and faculty motivation to attend resident didactics (P = .004). Residents reported an increased amount of time required to prepare lectures (P = .008). We are the first department, to our knowledge, to offer SAM credit to clinical faculty for participation in resident-generated didactics. Offering SAM credit at resident lectures is a cost-effective alternative
Rouch, Joshua D; Wagner, Justin P; Scott, Andrew; Sullins, Veronica F; Chen, David C; DeUgarte, Daniel A; Shew, Stephen B; Tillou, Areti; Dunn, James C Y; Lee, Steven L
General surgery residents lack a standardized educational experience in pediatric surgery. We hypothesized that the development of a mobile educational interface would provide general surgery residents broader access to pediatric surgical education materials. We created an educational mobile website for general surgery residents rotating on pediatric surgery, which included a curriculum, multimedia resources, the Operative Performance Rating Scale (OPRS), and Twitter functionality. Residents were instructed to consult the curriculum. Residents and faculty posted media using the Twitter hashtag, #UCLAPedSurg, and following each surgical procedure reviewed performance via the OPRS. Site visits, Twitter posts, and OPRS submissions were quantified from September 2013 to July 2014. The pediatric surgery mobile website received 257 hits; 108 to the homepage, 107 to multimedia, 28 to the syllabus, and 19 to the OPRS. All eligible residents accessed the content. The Twitter hashtag, #UCLAPedSurg, was assigned to 20 posts; the overall audience reach was 85 individuals. Participants in the mobile OPRS included 11 general surgery residents and 4 pediatric surgery faculty. Pediatric surgical education resources and operative performance evaluations are effectively administered to general surgery residents via a structured mobile platform. Copyright © 2015 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.
Full Text Available Resident-as-teacher courses are pretty common in Western medical schools however they are a rarity in Asian and developing countries. The current report is a scholarly analysis of a three day orientation program for senior residents in order to improve their functioning by providing new template either for supplementing basic workshops for faculty or to advocate a change in system. The experience gained by Medical Education Unit of University College of Medical Sciences can be used to conduct training breeding grounds at national or regional levels. Resident as teachers educational interventions need to be designed taking into account their impact on education system.
Lefeubvre, C; Viallard, M-L; Schell, M
The need for educational training of healthcare professionals in palliative care is an important issue. Training and practice of pediatric residents in the field of pediatric palliative care (PPC) has never been assessed, although the organization of the medical curriculum in France is currently being revised. This study presents a national survey of pediatric residents, using a computerized anonymous questionnaire. Four different areas were studied: epidemiological data, theoretical and practical knowledge, education, and clinical experience in PPC. The response rate was 39% (n=365/927). Whatever their age or regional location, 25% of residents did not know any details of the French law concerning patients' rights and the end of life. Experience with PPC starts very early since 77% of the first-year pediatric residents experienced at least one child in a palliative care and/or end-of-life situation. During their entire residency, 87% of the residents had experience with PPC and nearly all (96%) end-of-life care. Furthermore, 76% had participated in announcing palliative care (cancer, ICU, etc.) or a serious illness, and 45% had met and discussed with bereaved parents. Furthermore, while 97% of the pediatric residents received training in adult palliative care, mainly before their residency, only 60% received specific PPC training. Ninety-six percent of all French pediatric residents encountered a PPC situation during their residency. That 77% of them had experienced PPC during their first year of residency shows the importance of early training in PPC for pediatric residents. Furthermore, this study points out that there is a significant lack in PPC training since 40% of all residents in the study received no specific PPC training. Progress in education remains insufficient in the dissemination of knowledge on the legal framework and concepts of palliative medicine: while the medical curriculum is being revised, we suggest that training in medical ethics and PPC
Lakshmanan, Ashwini; Leeman, Kristen T; Brodsky, Dara; Parad, Richard
Integration of web-based educational tools into medical training has been shown to increase accessibility of resources and optimize teaching. We developed a web-based educational portal (WBEP) to support teaching of pediatric residents about newborn medicine by neonatology fellows. 1) To compare residents' attitudes about their fellow-led education in the NICU pre- and post-WBEP; including assessment of factors that impact their education and usefulness of teaching tools. 2) To compare fellow utilization of various teaching modalities pre- and post-WBEP. We queried residents about their attitudes regarding fellow-led education efforts and various teaching modalities in the NICU and logistics potentially impacting effectiveness. Based on these data, we introduced the WBEP - a repository of teaching tools (e.g., mock code cases, board review questions, journal articles, case-based discussion scenarios) for use by fellows to supplement didactic sessions in a faculty-based curriculum. We surveyed residents about the effectiveness of fellow teaching pre- and post-WBEP implementation and the type of fellow-led teaching modalities that were used. After analysis of survey responses, we identified that residents cited fellow level of interest as the most important factor impacting their education. Post-implementation, residents described greater utilization of various teaching modalities by fellows, including an increase in use of mock codes (14% to 76%, pteaching modalities by fellows and may encourage fellow involvement in resident teaching.
Lypson, Monica L; Hamstra, Stanley J; Colletti, Lisa
In 1999, the National Labor Relations Board reversed its own rulings and determined that resident physicians were categorized as employees and not students under the National Labor Relations Act in the private sector. This change opened the door for residents to collectively bargain for employment benefits. Concerns were raised that conflicts in the area of service-versus-educational demands on residents' time were better handled by the Accreditation Council for Graduate Medical Education (ACGME) than by residents' unions. This article explores the extent to which conflicts exist between advocating for working conditions and for educational issues and, more specifically, whether there are any resident interests that are not covered by current ACGME regulations. In other words, has the ACGME evolved into a reasonable proxy for resident unions? The authors describe their experience with the University of Michigan House Officer Association, mutual gains bargaining, the impact that the ACGME 2003 and 2007 institutional requirements have had on employment contracts, and whether these requirements clarify or confuse resident issues. To date, the ACGME continues to revise its requirements, many of which preempt and exceed the power that most local unions have. However, only blunt tools (e.g., removal of accreditation) are available to the ACGME to address violations of requirements. The ACGME, to potentially function as a full resident union, would need to find more precise methods for timely feedback to both resident and hospital parties as well as more powerful tools to deal with violations of its regulations and requirements.
White, Ian; Buchberg, Brian; Tsikitis, V Liana; Herzig, Daniel O; Vetto, John T; Lu, Kim C
Colorectal cancer is the second most common cause of death in the USA. The need for screening colonoscopies, and thus adequately trained endoscopists, particularly in rural areas, is on the rise. Recent increases in required endoscopic cases for surgical resident graduation by the Surgery Residency Review Committee (RRC) further emphasize the need for more effective endoscopic training during residency to determine if a virtual reality colonoscopy simulator enhances surgical resident endoscopic education by detecting improvement in colonoscopy skills before and after 6 weeks of formal clinical endoscopic training. We conducted a retrospective review of prospectively collected surgery resident data on an endoscopy simulator. Residents performed four different clinical scenarios on the endoscopic simulator before and after a 6-week endoscopic training course. Data were collected over a 5-year period from 94 different residents performing a total of 795 colonoscopic simulation scenarios. Main outcome measures included time to cecal intubation, "red out" time, and severity of simulated patient discomfort (mild, moderate, severe, extreme) during colonoscopy scenarios. Average time to intubation of the cecum was 6.8 min for those residents who had not undergone endoscopic training versus 4.4 min for those who had undergone endoscopic training (p Virtual reality endoscopic simulation is an effective tool for both augmenting surgical resident endoscopy cancer education and measuring improvement in resident performance after formal clinical endoscopic training.
Sheth, K N; Drogan, O; Manno, E; Geocadin, R G; Ziai, W
Limited information is available regarding the current state of neurocritical care education for neurology residents. The goal of our survey was to assess the need and current state of neurocritical care training for neurology residents. A survey instrument was developed and, with the support of the American Academy of Neurology, distributed to residency program directors of 132 accredited neurology programs in the United States in 2011. A response rate of 74% (98 of 132) was achieved. A dedicated neuroscience intensive care unit (neuro-ICU) existed in 64%. Fifty-six percent of residency programs offer a dedicated rotation in the neuro-ICU, lasting 4 weeks on average. Where available, the neuro-ICU rotation was required in the vast majority (91%) of programs. Neurology residents' exposure to the fundamental principles of neurocritical care was obtained through a variety of mechanisms. Of program directors, 37% indicated that residents would be interested in performing away rotations in a neuro-ICU. From 2005 to 2010, the number of programs sending at least one resident into a neuro-ICU fellowship increased from 14% to 35%. Despite the expansion of neurocritical care, large proportions of US neurology residents have limited exposure to a neuro-ICU and neurointensivists. Formal training in the principles of neurocritical care may be highly variable. The results of this survey suggest a charge to address the variability of resident education and to develop standardized curricula in neurocritical care for neurology residents.
Lawrie, Joshua D.
The current study sought to examine the impact parental educational attainment had on how students perceived their residence hall environment. This multi-campus study utilized the University Residence Environment Scale, along with a demographic form to gather data. The study occurred on three campuses during the Spring 2012 semester and had 347…
Amerine, Lindsey B Poppe; Granko, Robert P; Savage, Scott W; Daniels, Rowell; Eckel, Stephen F
The experience of health-system pharmacy administration (HSPA) residents in a longitudinal human resource (HR) management program is described. The subsequent benefits to the residents, department, and profession are also discussed. Postgraduate year 2 HSPA residents at an academic medical center desired more responsibility for managing an operational area. To this end, a program was created in which these residents directly manage a small group of pharmacy technicians and report to a clinical manager or assistant director with oversight responsibility. These "resident managers" are responsible, under the direction of the area's clinical manager, for the personnel, schedule, time and attendance, and HR activities of the area. Resident managers have led and sustained operational improvement projects in their areas. In addition to providing learning experiences to residents, the HSPA residency program has also improved the operations of the areas in which these residents work. Benefits to the residents include conducting annual performance evaluations for employees with whom they have a relationship as it is a task every administrator completes. Resident managers at UNC have consistently stated that this longitudinal HR experience is one of the most rewarding and most challenging experiences offered in the two-year HSPA residency. The involvement of HSPA residents in longitudinal management responsibilities furthers residents' leadership success by providing trained managers who are ready to immerse themselves into practice postresidency, having employee engagement and HR skills as well as experiences with leading operational improvements. A longitudinal HR management experience was successfully incorporated into an HSPA residency combined Master of Science degree program. Copyright © 2014 by the American Society of Health-System Pharmacists, Inc. All rights reserved.
Furze, Jennifer A; Tichenor, Carol Jo; Fisher, Beth E; Jensen, Gail M; Rapport, Mary Jane
The physical therapy profession continues to respond to the complex and changing landscape of health care to meet the needs of patients and the demands of patient care. Consistent with this evolution is the rapid development and expansion of residency and fellowship postprofessional programs. With the interested number of applicants exceeding the number of residency and fellowship slots available, a "critical period" in the educational process is emerging. The purposes of this perspective article are: (1) to analyze the state of residency and fellowship education within the profession, (2) to identify best practice elements from other health professions that are applicable to physical therapy residency and fellowship education, and (3) to propose a working framework grounded in common domains of competence to be used as a platform for dialogue, consistency, and quality across all residency and fellowship programs. Seven domains of competence are proposed to theoretically ground residency and fellowship programs and facilitate a more consistent approach to curricular development and assessment. Although the recent proliferation of residency and fellowship programs attempts to meet the demand of physical therapists seeking advanced educational opportunities, it is imperative that these programs are consistently delivering high-quality education with a common focus on delivering health care in the context of societal needs. © 2016 American Physical Therapy Association.
Gentles, John Quinn
This essay was selected as the winner of the 2015 Canadian Undergraduate Surgical Education Committee student essay competition. It was written in response to the prompt: ?How is your school preparing you for residency ? be it surgical or medical??.
Richard Myers; Lane Conn
The funds from the DOE Human Genome Program, for the project period 2/1/96 through 1/31/98, have provided major support for the curriculum development and field testing efforts for two high school level instructional units: Unit 1, ''Exploring Genetic Conditions: Genes, Culture and Choices''; and Unit 2, ''DNA Snapshots: Peaking at Your DNA''. In the original proposal, they requested DOE support for the partial salary and benefits of a Field Test Coordinator position to: (1) complete the field testing and revision of two high school curriculum units, and (2) initiate the education of teachers using these units. During the project period of this two-year DOE grant, a part-time Field-Test Coordinator was hired (Ms. Geraldine Horsma) and significant progress has been made in both of the original proposal objectives. Field testing for Unit 1 has occurred in over 12 schools (local and non-local sites with diverse student populations). Field testing for Unit 2 has occurred in over 15 schools (local and non-local sites) and will continue in 12-15 schools during the 96-97 school year. For both curricula, field-test sites and site teachers were selected for their interest in genetics education and in hands-on science education. Many of the site teachers had no previous experience with HGEP or the unit under development. Both of these first-year biology curriculum units, which contain genetics, biotechnology, societal, ethical and cultural issues related to HGP, are being implemented in many local and non-local schools (SF Bay Area, Southern California, Nebraska, Hawaii, and Texas) and in programs for teachers. These units will reach over 10,000 students in the SF Bay Area and continues to receive support from local corporate and private philanthropic organizations. Although HGEP unit development is nearing completion for both units, data is still being gathered and analyzed on unit effectiveness and student learning. The final field
Volertas, Sofija D; Rossi-Foulkes, Rita
The importance of a specific transition process is recognized by many health organizations. Got Transition, a cooperative endeavor aimed at improving the transition from pediatric to adult health care, developed Six Core Elements defining the basic components of health care transition support. In this article, we review the Six Core Elements by presenting a model that combines resident quality improvement and transition care training. In this Internal Medicine-Pediatrics residency program, ambulatory training for residents takes place in a combined adult and pediatric clinic. Aligned with the Six Core Elements, the program has crafted and disseminated a transition policy for the practice, designed a portable health summary template for the electronic medical record (EMR), created EMR tools for assessing transition readiness and setting transition goals, formed a registry of patients, and audited charts. [Pediatr Ann. 2017;46(5):e203-e206.]. Copyright 2017, SLACK Incorporated.
Freiburg, Carter; James, Ted; Ashikaga, Takamura; Moalem, Jacob; Cherr, Greg
The introduction of duty-hour restrictions has impacted surgical training. Several strategies were introduced by training programs in response to these restrictions. The purpose of this study was to assess the various strategies employed by residency programs to comply with work-hour restrictions with respect to the impact on the quality of surgical education. A national survey was developed and distributed to resident members of the Resident and Associate Society of the American College of Surgeons in all accredited residency programs across North America. Questions in the survey addressed 10 separate accommodation strategies used by training programs to adhere to resident work-hour restrictions. Resident respondents completed a 5-point Likert scale rating each strategy according to its impact on surgical education (detrimental, not very helpful, neutral, somewhat helpful, and very helpful). A total of 599 (9.7%) responses were received from 6186 members of the Resident Associate Society. The use of health information technology (IT), nurse practitioners, and physician assistants were most highly rated. Hiring clinical fellows, establishing nonteaching services, and shift-work scheduling were the three most poorly rated accommodations to work-hour restrictions with respect to resident education. Hospital IT and nonphysician care providers were rated by residents to optimize surgical education in the current work-hour limitation environment. We infer that strategies which lead to increased efficiency and redistribution of resident workload allow surgical trainees to spend more time on activities perceived to have higher educational value. Copyright © 2011 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.
the average, an individual's educational attainment tend to determine his occupational choice, income level and life style. The study found that respondents' educational attainment was not associated with fathers' educational level. On the other hand, close relationship were found between respondents' educational level ...
Baker, Suher; Thomas, Marc
To describe pediatric dental residents education as it pertains to children with special healthcare needs (CSHCN). A web-based survey was administered to 80 program directors of pediatric dental residencies recognized by the American Academy of Pediatric Dentistry (AAPD). The survey identified demographic data and education and training methods pertaining to CSHCN. Forty surveys (50 percent) were received from programs in all six AAPD regions. Programs that treated 4,500 patients or less/year were statistically less likely to require a specific assessment and were less likely to use written tests to assess competency treating CSHCN. A specific special needs didactic course (88 percent) and journal articles (85 percent) were the most common didactic training methods. The majority of the programs (69 percent) offered more than 20 hours of didactic education. On average 36.3 percent of the patients treated in residencies reported to be CSHCN and each resident clinically treated and average of 13 CSHCN/week. One-third of the respondents planned to increase CSHCN education in the next three years. Almost 70 percent of respondents supported the standardization of a national curriculum regarding CSHCN. A wide disparity exists among residencies regarding education related to CSHCN. Most pediatric dental residency directors support the national standardization of CSHCN education.
Fleenor, David; Sharma, Vanshdeep; Hirschmann, Jo; Swarts, Heidi
Journal clubs are an established means of ongoing learning in medicine. Beginning with physicians in the nineteenth century, journal clubs have gradually become established in nursing and other allied health professions. However, their use in Clinical Pastoral Education (CPE) is relatively new. We describe the creation of a journal club for CPE residents and discuss the lessons learned from this effort. Over two years, a journal club was conducted with two different cohorts of residents. Residents were surveyed regarding the perceived strengths and weaknesses of the journal club and their recommendations for improvement. A small group of six to eight residents appears to be most effective. Focusing on a specific topic is preferable to broad-based readings. Residents preferred greater discussion about the applicability of the research findings to their clinical activity. Finally, the pros and cons of residents selecting articles and use of the Rush Research Summary Worksheet are discussed.
This article describes an effort to create a coherent teacher recruitment, preparation and induction program in a large urban school district, based in part on the medical residency model. The article argues for several core principles in the creation of such a program: a) the program serves the school district, b) the program is structured to…
Bresolin, Linda; Bisset, George S; Hendee, William R; Kwakwa, Francis A
Over the past 2 years, ongoing efforts have been made to reevaluate and restructure the way physics education is provided to radiology residents. Program directors and faculty from North American radiology residency programs were surveyed about how physics is being taught and what resources are currently being used for their residents. Substantial needs were identified for additional educational resources in physics, better integration of physics into clinical training, and a standardized physics curriculum closely linked to the initial certification examination of the American Board of Radiology. (c) RSNA, 2008.
Green, Jessica; Kahan, Meldon; Wong, Suzanne
Ultrasound is a critical diagnostic imaging tool in obstetrics and gynecology (Ob/Gyn). Obstetric ultrasound is taught during residency, but we suspected a gap in Gyn ultrasound education. Proficiency in Gyn ultrasound allows real-time interpretation and management of pelvic disease and facilitates technical skill development for trainees learning blinded procedures. This study sought to evaluate ultrasound education in Canada's Ob/Gyn residency programs and assess whether residents and physicians perceived a need for a formalized Gyn ultrasound curriculum. We distributed a needs assessment survey to residents enrolled in Canadian Ob/Gyn residency programs and to all obstetrician/gynecologists registered as members of the Society of Obstetricians and Gynaecologists of Canada. Residents were asked to specify their current training in ultrasound and to rate the adequacy of their curriculum. All respondents rated the importance of proficiency in pelvic ultrasound for practicing obstetrician/gynecologists as well as the perceived need for formalized ultrasound training in Ob/Gyn residency programs. Eighty-two residents and 233 physicians completed the survey. Extents and types of ultrasound training varied across residency programs. Most residents reported inadequate exposure to Gyn ultrasound, and most residents and physicians agreed that it is important for obstetrician/gynecologists to be proficient in Gyn ultrasound and that the development of a standardized Gyn ultrasound curriculum for residency programs is important. Current ultrasound education in Ob/Gyn varies across Canadian residency programs. Training in Gyn ultrasound is lacking, and both trainees and physicians confirmed the need for a standardized Gyn ultrasound curriculum for residency programs in Canada. © 2015 by the American Institute of Ultrasound in Medicine.
Siri, Jean; Reed, Alan I; Flynn, Timothy C; Silver, Michele; Behrns, Kevin E
To design and implement a multidisciplinary systems-based practice learning experience that is focused on improving and standardizing the preoperative quality of care for general surgical patients. Four parameters of preoperative care were designated as quality assessment variables, including bowel preparation, perioperative beta-blockade, prophylactic antibiotic use, and deep venous thrombosis prevention. Four groups of general surgery residents (PGY I-V), each led by 1 chief resident, were assigned a quality parameter, performed an evidence-based current literature review, and formulated a standardized management approach based on the level of evidence and recommendations available. Because preoperative preparation includes anesthetic care and operating room preparation, we presented our findings at the Department of Surgery Grand Rounds in a multidisciplinary format that included presentations by each resident group, the Department of Anesthesia, the Department of Medicine, and the Department of Nursing. The aim of the multidisciplinary quality assurance conference was to present the evidence-based literature findings in order to determine how standardization of preoperative care would alter anesthetic and nursing care, and to obtain feedback about management protocols. To determine the educational impact of this model of integrated systems-based practice quality assessment on the teaching experience, residents were queried regarding the value of this educational venue and responses were rated on a Likert scale. Resident participation was excellent. The residents garnered valuable information by performing a literature review and evaluating the best preoperative preparation given each parameter. Furthermore, integration of their findings into systems-based practice including anesthesia and nursing care provided an appreciation of the complexities of care as well as the associated need for appropriate medical knowledge, communication, and professionalism. The
Reflection, where clinical experiences are analyzed to gain greater understanding and meaning, is an important step in workplace learning. Residency programs must teach their residents the skills needed for deep reflection. Medical educators may find it difficult to construct a curriculum which includes the key elements needed to enable learners to attain these skills. When we first implemented reflection into our residency curriculum, we soon realized that our curriculum only taught residents how to engage in superficial reflection. Our curriculum lacked some key elements. To help guide the transformation of our curriculum, we combed the literature for best practices. The CONTeMPLATE mnemonic was born out of this process. It is a tool to help medical educators consider and implement key elements required to enable deep reflection. The purpose of this article is to show medical educators how they can use the CONTeMPLATE mnemonic to incorporate reflective practice into their own curriculum.
Champion, Caitlin; Saidenberg, Elianna; Lampron, Jacinthe; Pugh, Debra
Evidence-based transfusion education for surgical residents is crucial to improving practice. A pilot study was undertaken to assess the effectiveness of an education module for improving transfusion knowledge among surgical residents. Modules were developed and delivered by experts in surgery and transfusion medicine. They were delivered to residents in their first 2 years of training (Surgical Foundations), and to General Surgery residents across all years of training. Premodule and postmodule and retention knowledge assessments were used to assess efficacy. Median assessment scores for each group were compared using a two-sample Wilcoxon rank-sum analysis. Chi-square tests were used to compare each group's correct response rates for each question across the three tests. Median assessment scores of residents in the Surgical Foundations program improved from a mean of 60% premodule to 80% postmodule and remained at 80% in the retention assessment (p transfusion dose, preoperative blood management, management of reactions, and informed consent (p Transfusion knowledge of surgical residents was improved by a collaborative educational initiative. This could serve as a model for other training programs to improve resident knowledge of evidence-based transfusion practices. The efficacy of such interventions in changing practice remains untested. © 2017 AABB.
Katz-Sidlow, Rachel J; Baer, Tamar G; Gershel, Jeffrey C
The objective of this study was to assess the attitudes of contemporary residents toward receiving rapid feedback on their teaching skills from their medical student learners. Participants consisted of 20 residents in their second post-graduate training year. These residents facilitated 44 teaching sessions with medical students within our Resident-as-Teacher program. Structured, written feedback from students was returned to the resident within 3 days following each session. Residents completed a short survey about the utility of the feedback, whether they would make a change to future teaching sessions based on the feedback, and what specifically they might change. The survey utilized a 4-point scale ("Not helpful/likely=1" to "Very helpful/likely=4"), and allowed for one free-text response. Free-text responses were hand-coded and underwent qualitative analysis to identify themes. There were 182 student feedback encounters resulting from 44 teaching sessions. The survey response rate was 73% (32/44). Ninety-four percent of residents rated the rapid feedback as "very helpful," and 91% would "very likely" make a change to subsequent sessions based on student feedback. Residents' proposed changes included modifications to session content and/or their personal teaching style. Residents found that rapid feedback received from medical student learners was highly valuable to them in their roles as teachers. A rapid feedback strategy may facilitate an optimal educational environment for contemporary trainees.
Barnett, Michael D; Maurer, Scott H; Wood, Gordon J
Prior research has shown that less than 40% of pediatric program directors believe their graduating residents competent in palliative care. While many curricula have been developed to address this need, few have demonstrated improved comfort and/or knowledge with palliative care principles. The purpose of this study was to test a pocket card educational intervention regarding resident knowledge and comfort with palliative care principles. Pocket reference cards were created to deliver fundamentals of pediatric palliative care to resident learners; didactics and case studies emphasized principles on the cards. Self-reported comfort and objective knowledge were measured before and after the curriculum among residents. Of 32 post-graduate year 2 (PGY2) residents, 23 (72%) completed the pre-test survey. The post-test was completed by 14 PGY2 residents (44%) and 16 of 39 PGY3/4 residents (41%). There was improvement in comfort with communication, as well as pain and symptom management among the residents. Knowledge of palliative care principles improved in part, with only a few survey questions reaching statistical significance. 100% of respondents recommended the cards be provided to their colleagues. This longitudinal curriculum, designed specifically for pediatric residents, was built into an existing training program and proved to be popular, feasible, and effective at improving comfort with basic palliative care principles. © The Author(s) 2015.
Wu, Ann Chen; Leventhal, John M; Ortiz, Jacqueline; Gonzalez, Ernesto E; Forsyth, Brian
To determine whether augmentation of the Spanish interpreter's role to include cultural education of residents can improve the satisfaction of Latino patients. We assessed parent satisfaction during 4 sequential 2-month periods between June 1, 2004, and February 11, 2005, using different interpretation methods: telephone interpretation (n = 91 patient encounters), trained in-person interpretation (n = 49), in-person interpretation with cultural education of residents (n = 65), and postprogram telephone interpretation (n = 45). General pediatric practice at a large teaching hospital. A total of 250 Spanish-speaking parents who were limited in English proficiency. The cultural education program included 3 brief preclinic conferences taught by an interpreter and one-on-one teaching of residents about language and cultural issues after each clinical encounter. Parent satisfaction was assessed using 8 questions that have previously been validated in Spanish. Lower scores indicated more satisfaction. Because they were limited in English proficiency, our Spanish-speaking patients were significantly more satisfied when an in-person interpreter was used compared with a telephone interpreter (mean total satisfaction score of 14.5 [in-person] vs 17.4 [telephone]; P = .006) but were even more satisfied when the interpreter educated residents in cultural and language issues (mean, 11.5 [in-person with education] vs 17.4 [telephone]; P<.001). Although use of an in-person interpreter can increase Latino parents' satisfaction, a program using an interpreter to educate residents in cultural and language issues can increase satisfaction further.
Sawatsky, Adam P; Rosenman, David J; Merry, Stephen P; McDonald, Furman S
To examine the educational benefits of international elective rotations during graduate medical education. We studied Mayo International Health Program (MIHP) participants from April 1, 2001, through July 31, 2008. Data from the 162 resident postrotation reports were reviewed and used to quantitatively and qualitatively analyze MIHP elective experiences. Qualitative analysis of the narrative data was performed using NVivo7 (QRS International, Melbourne, Australia), a qualitative research program, and passages were coded and analyzed for trends and themes. During the study period, 162 residents representing 20 different specialties were awarded scholarships through the MIHP. Residents rotated in 43 countries, serving over 40,000 patients worldwide. Their reports indicated multiple educational and personal benefits, including gaining experience with a wide variety of pathology, learning to work with limited resources, developing clinical and surgical skills, participating in resident education, and experiencing new peoples and cultures. The MIHP provides the structure and funding to enable residents from a variety of specialties to participate in international electives and obtain an identifiable set of unique, valuable educational experiences likely to shape them into better physicians. Such international health electives should be encouraged in graduate medical education.
Lebensohn, Patricia; Kligler, Benjamin; Dodds, Sally; Schneider, Craig; Sroka, Selma; Benn, Rita; Cook, Paula; Guerrera, Mary; Low Dog, Tieraona; Sierpina, Victor; Teets, Raymond; Waxman, Dael; Woytowicz, John; Weil, Andrew; Maizes, Victoria
The Integrative Medicine in Residency (IMR) program, a 200-hour Internet-based, collaborative educational initiative was implemented in 8 family medicine residency programs and has shown a potential to serve as a national model for incorporating training in integrative/complementary/alternative medicine in graduate medical education. The curriculum content was designed based on a needs assessment and a set of competencies for graduate medical education developed following the Accreditation Council for Graduate Medical Education outcome project guidelines. The content was delivered through distributed online learning and included onsite activities. A modular format allowed for a flexible implementation in different residency settings. TO ASSESS THE FEASIBILITY OF IMPLEMENTING THE CURRICULUM, A MULTIMODAL EVALUATION WAS UTILIZED, INCLUDING: (1) residents' evaluation of the curriculum; (2) residents' competencies evaluation through medical knowledge testing, self-assessment, direct observations, and reflections; and (3) residents' wellness and well-being through behavioral assessments. The class of 2011 (n = 61) had a high rate of curriculum completion in the first and second year (98.7% and 84.2%) and course evaluations on meeting objectives, clinical utility, and functioning of the technology were highly rated. There was a statistically significant improvement in medical knowledge test scores for questions aligned with content for both the PGY-1 and PGY-2 courses. The IMR program is an advance in the national effort to make training in integrative medicine available to physicians on a broad scale and is a success in terms of online education. Evaluation suggests that this program is feasible for implementation and acceptable to residents despite the many pressures of residency.
Stiles, Brendon M; Reece, T Brett; Hedrick, Traci L; Garwood, Robert A; Hughes, Michael G; Dubose, Joseph J; Adams, Reid B; Schirmer, Bruce D; Sanfey, Hilary A; Sawyer, Robert G
After adopting a night float system, the residency program at the University of Virginia Health System Department of Surgery initiated a daily morning report (MR). The conference was originated to sign out new admissions and consults from the previous day to the services that would assume care. Although initially oriented toward transfer of patient information, MR is also hypothesized to serve as a competency-based resident education tool. An anonymous survey was distributed to on-service residents (n = 25). Questions were asked on a 5-point Likert scale. Respondents also ranked the weekly conferences, including MR, in terms of educational benefit derived. Most residents agreed that MR is an efficient method to sign-out patient care [84% stongly agree (SA) or agree (A)] and that it provides an excellent educational experience (88% SA or A). They agreed that it is presented in an evidence-based format (88% SA or A). Regarding the core competencies, residents all asserted that MR addresses "patient care" (100% SA or A) and "medical knowledge" (100% SA or A). Most agreed that it addresses "professionalism" (60% SA or A), "interpersonal skills and communication" (76% SA or A), and "practice-based learning and improvement" (92% SA or A). The 4 most important components identified with respect to continuing to improve both patient care and resident education were the presence of the on-call attending, a review of relevant radiology, provision of follow-up on select cases, and critical review of the literature. On average, MR was seen as the most educational conference, with 52% of residents ranking it first. Although MR is ubiquitous in most primary care residency programs, such a conference has not typically been held on surgical services. The MR was developed at the University of Virginia Health System Department of Surgery as a necessity for patient sign-out. As this conference has continued to evolve, it has become an excellent tool for resident education. It now
McLendon, Michael K.; Mokher, Christine G.; Flores, Stella M.
Few recent issues in higher education have been as contentious as that of legislation extending in-state college tuition benefits to undocumented students, initiatives now known as in-state resident tuition (ISRT) policies. Building on several strands of literature in political science and higher education studies, we analyze the effects of…
Full Text Available Background: In the age of information and technology application, troublesome regulations and traditional procedures for medical education may cause serious stresses and be a threat to the general health (GH of the students of medicine.Purpose: To determine the relationship between educational stressors and the general health of residents studying at the Ahwaz Jundishapour University of Medical Sciences (Alums.Method: In this cross sectional study, the study group was consisted of ll4 cooperative residents (69% of all residents in the hospital, who were being trained in a variety of different specialties. The instruments used were the Educational Stressors Questionnaire, including 45 four-choice items and a General Health Questionnaire. When the questionnaires were completed, the results were analyzed through Pierson Correlation Coefficient using the SPSS.Results: The residents mentioned their educational stressors as follows: lack of an arranged curriculum, troublesome educational regulations, deficient educational instruments, and inadequate clinical instruction. of all the subjects, 43 ( 37.6% appeared to have problems in GH,and significantly positive correlation (p
Cristiane Trivisiol da Silva
Full Text Available This research aims to identify the perception of professional members of a multi-professional residency program on Permanent Health Education. It is a case study research using a qualitative approach, with sixteen members of a multi-professional residency program. The data were collected from January to May 2012, through semi-structured interviews, document analysis and systematic observation, and analyzed according to Thematic Content Analysis. Two categories were identified: Permanent Health Education establishing collective spaces of reflection of practices and Permanent Health Education that promotes integration between disciplines. The members of the multiprofessional residency team were found to be aware that permanent education permeates their training and enables reflection on their clinical practices and multidisciplinary action as producers of health actions.
Eisenstaedt, Richard S.; Glanz, Karen
Medical care evaluation studies suggest that doctors often do not use blood resources appropriately and key educational objectives in the field are not being met. The Delphi method was used to achieve a consensus opinion among transfusion medicine educators to determine goals and objectives. (MLW)
In many societies of the world today, educational attainment is one of the most important factors determining the occupational and income level to which a person can aspire. This fact becomes more relevant in Nigeria in view of the rapid expansion of educational facilities in the country since the past three decades.
Abstract Through the example of a Danish reform of educational plans in early childhood education, this paper analyses the emergence of a new pedagogical desire related to administrative educational reforms promoting accountability, visibility and documentation. Two arguments are made: first......, it is argued that the changes in administrative practices during the last decade constitute a transformation, but also a reproduction of relations between knowledge and governing that goes back to the big expansion of the welfare state. Second, it is argued that these relations between knowledge and governing...... are not restricted to the administrative practices, but are part of education and its humanistic legacy as well. As such, the administrative demand of documentation becomes possible and recognisable through its reproductive elements. Elements that are constituted in a transformative conjunction in which...
Panda, Mukta; Desbiens, Norman A
Lifelong learning is an integral component of practice-based learning and improvement. Physicians need to be lifelong learners to provide timely, efficient, and state-of-the-art patient care in an environment where knowledge, technology, and social requirements are rapidly changing. To assess graduates' self-reported perception of the usefulness of a residency program requirement to submit a narrative report describing their planned educational modalities for their future continued medical learning ("Education for Life" requirement), and to compare the modalities residents intended to use with their reported educational activities. Data was compiled from the Education for Life reports submitted by internal medicine residents at the University of Tennessee College of Medicine Chattanooga from 1998 to 2000, and from a survey sent to the same 27 graduates 2 to 4 years later from 2000 to 2004. Twenty-four surveys (89%) were returned. Of the responding graduates, 58% (14/24) found the Education for Life requirement useful for their future continued medical learning. Graduates intended to keep up with a mean of 3.4 educational modalities, and they reported keeping up with 4.2. In a multivariable analysis, the number of modalities graduates used was significantly associated with the number they had planned to use before graduation (P = .04) but not with their career choice of subspecialization. The majority of residents found the Education for Life requirement useful for their future continued medical learning. Graduates, regardless of specialty, reported using more modalities for continuing their medical education than they thought they would as residents. Considering lifelong learning early in training and then requiring residents to identify ways to practice lifelong learning as a requirement for graduation may be dispositive.
Young, Timothy P; Brown, Madison M; Reibling, Ellen T; Ghassemzadeh, Sassan; Gordon, Dawn M; Phan, Tammy H; Thomas, Tamara L; Brown, Lance
In 2001, less than 20% of emergency medicine residents had more than $150,000 of educational debt. Our emergency medicine residents anecdotally reported much larger debt loads. Surveys have reported that debt affects career and life choices. Qualitative approaches are well suited to explore how and why such complex phenomena occur. We aim to gain a better understanding of how our emergency medicine residents experience debt. We conducted individual semistructured interviews with emergency medicine residents. We collected self-reported data related to educational debt and asked open-ended questions about debt influence on career choices, personal life, future plans, and financial decisions. We undertook a structured thematic analysis using a qualitative approach based in the grounded theory method. Median educational debt was $212,000. Six themes emerged from our analysis: (1) debt influenced career and life decisions by altering priorities; (2) residents experienced debt as a persistent source of background stress and felt powerless to change it; (3) residents made use of various techniques to negotiate debt in order to focus on day-to-day work; (4) personal debt philosophy, based on individual values and obtained from family, shaped how debt affected each individual; (5) debt had a normative effect and was acculturated in residency; and (6) residents reported a wide range of financial knowledge, but recognized its importance to career success. Our emergency medicine residents' debt experience is complex and involves multiple dimensions. Given our current understanding, simple solutions are unlikely to be effective in adequately addressing this issue. Copyright © 2016 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.
Boyers, Lindsay N; Schultz, Amanda; Baceviciene, Rasa; Blaney, Susan; Marvi, Natasha; Dellavalle, Robert P; Dunnick, Cory A
Although teledermatology (TD) is regarded as a tool to improve patient access to specialty healthcare, little has been done to evaluate its role in medical education. We describe the TD program at the Denver (CO) Department of Veterans Affairs Medical Center and evaluate its use as an educational tool for teaching dermatology to dermatology residents and medical students. Dermatology residents manage TD consultations and review all cases with a faculty preceptor; medical students participate as observers when possible. This study assessed dermatology resident (n=14) and medical student (n=16) perceptions of TD and its usefulness in teaching six core clinical competencies. Both residents (79%) and medical students (88%) "strongly agree" or "agree" that TD is an important educational tool. In general, medical students were slightly more satisfied than residents across all of the core competencies assessed except for patient care. Medical students and residents were most satisfied with the competencies of practice-based learning and improvement and medical knowledge, whereas they were least satisfied with those of interpersonal and communication skills and professionalism. Overall, TD is valued as a teaching tool for dermatology in the areas of patient care, medical knowledge, practice-based learning and improvement, and systems-based practice.
Noll, Priscilla Rayanne E Silva; Silveira, Nusa de Almeida; Noll, Matias; Barros, Patrícia de Sá
Although several health-risk behaviors of adolescents have been described in the literature, data of high school students who reside at educational institutions in developing countries are scarce. This study aimed to describe behaviors associated with health risks among high school students who reside at an educational public institution and to associate these variables with the length of stay at the institution. This cross-sectional study was conducted during the year 2015 and included 122 students aged 14-19 years at a federal educational institution in the Midwest of Brazil; students were divided into residents of 20 months. Information concerning the family socioeconomic status and anthropometric, dietary and behavioral profiles was investigated. Despite being physically active, students exhibited risk-associated behaviors such as cigarette and alcohol use and risky sexual behaviors that were exacerbated by fragile socioeconomic conditions and distance from family. A longer time in residence at the institution was associated with an older age (p ≤ 0.001), adequate body mass index (BMI; p = 0.02), nutritional knowledge (p = 0.01), and less doses of alcohol consumption (p ≤ 0.01) compared with those with shorter times in residence. In conclusion, the students exhibited different health-risk behaviors, and a longer institutional residence time, compared with a shorter time, was found to associate with the reduction of health-risk behaviors.
Nishino, Mizuki; Wolfe, Donna; Yam, Chun-Shan; Larson, Michael; Boiselle, Phillip M; Hatabu, Hiroto
Because of the rapid increase in clinical workload in academic radiology departments, time for teaching rotating residents is getting more and more limited. As a solution to this problem, we introduced the Intranet Journal of Chest Radiology as a comprehensive innovative tool for assisting resident education. The Intranet Journal of Chest Radiology is constructed using Microsoft FrontPage version 2002 (Microsoft Corp, Redmond, WA) and is hosted in our departmental web server (Beth Israel Deaconess Medical Center, Boston, MA). The home page of the intranet journal provides access to the main features, "Cases of the Month," "Teaching File," "Selected Articles for Residents," "Lecture Series," and "Current Publications." These features provide quick access to the selected radiology articles, the interesting chest cases, and the lecture series and current publication from the chest section. Our intranet journal has been well utilized for 6 months after its introduction. It enhances residents' interest and motivation to work on case collections, to search and read articles, and to generate interest in research. Frequent updating is necessary for the journal to be kept current, relevant, and well-utilized. The intranet journal serves as a comprehensive innovative solution for resident education, providing basic educational resources and opportunities of interactive participation by residents.
Crotty, Bradley H; Anselmo, Melissa; Clarke, Deserae N; Famiglio, Linda M; Flier, Lydia; Green, Jamie A; Leveille, Suzanne; Mejilla, Roanne; Stametz, Rebecca A; Thompson, Michelle; Walker, Jan; Bell, Sigall K
OpenNotes is a growing national initiative inviting patients to read clinician progress notes (open notes) through a secure electronic portal. The goals of this study were to (1) identify resident and faculty preceptor attitudes about sharing notes with patients, and (2) assess specific educational needs, policy recommendations, and approaches to facilitate open notes implementation. This was a qualitative study using focus groups with residents and faculty physicians who supervise residents, representing primary care, general surgery, surgical and procedural specialties, and nonprocedural specialties, from Beth Israel Deaconess Medical Center and Geisinger Health System in spring 2013. Data were audio recorded and transcribed verbatim, then coded and organized into themes. Thirty-six clinicians (24 [66.7%] residents and 12 [33.3%] faculty physicians) participated. Four main themes emerged: (1) implications of full transparency, (2) note audiences and ideology, (3) trust between patients and doctors, and (4) time pressures. Residents and faculty discussed how open notes might yield more engaged patients and better notes but were concerned about the time needed to edit notes and respond to patient inquiries. Residents were uncertain how much detail they should share with patients and were concerned about the potential to harm the patient-doctor relationship. Residents and faculty offered several recommendations for open notes implementation. Overall, participants were ambivalent about resident participation in open notes. Residents and faculty identified clinical and educational benefits to open notes but were concerned about potential effects on the patient-doctor relationship, requirements for oversight, and increased workload and burnout.
Bret A. Nicks
Full Text Available Introduction: Emergency department (ED crowding negatively impacts patient care quality and efficiency. To reduce crowding many EDs use a physician-in-triage (PIT process. However, few studies have evaluated the effect of a PIT processes on resident education. Our objective was to determine the impact of a PIT process implementation on resident education within the ED of an academic medical center. Methods: We performed a prospective cross-sectional study for a 10-week period from March to June 2011, during operationally historic trended peak patient volume and arrival periods. Emergency medicine residents (three-year program and faculty, blinded to the research objectives, were asked to evaluate the educational quality of each shift using a 5-point Likert scale. Residents and faculty also completed a questionnaire at the end of the study period assessing the perceived impact of the PIT process on resident education, patient care, satisfaction, and throughput. We compared resident and attending data using Mann-Whitney U tests. Results: During the study period, 54 residents and attendings worked clinically during the PIT process with 78% completing questionnaires related to the study. Attendings and residents indicated “no impact” of the PIT process on resident education [median Likert score of 3.0, inter-quartile range (IQR: 2-4]. There was no difference in attending and resident perceptions (p-value =0.18. Both groups perceived patient satisfaction to be “positively impacted” [4.0, IQR:2-4 for attendings vs 4.0,IQR:1-5 for residents, p-value =0.75]. Residents perceived more improvement in patient throughput to than attendings [3.5, IQR:3-4 for attendings vs 4.0, IQR:3-5 for residents, p-value =0.006]. Perceived impact on differential diagnosis generation was negative in both groups [2.0, IQR:1-3 vs 2.5, IQR:1-5, p-value = 0.42]. The impact of PIT on selection of diagnostic studies and medical decision making was negative for attendings
Trinkoff, Alison M; Lerner, Nancy B; Storr, Carla L; Han, Kihye; Johantgen, Mary E; Gartrell, Kyungsook
Leadership is a key consideration in improving nursing home care quality. Previous research found nursing homes with more credentialed leaders had lower rates of care deficiencies than nursing homes with less credentialed leaders. Evidence that nursing home administrator (NHA) and director of nursing (DON) education and certification is related to resident outcomes is limited. To examine associations of education and certification among NHAs and DONs with resident outcomes. Cross-sectional secondary data analysis. This study used National Nursing Home Survey data on leadership education and certification and Nursing Home Compare quality outcomes (e.g. pain, catheter use). 1142 nursing homes in the survey which represented 16628 nursing homes in the US. Leadership education and certification were assessed separately for NHAs and DONs. Nursing home resident outcomes were measured using facility-level nursing home quality indicator rates selected from the Minimum Data Set. Facility-level quality indicators were regressed onto leadership variables in models that also held constant facility size and ownership status. Nursing homes led by NHAs with both Master's degrees or higher and certification had significantly better outcomes for pain. Nursing homes led by DONs with Bachelor's degrees or higher plus certification also had significantly lower pain and catheter use. Whereas pressure ulcer rates were higher in facilities led by DONs with more education. Selected outcomes for nursing home residents might be improved by increasing the education and certification requirements for NHAs and DONs. Additional research is needed to clarify these relationships. Copyright © 2014 Elsevier Ltd. All rights reserved.
Odell, David D; Macke, Ryan A; Tchantchaleishvili, Vakhtang; Loor, Gabriel; Nelson, Jennifer S; LaPar, Damien J; LaZar, John F; Wei, Benjamin; DeNino, Walter F; Berfield, Kathleen; Stein, William; Youssef, Samuel J; Nguyen, Tom C
Surgical skills are traditionally taught and practiced in the operating room. However, changes in health care policy and outcome-based evaluation have decreased trainee operative autonomy. We examined cardiothoracic residents' perceptions of operative experience and the role of simulation. The In-Training Examination (ITE) is taken each year by all residents. Completion of a 30-question preexamination survey is mandatory, ensuring a 100% response rate. Survey data related to operative experience, career preparedness, and surgical simulation were analyzed. Opinion questions were asked on a 5-point Likert scale. Respondents were grouped into three cohorts by training paradigm (2-year versus 3-year traditional programs and 6-year integrated programs). In all, 314 respondents (122 2-year, 96 3-year, and 96 6-year integrated) completed the survey. Of the three groups, residents in 3-year programs had the highest levels of satisfaction. Advanced training was most common among residents in 6-year integrated programs (66%, versus 49% for 2-year and 26% for 3-year programs; p = 0.63). Desire to specialize drove further training (97%), with 2% stating further training was needed owing to inadequacy and 1% owing to a poor job market. In all assessed categories, the majority of residents believed that simulation did not completely replicate the educational value of an operative case. Cardiothoracic residents largely feel well prepared for the transition to practice under the current educational paradigm. Although many residents seek advanced training, it seems driven by the desire for specialization. Residents view simulation as an adjunct to traditional intraoperative education, but not as a viable replacement. Further study is necessary to better understand how best to integrate simulation with operative experience. Copyright © 2015 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.
Full Text Available Background: Integration of web-based educational tools into medical training has been shown to increase accessibility of resources and optimize teaching. We developed a web-based educational portal (WBEP to support teaching of pediatric residents about newborn medicine by neonatology fellows. Objectives: 1 To compare residents’ attitudes about their fellow-led education in the NICU pre- and post-WBEP; including assessment of factors that impact their education and usefulness of teaching tools. 2 To compare fellow utilization of various teaching modalities pre- and post-WBEP. Design/methods: We queried residents about their attitudes regarding fellow-led education efforts and various teaching modalities in the NICU and logistics potentially impacting effectiveness. Based on these data, we introduced the WBEP – a repository of teaching tools (e.g., mock code cases, board review questions, journal articles, case-based discussion scenarios for use by fellows to supplement didactic sessions in a faculty-based curriculum. We surveyed residents about the effectiveness of fellow teaching pre- and post-WBEP implementation and the type of fellow-led teaching modalities that were used. Results: After analysis of survey responses, we identified that residents cited fellow level of interest as the most important factor impacting their education. Post-implementation, residents described greater utilization of various teaching modalities by fellows, including an increase in use of mock codes (14% to 76%, p<0.0001 and journal articles (33% to 59%, p=0.02. Conclusions: A web-based resource that supplements traditional curricula led to greater utilization of various teaching modalities by fellows and may encourage fellow involvement in resident teaching.
Full Text Available Introduction: In medical education, particularly in residency courses, most of the training occurs in real clinical environments. Workplace-based learning profoundly affects students’ knowledge, attitudes, and practice; therefore, it should be properly planned. Due to the extensiveness of the clinical environment and its importance in training residents, investigating how residents learn in these environments and detecting factors that influence effectiveness will help curriculum designers to promote residents’ learning by improving their learning environment. Therefore, our qualitative content analysis study, aimed to examine the experiences and perspectives of internal and surgical residents and their attending physicians about learning in clinical settings. Methods: This qualitative content analysis study was conducted through purposeful sampling. Semi-structured interviews were conducted with 15 internal and surgical residents and 15 of their attending physicians at educational hospitals of Tehran University of Medical Sciences. Results: The main categories explored in this study were hidden curriculum, learning resources, and learning conditions. In the context of clinical environment and under its individual culture, residents learn professionalism and learn to improve their communication skills with patients and colleagues. Because of clinical obligations such as priority of treating the patients for education or workload of the attending physicians, residents acquire most of their practical knowledge from colleagues, fellows, or follow-up patients in different learning conditions (such as: educational rounds, morning reports and outpatient clinics. They see some of their attending physicians as role models. Conclusion: Changing cultural and contextual factors is of prime importance to promote a learning-oriented environment in a clinical setting. The present findings will help curriculum planners and attending physicians to improve
Patel, Rupa R; Ravichandran, Sandhiya; Doering, Michelle M; Hardi, Angela C
Global health is becoming an increasingly important component of medical education. Medical libraries have an opportunity to assist global health residents with their information needs, but first it is important to identify what those needs are and how best they can be addressed. This article reports a collaboration between global health faculty and an academic medical librarian to assess the information needs of global health pathway residents and how assessment data are used to create a multicomponent program designed to enhance global health education.
Buckley, Peter; Bahmiller, Daniel; Kenna, Courtney Amanda; Shevitz, Stewart; Powell, Ike; Fricks, Larry
Recovery is emerging as a guiding influence in mental health service delivery and transformation. As a consequence, the expectations and curricular needs of trainees (as future stakeholders in a transformed, recovery-oriented system) are now of considerable importance. To this end, resident-led focus groups were held at the Medical College of Georgia to obtain perceptions of the Recovery Model. Certified Peer Support Specialists (CPSS) attended and topics covered were the Recovery Model, the CPSS training curriculum, and developing a Wellness Recovery Action Plan (WRAP) with consumers. Advantages and disadvantages of the Recovery model were discussed, with residents generally expressing cautious optimism regarding implementation of these principles, yet concern regarding the potential for diminishing confidence and support for traditional professional services. All residents indicated an interest in obtaining more information about the Recovery Model, including how to incorporate WRAPS and the role of CPSS in Recovery. Almost half of the residents selected a recovery-oriented workshop as the best method for further education about these concepts, with less support for other options of didactic handouts and expert lecture. Future efforts should be directed at implementing recovery curricula into resident education and evaluating the changes in resident knowledge, attitude toward recovery, and plans to implement recovery-oriented principles into their own professional practice.
Mohan, Shaun; Follansbee, Christopher; Nwankwo, Ugonna; Hofkosh, Dena; Sherman, Frederick S; Hamilton, Melinda F
High-fidelity patient simulation (HFPS) has been used in medical education to bridge gaps in medical knowledge and clinical skills. Few studies have analyzed the impact of HFPS in subspecialty rotations for pediatric residents. We hypothesized that pediatric residents exposed to HFPS with a structured content curriculum would perform better on a case quiz than residents without exposure to HFPS. Prospective randomized controlled Tertiary-care free standing children's hospital During a cardiology rotation, senior pediatric residents completed an online pediatric cardiology curriculum and a cardiology quiz. After randomization into two groups, the study group participated in a fully debriefed HFPS session. The control group had no HFPS. Both groups completed a case quiz. Confidence surveys pre- and postsimulation were completed. From October 2010 through March 2013, 55 residents who rotated through the pediatric cardiology rotation were used in the final analysis (30 control, 25 in the study group). There was no significant difference between groups on the initial cardiology quiz. The study group scored higher on the case quiz compared with the control group (P = .024). Based on pre- and postsimulation questionnaires, residents' confidence in approaching a pediatric cardiology patient improved from an average Likert score of 5.1 to 7.5 (on scale of 0-10) (P cardiology rotation was feasible and well received. Our study suggests that simulation promotes increased confidence and may modestly improve clinical reasoning compared to traditional educational techniques. Targeted simulation sessions may readily be incorporated into pediatric subspecialty rotations. © 2014 Wiley Periodicals, Inc.
Zwemer, Eric; Bernson-Leung, Miya; Rea, Corinna; Patel, Archana A; Guerriero, Rejean; Urion, David K; Toomey, Sara L
The national shortage of pediatric neurologists is worsening, yet referral rates by pediatricians are high. Suboptimal training of pediatric residents in care of patients with neurologic disease may be a contributing factor. We formed a partnership between the Boston Children's Primary Care at Longwood clinic and Child Neurology Residency Training Program. The educational intervention included lectures, observed neurologic examinations, in-person and virtual triage, and an electronic medical record-based consult system. Residents in other primary care clinics served as the comparison group. Intervention-group residents reported significantly improved confidence in diagnosis of chronic/recurrent headache, attention deficit hyperactivity disorder (ADHD), and developmental delay; initial management of ADHD and developmental delay; and secondary management of ADHD, developmental delay, and concussion/traumatic brain injury. Comparison-group residents reported significantly improved confidence only in diagnosis of developmental delay. Our multipronged intervention is a promising approach to improving pediatric resident training in pediatric neurology and may be generalizable to subspecialty collaborations for other residency programs.
Jensen, Aaron R; Wright, Andrew S; Kim, Sara; Horvath, Karen D; Calhoun, Kristine E
Immediate feedback regarding performance in the operating room remains a key component of resident education. The aim of this study was to assess resident and faculty perceptions regarding postoperative feedback. Anonymous surveys were distributed to residents and faculty members. Questions addressed the timing, amount, and specificity of feedback; satisfaction; and the definition and importance of feedback. Additional questions regarded the importance and frequency of feedback in 7 specific areas of surgical competency. Resident satisfaction with timing, amount, and specificity of feedback was significantly lower than faculty satisfaction. Perceptions of the importance of feedback for each of the 7 specific areas did not differ. Faculty members' perceptions on the frequency of feedback were higher than residents' perception in all competencies of feedback (5-point scale, all P values = .001). There are significant differences between resident and faculty perceptions regarding postoperative feedback. Although faculty members believed they delivered appropriate amounts of timely, quality feedback, this perception was not shared by residents. Copyright © 2012 Elsevier Inc. All rights reserved.
Jain, Shaili; Dunn, Laura B.; Warner, Christopher H.; Roberts, Laura Weiss
Objective: The authors assess the perspectives of psychiatry residents about the goals of receiving education in professionalism and ethics, how topics should be taught, and on what ethical principles the curriculum should be based. Method: A written survey was sent to psychiatry residents (N = 249) at seven U.S. residency programs in Spring 2005.…
Bowen, Judith L; Hirsh, David; Aagaard, Eva; Kaminetzky, Catherine P; Smith, Marie; Hardman, Joseph; Chheda, Shobhina G
Continuity of care is a core value of patients and primary care physicians, yet in graduate medical education (GME), creating effective clinical teaching environments that emphasize continuity poses challenges. In this Perspective, the authors review three dimensions of continuity for patient care-informational, longitudinal, and interpersonal-and propose analogous dimensions describing continuity for learning that address both residents learning from patient care and supervisors and interprofessional team members supporting residents' competency development. The authors review primary care GME reform efforts through the lens of continuity, including the growing body of evidence that highlights the importance of longitudinal continuity between learners and supervisors for making competency judgments. The authors consider the challenges that primary care residency programs face in the wake of practice transformation to patient-centered medical home models and make recommendations to maximize the opportunity that these practice models provide. First, educators, researchers, and policy makers must be more precise with terms describing various dimensions of continuity. Second, research should prioritize developing assessments that enable the study of the impact of interpersonal continuity on clinical outcomes for patients and learning outcomes for residents. Third, residency programs should establish program structures that provide informational and longitudinal continuity to enable the development of interpersonal continuity for care and learning. Fourth, these educational models and continuity assessments should extend to the level of the interprofessional team. Fifth, policy leaders should develop a meaningful recognition process that rewards academic practices for training the primary care workforce.
Platt, Michael P; Davis, Elizabeth M; Grundfast, Kenneth; Grillone, Gregory
Within otolaryngology residency training, the annual Otolaryngology Training Examination (OTE) is the primary method used to assess, quantify, and compare the factual knowledge acquired by each resident. The objective of this study was to develop a more frequent method for tracking of factual knowledge to prevent educational delay. Retrospective analysis of educational scores. For each didactic lecture within a single otolaryngology residency training program, multiple choice questions were provided before and after each lecture. Questions were based on lecture objectives that were derived from the American Board of Otolaryngology curriculum. Scores were tracked over the course of 1 academic year and compared to the scores of residents on the OTE administered in that year to determine correlation with a validated measure of factual knowledge. The effect of remedial measures on improvement in OTE scores was determined. Over the course of 1 academic year, there were 328 questions presented to 12 residents before and after 32 lectures in the didactic program. Ten residents completed an average of 244 questions. Overall OTE scores demonstrated a significant and very strong correlation to lecture question scores (Pearson r = 0.86, P = .002). Remedial measures for residents during the previous 5 years who had inadequate OTE scores were successful in improving scores (P = .002). A structured didactic program that uses review questions to assess knowledge can be used to track acquisition of factual knowledge. Early identification of residents with deficiencies facilitates the development of individualized learning plans that result in successful remediation. © 2014 The American Laryngological, Rhinological and Otological Society, Inc.
Full Text Available Audience and type of curriculum: The Ohio State University Wexner Medical Center Emergency Medicine Residency Program Ultrasound Education Curriculum is a three-year curriculum for PGY-1 to PGY-3 learners. Introduction/Background: Each year of the three-year The Ohio State University Wexner Medical Center Emergency Medicine Ultrasound Curriculum focuses on different aspects of emergency ultrasonography, thereby promoting progressive understanding and utilization of point-of-care ultrasound in medical decision-making during residency training. Ultrasound is an invaluable bedside tool for emergency physicians; this skill must be mastered by resident learners during residency training, and ultrasound competency is a required ACGME milestone.1 The American College of Emergency Physicians (ACEP currently recommends that 11 applications of emergency ultrasound be part of the core skills of an emergency physician.2 This curriculum acknowledges the standards developed by ACEP and the ACGME. Objectives: Learners will 1 know the indications for each the 11 ACEP point-of-care ultrasound (POCUS applications; 2 perform each of the 11 ACEP POCUS applications; 3 integrate POCUS into medical decision-making. Methods: The educational strategies used in this curriculum include: independent, self-directed learning (textbook and literature reading, brief didactic sessions describing indications and technique for each examination, hands-on ultrasound scanning under the direct supervision of ultrasound faculty with real-time feedback, and quality assurance review of ultrasound images. Residents are expected to perform a minimum of 150 ultrasound examinations with associated quality assurance during the course of their residency training. The time requirements, reading material, and ultrasound techniques taught vary depending on the year of training. Length of curriculum: The entirety of the curriculum is three years; however, each year of residency training has
Kirkpatrick, John S
Prospective randomized trial. This study will provide preliminary data on whether residents can be "self-taught" and to what extent a lecture, demonstration, and coaching can improve skills and knowledge. Practice-based learning is an essential competency in Accreditation Council for graduate Medical Education-accredited residencies. Little has been done to demonstrate whether residents can be self-taught or benefit from mentoring in understanding and performing difficult surgical tasks. A written test was given to orthopedic residents on C1-C2 transarticular screw placement. They were then provided reading on C1-C2 transarticular screw placement. Residents were then divided into a "self-directed learning" group and a "mentored learning" group. All residents then performed the technique on models, with the "mentored" group receiving a lecture and coaching from the mentor. The models were analyzed for technique errors and the previous test was administered again as a posttest. The test and screw placement were repeated 4 months later. Residents without mentoring had an average improvement of 4.5 points, those with mentoring had average improvement of 8.6 points (P=0.0068). The screw placement technique error rate for the nonmentored group (n=8) was 2.55, and for the mentored group (n=9) was 1.47 (P=0.004). Sixteen residents completed the delayed test, 7 from the nonmentored groups and 8 from the mentored group. Nine residents were able to repeat the screw placement technique 4 months after the initial test and screw placement, 3 nonentored, and 6 mentored. Although there were some trends toward the mentored group having better retention, neither knowledge nor skill was statistically different. This preliminary trial seems to indicate that residents provided a lecture and guided technical instruction will obtain knowledge and perform procedures better than those that do not. Conclusions based upon Post Graduate year, motivation, and interest in spine surgery could
Talib, Hina J; Karjane, Nicole; Teelin, Karen; Abraham, Margaret; Holt, Stephanie; Chelvakumar, Gayaythri; Dumont, Tania; Huguelet, Patricia S; Conner, Lindsay; Wheeler, Carol; Fleming, Nathalie
The degree of exposure to pediatric and adolescent gynecology (PAG) varies across residency programs in obstetrics and gynecology and pediatrics. Nevertheless, these programs are responsible for training residents and providing opportunities within their programs to fulfill PAG learning objectives. To that end, the North American Society for Pediatric and Adolescent Gynecology has taken a leadership role in PAG resident education by creating and systematically updating the Short Curriculum. This curriculum outlines specific learning objectives that are central to PAG education and lists essential resources for learners' reference. This updated curriculum replaces the previous 2014 publication with added content, resources, and updated references. Additionally, attention to the needs of learners in pediatrics and adolescent medicine is given greater emphasis in this revised North American Society for Pediatric and Adolescent Gynecology Short Curriculum 2.0. Copyright © 2017 North American Society for Pediatric and Adolescent Gynecology. Published by Elsevier Inc. All rights reserved.
Pearson, David; Cooney, Robert; Bond, Michael C
Social media (SM) is a form of electronic communication through which users create online communities and interactive platforms to exchange information, ideas, messages, podcasts, videos, and other user-generated content. Emergency medicine (EM) has embraced the healthcare applications of SM at a rapid pace and continues to explore the potential benefit for education. Free Open Access Meducation has emerged from the ever-expanding collection of SM interactions and now represents a virtual platform for sharing educational media. This guidance document constitutes an expert consensus opinion for best practices in the use of SM in EM residency education. The goals are the following: 1) Recommend adoption of SM as a valuable graduate medical education (GME) tool, 2) Provide advocacy and support for SM as a GME tool, and 3) Recommend best practices of educational deliverables using SM. These guidelines are intended for EM educators and residency programs for the development and use of a program-specific SM presence for residency education, taking into account appropriate SM stewardship that adheres to institution-specific guidelines, content management, Accreditation Council for GME milestone requirements, and integration of SM in EM residency curriculum to enhance the learner's experience. Additionally, potential obstacles to the uptake of SM as an educational modality are discussed with proposed solutions.
Lane-Fall, Meghan B; Brooks, Amber K; Wilkins, Sara A; Davis, Joshua J; Riesenberg, Lee Ann
The Accreditation Council for Graduate Medical Education requires that residency programs teach residents about handoffs and ensure their competence in this communication skill. Development of hand-off curricula for anesthesia residency programs is hindered by the paucity of evidence regarding how to conduct, teach, and evaluate handoffs in the various settings where anesthesia practitioners work. This narrative review draws from literature in anesthesia and other disciplines to provide recommendations for anesthesia resident hand-off curriculum development and evaluation.
Jansma, J.D.; Wagner, C.; Kate, R.W. ten; Bijnen, A.B.
Background: Medical residents are key figures in delivering health care and an important target group for patient safety education. Reporting incidents is an important patient safety domain, as awareness of vulnerabilities could be a starting point for improvements. This study examined effects of
Jansma, J.D.; Wagner, C.; ten Kate, R.W.; Bijnen, A.B.
Background: Medical residents are key figures in delivering health care and an important target group for patient safety education. Reporting incidents is an important patient safety domain, as awareness of vulnerabilities could be a starting point for improvements. This study examined effects of
Kurth, Jennifer A.
Typically, child characteristics such as IQ and severity of autism symptoms are thought to determine educational placement. The present study examines external factors, including state of residence and state funding formulas, to determine their potential influence on placement outcomes. Findings reveal that considerable variations exist among…
Jacobs, Mary M.
In this article, I draw on data from my qualitative dissertation study of the literacy practices of five families who resided in a homeless shelter to complicate the relationship between literacy, education, and inequality. Homelessness is examined through the lens of sponsorship to understand the differential access the families have to powerful…
Leonard, Alison E.
This research highlights a K-5 dance artist-in-residence as a form of democratic and exemplary dance education that ignited collaboration, promoted equity, fostered student autonomy, and demonstrated rigor in school curriculum. Through examining observation, interview, and performance-based data and calling upon critical, democratic education…
Gillham, John C.; Evans, Lesley Anne; Williams, Nicole V.
The purpose of this study was to learn if teachers believe their experience with the Resident Educator Program improved their ability to meet the Ohio Standards for the Teaching Profession and increased support and retention. The 189 participants completed a 33 question Likert-based survey and provided more than 406 comments. The findings indicate…
In the first half of the twentieth century, the training of American surgeons changed from an idiosyncratic, often isolated venture to a standardized, regulated, and mandated regimen in the form of the surgical residency. Over the three critical decades between 1930 and 1960, these residencies developed from an extraordinary, unique opportunity for a few leading practitioners to a widespread, uniform requirement. This article explores the transformation of surgical education in the United States, focusing on the standardization and dissemination of residencies during this key period. Utilizing the archives of professional organizations, it shows how surgical societies initiated and forced reform in the 1930s. It demonstrates the seminal and early role taken by the federal government in the expansion of surgical residencies through incentivized policies and, especially, the growth of the Veterans Administration health system after World War II. Finally, an examination of intra-professional debates over this process illustrates both the deeper struggles to control the nature of surgical training and the importance of residency education in defining the midcentury American surgeon. © The Author(s) 2018. Published by Oxford University Press. All rights reserved. For Permissions, please email: firstname.lastname@example.org.
Thibault, George E
Through a series of six recent conferences, the Josiah Macy Jr. Foundation wanted to try to change the discussion about graduate medical education (GME) reform to one that is about the innovations needed to better prepare residents for the changing world of practice they will be entering and for meeting the needs of the patient population they will serve. These conferences featured some of the encouraging innovations in GME that are occurring at local and regional levels. An ongoing theme from many of these reforms is the empowerment of residents. The author examines what it would mean for health care systems, residency programs, and residents themselves to pursue empowerment for this significant portion of the health care workforce. Residents should be seen as a valuable component of the health care workforce with the ability to contribute to institutional and societal goals. The author highlights examples of existing programs that use residents in this way, but to accomplish this more broadly will require culture change and greater flexibility on the part of GME and institutional leadership.
White, Colin P; Lecours, Catherine; Bortoluzzi, Patricia; Caouette-Laberge, Louise; Ying, Yvonne
Residency education has shifted over the past decade in an attempt to graduate well-rounded physicians. There is a recognition that a physician's abilities must extend beyond medical knowledge. The Royal College of Physicians and Surgeons of Canada introduced the CanMEDS physician competency framework in 2005. The framework provides 7 areas of competencies that are aimed at providing improved patient care. These competencies are medical expert, communicator, collaborator, manager, health advocate, scholar, and professional. Teaching and evaluating many of these competencies is often challenging for residency training programs. We believe that international surgical missions provide a prime opportunity to teach and evaluate all CanMEDS' roles.Plastic surgery is a field with many different organizations involved in international surgery. Many plastic surgery training programs offer opportunities for residents to become involved in these international surgical missions. Through these trips, residents gain surgical experience, see a variety and volume of clinical cases, and have the opportunity to travel to a foreign country and experience different cultures. We believe that international plastic surgery surgical missions also provide an exceptional micro environment for the teaching of CanMEDS roles. Using examples from residents' personal experiences on international plastic surgery missions to China, Mali, and Cambodia, we describe the benefits of these missions in transferring the CanMEDS competencies to resident training.
McHenry, Megan Song; Nutakki, Kavitha; Swigonski, Nancy L
Limited resources are available to educate health professionals on cultural considerations and specific healthcare needs of Burmese refugees. The objective of this study was to determine the effectiveness of a module focused on cross-cultural considerations when caring for Burmese refugees. A brief educational module using anonymously tracked pre- and post-intervention, self-administered surveys was developed and studied. The surveys measured pediatric and family medicine residents' knowledge, attitudes, and comfort in caring for Burmese refugees. Paired t-tests for continuous variables and Fisher's exact tests for categorical variables were used to test pre- and post-intervention differences. We included open-ended questions for residents to describe their experiences with the Burmese population. The survey was available to 173 residents. Forty-four pre- and post-intervention surveys were completed (response rate of 25%). Resident comfort in caring for Burmese increased significantly after the module (P = 0.04). Resident knowledge of population-specific cultural information increased regarding ethnic groups (P = 0.004), appropriate laboratory use (P = 0.04), and history gathering (P = 0.001). Areas of improved resident attitudes included comprehension of information from families (P = 0.03) and length of time required with interpreter (P = 0.01). Thematic evaluation of qualitative data highlighted four themes: access to interpreter and resources, verbal communication, nonverbal communication, and relationship building with cultural considerations. A brief intervention for residents has the potential to improve knowledge, attitudes, and comfort in caring for Burmese patients. Interventions focused on cultural considerations in medical care may improve cultural competency when caring for vulnerable patient populations.
Peterson, Linda N; Rusticus, Shayna A; Wilson, Derek A; Eva, Kevin W; Lovato, Chris Y
Health professions programs continue to search for meaningful and efficient ways to evaluate the quality of education they provide and support ongoing program improvement. Despite flaws inherent in self-assessment, recent research suggests that aggregated self-assessments reliably rank aspects of competence attained during preclerkship MD training. Given the novelty of those observations, the purpose of this study was to test their generalizability by evaluating an MD program as a whole. The Readiness for Residency Survey (RfR) was developed and aligned with the published Readiness for Clerkship Survey (RfC), but focused on the competencies expected to be achieved at graduation. The RfC and RfR were administered electronically four months after the start of clerkship and six months after the start of residency, respectively. Generalizability and decision studies examined the extent to which specific competencies were achieved relative to one another. The reliability of scores assigned by a single resident was G = 0.32. However, a reliability of G = 0.80 could be obtained by averaging over as few as nine residents. Whereas highly rated competencies in the RfC resided within the CanMEDS domains of professional, communicator, and collaborator, five additional medical expert competencies emerged as strengths when the program was evaluated after completion by residents. Aggregated resident self-assessments obtained using the RfR reliably differentiate aspects of competence attained over four years of undergraduate training. The RfR and RfC together can be used as evaluation tools to identify areas of strength and weakness in an undergraduate medical education program.
Wong, Anne K
Globalisation initiatives in medical education are premised on a universal model of medical education. This study was conducted to challenge this premise by empirically examining the impact of culture on the practice of medical education in anaesthesia residency training programmes in Thailand and Canada. Using a mixed-methods comparative case study research approach, one Thai and one Canadian anaesthesia residency training programme were examined with respect to curriculum, educational practices and teacher beliefs. Data sources included observations of academic and clinical teaching, programme document analysis, surveys and faculty interviews. Recruitment resulted in a 76% survey response rate and 13 interview participants at the Thai site and a 61% survey response rate and 16 interview participants at the Canadian site. Multiple linear regression analysis was used to compare survey responses between the two programmes. The qualitative analysis consisted of primary coding, clustering into pattern codes, and identifying themes and sub-themes. The integration of quantitative and qualitative data for each case was followed by a cross-case analysis. The two programmes were similarly organised and had similar curricular content. However, important differences emerged in curricular emphasis, educational practices, and teacher beliefs and values. Thai faculty staff emphasised knowledge and scholarship, described the faculty-resident relationship as 'familial' and focused on 'teaching methods'. Canadian faculty members emphasised clinical abilities, described the faculty-resident relationship as 'collegial' and focused on 'learning environments'. These findings were related to broader cultural differences that influenced how the curriculum was interpreted and enacted at each site. This study shows that although the scientific and knowledge base of medical education is universal, its enactment may be influenced by culture and context. Globalisation initiatives in medical
Latimer, Jonathan L.
Outlined is a course of driver education and traffic safety taught to retarded residents of a state institution. Stressed is the importance of driver education for residents able to leave the institution. The philosophy of the program is given to emphasize individualizing instruction, instructing students who possess the potential for driving,…
Fung, M F; Walker, M; Fung, K F; Temple, L; Lajoie, F; Bellemare, G; Bryson, S C
To describe the Computerized Obstetrics and Gynecology Automated Learning Anaalysis (KOALAtrade mark), a multicentre, Internet-based learning portfolio and to determine its effects on residents' perception of their self-directed learning abilities. The KOALA programme allows residents to record their obstetrical, surgical, ultrasound, and ambulatory patient encounters and to document critical incidents of learning or elements of surprise that arose during these encounters. By prompting the student to reflect on these learning experiences, KOALA encourages residents to articulate questions which can be directly pursued through hypertext links to evidence-based literature. Four Canadian residency training programmes participated in the pilot project, from February to May 1997, using a dynamic relational database with a central server. All participants completed the Self-directed Learning Readiness Scale and a learning habits questionnaire. The impact of the KOALA programme on residents' perception of their self-directed learning abilities was measured by comparing KOALA-naive schools (schools 2, 3, and 4) with school 1 (exposed to the KOALA prototype for 1 year). Ordered variables were compared using the Mann-Whitney U test and continuous variables with the Student t test (statistical significance P learning were recorded by 41 residents in the four participating universities. Residents at the exposed school (school 1) had a significantly higher perception of their self-directed learning (P learning was less likely to be from continuing medical education (P learning portfolio with online resources. This Internet-based, multi-user, multicentre learning portfolio has a significant effect on residents' perception of their self-directed learning abilities.
Chun, Robert; Jabbour, Noel; Balakrishnan, Karthik; Bauman, Nancy; Darrow, David H; Elluru, Ravindhra; Grimmer, J Fredrik; Perkins, Jonathan; Richter, Gresham; Shin, Jennifer
The field of vascular anomalies presents diverse challenges in diagnosis and management. Although many lesions involve the head and neck, training in vascular anomalies is not universally included in otolaryngology residencies and pediatric otolaryngology (POTO) fellowships. To explore the education in, exposure to, and comfort level of otolaryngology trainees with vascular anomalies. A survey was distributed to 39 POTO fellows and 44 residents in postgraduate year 5 who matched into POTO fellowships from April 22 through June 16, 2014. Survey responses from trainees on exposure to, education on, and comfort with vascular anomalies. Forty-four residents in postgraduate year 5 who applied to POTO fellowships and 39 POTO fellows were emailed the survey. Fourteen respondents were unable to be contacted owing to lack of a current email address. Thirty-six of 69 residents and fellows (18 fellows and 18 residents [52%]) responded to the survey. Twenty-seven trainees (75%) reported no participation in a vascular anomalies clinic during residency; 6 of these 27 individuals (22%) trained at institutions with a vascular anomalies clinic but did not participate in the clinic, and 28 of the 36 respondents (78%) reported that they had less than adequate or no exposure to vascular anomalies in residency. Among POTO fellows, 11 of 17 (65%) did not participate in a vascular anomalies clinic during fellowship, even though 8 of the 11 had a vascular anomalies clinic at their fellowship program. During fellowship training, 12 of 18 fellows (67%) reported that they had adequate exposure to vascular anomalies. Only 20 respondents (56%) felt comfortable distinguishing among diagnoses of vascular anomalies, and only 4 residents (22%) and 9 fellows (50%) felt comfortable treating patients with vascular anomalies. All fellows believed that training in vascular anomalies was important in fellowship, and 100% of respondents indicated that increased exposure to diagnosis and management of
Sliwa, J A; McPeak, L; Gittler, M; Bodenheimer, C; King, J; Bowen, J
Described as the balance of values on either side of a moral dilemma, ethics and ethical issues are of increasing importance in the changing practice of rehabilitation medicine. Because the substance of ethics and true ethical issues can be difficult to identify, the education of rehabilitation residents in ethics can similarly be challenging. This article discusses topics pertinent to an understanding of clinical ethics in rehabilitation medicine and provides a method of teaching residents through an algorithm of ethical issues, learning objectives, and illustrative cases.
Fleming, Nathalie; Amies Oelschlager, Anne-Marie; Browner-Elhanan, Karen J; Huguelet, Patricia S; Kaul, Paritosh; Talib, Hina J; Wheeler, Carol; Loveless, Meredith
The degree of exposure to Pediatric and Adolescent Gynecology (PAG) varies across academic programs in Obstetrics and Gynecology, Pediatrics, and Adolescent Medicine. Nevertheless, these programs are responsible to train residents and provide opportunities within their training programs to fulfill PAG learning objectives. To that end, North American Society for Pediatric and Adolescent Gynecology has taken a leadership role in PAG resident education by disseminating the Short Curriculum with specific learning objectives and list of essential resources where key concepts in PAG can be covered. Copyright © 2014 North American Society for Pediatric and Adolescent Gynecology. Published by Elsevier Inc. All rights reserved.
Faxén-Irving, G; Andrén-Olsson, B; Geijerstam, A; Basun, H; Cederholm, T
We investigated the nutritional, cognitive and functional status in residents of two service-flat (SF) complexes and the effects of a nutrition education programme for care staff. Controlled nonrandomised study. Two SF complexes, that is community-assisted accommodation. Of 115 eligible SF residents, 80 subjects participated (age 83+/-7 y, 70% women). The nutritional status was assessed using body mass index (BMI, kg/m(2)), subjective global assessment (SGA), serum concentrations of albumin, insulin-like growth factor-I (IGF-I) and vitamin B(12). Cognitive and functional status were evaluated using the Mini Mental State Examination (MMSE, 0-30 points, education programme was given to the staff at one of the SF complexes. At baseline, the means of BMI and the biochemical nutritional indices were normal, whereas one-third had BMI or =10% of previous weight. According to SGA, 30% demonstrated possible or serious malnutrition. The median MMSE was 23 points (19.5-26.5, 25-75th percentile). Nearly 70% were ADL-independent. At the 5-month follow-up there were no differences in the nutritional and cognitive status of the residents. The nutritional knowledge of the staff improved slightly (Pnutritional risk. Five months after a 12-h staff nutrition education programme, no objective changes were seen in the nutritional status of the SF residents.
Wilkening, G Lucy; Gannon, Jessica M; Ross, Clint; Brennan, Jessica L; Fabian, Tanya J; Marcsisin, Michael J; Benedict, Neal J
This pilot study evaluated the utility of branched-narrative virtual patients in an interprofessional education series for psychiatry residents. Third-year psychiatry residents attended four interprofessional education advanced psychopharmacology sessions that involved completion of a branched-narrative virtual patient and a debriefing session with a psychiatric pharmacist. Pre- and post-assessments analyzed resident learning and were administered around each virtual patient. Simulation 4 served as a comprehensive review. The primary outcome was differences in pre- and post-assessment scores. Secondary outcomes included resident satisfaction with the virtual patient format and psychiatric pharmacist involvement. Post-test scores for simulations 1, 2, and 3 demonstrated significant improvement (p virtual patient format and psychiatric pharmacist involvement was high throughout the series (100 %; n = 18). Although there are important methodological limitations to this study including a small sample size and absence of a comparator group, this pilot study supports the use of branched-narrative virtual patients in an interprofessional education series for advanced learners.
Mostaghimi, Arash; Wanat, Karolyn; Crotty, Bradley H; Rosenbach, Misha
In response to a perceived erosion of medical dermatology, combined internal medicine and dermatology programs (med/derm) programs have been developed that aim to train dermatologists who take care of medically complex patients. Despite the investment in these programs, there is currently no data with regards to the potential impact of these trainees on the dermatology workforce. To determine the experiences, motivations, and future plans of residents in combined med/derm residency programs. We surveyed residents at all United States institutions with both categorical and combined training programs in spring of 2012. Respondents used visual analog scales to rate clinical interests, self-assessed competency, career plans, and challenges. The primary study outcomes were comfort in taking care of patients with complex disease, future practice plans, and experience during residency. Twenty-eight of 31 med/derm residents (87.5%) and 28 of 91 (31%) categorical residents responded (overall response rate 46%). No significant differences were seen in self-assessed dermatology competency, or comfort in performing inpatient consultations, cosmetic procedures, or prescribing systemic agents. A trend toward less comfort in general dermatology was seen among med/derm residents. Med/derm residents were more likely to indicate career preferences for performing inpatient consultation and taking care of medically complex patients. Categorical residents rated their programs and experiences more highly. Med/derm residents have stronger interests in serving medically complex patients. Categorical residents are more likely to have a positive experience during residency. Future work will be needed to ascertain career choices among graduates once data are available.
This article proposes a set of human rights education standards for classroom teachers and, by implication, outcomes for teacher preparation programs. The discussion includes a brief description of human rights education and concludes with recommendations for teacher preparation programs.
Boulger, Creagh; Adams, Daniel Z; Hughes, Daralee; Bahner, David P; King, Andrew
Emergency Medicine residency programs offer ultrasound-focused curricula to address Accreditation Council for Graduate Medical Education (ACGME) milestones. Although some programs offer advanced clinical tracks in ultrasound, no standard curriculum exists. We sought to establish a well-defined ultrasound track curriculum to allow interested residents to develop advanced clinical skills and scholarship within this academic niche. The curriculum involves a greater number of clinical scans, ultrasound-focused scholarly and quality improvement projects, enhanced faculty-driven ultrasound focused didactics, and participation at a national ultrasound conference to receive certification. Successful ultrasound scholarly tracks can provide residents with the potential to obtain fellowships or competency beyond ACGME requirements. © 2017 by the American Institute of Ultrasound in Medicine.
Santhosh, Lekshmi; Jain, Snigdha; Brady, Anna; Sharp, Michelle; Carlos, W Graham
It is important for attending physicians to know which behaviors influence learner perceptions. To date, two studies focusing on general medicine attending physicians have been published addressing internal medicine residents' perceptions of attending physicians; there are no data on intensive care unit (ICU) attending physicians. We sought to expand the evidence regarding this topic through a multicenter study at four geographically diverse academic medical centers. Our study focused on identifying the teaching behaviors of ICU physicians that learners observe in attending physicians who they value as effective educators. The study was conducted at Indiana University (Indianapolis, IN), Johns Hopkins University (Baltimore, MD), University of California-San Francisco (San Francisco, CA), and University of Washington (Seattle, WA). Internal medicine residents completed an anonymous online survey rating the importance of behaviors of ICU attending physician role models. We created a 37-item questionnaire derived from prior studies and from the Clinician Teaching Program from the Stanford Faculty Development Center for Medical Teachers. This questionnaire included behaviors, current and past, that residents observed in their ICU attending physicians. A total of 260 of 605 residents responded to the survey (overall response rate of 43%). The five behaviors of attending physicians most commonly rated as "very important" to residents were: (1) enjoyment of teaching; (2) demonstrating empathy and compassion to patients and families; (3) ability to explain clinical reasoning and differential diagnoses; (4) treating nonphysician staff members respectfully; and (5) enthusiasm on rounds. Behaviors that trainees rated as less important were having numerous research publications, having served as chief resident, sharing personal life with residents, and organizing end-of-rotation social events. Our study provides new information to attending physicians striving to influence
Hill, Kim R; Walker, Robert S; Bozicević, Miran; Eder, James; Headland, Thomas; Hewlett, Barry; Hurtado, A Magdalena; Marlowe, Frank; Wiessner, Polly; Wood, Brian
Contemporary humans exhibit spectacular biological success derived from cumulative culture and cooperation. The origins of these traits may be related to our ancestral group structure. Because humans lived as foragers for 95% of our species' history, we analyzed co-residence patterns among 32 present-day foraging societies (total n = 5067 individuals, mean experienced band size = 28.2 adults). We found that hunter-gatherers display a unique social structure where (i) either sex may disperse or remain in their natal group, (ii) adult brothers and sisters often co-reside, and (iii) most individuals in residential groups are genetically unrelated. These patterns produce large interaction networks of unrelated adults and suggest that inclusive fitness cannot explain extensive cooperation in hunter-gatherer bands. However, large social networks may help to explain why humans evolved capacities for social learning that resulted in cumulative culture.
Mazzola, Catherine A; Lobel, Darlene A; Krishnamurthy, Satish; Bloomgarden, Gary M; Benzil, Deborah L
Neurosurgical residency training paradigms have changed in response to Accreditation Council for Graduate Medical Education mandates and demands for quality patient care. Little has been done to assess resident education from the perspective of readiness to practice. To assess the efficacy of resident training in preparing young neurosurgeons for practice. In response to Resolution V-2007F of the Council of State Neurosurgical Societies, a survey was developed for neurosurgeons who applied for oral examination, Part II of the American Board of Neurological Surgery boards, in 2002 through 2007 (N = 800). The survey was constructed in "survey monkey" format and sent to 775 of 800 (97%) neurosurgeons for whom e-mail addresses were available. The response rate was 30% (233/775). Most neurosurgeons were board certified (n = 226, 97%). General neurosurgical training was judged as adequate by a large majority (n = 188, 80%). Sixty-percent chose to pursue at least 1 additional year of fellowship training (n = 138, 60%). Surgical skills training was acceptable, but 6 skill-technique areas were reported to be inadequate (endovascular techniques, neurosurgical treatment of pain, stereotactic radiosurgery, epilepsy surgery, cranial base surgery, and stereotactic neurosurgery). Respondents also noted inadequate education in contract negotiation, practice evaluation, and management. The study suggests that neurosurgeons believed that they were well trained in their surgical skills except for some areas of subspecialization. However, there is a significant need for improvement of resident training in the areas of socioeconomic and medicolegal education. Continued evaluation of the efficacy of neurosurgical education is important.
Faucett, Erynne A; McCrary, Hilary C; Barry, Jonnae Y; Saleh, Ahlam A; Erman, Audrey B; Ishman, Stacey L
Objective The Accreditation Council for Graduate Medical Education (ACGME) requires competency-based education for residents and recommends 5 basic features of high-quality feedback. Our aim was to examine the incorporation of feedback in articles regarding professionalism and interpersonal/communication skills for otolaryngology residency training curriculum. Data Sources PubMed, Embase, ERIC, Cochrane Library, Web of Science, Scopus, and ClinicalTrials.gov . Methods We used studies identified during a systematic review of all indexed years through October 4, 2016. Results Eighteen studies were included in this review. Professionalism was discussed in 16, of which 15 (94%) examined aspects of feedback. Interpersonal/communication skills were the focus of 16 articles, of which 14 16 (88%) discussed aspects of feedback. Our assessment demonstrated that timeliness was addressed in 8 (44%) articles, specificity in 4 (22%), learner reaction and reflection in 4 (22%), action plans in 3 (20%), and balancing reinforcing/corrective feedback in 2 (13%). Two articles did not address feedback, and 6 did not address aspects of high-quality feedback. The ACGME-recommended feedback systems of ADAPT (ask, discuss, ask, plan together) and R2C2 (relationship, reactions, content, and coach) were not reported in any of the studies. Conclusion Feedback is an essential component of graduate medical education and is required by the ACGME milestones assessment system. However, the core feedback components recommended by the ACGME are rarely included in the otolaryngology resident education literature.
Tender, Jennifer A F; Cuzzi, Sandra; Kind, Terry; Simmens, Samuel J; Blatt, Benjamin; Greenberg, Larrie
Previously reported breastfeeding curricula for residents have combined different teaching methods, have focused on knowledge and attitudes, and have been time-intensive. This study aimed to evaluate 3 time-efficient breastfeeding curricula for effectiveness in regard to pediatric residents' knowledge, confidence, and skills in managing a simulated breastfeeding scenario. First-year pediatric residents during their 4-week community hospital newborn nursery rotation were consecutively assigned to 1 of 3 groups. Group 1 shadowed an International Board Certified Lactation Consultant (IBCLC) for 1 hour; group 2 watched a 25-minute case-based breastfeeding DVD; and group 3 observed a 3-hour prenatal parent breastfeeding class (CLS). Residents were assessed by (1) a pretest and posttest evaluating their breastfeeding knowledge and confidence, and (2) a clinical skills scenario managing a breastfeeding standardized patient (SP). Thirty-nine pediatric residents participated in the study (11 in IBCLC, 16 DVD, 12 CLS) over a 1-year period. All groups significantly improved their knowledge scores and confidence in managing breastfeeding problems, with the IBCLC group showing more improvement in knowledge than the other groups (P = .02) and a higher rating of their teaching method (P = .01). All groups performed well on the SP clinical skills scenario, with no significant difference between groups. All 3 teaching methods were time-efficient and produced important gains in knowledge and confidence, with residents in the IBCLC group demonstrating greatest improvement in knowledge and a higher rating of their teaching method. Our study provides support for 3 methods of teaching residents breastfeeding management and demonstrates that IBCLCs are well-received as interprofessional educators. © The Author(s) 2014.
Goldberg, Michael B; Mazzei, Michael; Maher, Zoë; Fish, Joel H; Milner, Richard; Yu, Daohai; Goldberg, Amy J
Stress management programs improve efficacy in aviation, military, and professional sports; however, similar educational strategies have not been adopted in surgical training. We have evaluated the effectiveness of a stress management program for surgical residents. From 2011 to 2016, 137 surgical residents participated in a prospective, blinded study. The intervention group (n = 65) underwent training in self-awareness, focus, relaxation, positive self-talk, visualization, and team building. All participants subsequently completed a high-stress trauma simulation, requiring diagnosis and management of a life-threatening problem. Study endpoints included measures of procedural efficiency, and physiologic and subjective measurements of anxiety. Residents with stress training came to an accurate diagnosis 21% faster than controls (mean diagnosis time: 2.2 vs. 2.8 min; p = 0.04), and performed with greater technical accuracy (mean OSAT scores: 9.4 vs. 8.9; p = 0.03). Both cohorts exhibited similar physiologic and subjective anxiety metrics after simulation. Stress management education may enhance technical performance in surgical trainees during simulation. This underscores the need for early, comprehensive stress training in surgical residency. Copyright © 2017. Published by Elsevier Inc.
Chudnoff, Scott G; Liu, Connie S; Levie, Mark D; Bernstein, Peter; Banks, Erika H
To assess whether a novel educational curriculum using a simulation teaching laboratory improves resident knowledge, comfort with, and surgical performance of hysteroscopic sterilization. An educational prospective, pretest/posttest study. The Montefiore Institute of Minimally Invasive Surgery Laboratory. PATIENT(S)/SUBJECT(S): Thirty-four OB/GYN residents in an academic medical center. Hysteroscopic sterilization simulation laboratory and a brief didactic lecture. Differences in scores on validated skill assessment tools: Task specific checklist, Global Rating Scale (GRS), pass fail assessment, and a multiple-choice examination to evaluate knowledge and attitude. In the entire cohort improvements were observed on all evaluation tools after the simulation laboratory, with 31% points (SD+/-11.5, 95% confidence interval [CI] 27.3-35.3) higher score on the written evaluation; 63% points (SD+/-15.7, 95% CI 57.8-68.8) higher score on the task specific checklist; and 54% points (SD+/-13.6, 95% CI 48.8-58.3) higher score on the GRS. Higher PGY status was correlated with better pretest performance, but was not statistically significant in posttest scores. Residents reported an improvement in comfort performing the procedure after the laboratory. Simulation laboratory teaching significantly improved resident knowledge, comfort level, and technical skill performance of hysteroscopic sterilization. Copyright (c) 2010 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.
Moeller, Andrew; Webber, Jordan; Epstein, Ian
Resident duty hours have recently been under criticism, with concerns for resident and patient well-being. Historically, call shifts have been long, and some residency training programs have now restricted shift lengths. Data and opinions about the effects of such restrictions are conflicting. The Internal Medicine Residency Program at Dalhousie University recently moved from a traditional call structure to a day float/night float system. This study evaluated how this change in duty hours affected resident perceptions in several key domains. Senior residents from an internal medicine training program in Canada responded to an anonymous online survey immediately before and 6 months after the implementation of duty hour reform. The survey contained questions relating to three major domains: resident wellness, ability to deliver quality health care, and medical education experience. Mean pre- and post-intervention scores were compared using the t-test for paired samples. Twenty-three of 27 (85 %) senior residents completed both pre- and post-reform surveys. Residents perceived significant changes in many domains with duty hour reform. These included improved general wellness, less exposure to personal harm, fewer feelings of isolation, less potential for error, improvement in clinical skills expertise, increased work efficiency, more successful teaching, increased proficiency in medical skills, more successful learning, and fewer rotation disruptions. Senior residents in a Canadian internal medicine training program perceived significant benefits in medical education experience, ability to deliver healthcare, and resident wellness after implementation of duty hour reform.
Henricks, Walter H; Karcher, Donald S; Harrison, James H; Sinard, John H; Riben, Michael W; Boyer, Philip J; Plath, Sue; Thompson, Arlene; Pantanowitz, Liron
-Recognition of the importance of informatics to the practice of pathology has surged. Training residents in pathology informatics has been a daunting task for most residency programs in the United States because faculty often lacks experience and training resources. Nevertheless, developing resident competence in informatics is essential for the future of pathology as a specialty. -To develop and deliver a pathology informatics curriculum and instructional framework that guides pathology residency programs in training residents in critical pathology informatics knowledge and skills, and meets Accreditation Council for Graduate Medical Education Informatics Milestones. -The College of American Pathologists, Association of Pathology Chairs, and Association for Pathology Informatics formed a partnership and expert work group to identify critical pathology informatics training outcomes and to create a highly adaptable curriculum and instructional approach, supported by a multiyear change management strategy. -Pathology Informatics Essentials for Residents (PIER) is a rigorous approach for educating all pathology residents in important pathology informatics knowledge and skills. PIER includes an instructional resource guide and toolkit for incorporating informatics training into residency programs that vary in needs, size, settings, and resources. PIER is available at http://www.apcprods.org/PIER (accessed April 6, 2016). -PIER is an important contribution to informatics training in pathology residency programs. PIER introduces pathology trainees to broadly useful informatics concepts and tools that are relevant to practice. PIER provides residency program directors with a means to implement a standardized informatics training curriculum, to adapt the approach to local program needs, and to evaluate resident performance and progress over time.
Wouda, Jan C; van de Wiel, Harry B M
To determine the effects of residents' communication self-assessment and supervisor feedback on residents' communication-competency awareness, on their patient-education competency, and on their patients' opinion. The program consisted of the implementation of a communication self-assessment and feedback process using videoed outpatient consultations (video-CAF). Residents wrote down communication learning objectives during the instruction and after each video-CAF session. Residents' patient-education competency was assessed by trained raters, using the CELI instrument. Participating patients completed a questionnaire about the contact with their physician. Forty-four residents and 21 supervisors participated in 87 video-CAF sessions. After their first video-CAF session, residents wrote down more learning objectives addressing their control and rapport skills and their listening skills. Video-CAF participation improved residents' patient-education competency, but only in their control and rapport skills. Video-CAF participation had no effect on patients' opinion. Video-CAF appears to be a feasible procedure and might be effective in improving residents' patient-education competency in clinical practice. Video-CAF could fill the existing deficiency of communication training in residency programs. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.
Hicks, Caitlin W; Kernodle, Amber; Abularrage, Christopher J; Heller, Jennifer A
The objective of this study was to characterize U.S. vascular surgery trainees' perceptions, case numbers, and attitudes toward venous disease education, as well as their intent to incorporate it into future practice. These data will provide us with a current snapshot of postgraduate venous education from a resident's perspective. Institutional Review Board approval was obtained. A 13-question survey was created and distributed to all vascular surgery residents in the United States by SurveyMonkey. Formal electronic distribution remained deidentified as the surveys were e-mailed to residents from the Association of Program Directors in Vascular Surgery. Of 464 vascular surgery trainees queried, 104 (22%) responded to the survey. The majority of responders (80%) were between 25 and 34 years of age, 60% were male, and 72% were white; 91% reported that they were in an academic training program, and 57% were enrolled in an integrated vascular surgery residency program. Postgraduate years (PGYs) of training among respondents were well represented: PGY 1, 14%; PGY 2, 8%; PGY 3, 14%; PGY 4, 12%; PGY 5, 9%; PGY 6, 18%; and PGY 7, 25%. Vascular resident training experience with venous disease revealed the following: 63% performed training. Experience with endothermal ablations was slightly better, with 74% of responders reporting having performed up to 20 cases. Case volumes for endothermal ablation, vein stripping/ligation, inferior vena cava stenting, and iliac stenting increased progressively by clinical training year among integrated vascular residents (P ≤ .02) but were relatively stable for classic 5 + 2 vascular fellows (P ≥ .67). Integrated residents reported having received more didactic venous education than the 5 + 2 vascular surgery fellows (P = .01). There were no differences in overall reported venous procedure volumes between groups (P ≥ .28). The majority of trainees (82%) acknowledged that treating venous disease is part of a standard vascular
Brandt-Kreutz, Richard L; Ferguson, Kyle E; Sawyer, Devin
The family medicine residency behavioral science curriculum is more effective if prioritized to match what is needed in practice after graduation. Two prior studies (Kendall, Marvel, & Cruickshank, 2003; Marvel & Major, 1999) identified physician priorities for behavioral science education. The present study extends this research to include topics from more recent curriculum guidelines and examines the extent to which size of community and perceived competence correlate with prioritization of Washington state family physicians. Practicing family physicians in Washington state (N = 2,270) were invited to complete the survey. Respondents provided demographic and practice information. Respondents then rated, on a scale from 1 to 4, 35 behavioral science topics on 2 different scales including (a) priority to be given in residency education and (b) perceived level of competence. A total of 486 responded and 430 completed both priority and competence scales for a response rate of 19%. The top half of 35 topics of the present study included the top 13 topics found in the 2 prior studies. Priority and competence scales were moderately correlated (r = .48, n = 430, p = .001). There was a small significant correlation with size of community and priority ratings (r = .13, n = 435, p = .006). Family physicians in Washington state prioritize behavioral science topics in residency education similar to Colorado and Mississippi. The results of this study support recent ACGME guidelines, in that training should focus on common psychiatric illnesses, including depression and anxiety, and interpersonal processes. (PsycINFO Database Record (c) 2015 APA, all rights reserved).
Huri, Gazi; Cabuk, Yusuf Sertan; Gursoy, Safa; Akkaya, Mustafa; Ozkan, Secil; Oztuna, Volkan; Aydingoz, Onder; Senkoylu, Alparslan
The objective of this study is to describe the current situation regarding the training, working conditions, future plans, fields of interest and satisfaction of orthopaedics and traumatology residents in Turkey. A descriptive survey questionnaire consisting of 24 questions was designed to identify the problems and solution suggestions concerning training of orthopaedic residents. All orthopaedics and traumatology residents who took the 2013 Progress Testing for Speciality in Medicine (UEGS) held by Turkish Orthopaedics and Traumatology Education Council (TOTEK) were surveyed in the class at the end thereof as well as the young orthopaedic surgeons who were reached through the email groups of Turkish Society of Orthopaedics and Traumatology - Residents and Young Attendings Council (TOTBID-AGUH). A total of 725 residents and 132 young attendings were surveyed. The most outstanding answers are as follows: 62,7% of the respondents replied to the question "Is there a training program/Is it being applied" as "yes/yes". It was found out that 94,3% of the respondents wanted to be involved in a rotation abroad. The "patient care" was the most common answer, with a ratio of 36,9%, to the question "What's the priority of the department you are studying in?". Regarding work conditions, "many emergency on-calls" was found to be the most important parameter affecting life conditions (p < 0.05). Aiming to identify the challenges that orthopaedics and traumatology residents in Turkey face as regards their training, this survey stands as a pioneering study with a high participation rate. Analysis of survey data highlights the importance of several key factors such as the development of training programs and increasing the time spent with academicians as well as spreading and promotion of log book application. Copyright © 2016 Turkish Association of Orthopaedics and Traumatology. Production and hosting by Elsevier B.V. All rights reserved.
Pourmand, Ali; Tanski, Mary; Davis, Steven; Shokoohi, Hamid; Lucas, Raymond; Zaver, Fareen
Asynchronous online training has become an increasingly popular educational format in the new era of technology-based professional development. We sought to evaluate the impact of an online asynchronous training module on the ability of medical students and emergency medicine (EM) residents to detect electrocardiogram (ECG) abnormalities of an acute myocardial infarction (AMI). We developed an online ECG training and testing module on AMI, with emphasis on recognizing ST elevation myocardial infarction (MI) and early activation of cardiac catheterization resources. Study participants included senior medical students and EM residents at all post-graduate levels rotating in our emergency department (ED). Participants were given a baseline set of ECGs for interpretation. This was followed by a brief interactive online training module on normal ECGs as well as abnormal ECGs representing an acute MI. Participants then underwent a post-test with a set of ECGs in which they had to interpret and decide appropriate intervention including catheterization lab activation. 148 students and 35 EM residents participated in this training in the 2012-2013 academic year. Students and EM residents showed significant improvements in recognizing ECG abnormalities after taking the asynchronous online training module. The mean score on the testing module for students improved from 5.9 (95% CI [5.7-6.1]) to 7.3 (95% CI [7.1-7.5]), with a mean difference of 1.4 (95% CI [1.12-1.68]) (p<0.0001). The mean score for residents improved significantly from 6.5 (95% CI [6.2-6.9]) to 7.8 (95% CI [7.4-8.2]) (p<0.0001). An online interactive module of training improved the ability of medical students and EM residents to correctly recognize the ECG evidence of an acute MI.
Schram, Patricia; Harris, Sion K; Van Hook, Shari; Forman, Sara; Mezzacappa, Enrico; Pavlyuk, Roman; Levy, Sharon
Screening, brief intervention, and referral to treatment (SBIRT) is recommended as part of routine health care for adolescents as well as adults. In an effort to promote universal SBIRT, the Substance Abuse and Mental Health Services Administration awarded funding to residency programs to develop and implement SBIRT education and training. Our project focused on creating scientifically based, developmentally appropriate strategies and teaching materials for the adolescent age range. This paper describes curriculum development and implementation and presents evaluation data. Pediatric and child psychiatry residents were trained. The training consisted of 4 activities: (1) case-based teaching modules, (2) role-play of motivational interviewing and brief interventions, (3) mock interviews with trained adolescents, and (4) supervised "hands-on" screening and brief interventions. Main outcome measures included trainee satisfaction, and SBIRT knowledge, perceived self-efficacy, and self- and observer report of use of the SBIRT algorithm. Among 150 total participants completing the SBIRT training modules, nearly all (92.3%) were satisfied/very satisfied with the training modules. Knowledge accuracy immediately post training was high, but declined significantly by the end of the first residency year, with little change across subsequent years of residency. Confidence ratings also declined over time. Use of the SBIRT algorithm during the Adolescent Medicine rotation was high according to trainee self- and faculty observer report. We found evidence of training satisfaction, increased confidence in talking to adolescents about substance use, and widespread use of recommended practices immediately following training. Use of a highly structured algorithm to guide practice, and simple, highly structured brief interventions was a successful training approach, as residents self-reported accurate use of the SBIRT algorithm immediately after training. Knowledge and self
Harris, Joshua D; Staheli, Greg; LeClere, Lance; Andersone, Diana; McCormick, Frank
More than 15 years ago, the Institute of Medicine (IOM) identified medical error as a problem worthy of greater attention; in the wake of the IOM report, numerous changes were made to regulations to limit residents' duty hours. However, the effect of resident work-hour changes remains controversial within the field of orthopaedics. We performed a systematic review to determine whether work-hour restrictions have measurably influenced quality-of-life measures, operative and technical skill development, resident surgical education, patient care outcomes (including mortality, morbidity, adverse events, sentinel events, complications), and surgeon and resident attitudes (such as perceived effect on learning and training experiences, personal benefit, direct clinical experience, clinical preparedness). We performed a systematic review of PubMed, Scopus, CINAHL (Cumulative Index to Nursing and Allied Health Literature), and Google Scholar using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Inclusion criteria were any English language peer-reviewed articles that analyzed the effect(s) of orthopaedic surgery resident work-hour restrictions on patient safety, resident education, resident/surgeon quality of life, resident technical operative skill development, and resident surgeon attitudes toward work-hour restrictions. Eleven studies met study inclusion criteria. One study was a prospective analysis, whereas 10 studies were of level IV evidence (review of surgical case logs) or survey results. Within our identified studies, there was some support for improved resident quality of life, improved resident sleep and less fatigue, a perceived negative impact on surgical operative and technical skill, and conflicting evidence on the topic of resident education, patient outcomes, and variable attitudes toward the work-hour changes. There is a paucity of high-level or clear evidence evaluating the effect of the changes to resident work
Sanchez-Vaznaugh, Emma V; Kawachi, Ichiro; Subramanian, S V; Sánchez, Brisa N; Acevedo-Garcia, Dolores
Although birthplace and length of residence have been found to be associated with Body Mass Index (BMI)/obesity in the USA, their effects may not be the same across groups defined by education, gender and race/ethnicity. Using cross-sectional population based data from the 2001 California Health Interview Survey, we investigated the associations of birthplace and US length of residence with BMI, and whether the influence of birthplace-US length of residence on BMI varied by education, gender and race/ethnicity. Our sample included 37,350 adults aged 25-64 years. Self-reported weight and height were used to calculate BMI. Birthplace and length of residence were combined into a single variable divided into five levels: US-born, foreign-born living in the United States for more than 15, 10-14, 5-9, and less than 5 years. Controlling for age, gender, marital status, race/ethnicity, education, income, fruit and vegetable consumption, current smoking and alcohol use, we found that: (1) foreign-born adults had lower BMI than US-born adults; (2) among foreign-born adults, longer residence in the United States was associated with higher BMI; and (3) the effect of birthplace-length of US residence on BMI differed by education level, gender and race/ethnicity. Specifically, longer residence in the United States was associated with the greatest percent increases in BMI among the lowest educated groups than higher educated groups, among women (vs. men) and among Hispanics (vs. other racial/ethnic groups). These findings suggest that a protective effect of foreign birthplace on BMI appears to attenuate with length of residence in the United States, and also reveal that BMI/obesity trajectories associated with length of US residence vary by education, gender and race/ethnicity. Immigrant status, independently and in combination with education, gender and race/ethnicity should be considered in future obesity prevention and reduction efforts.
Sarin, Ritu R; Cattamanchi, Srihari; Alqahtani, Abdulrahman; Aljohani, Majed; Keim, Mark; Ciottone, Gregory R
The increase in natural and man-made disasters occurring worldwide places Emergency Medicine (EM) physicians at the forefront of responding to these crises. Despite the growing interest in Disaster Medicine, it is unclear if resident training has been able to include these educational goals. Hypothesis This study surveys EM residencies in the United States to assess the level of education in Disaster Medicine, to identify competencies least and most addressed, and to highlight effective educational models already in place. The authors distributed an online survey of multiple-choice and free-response questions to EM residency Program Directors in the United States between February 7 and September 24, 2014. Questions assessed residency background and details on specific Disaster Medicine competencies addressed during training. Out of 183 programs, 75 (41%) responded to the survey and completed all required questions. Almost all programs reported having some level of Disaster Medicine training in their residency. The most common Disaster Medicine educational competencies taught were patient triage and decontamination. The least commonly taught competencies were volunteer management, working with response teams, and special needs populations. The most commonly identified methods to teach Disaster Medicine were drills and lectures/seminars. There are a variety of educational tools used to teach Disaster Medicine in EM residencies today, with a larger focus on the use of lectures and hospital drills. There is no indication of a uniform educational approach across all residencies. The results of this survey demonstrate an opportunity for the creation of a standardized model for resident education in Disaster Medicine. Sarin RR , Cattamanchi S , Alqahtani A , Aljohani M , Keim M , Ciottone GR . Disaster education: a survey study to analyze disaster medicine training in emergency medicine residency programs in the United States. Prehosp Disaster Med. 2017;32(4):368-373.
Pacsi, Alsacia L
The purpose of this paper is to discuss and explore the historical perspectives, capacities, and usage of human patient simulators (HPS) in clinical simulations and propose future uses for HPS in nursing education. The use of HPS at all levels of nursing education appears promising because research suggests that the use of HPS facilitates the development of students' physical assessment and critical thinking skills in a user-friendly environment (Spunt, Foster, & Adams, 2004). By combining HPS scenarios with lectures and actual clinical experiences, students become actively engaged and confident in their competency of the nursing process in multiple clinical arenas. The use of this technology addresses patient safety because the student is able to refine skills and develop competency in a simulated environment.
Wouda, Jan C.; van de Wiel, Harry B. M.
Objectives: To determine the effects of residents' communication self-assessment and supervisor feedback on residents' communication-competency awareness, on their patient-education competency, and on their patients' opinion. Methods: The program consisted of the implementation of a communication
Jairo Hernando Gómez-Esteban**
Full Text Available The purpose of this article is to problematize the three fundamental dimensions of the human rights education: the dialogicity, the ”Otherness” and the juridicity, having previously discussed minimum ethical, political and legal conditions for a critical education in human rights. The article ends with some methodological assumptions to continue this discussion and this type of education.
Miller, David C; Sullivan, Amy M; Soffler, Morgan; Armstrong, Brett; Anandaiah, Asha; Rock, Laura; McSparron, Jakob I; Schwartzstein, Richard M; Hayes, Margaret M
We present a pilot study exploring the effects of a brief, 30-minute educational intervention targeting resident communication surrounding dying in the intensive care unit (ICU). We sought to determine whether simulation or didactic educational interventions improved resident-reported comfort, preparation, and skill acquisition. We also sought to identify resident barriers to using the word "dying." In this mixed-methods prospective study, second- and third-year medical residents were randomized to participate in a simulation-based communication training or a didactic session. Residents completed a pre-post survey after the sessions evaluating the sessions and reflecting on their use of the word "dying" in family meetings. Forty-five residents participated in the study. Residents reported increases in comfort (Mean [M]-pre = 3.3 [standard deviation: 0.6], M-post = 3.7 [0.7]; P < .01, Cohen d = 0.75) and preparation (M-pre = 3.4 [0.7], M-post = 3.9 [0.6]; P < .01, d = 1.07) using the word "dying" after both the simulation and didactic versions. Residents randomized to the simulation reported they were more likely to have learned new skills as compared to residents in the didactic (M-simulation = 2.2 [0.4], M-didactic = 1.9 [0.3]; P = .015, d = 0.80). They estimated that they used the word "dying" in 50% of their end-of-life (EOL) conversations and identified uncertain prognosis as the main barrier to explicitly stating the word "dying." A 30-minute educational intervention improves internal medicine residents' self-reported comfort and preparation in talking about death and dying in the ICU. Residents in simulation-based training were more likely to report they learned new skills as compared to the didactic session. Residents report multiple barriers to using the word "dying" EOL conversations.
Imamura, Keiko; Nakajima, Yasuo; Kiba, Ritsuko; Mizunuma, Kimiyoshi; Ida, Masahiro; Kawabuchi, Koichi
This report is a summary of investigations on the title from the aspect of human resources. Data were collected from databases of websites of Residency Electronic Information System, www.reisjp.org, and Foundation for Promotion of Medical training, www.pmet.org.jp, and from Hospital List (February, 2003) where Japanese radiology physicians were actually working. Investigations were performed on: qualification criteria of hospitals for training, their bed number, number of residents to be admitted, number of physicians and supervising doctors, presence/absence of independent radiology department, number of physicians, supervising doctors and expert physicians in the department. The number rate of physicians in the department is identified to be 64.7% and 84.3% of general and university hospitals, respectively; number of residents to be admitted per one supervisor in the university hospitals is 1.5-2.6 times as high as that in general hospitals; and about 1/4 of residents to be admitted may be in circumstances poor for radiology training. (author)
While respect for human rights has long been endorsed as a goal of education, only recently has significant attention been paid to the need to incorporate rights within educational processes. Current support for human rights within education, however, has a variety of motivations. This paper provides a theoretical exploration of these diverse…
Sozener, Cemal B; Lypson, Monica L; House, Joseph B; Hopson, Laura R; Dooley-Hash, Suzanne L; Hauff, Samantha; Eddy, Mary; Fischer, Jonathan P; Santen, Sally A
Competency-based education, including assessment of specialty-specific milestones, has become the dominant medical education paradigm; however, how to determine baseline competency of entering interns is unclear-as is to whom this responsibility falls. Medical schools should take responsibility for providing residency programs with accurate, competency-based assessments of their graduates. A University of Michigan ad hoc committee developed (spring 2013) a post-Match, milestone-based medical student performance evaluation for seven students matched into emergency medicine (EM) residencies. The committee determined EM milestone levels for each student based on assessments from the EM clerkship, end-of-third-year multistation standardized patient exam, EM boot camp elective, and other medical school data. In this feasibility study, the committee assessed nearly all 23 EM milestones for all seven graduates, shared these performance evaluations with the program director (PD) where each student matched, and subsequently surveyed the PDs regarding this pilot. Of the five responding PDs, none reported using the traditional medical student performance evaluation to customize training, four (80%) indicated that the proposed assessment provided novel information, and 100% answered that the assessment would be useful for all incoming trainees. An EM milestone-based, post-Match assessment that uses existing assessment data is feasible and may be effective for communicating competency-based information about medical school graduates to receiving residency programs. Next steps include further aligning assessments with competencies, determining the benefit of such an assessment for other specialties, and articulating the national need for an effective educational handover tool between undergraduate and graduate medical education institutions.
Watanabe, Rei; Gehad, Ahmed; Yang, Chao; Scott, Laura L.; Teague, Jessica E.; Schlapbach, Christoph; Elco, Christopher P.; Huang, Victor; Matos, Tiago R.; Kupper, Thomas S.; Clark, Rachael A.
The skin of an adult human contains about 20 billion memory T cells. Epithelial barrier tissues are infiltrated by a combination of resident and recirculating T cells in mice, but the relative proportions and functional activities of resident versus recirculating T cells have not been evaluated in
Wittich, Christopher M; Agrawal, Anoop; Cook, David A; Halvorsen, Andrew J; Mandrekar, Jayawant N; Chaudhry, Saima; Dupras, Denise M; Oxentenko, Amy S; Beckman, Thomas J
E-learning-the use of Internet technologies to enhance knowledge and performance-has become a widely accepted instructional approach. Little is known about the current use of e-learning in postgraduate medical education. To determine utilization of e-learning by United States internal medicine residency programs, program director (PD) perceptions of e-learning, and associations between e-learning use and residency program characteristics. We conducted a national survey in collaboration with the Association of Program Directors in Internal Medicine of all United States internal medicine residency programs. Of the 368 PDs, 214 (58.2%) completed the e-learning survey. Use of synchronous e-learning at least sometimes, somewhat often, or very often was reported by 85 (39.7%); 153 programs (71.5%) use asynchronous e-learning at least sometimes, somewhat often, or very often. Most programs (168; 79%) do not have a budget to integrate e-learning. Mean (SD) scores for the PD perceptions of e-learning ranged from 3.01 (0.94) to 3.86 (0.72) on a 5-point scale. The odds of synchronous e-learning use were higher in programs with a budget for its implementation (odds ratio, 3.0 [95% CI, 1.04-8.7]; P = .04). Residency programs could be better resourced to integrate e-learning technologies. Asynchronous e-learning was used more than synchronous, which may be to accommodate busy resident schedules and duty-hour restrictions. PD perceptions of e-learning are relatively moderate and future research should determine whether PD reluctance to adopt e-learning is based on unawareness of the evidence, perceptions that e-learning is expensive, or judgments about value versus effectiveness.
Shaw, Christiana M; Tan, Sanda A
Traditional education consists of didactics and book learning. Recently, technology has been integrated into graduate medical education, primarily in the form of simulation. The primary aim of this study was to investigate if a novel smartphone application using technology to engage learners would improve participation in an educational activity when compared with a daily e-mail format and how this use translated to performance on standardized testing. The UF Surgery App (App), which is a smartphone application, was developed to deliver 2 questions from a general surgery educational database every weekday from October to February 2013. The App, developed for iOS, featured a notification alarm and a reminder icon to actively engage the learner. Learners who used the App responded to multiple-choice questions and were provided instantaneous feedback in the form of a correct answer with an explanation. The response rate and answers were collected prospectively and compared with the American Board of Surgery In-Training Examination score. University of Florida, College of Medicine, Gainesville, Florida, a university teaching hospital. A total of 46 general surgical residents were enrolled in a university training program. Participation was voluntary. Overall, 26 of 46 (57%) residents participated. Of the users, 70% answered more than 20% of the questions, while 46% responded to more than 70% of questions. The percentage of correct answers on the App was positively correlated with standardized score (p = 0.005), percentage correct (p = 0.02), and percentile (p = 0.034) on the ABSITE examination. Technology can be used to actively engage residents. Deployment of this novel App improved participation over a daily question-answer e-mail format, and answers correlated with standardized test performance. The effect of the App on overall education is unclear, and a multi-institutional study has been initiated. Copyright © 2015 Association of Program Directors in Surgery. All
Larkin, Anne C; Cahan, Mitchell A; Whalen, Giles; Hatem, David; Starr, Susan; Haley, Heather-Lyn; Litwin, Demetrius; Sullivan, Kate; Quirk, Mark
This study examines the development and implementation of a pilot human factors curriculum during a 2-year period. It is one component of a comprehensive 5-year human factors curriculum spanning core competencies of interpersonal and communication skills, systems-based practice, and professionalism and using low-and high-fidelity simulation techniques. Members of the Department of Surgery and the Center for Clinical Communication and Performance Outcomes jointly constructed a curriculum for PGY1 and PGY2 residents on topics ranging from challenging communication to time and stress management. Video demonstrations, triggers, and simulated scenarios involving acting patients were created by surgeons and medical educators. Pre- and postintervention measures were obtained for communication skills, perceived stress level, and teamwork. Communication skills were evaluated using a series of video vignettes. The validated Perceived Stress Scale and Teamwork and Patient Safety Attitudes survey were used. Residents' perceptions of the program were also measured. Twenty-seven PGY1 residents and 15 PGY2 residents participated during 2 years. Analyses of video vignette tests indicated significant improvement in empathic communication for PGY1 (t = 3.62, p = 0.001) and PGY2 (t = 5.00, p = 0.004). There were no significant changes to teamwork attitudes. Perceived levels of stress became considerably higher. PGY1 residents reported trying 1 to 3 strategies taught in the time management session, with 60% to 75% reporting improvement post-training. This unique and comprehensive human factors curriculum is shown to be effective in building communication competency for junior-level residents in the human and emotional aspects of surgical training and practice. Continued refinement and ongoing data acquisition and analyses are underway. Copyright 2010 American College of Surgeons. Published by Elsevier Inc. All rights reserved.
Kansier, Nicole; Varghese, Thomas K.; Verrier, Edward D.; Drake, F. Thurston; Gow, Kenneth W.
Background General surgery resident training has changed dramatically over the past 2 decades, with likely impact on specialty exposure. We sought to assess trends in general surgery resident exposure to thoracic surgery using the Accreditation Council for Graduate Medical Education (ACGME) case logs over time. Methods The ACGME case logs for graduating general surgery residents were reviewed from academic year (AY) 1989–1990 to 2011–2012 for defined thoracic surgery cases. Data were divided into 5 eras of training for comparison: I, AY89 to 93; II, AY93 to 98; III, AY98 to 03; IV, AY03 to 08; V, AY08 to 12. We analyzed quantity and types of cases per time period. Student t tests compared averages among the time periods with significance at a p values less than 0.05. Results A total of 21,803,843 general surgery cases were reviewed over the 23-year period. Residents averaged 33.6 thoracic cases each in period I and 39.7 in period V. Thoracic cases accounted for nearly 4% of total cases performed annually (period I 3.7% [134,550 of 3,598,574]; period V 4.1% [167,957 of 4,077,939]). For the 3 most frequently performed procedures there was a statistically significant increase in thoracoscopic approach from period II to period V. Conclusions General surgery trainees today have the same volume of thoracic surgery exposure as their counterparts over the last 2 decades. This maintenance in caseload has occurred in spite of work-hour restrictions. However, general surgery graduates have a different thoracic surgery skill set at the end of their training, due to the predominance of minimally invasive techniques. Thoracic surgery educators should take into account these differences when training future cardiothoracic surgeons. PMID:24968766
Foster, Megan E; Lighter, Donald E; Godambe, Ashok V; Edgerson, Brandon; Bradley, Randy; Godambe, Sandip
To determine the effects of a resident physician educational program in a pediatric emergency department (ED) on pharmacy interventions and medication errors, particularly dose adjustments, order clarifications, and adverse drug events (ADE). The ED pharmacist recorded all interventions and medication errors on weekdays from 3 to 11 pm during a 9-month period, consisting of a preobservational (Quarter 1), observational (Quarter 2), and interventional (Quarter 3) phases. Program implementation occurred in Quarter 3, with an initial 3-hour lecture during the ED orientation, followed by daily patient case discussions. Weekly interventions and errors were analyzed using statistical process control u-chart analyses. Chi-square analyses of independence were also performed. Resident and ED staff feedback on the program was obtained through anonymous internet-based surveys. A total of 3507 interventions were recorded during the 9-month period. Chi-square approximation and interval estimation of odds ratio showed a statistically significant decrease between Quarters 1 and 3 in the number of dose adjustments (95% confidence interval [CI], 0.324-0.689) and order clarifications (95% CI, 0.137 to 0.382) after initiation of the program. The decline in ADE, while not as substantial (95% CI, 0.003 to 1.078), still achieved a level of significance (90% CI, 0.006 to 0.674). Survey results were positive toward the program. The implementation of a resident physician educational program in our pediatric ED significantly decreased the number of medication errors, increased resident physician awareness of the potential for errors, and increased ED pharmacist utilization.
Poon, Charles; Stevens, Shawn M; Golub, Justin S; Pensak, Myles L; Samy, Ravi N
This provides a basis to discuss some issues pertinent to Cornelia Roux's personal and professional journey as a researcher in religion education and related fields, including intercultural education, human rights education and citizenship education. I refer to our meetings over the years, both in and beyond South Africa, ...
Patel, Ekta; Muthusamy, Veena; Young, John Q
Residency programs must provide training in patient safety. Yet, significant gaps exist among published patient safety curricula. The authors developed a rotation designed to be scalable to an entire residency, built on sound pedagogy, aligned with hospital safety processes, and effective in improving educational outcomes. From July 2015 to May 2017, each second-year resident completed the two-week rotation. Residents learned the foundational science via multiple information modalities and then practiced applying key concepts during a mock root cause analysis. Next, each resident performed a special review of an actual adverse patient event and presented findings to the hospital's Special Review Committee (SRC). Multiple educational outcomes were assessed, including resident satisfaction and attitudes (post-rotation survey), changes in knowledge via pre- and two weeks post-test, quality of the resident's written safety analysis and oral presentation (per survey of SRC members), and organizational changes resulting from residents' reviews. Twenty-two residents completed the rotation. Most components were rated favorably; 80% (12/15 respondents) indicated interest in future patient safety work. Knowledge improved by 44.3% (P presentations as inferior to faculty's. The reviews identified safety vulnerabilities and led to multiple corrective actions. The authors will evaluate the curriculum in a controlled trial with better measures of change in behavior. Further tests of the curriculum's scalability to other contexts are needed.
Cayley, William E
Educating medical students and residents in the office presents the challenges of providing quality medical care, maintaining efficiency, and incorporating meaningful education for learners. Numerous teaching strategies to address these challenges have been described in the medical educational literature, but only a few teaching strategies have been evaluated for their impact on education and office practice. Literature on the impact of office-based teaching strategies on educational outcomes and on office efficiency was selected from a Pub Med search, from review of references in retrieved articles, and from the author's personal files. Two teaching strategies, "one-minute preceptor" (OMP) and "SNAPPS," have been shown to improve educational processes and outcomes. Two additional strategies, "Aunt Minnie" pattern recognition and "activated demonstration," show promise but have not been fully evaluated. None of these strategies has been shown to improve office efficiency. OMP and SNAPPS are strategies that can be used in office precepting to improve educational processes and outcomes, while pattern recognition and activated demonstration show promise but need further assessment. Additional areas of research also are suggested.
Raslau, David; Kasten, Mary Jo; Kebede, Esayas; Mohabbat, Arya; Ratrout, Basem; Mikhail, Michael
Patients undergoing surgery are becoming increasingly complex and internists are becoming more involved in their perioperative care. Therefore, new requirements from the ACGME/ABIM necessitate education in this area. We aim to discuss how our institution adapted a perioperative curriculum to fill this need. Perioperative education is primarily given to the residents during their one month rotation through the General Internal Medicine Consult Service rotation. This is an inpatient rotation that provides perioperative expertise to surgical teams, medicine consultation to medical subspecialty teams, and outpatient preoperative evaluations. Our implementation complies with ACGME/ABIM requirements and ensures that the educational and clinical needs of our institution are met. Developing a new curriculum can be daunting. We hope that this explanation of our approach will aid others who are working to develop an effective perioperative curriculum at their institutions.
Speakers in this session will present overview and details of a specific rotation or feature of their Medical Physics Residency Program that is particularly exceptional and noteworthy. The featured rotations include foundational topics executed with exceptional acumen and innovative educational rotations perhaps not commonly found in Medical Physics Residency Programs. A site-specific clinical rotation will be described, where the medical physics resident follows the physician and medical resident for two weeks into patient consultations, simulation sessions, target contouring sessions, planning meetings with dosimetry, patient follow up visits, and tumor boards, to gain insight into the thought processes of the radiation oncologist. An incident learning rotation will be described where the residents learns about and practices evaluating clinical errors and investigates process improvements for the clinic. The residency environment at a Canadian medical physics residency program will be described, where the training and interactions with radiation oncology residents is integrated. And the first month rotation will be described, where the medical physics resident rotates through the clinical areas including simulation, dosimetry, and treatment units, gaining an overview of the clinical flow and meeting all the clinical staff to begin the residency program. This session will be of particular interest to residency programs who are interested in adopting or adapting these curricular ideas into their programs and to residency candidates who want to learn about programs already employing innovative practices. Learning Objectives: To learn about exceptional and innovative clinical rotations or program features within existing Medical Physics Residency Programs. To understand how to adopt/adapt innovative curricular designs into your own Medical Physics Residency Program, if appropriate.
Lehmann, Ronny; Hanebeck, Benjamin; Oberle, Stephan; Simon, Anke; Choukair, Daniela; Tönshoff, Burkhard; Huwendiek, Sören
Virtual patients (VPs) are a one-of-a-kind e-learning resource, fostering clinical reasoning skills through clinical case examples. The combination with face-to-face teaching is important for their successful integration, which is referred to as "blended learning". So far little is known about the use of VPs in the field of continuing medical education and residency training. The pilot study presented here inquired the application of VPs in the framework of a pediatric residency revision course. Around 200 participants of a pediatric nephology lecture ('nephrotic and nephritic syndrome in children') were offered two VPs as a wrap-up session at the revision course of the German Society for Pediatrics and Adolescent Medicine (DGKJ) 2009 in Heidelberg, Germany. Using a web-based survey form, different aspects were evaluated concerning the learning experiences with VPs, the combination with the lecture, and the use of VPs for residency training in general. N=40 evaluable survey forms were returned (approximately 21%). The return rate was impaired by a technical problem with the local Wi-Fi firewall. The participants perceived the work-up of the VPs as a worthwhile learning experience, with proper preparation for diagnosing and treating real patients with similar complaints. Case presentations, interactivity, and locally and timely independent repetitive practices were, in particular, pointed out. On being asked about the use of VPs in general for residency training, there was a distinct demand for more such offers. VPs may reasonably complement existing learning activities in residency training.
Al Achkar M
Full Text Available Morhaf Al Achkar,1 Mathew Hanauer,1 Elizabeth H Morrison,2 M Kelly Davies,1 Robert C Oh3 1Department of Family Medicine-Indiana University, Indianapolis, IN, USA; 2Health Sciences, University of California, Riverside School of Medicine, Riverside, CA, USA; 3Family Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, USA Background: Teaching residents how to teach is a critical part of residents’ training in graduate medical education (GME. The purpose of this study was to assess the change in resident-as-teacher (RaT instruction in GME over the past 15 years in the US. Methods: We used a quantitative and qualitative survey of all program directors (PDs across specialties. We compared our findings with a previous work from 2000–2001 that studied the same matter. Finally, we qualitatively analyzed PDs’ responses regarding the reasons for implementing and not implementing RaT instruction. Results: Two hundred and twenty-one PDs completed the survey, which yields a response rate of 12.6%. Over 80% of PDs implement RaT, an increase of 26.34% compared to 2000–2001. RaT instruction uses multiple methods with didactic lectures reported as the most common, followed by role playing in simulated environments, then observing and giving feedback. Residents giving feedback, clinical supervision, and bedside teaching were the top three targeted skills. Through our qualitative analysis we identified five main reasons for implementing RaT: teaching is part of the residents’ role; learners desire formal RaT training; regulatory bodies require RaT training; RaT improves residents’ education; and RaT prepares residents for their current and future roles. Conclusion: The use of RaT instruction has increased significantly in GME. More and more PDs are realizing its importance in the residents’ formative training experience. Future studies should examine the effectiveness of each method for RaT instruction. Keywords: resident as
Morrison, Shane D.; Dy, Geolani W.; Chong, H. Jonathan; Holt, Sarah K.; Vedder, Nicholas B.; Sorensen, Mathew D.; Joyner, Byron D.
Background With increasing public awareness of and greater coverage for gender-confirming surgery by insurers, more transgender patients are likely to seek surgical transition. The degree to which plastic surgery and urology trainees are prepared to treat transgender patients is unknown. Objective We assessed the number of hours dedicated to transgender-oriented education in plastic surgery and urology residencies, and the impact of program director (PD) attitudes on provision of such training. Methods PDs of all Accreditation Council for Graduate Medical Education–accredited plastic surgery (91) and urology (128) programs were invited to participate. Surveys were completed between November 2015 and March 2016; responses were collected and analyzed. Results In total, 154 PDs (70%) responded, and 145 (66%) completed the survey, reporting a yearly median of 1 didactic hour and 2 clinical hours of transgender content. Eighteen percent (13 of 71) of plastic surgery and 42% (31 of 74) of urology programs offered no didactic education, and 34% (24 of 71) and 30% (22 of 74) provided no clinical exposure, respectively. PDs of programs located in the southern United States were more likely to rate transgender education as unimportant or neutral (23 of 37 [62%] versus 39 of 105 [37%]; P = .017). PDs who rated transgender education as important provided more hours of didactic content (median, 1 versus 0.75 hours; P = .001) and clinical content (median, 5 versus 0 hours; P plastic surgery and urology residencies provide no education on transgender health topics, and those that do, provide variable content. PD attitudes toward transgender-specific education appear to influence provision of training. PMID:28439350
Bedi, Harprit S; Yucel, Edgar K
This article describes how mobile technologies can improve the way we teach radiology and offers ideas to bridge the clinical gap with technology. Radiology programs across the country are purchasing iPads and other mobile devices for their residents. Many programs, however, do not have a concrete vision for how a mobile device can enhance the learning environment.
Ahmad, Fahd A; White, Andrew J; Hiller, Katherine M; Amini, Richard; Jeffe, Donna B
This study aimed to assess residents' and fellows' knowledge of finance principles that may affect their personal financial health. A cross-sectional, anonymous, web-based survey was administered to a convenience sample of residents and fellows at two academic medical centers. Respondents answered 20 questions on personal finance and 28 questions about their own financial planning, attitudes, and debt. Questions regarding satisfaction with one's financial condition and investment-risk tolerance used a 10-point Likert scale (1=lowest, 10=highest). Of 2,010 trainees, 422 (21%) responded (median age 30 years; interquartile range, 28-33). The mean quiz score was 52.0% (SD = 19.1). Of 299 (71%) respondents with student loan debt, 144 (48%) owed over $200,000. Many respondents had other debt, including 86 (21%) with credit card debt. Of 262 respondents with retirement savings, 142 (52%) had saved less than $25,000. Respondents' mean satisfaction with their current personal financial condition was 4.8 (SD = 2.5) and investment-risk tolerance was 5.3 (SD = 2.3). Indebted trainees reported lower satisfaction than trainees without debt (4.4 vs. 6.2, F (1,419) = 41.57, p < .001). Knowledge was moderately correlated with investment-risk tolerance (r=0.41, p < .001), and weakly correlated with satisfaction with financial status (r=0.23, p < .001). Residents and fellows had low financial literacy and investment-risk tolerance, high debt, and deficits in their financial preparedness. Adding personal financial education to the medical education curriculum would benefit trainees. Providing education in areas such as budgeting, estate planning, investment strategies, and retirement planning early in training can offer significant long-term benefits.
Yeung, Anamaria; Greenwalt, Julie
In training future radiation oncologists, we must begin to focus on training future QI specialists. Our patients are demanding better quality and safer care, and accrediting bodies are requiring it. We must equip radiation oncology trainees to be leaders in this new world. To that end, a QI/PS educational program should contain 2 components: a didactic portion focused on teaching basic QI tools as well as an overview of the quality and safety goals of the institution, and an experiential component, ideally a resident-led QI project mentored by an expert faculty member and that is linked to the department's and institution's goals.
Doukas, David J; Kirch, Darrell G; Brigham, Timothy P; Barzansky, Barbara M; Wear, Stephen; Carrese, Joseph A; Fins, Joseph J; Lederer, Susan E
Effectively developing professionalism requires a programmatic view on how medical ethics and humanities should be incorporated into an educational continuum that begins in premedical studies, stretches across medical school and residency, and is sustained throughout one's practice. The Project to Rebalance and Integrate Medical Education National Conference on Medical Ethics and Humanities in Medical Education (May 2012) invited representatives from the three major medical education and accreditation organizations to engage with an expert panel of nationally known medical educators in ethics, history, literature, and the visual arts. This article, based on the views of these representatives and their respondents, offers a future-tense account of how professionalism can be incorporated into medical education.The themes that are emphasized herein include the need to respond to four issues. The first theme highlights how ethics and humanities can provide a response to the dissonance that occurs in current health care delivery. The second theme focuses on how to facilitate preprofessional readiness for applicants through reform of the medical school admission process. The third theme emphasizes the importance of integrating ethics and humanities into the medical school administrative structure. The fourth theme underscores how outcomes-based assessment should reflect developmental milestones for professional attributes and conduct. The participants emphasized that ethics and humanities-based knowledge, skills, and conduct that promote professionalism should be taught with accountability, flexibility, and the premise that all these traits are essential to the formation of a modern professional physician.
Diane L. Gorgas
Full Text Available Introduction: Emotional Intelligence (EI is defined as an ability to perceive another’s emotional state combined with an ability to modify one’s own. Physicians with this ability are at a distinct advantage, both in fostering teams and in making sound decisions. Studies have shown that higher physician EI’s are associated with lower incidence of burn-out, longer careers, more positive patient-physician interactions, increased empathy, and improved communication skills. We explored the potential for EI to be learned as a skill (as opposed to being an innate ability through a brief educational intervention with emergency medicine (EM residents. Methods: This study was conducted at a large urban EM residency program. Residents were randomized to either EI intervention or control groups. The intervention was a two-hour session focused on improving the skill of social perspective taking (SPT, a skill related to social awareness. Due to time limitations, we used a 10-item sample of the Hay 360 Emotional Competence Inventory to measure EI at three time points for the training group: before (pre and after (post training, and at six-months post training (follow up; and at two time points for the control group: pre- and follow up. The preliminary analysis was a four-way analysis of variance with one repeated measure: Group x Gender x Program Year over Time. We also completed post-hoc tests. Results: Thirty-three EM residents participated in the study (33 of 36, 92%, 19 in the EI intervention group and 14 in the control group. We found a significant interaction effect between Group and Time (p<0.05. Post-hoc tests revealed a significant increase in EI scores from Time 1 to 3 for the EI intervention group (62.6% to 74.2%, but no statistical change was observed for the controls (66.8% to 66.1%, p=0.77. We observed no main effects involving gender or level of training. Conclusion: Our brief EI training showed a delayed but statistically significant
Bogetz, Jori F; Gabhart, Julia M; Rassbach, Caroline E; Sanders, Lee M; Mendoza, Fernando S; Bergman, David A; Blankenburg, Rebecca L
To evaluate an innovative curriculum meeting new pediatric residency education guidelines, Special Care Optimization for Patients and Education (SCOPE). Residents were randomized to intervention (n = 23) or control (n = 25) groups. Intervention residents participated in SCOPE, pairing them with a child with special health care needs (CSHCN) and faculty mentor to make a home visit, complete care coordination toolkits, and participate in case discussions. The primary outcome was resident self-efficacy in nine skills in caring for CSHCN. Secondary outcomes included curriculum feasibility/acceptance, resident attitudes, and family satisfaction. Response rates were ≥65%. Intervention residents improved in their self-efficacy for setting patient-centered goals compared with controls (mean change on 4-point Likert-type scale, 1.36 vs 0.56, P < .05). SCOPE was feasible/acceptable, residents had improved attitudes toward CSHCN, and families reported high satisfaction. SCOPE may serve as a model for efforts to increase residents' self-efficacy in their care of patients with chronic disease. © The Author(s) 2015.
Kerfoot, B Price; Baker, Harley
While games are frequently used in resident education, there is little evidence supporting their efficacy. We investigated whether a spaced-education (SE) game can be both a reliable and valid method of assessing residents' knowledge and an effective means of teaching core content. The SE game consisted of 100 validated multiple-choice questions and explanations on core urology content. Residents were sent 2 questions each day via email. Adaptive game mechanics re-sent the questions in 2 or 6 weeks if answered incorrectly and correctly, respectively. Questions expired if not answered on time (appointment dynamic). Residents retired questions by answering each correctly twice in a row (progression dynamic). Competition was fostered by posting relative performance among residents. Main outcomes measures were baseline scores (percentage of questions answered correctly on initial presentation) and completion scores (percentage of questions retired). Nine hundred thirty-one US and Canadian residents enrolled in the 45-week trial. Cronbach alpha reliability for the SE baseline scores was 0.87. Baseline scores (median 62%, interquartile range [IQR] 17%) correlated with scores on the 2008 American Urological Association in-service examination (ISE08), 2009 American Board of Urology qualifying examination (QE09), and ISE09 (r = 0.76, 0.46, and 0.64, respectively; all p games. An SE game is a reliable and valid means to assess residents' knowledge and is a well-accepted method by which residents can master core content. Published by Elsevier Inc.
Colvin, Jennifer; French, Judith; Siperstein, Allan; Capizzani, Tony R; Krishnamurthy, Vikram D
We aimed to conduct professionalism and social competencies (PSC) training by integrating humanities into structured workshops, and to assess reception of this curriculum by first-year surgical residents. An IRB-approved, pilot curriculum consisting of 4 interactive workshops for surgical interns was developed. The workshops were scheduled quarterly, often in small group format, and supplemental readings were assigned. Humanities media utilized to illustrate PSC included survival scenarios, reflective writing, television portrayals, and social media. Emphasis was placed on recognizing personal values and experiences that influence judgment and decision-making, using social media responsibly, identifying and overcoming communication barriers related to generational changes in training (especially technology and work-life balance), and tackling stereotypes of surgeons. Anonymous and voluntary pre- and postcurriculum surveys were administered. Univariate analysis of responses was performed with JMP Pro v12 using Fisher's exact, χ 2 , and Students' t-tests for categorical and continuous variables. The study took place at the Cleveland Clinic in Cleveland, OH, within the general surgery program. Surgical interns at the Cleveland Clinic were included in the study. A total of 16 surgical interns completed the curriculum. Sixteen surgical interns participated in the curriculum: 69% were domestic medical school graduates (DG) and 31% were international medical school graduates (IMG). Overall, the majority (81%) of residents had received PSC courses during medical school: 100% of DG compared to 40% of IMG (p = 0.02). Before beginning the curriculum, 86% responded that additional PSC training would be useful during residency, which increased to 94% upon completion (p = 0.58). Mean number of responses supporting the usefulness of PSC training increased from 1.5 ± 0.2 before the curriculum to 1.75 ± 0.2 upon completion (p = 0.4). When describing public and medical student
Jack, Megan C; Kenkare, Sonya B; Saville, Benjamin R; Beidler, Stephanie K; Saba, Sam C; West, Alisha N; Hanemann, Michael S; van Aalst, John A
Faced with work-hour restrictions, educators are mandated to improve the efficiency of resident and medical student education. Few studies have assessed learning styles in medicine; none have compared teaching and learning preferences. Validated tools exist to study these deficiencies. Kolb describes 4 learning styles: converging (practical), diverging (imaginative), assimilating (inductive), and accommodating (active). Grasha Teaching Styles are categorized into "clusters": 1 (teacher-centered, knowledge acquisition), 2 (teacher-centered, role modeling), 3 (student-centered, problem-solving), and 4 (student-centered, facilitative). Kolb's Learning Style Inventory (HayGroup, Philadelphia, Pennsylvania) and Grasha-Riechmann's TSS were administered to surgical faculty (n = 61), residents (n = 96), and medical students (n = 183) at a tertiary academic medical center, after informed consent was obtained (IRB # 06-0612). Statistical analysis was performed using χ(2) and Fisher exact tests. Surgical residents preferred active learning (p = 0.053), whereas faculty preferred reflective learning (p teaching preferences, although both groups preferred student-centered, facilitative teaching, faculty preferred teacher-centered, role-modeling instruction (p = 0.02) more often. Residents had no dominant teaching style more often than surgical faculty (p = 0.01). Medical students preferred converging learning (42%) and cluster 4 teaching (35%). Statistical significance was unchanged when corrected for gender, resident training level, and subspecialization. Significant differences exist between faculty and residents in both learning and teaching preferences; this finding suggests inefficiency in resident education, as previous research suggests that learning styles parallel teaching styles. Absence of a predominant teaching style in residents suggests these individuals are learning to be teachers. The adaptation of faculty teaching methods to account for variations in resident
Henricks, Walter H; Karcher, Donald S; Harrison, James H; Sinard, John H; Riben, Michael W; Boyer, Philip J; Plath, Sue; Thompson, Arlene; Pantanowitz, Liron
Context: Recognition of the importance of informatics to the practice of pathology has surged. Training residents in pathology informatics have been a daunting task for most residency programs in the United States because faculty often lacks experience and training resources. Nevertheless, developing resident competence in informatics is essential for the future of pathology as a specialty. Objective: The objective of the study is to develop and deliver a pathology informatics curriculum and instructional framework that guides pathology residency programs in training residents in critical pathology informatics knowledge and skills and meets Accreditation Council for Graduate Medical Education Informatics Milestones. Design: The College of American Pathologists, Association of Pathology Chairs, and Association for Pathology Informatics formed a partnership and expert work group to identify critical pathology informatics training outcomes and to create a highly adaptable curriculum and instructional approach, supported by a multiyear change management strategy. Results: Pathology Informatics Essentials for Residents (PIER) is a rigorous approach for educating all pathology residents in important pathology informatics knowledge and skills. PIER includes an instructional resource guide and toolkit for incorporating informatics training into residency programs that vary in needs, size, settings, and resources. PIER is available at http://www.apcprods.org/PIER (accessed April 6, 2016). Conclusions: PIER is an important contribution to informatics training in pathology residency programs. PIER introduces pathology trainees to broadly useful informatics concepts and tools that are relevant to practice. PIER provides residency program directors with a means to implement a standardized informatics training curriculum, to adapt the approach to local program needs, and to evaluate resident performance and progress over time. PMID:27563486
Dietl, Charles A; Russell, John C
The purpose of this article is to review the literature on current technology for surgical education and to evaluate the effect of technological advances on the Accreditation Council of Graduate Medical Education (ACGME) Core Competencies, American Board of Surgery In-Training Examination (ABSITE) scores, and American Board of Surgery (ABS) certification. A literature search was obtained from MEDLINE via PubMed.gov, ScienceDirect.com, and Google Scholar on all peer-reviewed studies published since 2003 using the following search queries: technology for surgical education, simulation-based surgical training, simulation-based nontechnical skills (NTS) training, ACGME Core Competencies, ABSITE scores, and ABS pass rate. Our initial search list included the following: 648 on technology for surgical education, 413 on simulation-based surgical training, 51 on simulation-based NTS training, 78 on ABSITE scores, and 33 on ABS pass rate. Further, 42 articles on technological advances for surgical education met inclusion criteria based on their effect on ACGME Core Competencies, ABSITE scores, and ABS certification. Systematic review showed that 33 of 42 and 26 of 42 publications on technological advances for surgical education showed objective improvements regarding patient care and medical knowledge, respectively, whereas only 2 of 42 publications showed improved ABSITE scores, but none showed improved ABS pass rates. Improvements in the other ACGME core competencies were documented in 14 studies, 9 of which were on simulation-based NTS training. Most of the studies on technological advances for surgical education have shown a positive effect on patient care and medical knowledge. However, the effect of simulation-based surgical training and simulation-based NTS training on ABSITE scores and ABS certification has not been assessed. Studies on technological advances in surgical education and simulation-based NTS training showing quantitative evidence that surgery residency
Parker, W; Yanasak, N [Georgia Regents University, Augusta, GA (Georgia)
Purpose: The goal of this project was to create a readily accessible, comprehensive-yet-flexible interactive MRI simulation tool for use in training and education of radiology residents in particular. This tool was developed to take the place of an MR scanner in laboratory activities, as magnet time has become scarce while hospitals are optimizing clinical scheduling for improved throughput. Methods: MrRSCAL (Magnetic resonance Resident Simulation Console for Active Learning) was programmed and coded using Matlab on a Mac workstation utilizing OS X platform. MR-based brain images were obtained from one of the co-authors and processed to generate parametric maps. Scanner sounds are also generated via mp3 convolution of a single MR gradient slew with a time-profile of gradient waveforms. Results: MrRSCAL facilitates the simulation of multiple MR sequences with the ability to alter MR parameters via an intuitive GUI control panel. The application allows the user to gain real-time understanding of image transformation when varying these said parameters by examining the resulting images. Lab procedures can be loaded and displayed for more directed study. The panel is also configurable, providing a simple interface for elementary labs or a full array of controls for the expert user. Conclusion: Our introduction of MrRSCAL, which is readily available to users with a current laptop or workstation, allows for individual or group study of MR image acquisition with immediate educational feedback as the MR parameters are manipulated. MrRSCAL can be used at any time and any place once installed, offering a new tool for reviewing relaxometric and artifact principles when studying for boards or investigating properties of a pulse sequence. This tool promises to be extremely useful in conveying traditionally difficult and abstract concepts involved with MR to the radiology resident and other medical professionals at large.
Martin, Kevin D; Amendola, Annunziato; Phisitkul, Phinit
Abstract Purpose Orthopedic education continues to move towards evidence-based curriculum in order to comply with new residency accreditation mandates. There are currently three high fidelity arthroscopic virtual reality (VR) simulators available, each with multiple instructional modules and simulated arthroscopic procedures. The aim of the current study is to assess face validity, defined as the degree to which a procedure appears effective in terms of its stated aims, of three available VR simulators. Methods Thirty subjects were recruited from a single orthopedic residency training program. Each subject completed one training session on each of the three leading VR arthroscopic simulators (ARTHRO mentor-Symbionix, ArthroS-Virtamed, and ArthroSim-Toltech). Each arthroscopic session involved simulator-specific modules. After training sessions, subjects completed a previously validated simulator questionnaire for face validity. Results The median external appearances for the ARTHRO Mentor (9.3, range 6.7-10.0; p=0.0036) and ArthroS (9.3, range 7.3-10.0; p=0.0003) were statistically higher than for Arthro- Sim (6.7, range 3.3-9.7). There was no statistical difference in intraarticular appearance, instrument appearance, or user friendliness between the three groups. Most simulators reached an appropriate level of proportion of sufficient scores for each categor y (≥70%), except for ARTHRO Mentor (intraarticular appearance-50%; instrument appearance- 61.1%) and ArthroSim (external appearance- 50%; user friendliness-68.8%). Conclusion These results demonstrate that ArthroS has the highest overall face validity of the three current arthroscopic VR simulators. However, only external appearance for ArthroS reached statistical significance when compared to the other simulators. Additionally, each simulator had satisfactory intraarticular quality. This study helps further the understanding of VR simulation and necessary features for accurate arthroscopic representation
Ogunyemi, Dotun; Tangchitnob, Edward; Mahler, Yonathan; Chung, Connie; Alexander, Carolyn; Korwin, Devra
To assess conflict styles and construct validity of the Thomas-Kilmann Mode of Conflict Instrument (TKI) among medical education personnel. From 2006 to 2009, 23 board-certified physicians (faculty), 46 residents, and 31 graduate medical education (GME) administrators participated in 3 behavior surveys. We used self-reported data (as completed by participants on the questionnaire). The TKI defines 5 conflict styles: competing, collaborating, compromising, accommodating, and avoiding. The My Best Communication Style Survey assesses 4 styles of communication: bold, expressive, sympathetic, and technical. The Interpersonal Influence Inventory categorizes 4 behavior styles: openly aggressive, assertive, concealed aggressive, and passive behaviors. A P value of style most chosen, closely followed by compromising and accommodating, whereas collaborating was the least likely to be selected. Collaborating percentiles were highest in GME administrators and lowest in faculty. Competing percentiles decreased from faculty to GME administrators (r = -0.237, P = .017). Openly aggressive scores were highest in faculty and lowest in GME administrators (P = .028). Technical communication scores were highest in residents and lowest in GME administrators (P = .008). Technical communication scores were highest in African Americans (P = .000). Asian Americans were more likely to be high in accommodating style (P = .019). Midwest respondents selected the collaborating style more than others did (41.3% versus 25%) (P = .009). Competing conflict style correlated positively with openly aggressive behavior and bold communication but negatively with expressive and sympathetic communications. There are differences in behavior patterns among faculty, residents, and GME administrators with suggestions of ethnic and geographic influences. Correlation among instruments supported theoretical relationships of construct validity.
Parker, W; Yanasak, N
Purpose: The goal of this project was to create a readily accessible, comprehensive-yet-flexible interactive MRI simulation tool for use in training and education of radiology residents in particular. This tool was developed to take the place of an MR scanner in laboratory activities, as magnet time has become scarce while hospitals are optimizing clinical scheduling for improved throughput. Methods: MrRSCAL (Magnetic resonance Resident Simulation Console for Active Learning) was programmed and coded using Matlab on a Mac workstation utilizing OS X platform. MR-based brain images were obtained from one of the co-authors and processed to generate parametric maps. Scanner sounds are also generated via mp3 convolution of a single MR gradient slew with a time-profile of gradient waveforms. Results: MrRSCAL facilitates the simulation of multiple MR sequences with the ability to alter MR parameters via an intuitive GUI control panel. The application allows the user to gain real-time understanding of image transformation when varying these said parameters by examining the resulting images. Lab procedures can be loaded and displayed for more directed study. The panel is also configurable, providing a simple interface for elementary labs or a full array of controls for the expert user. Conclusion: Our introduction of MrRSCAL, which is readily available to users with a current laptop or workstation, allows for individual or group study of MR image acquisition with immediate educational feedback as the MR parameters are manipulated. MrRSCAL can be used at any time and any place once installed, offering a new tool for reviewing relaxometric and artifact principles when studying for boards or investigating properties of a pulse sequence. This tool promises to be extremely useful in conveying traditionally difficult and abstract concepts involved with MR to the radiology resident and other medical professionals at large
Tarpada, Sandip P; Hsueh, Wayne D; Gibber, Marc J
E-learning, in its most rudimentary form, is the use of Internet-based resources for teaching and learning purposes. In surgical specialties, this definition encompasses the use of virtual patient cases, digital modeling, and online tutorials, as well as standardized video and imaging. As new technological frontiers rapidly emerge within otolaryngology, e-learning may be an effective alternative to traditional teaching. Here we present a systematic review of the literature assessing the efficacy of e-learning for otolaryngology education and a discussion of the relevance of these programs for both medical students and residents within the field. Systematic review. A systematic search of PubMed, Embase, Web of Science, and the Cochrane Library was conducted according to the guidelines defined in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Twelve studies met inclusion criteria. These studies measured a range of outcomes from basic science anatomical knowledge to clinically relevant endpoints such as diagnostic accuracy. Nearly all of the studies reported greater satisfaction and/or significantly increased objective knowledge using the e-learning intervention compared to traditional techniques. E-learning proves to be a powerful alternative to standard teaching techniques within otolaryngology education for both residents and medical students. Future work should focus on validating specific e-learning programs and accessing long-term knowledge retention using these innovative platforms. NA Laryngoscope, 127:E219-E224, 2017. © 2016 The American Laryngological, Rhinological and Otological Society, Inc.
Full Text Available Introduction: Burnout, depression, and suicidality among residents of all specialties have become a critical focus of attention for the medical education community. Methods: As part of the 2017 Resident Wellness Consensus Summit in Las Vegas, Nevada, resident participants from 31 programs collaborated in the Educator Toolkit workgroup. Over a seven-month period leading up to the summit, this workgroup convened virtually in the Wellness Think Tank, an online resident community, to perform a literature review and draft curricular plans on three core wellness topics. These topics were second victim syndrome, mindfulness and meditation, and positive psychology. At the live summit event, the workgroup expanded to include residents outside the Wellness Think Tank to obtain a broader consensus of the evidence-based toolkits for these three topics. Results: Three educator toolkits were developed. The second victim syndrome toolkit has four modules, each with a pre-reading material and a leader (educator guide. In the mindfulness and meditation toolkit, there are three modules with a leader guide in addition to a longitudinal, guided meditation plan. The positive psychology toolkit has two modules, each with a leader guide and a PowerPoint slide set. These toolkits provide educators the necessary resources, reading materials, and lesson plans to implement didactic sessions in their residency curriculum. Conclusion: Residents from across the world collaborated and convened to reach a consensus on high-yield—and potentially high-impact—lesson plans that programs can use to promote and improve resident wellness. These lesson plans may stand alone or be incorporated into a larger wellness curriculum.
Chung, Arlene S; Smart, Jon; Zdradzinski, Michael; Roth, Sarah; Gende, Alecia; Conroy, Kylie; Battaglioli, Nicole
Burnout, depression, and suicidality among residents of all specialties have become a critical focus of attention for the medical education community. As part of the 2017 Resident Wellness Consensus Summit in Las Vegas, Nevada, resident participants from 31 programs collaborated in the Educator Toolkit workgroup. Over a seven-month period leading up to the summit, this workgroup convened virtually in the Wellness Think Tank, an online resident community, to perform a literature review and draft curricular plans on three core wellness topics. These topics were second victim syndrome, mindfulness and meditation, and positive psychology. At the live summit event, the workgroup expanded to include residents outside the Wellness Think Tank to obtain a broader consensus of the evidence-based toolkits for these three topics. Three educator toolkits were developed. The second victim syndrome toolkit has four modules, each with a pre-reading material and a leader (educator) guide. In the mindfulness and meditation toolkit, there are three modules with a leader guide in addition to a longitudinal, guided meditation plan. The positive psychology toolkit has two modules, each with a leader guide and a PowerPoint slide set. These toolkits provide educators the necessary resources, reading materials, and lesson plans to implement didactic sessions in their residency curriculum. Residents from across the world collaborated and convened to reach a consensus on high-yield-and potentially high-impact-lesson plans that programs can use to promote and improve resident wellness. These lesson plans may stand alone or be incorporated into a larger wellness curriculum.
"What (Whose) purpose does your knowledge serve?" In her book, Not for Profit: Why Democracy Needs the Humanities, Martha Nussbaum states the difference between a democratic education for citizenship and an education for profit, and draws attention to the current education crisis caused by an overvaluation of the latter over the former.…
Lutz, Wolfgang; KC, Samir
Almost universally, women with higher levels of education have fewer children. Better education is associated with lower mortality, better health, and different migration patterns. Hence, the global population outlook depends greatly on further progress in education, particularly of young women. By 2050, the highest and lowest education scenarios--assuming identical education-specific fertility rates--result in world population sizes of 8.9 and 10.0 billion, respectively. Better education also matters for human development, including health, economic growth, and democracy. Existing methods of multi-state demography can quantitatively integrate education into standard demographic analysis, thus adding the "quality" dimension.
Stepanskaya, T. M.; Chernyaeva, I. V.; Naumova, V. I.
The article analyzes the role of humanities in forming the worldview of modern person in the system of higher education. It emphasizes the idea that a graduate of the higher education institute, and especially the university, should not only be an expert (a professional), but above all, a person of culture. Humanities as the basis of university…
Donnelly, Michael P.
Homeschooling is legal and growing in many countries but is virtually forbidden by law in Germany and a few others. The European Court of Human Rights (ECtHR) has reviewed and upheld this ban. Is home education a human right? How do these courts employ their jurisprudence of proportionality to find banning home education does not violate relevant…
Banks, James A.
The 60th anniversary of the Universal Declaration of Human Rights is a propitious time for educators to examine its implications for educating citizens in multicultural nation states. The author argues that students must experience democratic classrooms and schools that reflect their cultures and identities to internalize human rights values,…
Kerai, Sara Moore; Wheeler, Margot
An intervention was conducted, aimed at providing residents in internal medicine with communication skills to address end-of-life issues with patients. Residents participated in two 1-hour educational sessions designed to teach a communication protocol, enhance listening skills, and to provide practice in effective communication in a safe, small-group format. An anonymous on-line survey assessed the effectiveness of the intervention. Twenty-five residents completed the intervention. There was a trend toward increased comfort level in addressing end-of-life issues among residents who completed the intervention, versus a comparison group. Residents who completed the intervention reported that using the words "death" and "dying" with patients and families was an important teaching point.
Bergen, Timothy J., Jr.
Traces the roots of the concepts of the humanities and liberal arts education to the ancient Greeks, describing how their customs, language, philosophy, and literature have contributed to current concepts of education. Suggests that the Greek idea of education stressed the arts and mathematics but was opposed to all professionalism. (MAB)
Full Text Available Formal education, personal abilities and the health state play an important role in this paper. Those are all essential constituent elements of the human capital. In the present paper we intend to present briefly the fundamental concepts of the human capital, with an emphasis on education and abilities. We also mark out the importance of the human capital development in the purpose of maintaining the development and the motivation of the human resources, which are the main premises organizations need to capitalize. The higher education has a determinant role in the attainment of this desideratum.
Mallin, Mike; Schlein, Sarah; Doctor, Shaneen; Stroud, Susan; Dawson, Matthew; Fix, Megan
Medical education is transitioning from traditional learning methods. Resident interest in easily accessible education materials is forcing educators to reevaluate teaching methodology. To determine emergency medicine residents' current methods of and preferences for obtaining medical knowledge, the authors created a survey and sent it to residents, at all levels of training throughout the United States, whose e-mail addresses were available via their residency's official Web site (June-December 2012). The eight-question voluntary survey asked respondents about demographics, their use of extracurricular time, and the materials they perceived as most beneficial. The authors used descriptive statistics to analyze results. Of the 401 residents who received the e-mailed survey, 226 (56.3%) completed it. Of these, 97.7% reported spending at least one hour per week engaging in extracurricular education, and 34.5% reported spending two to four hours per week (P journals (36.5%), and Google (33.8%; P educators must engage with current learners to guide appropriate use of these.
Sabzghabaei, Anita; Shojaee, Majid; Alimohammadi, Hossein; Derakhshanfar, Hojjat; Kashani, Parvin; Nassiriabrishamchi, Shohreh
Creating a calm and stress-free environment affects education significantly. The effects of the emergency department overcrowding (EDO) on the training of emergency medicine residents (EMR) is a highly debated subject. Therefore, this study aimed to evaluate the effect of EDO on efficiency of EMR's education. In this cross-sectional study, the effects of overcrowding on EMR's education in the resuscitation room and acute care unit. Data collection was done using a questionnaire, which was filled out by the second year EMRs. The crowding level was calculated based on the national emergency department overcrowding scale (NEDOCS). The relationship between the two studied variables was evaluated using independent sample t-test and SPSS 21 statistical software. 130 questionnaires were filled out during 61 shifts. 47 (77.05%) shifts were overcrowded. The attend's ability to teach was not affected by overcrowding in the resuscitation room (p=0.008). The similar results were seen regarding the attend's training ability in the acute care unit. It seems that the emergency department overcrowding has no effect on the quality of education to the EMRs.
Park, Inchoel; Gupta, Amit; Mandani, Kaivon; Haubner, Laura; Peckler, Brad
Breaking bad news (BBN) in the emergency department (ED) is a common occurrence. This is especially true for an emergency physician (EP) as there is little time to prepare for the event and likely little or no knowledge of the patients or family background information. At our institution, there is no formal training for EP residents in delivering bad news. We felt teaching emergency medicine residents these communication skills should be an important part of their educational curriculum. We d...
Nicksa, Grace A; Anderson, Cristan; Fidler, Richard; Stewart, Lygia
The Accreditation Council for Graduate Medical Education core competencies stress nontechnical skills that can be difficult to evaluate and teach to surgical residents. During emergencies, surgeons work in interprofessional teams and are required to perform certain procedures. To obtain proficiency in these skills, residents must be trained. To educate surgical residents in leadership, teamwork, effective communication, and infrequently performed emergency surgical procedures with the use of interprofessional simulations. SimMan 3GS was used to simulate high-risk clinical scenarios (15-20 minutes), followed by debriefings with real-time feedback (30 minutes). A modified Oxford Non-Technical Skills scale (score range, 1-4) was used to assess surgical resident performance during the first half of the academic year (July-December 2012) and the second half of the academic year (January-June 2013). Anonymous online surveys were used to solicit participant feedback. Simulations were conducted in the operating room, intensive care unit, emergency department, ward, and simulation center. A total of 43 surgical residents (postgraduate years [PGYs] 1 and 2) participated in interdisciplinary clinical scenarios, with other health care professionals (nursing, anesthesia, critical care, medicine, respiratory therapy, and pharmacy; mean number of nonsurgical participants/session: 4, range 0-9). Thirty seven surgical residents responded to the survey. Simulation of high-risk clinical scenarios: postoperative pulmonary embolus, pneumothorax, myocardial infarction, gastrointestinal bleeding, anaphylaxis with a difficult airway, and pulseless electrical activity arrest. Evaluation of resident skills: communication, leadership, teamwork, problem solving, situation awareness, and confidence in performing emergency procedures (eg, cricothyroidotomy). A total of 31 of 35 (89%) of the residents responding found the sessions useful. Additionally, 28 of 33 (85%) reported improved confidence
Full Text Available Aim: Virtual patients (VPs are a one-of-a-kind e-learning resource, fostering clinical reasoning skills through clinical case examples. The combination with face-to-face teaching is important for their successful integration, which is referred to as “blended learning”. So far little is known about the use of VPs in the field of continuing medical education and residency training. The pilot study presented here inquired the application of VPs in the framework of a pediatric residency revision course. Methods: Around 200 participants of a pediatric nephology lecture (‘nephrotic and nephritic syndrome in children’ were offered two VPs as a wrap-up session at the revision course of the German Society for Pediatrics and Adolescent Medicine (DGKJ 2009 in Heidelberg, Germany. Using a web-based survey form, different aspects were evaluated concerning the learning experiences with VPs, the combination with the lecture, and the use of VPs for residency training in general.Results: N=40 evaluable survey forms were returned (approximately 21%. The return rate was impaired by a technical problem with the local Wi-Fi firewall. The participants perceived the work-up of the VPs as a worthwhile learning experience, with proper preparation for diagnosing and treating real patients with similar complaints. Case presentations, interactivity, and locally and timely independent repetitive practices were, in particular, pointed out. On being asked about the use of VPs in general for residency training, there was a distinct demand for more such offers. Conclusion: VPs may reasonably complement existing learning activities in residency training.
Calder, Bennett W; Sakran, Joseph V; Streck, Christian J; Cina, Robert A
Morbidity and Mortality (M&M) conference is considered the golden hour of surgical education. Most training programs lack standardized methods to evaluate self-reported outcomes and contributions to resident education. The purpose of this study was to determine whether residents underreport pediatric postoperative complications thereby limiting a comprehensive educational opportunity and the ability to adequately perform quality improvement during M&M conference. A retrospective analysis of resident reports submitted to the M&M committee at an academic medical center was conducted over 1 year. All complications were compared to the American College of Surgeons (ACS) Pediatric National Surgical Quality Improvement Program (NSQIP) data abstracted over the same period. A descriptive analysis of perioperative events was performed. This study was conducted at the Medical University of South Carolina Medical Center and MUSC Children's Hospital, an academic tertiary care center located in Charleston, South Carolina. Overall, 81 complications were captured. Resident and NSQIP databases captured 27 (33%) and 68 (84%) complications, respectively. Residents were more likely to report major complications. More common sources of postoperative morbidity, including surgical site infection and transfusion, were underreported at 20% and 5%, respectively. Resident reporting inadequately captures the full complement of pediatric perioperative complications. NSQIP-abstracted data serve as a useful adjunct to traditional M&M reporting in capturing complications underreported by trainees. Copyright © 2017 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.
Goebels, S; Viestenz, A; Seitz, B
The Homburger Curriculum was introduced in 2012 to enhance the medical resident education and professional satisfaction. At the same time different steps were taken to encourage applications of eligible candidates. To address candidates, the Homburger Curriculum is presented on the department's website and a short-term hospitation was introduced. The curriculum has been divided into time slots of 4 months throughout the 5 years of residency. In addition, a booklet of documented evidence of the rotations and a Resident's Compendium were introduced. Internal and external teaching programs, additional research projects and involvement of the residents in the organization of their curriculum were introduced. The paper describes the rationale behind the new structure of the curriculum and its practical outcomes for the department (e. g. a regular standby resident to fill in unexpected gaps). It is discussed in detail which steps were easy to implement and which steps were more difficult to introduce. After consolidation of the numerous steps, the number of resigning residents dropped significantly and the number of applicants increased. The new rotation schedule guarantees every young resident to be able to work at each work area of the Department of Ophthalmology. External training courses can be planned suitable to his/her rotations. An "internal competition" for popular rotations is no longer necessary. Clear organization and transparency in all areas provide good interpersonal climate in which much work still has to be done, but by motivated and satisfied residents.
Czarnecki, Gail A; Kloostra, Stephanie J; Boynton, James R; Inglehart, Marita R
Interprofessional education (IPE) has received increasingly more attention over recent years. The objectives of this study were to assess 1) how nursing students' considerations concerning their own oral health and oral health-related knowledge changed from before to after experiencing IPE; 2) how nursing students', dental students', and pediatric dentistry residents' IPE-related attitudes and Readiness for Interprofessional Learning Scale (RIPLS) scores changed after experiencing an IPE rotation; and 3) how these groups' attitudes and RIPLS scores were related. Data were collected from three groups who participated in an IPE rotation: thirty-eight of forty third-year dental students (95 percent response rate), all thirty-three nursing students (100 percent), and all six pediatric dentistry residents (100 percent) prior to the rotation, and 100 percent of each group after the rotation. As a control group, data were also collected at the beginning of the winter term from first-year dental students (104 out of 105; 99 percent response rate) and second-year dental students (102 out of 116; 88 percent); the same groups were surveyed at the end of term, with response rates of 98 percent for first-year students and 89 percent for second-year students. After the rotation, the nursing students' tooth brushing frequency increased, and their comfort level with dental visits and oral health-related knowledge improved. The dental students rated the importance of nurses' having oral health-related knowledge and skills lower than did the nursing students and pediatric dentistry residents. The groups' RIPLS scores correlated with these importance ratings. Overall, while the nursing students showed positive responses to IPE, the dental students' attitudes and RIPLS scores did not change as a result of the IPE experience. Future research should explore the conditions under which dental students are impacted by IPE.
Joukhadar, Nadim; Bourget, Genna; Manos, Sarah; Mann, Karen; Hatchette, Jill; Blake, Kim
Effective adolescent (10 to 19 years) interviewing by physicians is an essential skill that many trainees can find challenging. We assessed whether structured adolescent interviewing using standardized patients (SPs) and feedback in undergraduate medical education (UME) has a sustained effect on residents' skills. Postgraduate year (PGY) 1 residents conducted interviews with a SP adolescent-mother pair. The SPs independently scored each PGY-1 interview using the structured communication adolescent guide (SCAG). Unpaired t tests were conducted comparing "Total-Item" and "Global" scores of PGY-1s who received structured SP adolescent interviewing with feedback in UME ("structured training" group) to those who had not ("no structured training" group). PGY-1s in the structured training group (n = 23) received significantly higher mean Total-Item scores from both the SP adolescent (40.78 ± 7.04 and 32.41 ± 10.12, respectively; P = .001) and the SP mother (40.48 ± 7.90 and 33.34 ± 10.90, respectively; P = .01) than those without structured training (n = 29). Statistically significant results favoring PGY-1s with prior training were also seen with the SP adolescent and mother total Global SCAG scores. Structured training in adolescent interviewing with SPs and feedback in UME appears to have a sustained effect on residents' adolescent interviewing skills. PGY-1s will interview adolescents and may benefit from structured adolescent SP interviewing with feedback, especially individuals who did not have this experience during their medical school training.
In this article, I question the general idea that inclusive education--i.e., to teach all students in one class--is a moral human right. The following discussion shows that the widespread view in disability studies that there is a moral human right to inclusive education can be reasonably called into question by virtue of the proposed counter arguments, but without denying that inclusive education is of utmost importance. Practically speaking, the legal human right to inclusive education is of great practical value for impaired students, and for their basic right to be free from discrimination in education, since their concern thereby gains great legal and moral force. But, theoretically speaking, this particular human right lacks an attainable consensus concerning proper moral justification. © 2013 American Society of Law, Medicine & Ethics, Inc.
Ahn, James; Martin, Shannon K; Farnan, Jeanne M; Fromme, H Barrett
Residency clinician-educator tracks have been created; however, they have generally been limited to a single discipline or program and experienced some challenges. The Graduate Medical Education Scholars Track (GMEST), an embedded longitudinal, multimodal, multidisciplinary clinician-educator track for residents, was piloted at the Pritzker School of Medicine, University of Chicago, in academic year 2014-2015. The GMEST is a two-year experience completed during residency training. The goal is to prepare trainees for academic careers as clinician-educators with a focus on medical education scholarship. This track is designed for residents from diverse training programs with variable clinical schedules and blends a live interactive program, asynchronous instruction and discussion, and overarching multimodal mentorship in medical education. Participants are expected to complete a capstone medical education project and submit it to institutional, regional, and/or national venues. Data gathered from the 2014-2016 and 2015-2017 cohorts demonstrated that 21/22 (95%) participants were satisfied with the GMEST curriculum, felt it was important to their development as future clinician-educators, and felt it would positively influence their ability to work in medical education. Further, 18/22 (82%) participants wished to pursue a career as a clinician-educator and in medical education leadership and/or scholarship. The authors will longitudinally track graduates' future career positions, projects, publications, and awards, and cross-match and compare GMEST graduates with non-GMEST residents interested in medical education. Faculty mentors, program directors, and the Medical Education, Research, Innovation, Teaching, and Scholarship community will be asked for feedback on the GMEST.
Falcone, John L; Feinn, Richard S
The study purpose is to evaluate the Surgical Council on Resident Education (SCORE) Curriculum regarding American Board of Surgery Qualifying Examination (ABS QE) outcomes. The goal is to perform effect size analyses, sensitivity analyses, and sample size analyses with opportunity cost estimates required to favor the SCORE Curriculum subscription regarding ABS QE outcomes. Published data were used to construct 2 × 2 matrices regarding ABS QE outcome (pass/fail) and SCORE subscription status (subscriber/nonsubscriber). Post hoc analyses of effect sizes and sample sizes, with opportunity cost estimates, were performed to evaluate ABS QE outcomes favoring SCORE subscription (2-tailed and 1-tailed tests) using an α = 0.05. The absolute risk increase of SCORE subscription on ABS QE outcome was 1.6% (number needed to treat = 63). Sensitivity analyses showed that a pass rate difference of 4.9% to 7.5% was required to favor SCORE subscription (all p < 0.05). Sample size analyses required an 8- to 18-fold increase to favor SCORE subscription to achieve statistical significance with an opportunity cost of $6.0 to $13.5 million ($30,000-$67,000/program), not adjusting for inflation. The number needed to treat and pass rate differences required to favor SCORE subscription are large. The opportunity costs of SCORE subscription are substantial. Residency programs with more limited resources should determine if the subscription costs are financially sound. Copyright © 2015 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.
Full Text Available Breaking bad news (BBN in the emergency department (ED is a common occurrence. This is especially true for an emergency physician (EP as there is little time to prepare for the event and likely little or no knowledge of the patients or family background information. At our institution, there is no formal training for EP residents in delivering bad news. We felt teaching emergency medicine residents these communication skills should be an important part of their educational curriculum. We describe our experience with a defined educational program designed to educate and improve physician′s confidence and competence in bad news and death notification. A regularly scheduled 5-h grand rounds conference time frame was dedicated to the education of EM residents about BBN. A multidisciplinary approach was taken to broaden the prospective of the participants. The course included lectures from different specialties, role playing for three short scenarios in different capacities, and hi-fidelity simulation cases with volatile psychosocial issues and stressors. Participants were asked to fill out a self-efficacy form and evaluation sheets. Fourteen emergency residents participated and all thought that this education is necessary. The mean score of usefulness is 4.73 on a Likert Scale from 1 to 5. The simulation part was thought to be the most useful (43%, with role play 14%, and lecture 7%. We believe that teaching physicians to BBN in a controlled environment is a good use of educational time and an important procedure that EP must learn.
Jordan, A; El Haloui, O; Breaud, J; Chevalier, D; Antomarchi, J; Bongain, A; Boucoiran, I; Delotte, J
Evaluate an educational program in the training of residents in gynecology-obstetrics (GO) with a theory session and a practical session on simulators and analyze their learning curve. Single-center prospective study, at the university hospital (CHU). Two-day sessions were leaded in April and July 2013. An evaluation on obstetric and gynecological surgery simulator was available to all residents. Theoretical knowledge principles of obstetrics were evaluated early in the session and after formal lectures was taught to them. At the end of the first session, a satisfaction questionnaire was distributed to all participants. Twenty residents agreed to participate to the training sessions. Evaluation of theoretical knowledge: at the end of the session, the residents obtained a significant improvement in their score on 20 testing knowledge. Obstetrical simulator: a statistically significant improvement in scores on assessments simulator vaginal delivery between the first and second session. Subjectively, a larger increase feeling was seen after breech delivery simulation than for the cephalic vaginal delivery. However, the confidence level of the resident after breech delivery simulation has not been improved at the end of the second session. Simulation in gynecological surgery: a trend towards improvement in the time realized on the peg-transfer between the two sessions was noted. In the virtual simulation, no statistically significant differences showed, no improvement for in salpingectomy's time. Subjectively, the residents felt an increase in the precision of their gesture. Satisfaction: All residents have tried the whole program. They considered the pursuit of these sessions on simulators was necessary and even mandatory. The approach chosen by this structured educational program allowed a progression for the residents, both objectively and subjectively. This simulation program type for the resident's training would use this tool in assessing their skills and develop
Boateng, John; Flanagan, Constance
Women's physical and psychological access to health care was analyzed using the 2003 Ghana Demographic and Health Survey (GDHS), a nationally representative study for monitoring population and health in Ghana. Female respondents from the 2133 cases in the couple's data set were used in this study. Women's level of education was positively related to physical but not to psychological access to health care. Residing in an urban area was positively related to both types of access. Matriliny consistently showed positive effects on physical access. In addition to these demographic factors, both physical and psychological access were positively related to women's self-determination, i.e., women's right and ability to make real choices about their lives including their health, fertility, sexuality, childcare and all areas where women are denied autonomy and dignity in their identities as women. Self-determination factors both mediated the effects of background factors on access and added explanatory power to the models.
Hansen, Høgni Kalsø; Winther, Lars
human capital in understanding regional growth. We examine to what extent different labour competences and capabilities relate to municipal employment growth using nine stratified, educational categories as proxies for different levels of human capital. Dividing municipalities into four spatial...... categories ranging from the urban to the peripheral, we conclude that there is a strong spatial distinction of educational structures with an urban bias, and that educational categories other than academic human capital can make an important contribution to our understanding of what drives employment growth...
Nakhla, Jonathan; Kobets, Andrew; De la Garza Ramos, Rafeal; Haranhalli, Neil; Gelfand, Yaroslav; Ammar, Adam; Echt, Murray; Scoco, Aleka; Kinon, Merritt; Yassari, Reza
The relatively decreased time spent in the operating room and overall reduction in cases performed by neurosurgical trainees as a result of duty-hour restrictions demands that the pedagogical content within each surgical encounter be maximized and crafted toward the specific talents and shortcomings of the individual. It is imperative to future generations that the quality of training adapts to the changing administrative infrastructures and compensates for anything that may compromise the technical abilities of trainees. Neurosurgeons in teaching hospitals continue to experiment with various emerging technologies-such as simulators and virtual presence-to supplement and improve surgical training. The authors participated in the Google Glass Explorer Program in order to assess the applicability of Google Glass as a tool to enhance the operative education of neurosurgical residents. Google Glass is a type of wearable technology in the form of eyeglasses that employs a high-definition camera and allows the user to interact using voice commands. Google Glass was able to effectively capture video segments of various lengths for residents to review in a variety of clinical settings within a large, tertiary care university hospital, as well as during a surgical mission to a developing country. The resolution and quality of the video were adequate to review and use as a teaching tool. While Google Glass harbors the potential to dramatically improve both neurosurgical education and practice in a variety of ways, certain technical drawbacks of the current model limit its effectiveness as a teaching tool. Copyright © 2016 Elsevier Inc. All rights reserved.
This article attempts a contrast to the contribution by Hugh Starkey. Rather than his account of the inexorable rise of human rights discourse, and of the implementation of human rights standards, human rights are here presented as always and necessarily scandalous and highly contested. First, I explain why the UK has lagged so far behind its…
This article is based largely on a research study undertaken by the author into the teaching of human rights in nursing courses in the UK on behalf of the national section of the human rights organization Amnesty International. It attempts to provide a baseline estimate of human rights education in nursing curricula in the UK while making suggestions on how the teaching of human rights issues could be more clearly incorporated into nursing curricula, ending with some recommendations for further research.
Duerinckx, Andre J.; Grant, Edward G.; Melany, Michelle; Narin, Sherelle L.; Hayrapetian, Alek S.; Valentino, Daniel J.
Transmission of high quality images between hospitals would be of value by exposing residents at individual institutions to a greater mix of disease processes. This problem is particularly serious in ultrasound where individual hospitals may not perform the entire range of examinations. We undertook this study to assess the effectiveness of image transmission via a PACS/ATM global network in improving ultrasound education among residents at affiliated hospitals. Image management was performed by AGFA PACS; global network was Asynchronous Transfer Mode. Selected cases from the two hospitals (OB/GYN cases at one, vascular at the other) were transmitted. Readout/teaching sessions included cases performed at base hospital and those received via network. Evaluation forms were collected from participants at both institutions. No image degradation occurred with transmission. Residents' exposure to ultrasound cases increased at the two hospitals. The system was considered an excellent teaching tool by all faculty and residents surveyed.
This article discusses youth and adult education in a twofold perspective: that of a human right and that of human development. The first perspective is related to the concept of rights and the second perspective is related to the guarantee or negation of the right to development. In this article, the author discusses the universality of rights…
descriptive analysis of the state of education and human development in. Delta state and assesses the ... Education is an extremely important element in the organisation of modern society. There is now growing ... process of learning and training, instruction as impacted in schools, colleges and universities. In the light of the ...
McInerney, Joseph D.
Highlights the importance of the Human Genome Project in educating the public about genetics. Discusses four challenges that science educators must address: teaching for conceptual understanding, the nature of science, the personal and social impact of science and technology, and the principles of technology. Contains 45 references. (JRH)
Koutsogiannou, Persa; Dimoliatis, Ioannis D K; Mavridis, Dimitris; Bellos, Stefanos; Karathanos, Vassilis; Jelastopulu, Eleni
The Greek version of the Postgraduate Hospital Educational Environment Measure (PHEEM) was evaluated to determine its psychometric properties, i.e., validity, internal consistency, sensitivity and responsiveness to be used for measuring the learning environment in Greek hospitals. The PHEEM was administered to Greek hospital residents. Internal consistency was measured using Cronbach's alpha. Root Mean Square Error of Approximation (RMSEA) was used to evaluate the fit of Structural Equation Models. Content validity was addressed by the original study. Construct validity was tested using confirmatory (to test the set of underlying dimensions suggested by the original study) and exploratory (to explore the dimensions needed to explain the variability of the given answers) factor analysis using Varimax rotation. Convergent validity was calculated by Pearson's correlation coefficient regarding the participant's PHEEM score and participant's overall satisfaction score of the added item "Overall, I am very satisfied with my specialization in this post". Sensitivity was checked by comparing good versus poor aspects of the educational environment and by satisfied versus unsatisfied participants. A total of 731 residents from 83 hospitals and 41 prefectures responded to the PHEEM. The original three-factor model didn't fit better compared to one factor model that is accounting for 32% of the variance. Cronbach's α was 0.933 when assuming one-factor model. Using a three-factor model (autonomy, teaching, social support), Cronbach's α were 0.815 (expected 0.830), 0.908 (0.839), 0.734 (0.793), respectively. The three-factor model gave an RMSEA value of 0.074 (90% confidence interval 0.071, 0.076), suggesting a fair fit. Pearson's correlation coefficient between total PHEEM and global satisfaction was 0.765. Mean question scores ranged from 19.0 (very poor) to 73.7 (very good), and mean participant scores from 5.5 (very unsatisfied) to 96.5 (very satisfied). The Greek version
National Aeronautics and Space Administration, Washington, DC.
This brief discusses human movement and robotic human movement simulators. The activity for students in grades 5-12 provides a history of robotic movement and includes making an End Effector for the robotic arms used on the Space Shuttle and the International Space Station (ISS). (MVL)
Osler, Audrey; Starkey, Hugh
Why do teachers need to be familiar with human rights? In multicultural societies, whose values take precedence? How do schools resolve tensions between children's rights and teachers' rights? Campaigners, politicians and the media cite human rights to justify or challenge anything from peaceful protest to military action. The phrase "human…
Nauta, Russell J
Despite a quarter century of discourse since a sentinel event in New York City raised the question of appropriate oversight for graduate medical education, many questions remain unanswered. Even with the Accreditation Council for Graduate Medical Education rules in place, some opportunity remains to examine handoff methodology, the relationship of duty hours to education, and the impact of fatigue on resident performance. Neurophysiologic adjuncts applied concomitantly to evaluation of didactic performance offer promise for data-driven definition of the optimal shift. Concurrently, the merits of specialty-specific oversight of graduate medical education remain under active consideration. Copyright © 2012 Elsevier Inc. All rights reserved.
Durante-Montiel Irene; García-Durán Rocío; Graue-Wiechers Enrique L; Ruiz-Pérez Leobardo C; Sánchez-Mendiola Melchor
Abstract Background The role of residents as educators is increasingly recognized, since it impacts residents, interns, medical students and other healthcare professionals. A widespread implementation of resident-as-teacher courses in developed countries' medical schools has occurred, with variable results. There is a dearth of information about this theme in developing countries. The National Autonomous University of Mexico (UNAM) Faculty of Medicine has more than 50% of the residency progra...
Drake, Frederick Thurston; Aarabi, Shahram; Garland, Brandon T; Huntington, Ciara R; McAteer, Jarod P; Richards, Morgan K; Zern, Nicole Kansier; Gow, Kenneth W
To describe secular trends in operative experience for surgical trainees across an extended period using the most comprehensive data available, the Accreditation Council for Graduate Medical Education (ACGME) case logs. Some experts have expressed concern that current trainees are inadequately prepared for independent practice. One frequently mentioned factor is whether duty hours' restrictions (DHR) implemented in 2003 and 2004 contributed by reducing time spent in the operating room. A dataset was generated from annual ACGME reports. Operative volume for total major cases (TMC), defined categories, and four index laparoscopic procedures was evaluated. TMC dropped after implementation of DHR but rebounded after a transition period (949 vs 946 cases, P = nonsignificance). Abdominal cases increased from 22% of overall cases to 31%. Alimentary cases increased from 21% to 26%. Trauma and vascular surgery substantially decreased. For trauma, this drop took place well before DHR. The decrease in vascular surgery also began before DHR but continued afterward as well: 148 cases/resident in the late 1990s to 107 currently. Although total operative volume rebounded after implementation of DHR, diversity of operative experienced narrowed. The combined increase in alimentary and abdominal cases is nearly 13%, over a half-year's worth of operating in 5-year training programs. Bedrock general surgery cases-trauma, vascular, pediatrics, and breast-decreased. Laparoscopic operations have steadily increased. If the competence of current graduates has, in fact, diminished. Our analysis suggests that operative volume is not the problem. Rather, changing disease processes, subspecialization, reductions in resident autonomy, and technical innovation challenge how today's general surgeons are trained.
Wittich, Christopher M; Agrawal, Anoop; Wang, Amy T; Halvorsen, Andrew J; Mandrekar, Jayawant N; Chaudhry, Saima; Dupras, Denise M; Oxentenko, Amy S; Beckman, Thomas J
To begin to quantify and understand the use of the flipped classroom (FC)-a progressive, effective, curricular model-in internal medicine (IM) education in relation to residency program and program director (PD) characteristics. The authors conducted a survey that included the Flipped Classroom Perception Instrument (FCPI) in 2015 regarding programs' use and PDs' perceptions of the FC model. Among the 368 IM residency programs, PDs at 227 (61.7%) responded to the survey and 206 (56.0%) completed the FCPI. Regarding how often programs used the FC model, 34 of the 206 PDs (16.5%) reported "never"; 44 (21.4%) reported "very rarely"; another 44 (21.4%) reported "somewhat rarely"; 59 (28.6%) reported "sometimes"; 16 (7.8%) reported "somewhat often"; and 9 (4.4%) reported "very often." The mean FCPI score (standard deviation [SD]) for the in-class application factor (4.11 [0.68]) was higher (i.e., more favorable) than for the preclass activity factor (3.94 [0.65]) (P 50 years, 3.94 [0.61]; P = .04) and women compared with men (4.28 [0.56] vs. 3.91 [0.62]; P < .001). PDs with better perceptions of FCs had higher odds of using FCs (odds ratio, 4.768; P < .001). Most IM programs use the FC model at least to some extent, and PDs prefer the interactive in-class components over the independent preclass activities. PDs who are women and younger perceived the model more favorably.
Full Text Available Andrew C Dixon Department of Pediatrics, University of Alberta, Edmonton, AB, Canada Objectives: To determine the gaps in knowledge of Canadian pediatric emergency medicine residents with regards to acute fracture identification and management. Due to their predominantly medical prior training, fractures may be an area of weakness requiring a specific curriculum to meet their needs. Methods: A questionnaire was developed examining comfort level and performance on knowledge based questions of trainees in the following areas: interpreting musculoskeletal X-rays; independently managing pediatric fractures, physical examination techniques, applied knowledge of fracture management, and normal development of the bony anatomy. Using modified Dillman technique the instrument was distributed to pediatric emergency medicine residents at seven Canadian sites. Results: Out of 43 potential respondents, 22 (51% responded. Of respondents, mean comfort with X-ray interpretation was 69 (62–76 95% confidence interval [CI] while mean comfort with fracture management was only 53 (45–63 95% CI; mean comfort with physical exam of shoulder 60 (53–68 95% CI and knee 69 (62–76 95% CI was low. Less than half of respondents (47%; 95% CI 26%–69% could accurately identify normal wrist development, correctly manage a supracondylar fracture (39%; 95% CI 20%–61%, or identify a medial epicondyle fracture (44%; 95% CI 24%–66%. Comfort with neurovascular status of the upper (mean 82; 95% CI 75–89 and lower limb (mean 81; 95% CI 74–87 was high. Interpretation: There are significant gaps in knowledge of physical exam techniques, fracture identification and management among pediatric emergency medicine trainees. A change in our current teaching methods is required to meet this need. Keywords: pediatric, fractures, education, radiologic interpretation
Arvate, Paulo Roberto; Zoghbi, Ana Carolina Pereira
The main objective of this paper is to show that a family arrangement in which the elderly co-reside with the young determines that the elderly support the public education expenditure. Considering that this type of family arrangement is more common in Latin American countries than in the United States, our study is concentrated in Brazil. This…
Weeks, Matthew; Cole, Brandon; Flake, Eric; Roy, Daniel
This study aims to describe the quantity and satisfaction current residents and experienced pediatricians have with graduate medical education on transitioning medically complex patients to adult care. There is an increasing need for transitioning medically complex adolescents to adult care. Over 90% now live into adulthood and require transition to adult healthcare providers. The 2010 National Survey of Children with Special Health Care Needs found that only 40% of youth 12-17 yr receive the necessary services to appropriately transition to adult care. Prospective, descriptive, anonymous, web-based survey of pediatric residents and staff pediatricians at Army pediatric residency training programs was sent in March 2017. Questions focused on assessing knowledge of transition of care, satisfaction with transition training, and amount of education on transition received during graduate medical education training. Of the 145 responders (310 potential responders, 47% response rate), transition was deemed important with a score of 4.3 out of 5. The comfort level with transition was rated 2.6/5 with only 4.2% of participants receiving formal education during residency. The most commonly perceived barriers to implementing a curriculum were time constraints and available resources. Of the five knowledge assessment questions, three had a correct response rate of less than 1/3. The findings show the disparity between the presence of and perceived need for a formal curriculum on transitioning complex pediatric patients to adult care. This study also highlighted the knowledge gap of the transition process for novice and experienced pediatricians alike.
Darolia, Rajeev; Potochnick, Stephanie
This paper presents an analysis of the effects of in-state resident tuition (IRT) policies, which allow undocumented immigrants to pay in-state rather than out-of state tuition, on when and where undocumented immigrant students enroll, and how they finance their education. We identify effects based on differences in pre- and post-policy outcomes…
Full Text Available Abstract Background The role of residents as educators is increasingly recognized, since it impacts residents, interns, medical students and other healthcare professionals. A widespread implementation of resident-as-teacher courses in developed countries' medical schools has occurred, with variable results. There is a dearth of information about this theme in developing countries. The National Autonomous University of Mexico (UNAM Faculty of Medicine has more than 50% of the residency programs' physician population in Mexico. This report describes a needs assessment survey for a resident as teacher program at our institution. Methods A cross-sectional descriptive survey was developed based on a review of the available literature and discussion by an expert multidisciplinary committee. The goal was to identify the residents' attitudes, academic needs and preferred educational strategies regarding resident-as-teacher activities throughout the residency. The survey was piloted and modified accordingly. The paper anonymous survey was sent to 7,685 residents, the total population of medical residents in UNAM programs in the country. Results There was a 65.7% return rate (5,186 questionnaires, a broad and representative sample of the student population. The residents felt they had knowledge and were competent in medical education, but the majority felt a need to improve their knowledge and skills in this discipline. Most residents (92.5% felt that their role as educators of medical students, interns and other residents was important/very important. They estimated that 45.5% of their learning came from other residents. Ninety percent stated that it was necessary to be trained in teaching skills. The themes identified to include in the educational intervention were mostly clinically oriented. The educational strategies in order of preference were interactive lectures with a professor, small groups with a moderator, material available in a website for
Mihr, A.; Schmitz, Hans-Peter
Transnational human rights activism occupies today a significant place in the practice and scholarship of current global affairs. This article reviews the past successes and limits of this activism and suggests Human Rights Education (HRE) as a strategic tool currently underutilized by activists and
The 1990s was the era of human rights awareness, democratic transitions, and growing involvement of international organizations and the nongovernmental sector in human rights education (HRE). The UN Decade for HRE from 1995–2004 was not only born out of the initiatives and pressures of
McCalmont, Kate; Norris, Jeffrey; Garzon, Agustina; Cisneros, Raquel; Greene, Heather; Regino, Lidia; Sandoval, Virginia; Gomez, Roberto; Page-Reeves, Janet; Kaufman, Arthur
Neither the health care system nor the training of medical residents focus sufficiently on social determinants of health. Community health workers (CHWs) are a growing presence in health care settings. Culturally and linguistically competent, typically they are from underserved communities and spend more time addressing social determinants of health than others on the health care team. However, CHWs are an infrequent presence in resident clinical training environments. The University of New Mexico Family Medicine Residency placed family medicine residents at a community clinic in Albuquerque managed by CHWs, recognizing that CHWs' collaboration with residents would enhance resident competency in multiple domains. Residents gained skills from CHWs in inter-professional teamwork, cultural proficiency in patient care, effective communication, provision of cost-conscious care, and advocating for both individual and community health. Our model recognizes the value of CHW skills and knowledge and creates a powerful rationale for greater recognition of CHW expertise and integration of CHWs as members of the care team.
Hombrink, Pleun; Helbig, Christina; Backer, Ronald A; Piet, Berber; Oja, Anna E; Stark, Regina; Brasser, Giso; Jongejan, Aldo; Jonkers, René E; Nota, Benjamin; Basak, Onur; Clevers, Hans C; Moerland, Perry D; Amsen, Derk; van Lier, René A W
Tissue-resident memory T cells (T RM cells) in the airways mediate protection against respiratory infection. We characterized T RM cells expressing integrin α E (CD103) that reside within the epithelial barrier of human lungs. These cells had specialized profiles of chemokine receptors and adhesion molecules, consistent with their unique localization. Lung T RM cells were poised for rapid responsiveness by constitutive expression of deployment-ready mRNA encoding effector molecules, but they also expressed many inhibitory regulators, suggestive of programmed restraint. A distinct set of transcription factors was active in CD103 + T RM cells, including Notch. Genetic and pharmacological experiments with mice revealed that Notch activity was required for the maintenance of CD103 + T RM cells. We have thus identified specialized programs underlying the residence, persistence, vigilance and tight control of human lung T RM cells.
Luz Esperanza Hernández Terrazas
Full Text Available Abstract Objective: To evaluate the effect of an educational intervention for the adequate use of the Dignified Treatment indicator by the nursing staff before the care of hospitalized patients. Methods: Pre-experimental analysis performed from February to March of 2017 in a public hospital in San Luis Potosí Mexico, with 37 nurses. In the first stage, a diagnostic evaluation of knowledge was elaborated. In the second, an education program was implemented for the proper use of the decent treatment indicator. In the third, nursing knowledge was evaluated and the before and after tests were compared by the t-Student parametric test. Results: For the diagnostic stage, 97% of nursing staff had a low level of knowledge. After implementing the program, 80% of the team increased their level. Conclusions: The educational intervention increased the knowledge about the use of the Dignified Treatment indicator.
Ecker, Brett L; Maduka, Richard; Ramdon, Andre; Dempsey, Daniel T; Dumon, Kristoffel R; Williams, Noel N
Robotic technology is increasingly prevalent in bariatric surgery, yet there are national deficiencies in exposure of surgical residents to robotic techniques. The purpose of this study is to accurately characterize the perioperative outcomes of a resident teaching model using the robotic-assisted sleeve gastrectomy. University Hospital. We identified 411 consecutive patients who underwent robotic sleeve gastrectomy at our institution from a prospectively maintained administrative database. Perioperative morbidity, operative time, and supply cost of the procedure were analyzed. Mean operative time was 96.4±24.9 minutes; mean robot usage time was 63.9 minutes (range 30.0-122.0 min). Ninety-day morbidities included reoperation (0.72%), major bleeding complications (0.48%), staple line leak (0.24%), stricture (0.97%), need for blood transfusion (3.86%), surgical site infection (1.69%), deep vein thrombosis (0.48%), and pulmonary embolism (0.48%). Mortality was nil. The resident cohort achieved operative time plateaus after five consecutive cases. Subset analysis for fiscal year 2014 demonstrated significantly increased supply cost for robotic sleeve gastrectomy compared with its laparoscopic equivalent. Robotic-assisted sleeve gastrectomy can be instituted as a model for resident robotic education with rates of morbidity and operative times equivalent to historical laparoscopic controls. The robot's enhanced ergonomics and its opportunity for resident education must be weighed against its increased supply cost. Copyright © 2016 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.
Kawauchi, Kiye; Itoh, Natsuko; Ishikawa, Tomiye; Nihonyanagi, Haruko; Aratani, Michi
The neutron criticality accident at the JCO, a private company for nuclear fuel processing facilities in Tokai has drastically changed minds and attitudes of residents toward environmental radioactivity. The accident happened on September 30, 1999. Before the accident the residents of the Rokkasho Site were not anxious about environmental radioactivity, because they thought the facilities were safe enough concerning containment policy of the radioactivity inside the facilities. Residents, however, had not been taught on a neutron. It is an unfamiliar radiation for them. So, they promptly learnt on neutrons, and some of them began the fixed point measurement of neutrons at the nearest site of the Spent Fuel Recycling Facilities of Rokkasho by the help of Prof. Kazuhisa. Komura, Kanazawa University. Members of the Reading Cicle, Rokkasho Culture Society, mainly women, learnt measurements of environmental radioactivity using simplified counters for alpha-, beta-, and gamma-ray from natural radioactive elements and prepared various kinds of environmental samples. After learning of environmental radioactivity, they began educational activities on the environmental radioactivity for boys and girls in the region. Monitoring of environmental radioactivity is performed by different institutions and with their purposes. Here is reported learning of environmental radioactivity by the residents and education of environmental radioactivity toward the young. Even with the simplest counters, we think that the monitoring of environmental radioactivity by the residents themselves is the royal road to the safety of the regional society. (author)
Ogrinc, Greg; Ercolano, Ellyn; Cohen, Emily S; Harwood, Beth; Baum, Karyn; van Aalst, Robertus; Jones, Anne C; Davies, Louise
Learning about quality improvement (QI) in resident physician training is often relegated to elective or noncore clinical activities. The authors integrated teaching, learning, and doing QI into the routine clinical work of inpatient internal medicine teams at a Veterans Affairs (VA) hospital. This study describes the design factors that facilitated and inhibited the integration of a QI curriculum-including real QI work-into the routine work of inpatient internal medicine teams. A realist evaluation framework used three data sources: field notes from QI faculty; semistructured interviews with resident physicians; and a group interview with QI faculty and staff. From April 2011 to July 2012, resident physician teams at the White River Junction VA Medical Center used the Model for Improvement for their QI work and analyzed data using statistical process control charts. Three domains affected the delivery of the QI curriculum and engagement of residents in QI work: setting, learner, and teacher. The constant presence of the QI material on a public space in the team workroom was a facilitating mechanism in the setting. Explicit sign-out of QI work to the next resident team formalized the handoff in the learner domain. QI teachers who were respected clinical leaders with QI expertise provided role modeling and local system knowledge. Integrating QI teaching into the routine clinical and educational systems of an inpatient service is challenging. Identifiable, concrete strategies in the setting, learner, and teacher domains helped integrate QI into the clinical and educational systems.
Bhatia, Kriti; Takayesu, James Kimo; Arbelaez, Christian; Peak, David; Nadel, Eric S
Given the discrepancy between men and women's equal rates of medical school matriculation and their rates of academic promotion and leadership role acquisition, the need to provide mentorship and education to women in academic medicine is becoming increasingly recognized. Numerous large-scale programs have been developed to provide support and resources for women's enrichment and retention in academic medicine. Analyses of contributory factors to the aforementioned discrepancy commonly cite insufficient mentoring and role modeling as well as challenges with organizational navigation. Since residency training has been shown to be a critical juncture for making the decision to pursue an academic career, there is a need for innovative and tailored educational and mentorship programs targeting residents. Acknowledging residents' competing demands, we designed a program to provide easily accessible mentorship and contact with role models for our trainees at the departmental and institutional levels. We believe that this is an important step towards encouraging women's pursuit of academic careers. Our model may be useful to other emergency medicine residencies looking to provide such opportunities for their women residents.
Emily E. Fay
Full Text Available Objective. The 23-valent pneumococcal vaccine is recommended for adults over 65 years of age and younger adults with certain medical conditions. The Centers for Disease Control and Prevention (CDC state insufficient evidence to recommend routine pneumococcal vaccination during pregnancy, but the vaccine is indicated for pregnant women with certain medical conditions. We designed this project to gauge obstetrics and gynecology (OB/GYN resident knowledge of maternal pneumococcal vaccination. Methods. We administered a 22-question survey to OB/GYN residents about maternal pneumococcal vaccination. We performed descriptive analysis for each question. Results. 238 OB/GYN residents responded. Overall, 69.3% of residents reported receiving vaccination education and 86.0% reported having ready access to vaccine guidelines and safety data. Most residents knew that asplenia (78.2%, pulmonary disease (77.3%, and HIV/AIDS (69.4% are indications for vaccination but less knew that cardiovascular disease (45.0%, diabetes (35.8%, asthma (42.8%, nephrotic syndrome (19.7%, and renal failure (33.6% are also indications for vaccination. Conclusion. OB/GYN residents are taught about vaccines and have ready access to vaccine guidelines and safety data. However, knowledge of indications for pneumococcal vaccination in pregnancy is lacking. Likely, the opportunity to vaccinate at-risk pregnant patients is being missed.
Haspel, Richard L; Lin, Yulia; Mallick, Ranjeeta; Tinmouth, Alan; Cid, Joan; Eichler, Hermann; Lozano, Miguel; van de Watering, Leo; Fisher, Patrick B; Ali, Asma; Parks, Eric
Blood transfusion is the most common hospital procedure performed in the United States. While inadequate physician transfusion medicine knowledge may lead to inappropriate practice, such an educational deficit has not been investigated on an international scale using a validated assessment tool. Identifying specific deficiencies is critical for developing curricula to improve patient care. Rasch analysis, a method used in high-stakes testing, was used to validate an assessment tool consisting of a 23-question survey and a 20-question examination. The assessment tool was administered to internal medicine residents to determine prior training, attitudes, perceived ability, and actual knowledge related to transfusion medicine. A total of 474 residents at 23 programs in nine countries completed the examination. The overall mean score of correct responses was 45.7% (site range, 32%-56%). The mean score for Postgraduate Year (PGY)1 (43.9%) was significantly lower than for PGY3 (47.1%) and PGY4 (50.6%) residents. Although 89% of residents had participated in obtaining informed consent from a patient for transfusion, residents scored poorly (<25% correct) on questions related to transfusion reactions. The majority of residents (65%) would find additional transfusion medicine training "very" or "extremely" helpful. Internationally, internal medicine residents have poor transfusion medicine knowledge and would welcome additional training. The especially limited knowledge of transfusion reactions suggests an initial area for focused training. This study not only represents the largest international assessment of transfusion medicine knowledge, but also serves as a model for rigorous, collaborative research in medical education. © 2014 AABB.
Full Text Available Modernity is characterized by profound changes in all spheres of human life caused by the global transformations on macro and micro levels of social reality. These changes allow us to speak about the present as the era of civilizational transition in the mode of uncertainty. Therefore, this situation demands qualitative transformations of human adaptive strategies and educational technologies accordingly. The dominant role in the dynamics of pedagogics and andragogy’s landscape belongs to transformative learning. The transformative learning theory is considered as the relevant approach to education of the individual, which is able to become an autonomous communicative actor of the social complexity. The article considers the cognitive technologies of social cohesion development and perspectives of their implementation in the educational dimension. In addition to implementing the principles of inclusion, equity in education, an important factor for improving social cohesion, stability and unity of society is the development of cognitive educational technologies. The key factors and foundations for the cognitive educational technologies are transversal competencies. They create the conditions for civil, public dialogue, non-violent type of communication. These “21st century skills” are extremely important for better human adaptation. One of the aspects and roots of social adaptation is social cohesion. Mutual determinations and connections between social cohesion development and transversal competences have been shown. The perspective direction of further researches is to find a methodological base for the further development of cognitive education technologies and platform for realization of innovative services for educational programs. New educational paradigm offers the concept of human adaptation as cognitive effectiveness and how to reach it through educational technologies. The article includes topics of creative thinking, teambuilding
Ovadia, Steven A; Gishen, Kriya; Desai, Urmen; Garcia, Alejandro M; Thaller, Seth R
Entrepreneurial skills are important for physicians, especially plastic surgeons. Nevertheless, these skills are not typically emphasized during residency training. Evaluate the extent of business training at plastic surgery residency programs as well as means of enhancing business training. A 6-question online survey was sent to plastic surgery program directors for distribution to plastic surgery residents. Responses from residents at the PGY2 level and above were included for analysis. Tables were prepared to present survey results. Hundred and sixty-six residents including 147 PGY2 and above residents responded to our survey. Only 43.5% reported inclusion of business training in their plastic surgery residency. A majority of residents reported they do not expect on graduation to be prepared for the business aspects of plastic surgery. Additionally, a majority of residents feel establishment of a formal lecture series on the business of plastic surgery would be beneficial. Results from our survey indicate limited training at plastic surgery programs in necessary business skills. Plastic surgery residency programs should consider incorporating or enhancing elements of business training in their curriculum. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
Doukas, David J; McCullough, Laurence B; Wear, Stephen
Medical education accreditation organizations require medical ethics and humanities education to develop professionalism in medical learners, yet there has never been a comprehensive critical appraisal of medical education in ethics and humanities. The Project to Rebalance and Integrate Medical Education (PRIME) I Workshop, convened in May 2010, undertook the first critical appraisal of the definitions, goals, and objectives of medical ethics and humanities teaching. The authors describe assembling a national expert panel of educators representing the disciplines of ethics, history, literature, and the visual arts. This panel was tasked with describing the major pedagogical goals of art, ethics, history, and literature in medical education, how these disciplines should be integrated with one another in medical education, and how they could be best integrated into undergraduate and graduate medical education. The authors present the recommendations resulting from the PRIME I discussion, centered on three main themes. The major goal of medical education in ethics and humanities is to promote humanistic skills and professional conduct in physicians. Patient-centered skills enable learners to become medical professionals, whereas critical thinking skills assist learners to critically appraise the concept and implementation of medical professionalism. Implementation of a comprehensive medical ethics and humanities curriculum in medical school and residency requires clear direction and academic support and should be based on clear goals and objectives that can be reliably assessed. The PRIME expert panel concurred that medical ethics and humanities education is essential for professional development in medicine.
The Resilience of Women in Higher Education in Afghanistan. Study No 1: Obstacles and Opportunities in Women's Enrollment and Graduation; Study No. 2: The Human, Social and Institutional Resilience of Female Doctors and Postgraduate Residency Programs. Resilience in Education Settings (RES)-Research Studies Series
Kosha, Afifa; Oriya, Spozhmay; Nabi, Tahira; Halim, Sabera; Hofyani, Sohaila; Liwal, Abida; Safi, Najibullah; Sahak, Mohamad Nadir; Noormal, Bashir
Female access to higher education in Afghanistan has been and continues to be limited. At the basic education level, the country has made great advances since 2000; it increased access from 900,000 students in 2000, almost all boys, to 6.7 million students in 2009, and girl's enrollment increased from 5,000 under the Taliban to 2.4 million in the…
Castleberry, Anthony W; Clary, Bryan M; Migaly, John; Worni, Mathias; Ferranti, Jeffrey M; Pappas, Theodore N; Scarborough, John E
Complex, oncologic surgery is an important component of resident education. Our objective was to evaluate the impact of resident participation in oncologic procedures on overall 30-day morbidity and mortality. A retrospective cohort analysis was performed using the National Surgical Quality Improvement Program Participant User Files for 2005-2009. Colorectal, hepatopancreaticobiliary, and gastroesophageal oncology procedures were included. Multivariate logistic regression was used to assess the impact of trainee involvement on 30-day morbidity and mortality after adjusting for potential confounders. A total of 77,862 patients were included for analysis, 53,885 (69.2%) involving surgical trainees and 23,977 (30.8%) without trainees. The overall 30-day morbidity was significantly higher in the trainee group [27.2 vs. 21%, adjusted odds ratio (AOR) 1.19, 95% confidence interval (CI) 1.15-1.24, p patients suffering one or more postoperative complications) (5.9 vs. 7.6%, AOR 0.79, 95% CI 0.68-0.90, p = 0.001). The overall 30-day morbidity was highest in the PGY 5 level (29%) compared to 24% for PGY 1 or 2 and 23% for PGY 3 (AOR per level increase 1.05, 95% CI 1.03-1.07, p surgery is associated with significantly higher rates of 30-day postoperative complications in NSQIP-participating hospitals; however, this effect is countered by overall lower 30-day mortality and improved rescue rate in preventing death among patients suffering complications.
Reed, Suzanne; Kassis, Karyn; Nagel, Rollin; Verbeck, Nicole; Mahan, John D; Shell, Richard
Patients and physicians identify communication of bad news as a skill in need of improvement. Our objectives were to measure change in performance of first-year pediatric residents in the delivery of bad news after an educational intervention and to measure if changes in performance were sustained over time. Communication skills of 29 residents were assessed via videotaped standardized patient (SP) encounters at 3 time points: baseline, immediately post-intervention, and 3 months post-intervention. Educational intervention used was the previously published "GRIEV_ING Death Notification Protocol." The intraclass correlation coefficient demonstrated substantial inter-rater agreement with the assessment tool. Performance scores significantly improved from baseline to immediate post-intervention. Performance at 3 months post-intervention showed no change in two subscales and small improvement in one subscale. We concluded that breaking bad news is a complex and teachable skill that can be developed in pediatric residents. Improvement was sustained over time, indicating the utility of this educational intervention. This study brings attention to the need for improved communication training, and the feasibility of an education intervention in a large training program. Further work in development of comprehensive communication curricula is necessary in pediatric graduate medical education programs. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.
Hixon, Allen L; Buenconsejo-Lum, Lee E; Racsa, C Philip
Access to care for patients in Hawai'i is compromised by a significant primary care workforce shortage. Not only are there not enough primary care providers, they are often not practicing in locations of high need such as rural areas on the neighbor islands or in the Pacific. This study used geographic information systems (GIS) spatial analysis to look at practice locations for 86 University of Hawai'i Family Medicine and Community Health graduates from 1993 to the 2010. Careful alumni records were verified and entered into the data set using the street address of major employment. Questions to be answered were (1) what percentage of program graduates remain in the state of Hawai'i and (2) what percentage of graduates practice in health professional shortage areas (HPSAs) throughout the United States. This study found that 73 percent of graduates remain and practice in Hawai'i with over 36 percent working in Health Professional Shortage Areas. Spatial analysis using GIS residency footprinting may be an important analytic tool to ensure that graduate medical education programs are meeting Hawai'i's health workforce needs.
Buenconsejo-Lum, Lee E; Racsa, C Philip
Background Access to care for patients in Hawai‘i is compromised by a significant primary care workforce shortage. Not only are there not enough primary care providers, they are often not practicing in locations of high need such as rural areas on the neighbor islands or in the Pacific. Methods This study used geographic information systems (GIS) spatial analysis to look at practice locations for 86 University of Hawai‘i Family Medicine and Community Health graduates from 1993 to the 2010. Careful alumni records were verified and entered into the data set using the street address of major employment. Questions to be answered were (1) what percentage of program graduates remain in the state of Hawai‘i and (2) what percentage of graduates practice in health professional shortage areas (HPSAs) throughout the United States. Results This study found that 73 percent of graduates remain and practice in Hawai‘i with over 36 percent working in Health Professional Shortage Areas. Discussion Spatial analysis using GIS residency footprinting may be an important analytic tool to ensure that graduate medical education programs are meeting Hawai‘i's health workforce needs. PMID:22737640
Podlesak, David W; Bowen, Gabriel J; O'Grady, Shannon; Cerling, Thure E; Ehleringer, James R
An understanding of the factors influencing the isotopic composition of body water is important to determine the isotopic composition of tissues that are used to reconstruct movement patterns of humans. The δ(2)H and δ(18)O values of body water (δ(2)H(bw) and δ(18)O(bw)) are related to the δ(2)H and δ(18)O values of drinking water (δ(2)H(dw) and δ(18)O(dw)), but clearly distinct because of other factors including the composition of food. Here, we develop a mechanistic geographical information system (GIS) model to produce spatial projections of δ(2)H(bw) and δ(18)O(bw) values for the USA. We investigate the influence of gender, food, and drinking water on the predicted values by comparing them with the published values. The strongest influence on the predicted values was related to the source of δ(2)H(dw) and δ(18)O(dw) values. We combine the model with equations that describe the rate of turnover to produce estimates for the time required for a non-resident to reach an isotopic equilibrium with a resident population.
DiGiuseppe, Stephen; Luszczek, Wioleta; Keiffer, Timothy R; Bienkowska-Haba, Malgorzata; Guion, Lucile G M; Sapp, Martin J
During the entry process, the human papillomavirus (HPV) capsid is trafficked to the trans-Golgi network (TGN), whereupon it enters the nucleus during mitosis. We previously demonstrated that the minor capsid protein L2 assumes a transmembranous conformation in the TGN. Here we provide evidence that the incoming viral genome dissociates from the TGN and associates with microtubules after the onset of mitosis. Deposition onto mitotic chromosomes is L2-mediated. Using differential staining of an incoming viral genome by small molecular dyes in selectively permeabilized cells, nuclease protection, and flotation assays, we found that HPV resides in a membrane-bound vesicle until mitosis is completed and the nuclear envelope has reformed. As a result, expression of the incoming viral genome is delayed. Taken together, these data provide evidence that HPV has evolved a unique strategy for delivering the viral genome to the nucleus of dividing cells. Furthermore, it is unlikely that nuclear vesicles are unique to HPV, and thus we may have uncovered a hitherto unrecognized cellular pathway that may be of interest for future cell biological studies.
Schroedl, Clara J; Corbridge, Thomas C; Cohen, Elaine R; Fakhran, Sherene S; Schimmel, Daniel; McGaghie, William C; Wayne, Diane B
The purpose of this study is to determine the effect of simulation-based education on the knowledge and skills of internal medicine residents in the medical intensive care unit (MICU). From January 2009 to January 2010, 60 first-year residents at a tertiary care teaching hospital were randomized by month of rotation to an intervention group (simulator-trained, n = 26) and a control group (traditionally trained, n = 34). Simulator-trained residents completed 4 hours of simulation-based education before their medical intensive care unit (MICU) rotation. Topics included circulatory shock, respiratory failure, and mechanical ventilation. After their rotation, residents completed a standardized bedside skills assessment using a 14-item checklist regarding respiratory mechanics, ventilator settings, and circulatory parameters. Performance of simulator-trained and traditionally trained residents was compared using a 2-tailed independent-samples t test. Simulator-trained residents scored significantly higher on the bedside skills assessment compared with traditionally trained residents (82.5% ± 10.6% vs 74.8% ± 14.1%, P = .027). Simulator-trained residents were highly satisfied with the simulation curriculum. Simulation-based education significantly improved resident knowledge and skill in the MICU. Knowledge acquired in the simulated environment was transferred to improved bedside skills caring for MICU patients. Simulation-based education is a valuable adjunct to standard clinical training for residents in the MICU. Copyright © 2012 Elsevier Inc. All rights reserved.
Bansal, Pankaj; Chakrabarti, Kausiki; Gupta, Satish K
Zona pellucida glycoprotein 3 (ZP3) has been ascribed as a putative primary sperm receptor during fertilization in humans. Herein, attempts have been made to delineate the functional domain of human ZP3. ZP3 has been cloned and expressed in a baculovirus expression system as N-terminal fragments (amino acid [aa] residues 1-175 [pAc-ZP3(1-175 aa)] and 23-175 [pBg-ZP3(23-175 aa)]) and as C-terminal fragments (aa residues 214-305 [pBg-ZP3(214-305 aa)] and 214-348 [pBg-ZP3(214-348 aa)]). ZP3 encompassing both N- and C-terminal fragments corresponding to aa residues 1-370 (pAc-ZP3([1-370 aa])) has also been expressed. Lectin-binding analysis with these recombinant proteins revealed the presence of N- and O-linked glycosylation. Significant induction of acrosomal exocytosis was observed when capacitated sperm were incubated with pBg-ZP3(214-348 aa), pBg-ZP3(214-305 aa), and pAc-ZP3(1-370 aa) (P pBg-ZP3(23-175 aa) failed to do so under similar experimental conditions. However, N- and C-terminal fragments labeled with fluorescein isothiocyanate revealed binding to the anterior head of capacitated human spermatozoa. Escherichia coli-expressed ZP3 C-terminal fragments and chemically deglycosylated pBg-ZP3(214-348 aa) failed to induce a significant (P > 0.05) increase in acrosomal exocytosis, suggesting the relevance of glycosylation in imparting functional activity to ZP3 C-terminal fragments. pBg-ZP3(214-348 aa)-mediated induction of acrosomal exocytosis is regulated by G(i) protein, extracellular calcium, GABA(A) [gamma aminobutyric acid (A)] receptor-mediated Cl(-) channel, and T-type voltage-operated calcium channels. Taken together, the results of these studies suggest that the functional activity of human ZP3 resides in its C-terminal domain.
Oja, A. E.; Piet, B.; Helbig, C.; Stark, R.; van der Zwan, D.; Blaauwgeers, H.; Remmerswaal, E. B. M.; Amsen, D.; Jonkers, R. E.; Moerland, P. D.; Nolte, M. A.; van Lier, R. A. W.; Hombrink, P.
Resident memory T cells (TRM) reside in the lung epithelium and mediate protective immunity against respiratory pathogens. Although lung CD8(+) TRM have been extensively characterized, the properties of CD4(+) TRM remain unclear. Here we determined the transcriptional signature of CD4(+) TRM,
Centofanti, J; Swinton, M; Dionne, J; Barefah, A; Boyle, A; Woods, A; Shears, M; Heels-Ansdell, D; Cook, D
The objectives of this study were to describe residents' experiences with end-of-life (EOL) education during a rotation in the intensive care unit (ICU), and to understand the possible influence of the 3 Wishes Project. We enrolled dying patients, their families and 1-3 of their clinicians in the 3 Wishes Project, eliciting and honouring a set of 3 wishes to bring peace to the final days of a critically ill patient's life, and ease the grieving process for families. We conducted semistructured interviews with 33 residents who had cared for 50 dying patients to understand their experiences with the project. Interviews were recorded, transcribed verbatim, then analysed using a qualitative descriptive approach. 21-bed medical surgical ICU in a tertiary care, university-affiliated hospital. 33 residents participated from internal medicine (24, 72.7%), anaesthesia (8, 24.2%) and laboratory medicine (1, 3.0%) programmes in postgraduate years 1-3. 3 categories and associated themes emerged. (1) EOL care is a challenging component of training in that (a) death in the ICU can invoke helplessness, (b) EOL education is inadequate, (c) personal connections with dying patients is difficult in the ICU and (d) EOL skills are valued by residents. (2) The project reframes the dying process for residents by (a) humanising this aspect of practice, (b) identifying that family engagement is central to the dying process, (c) increasing emotional responsiveness and (d) showing that care shifts, not stops. (3) The project offers experiential education by (a) intentional role modelling, (b) facilitating EOL dialogue, (c) empowering residents to care in a tangible way and (d) encouraging reflection. For residents, the 3 Wishes Project integrated many forms of active learning for residents. Practice-based rather than classroom-based programmes may engage trainees to develop EOL skills transferable to other settings. Published by the BMJ Publishing Group Limited. For permission to use (where
Yulita, Leticia; Porto, Melina
As intercultural communication in language teaching is extending to citizenship education, there is an increasing need for research focusing on the implementation of theory into practice. With Critical Pedagogy as its driving principle, this chapter examines an online international project between language undergraduates within Argentina and the UK as an approach to human rights education in language teaching. It provides an overview of the pedagogical interventions designed to enhance awaren...
Full Text Available Tissue-resident macrophages, such as microglia, Kupffer cells, and Langerhans cells, derive from Myb-independent yolk sac (YS progenitors generated before the emergence of hematopoietic stem cells (HSCs. Myb-independent YS-derived resident macrophages self-renew locally, independently of circulating monocytes and HSCs. In contrast, adult blood monocytes, as well as infiltrating, gut, and dermal macrophages, derive from Myb-dependent HSCs. These findings are derived from the mouse, using gene knockouts and lineage tracing, but their applicability to human development has not been formally demonstrated. Here, we use human induced pluripotent stem cells (iPSCs as a tool to model human hematopoietic development. By using a CRISPR-Cas9 knockout strategy, we show that human iPSC-derived monocytes/macrophages develop in an MYB-independent, RUNX1-, and SPI1 (PU.1-dependent fashion. This result makes human iPSC-derived macrophages developmentally related to and a good model for MYB-independent tissue-resident macrophages, such as alveolar and kidney macrophages, microglia, Kupffer cells, and Langerhans cells.
Reisdorff, Earl J.; Hayes, Oliver W.; Carlson, Dale J.; Walker, Gregory L.
Based on the experience of Michigan State University's emergency medicine residency program, proposes a practical method for modifying an existing student evaluation format. The model provides a template other programs could use in assessing residents' acquisition of the knowledge, skills, and attitudes reflected in the six general competencies…
Klein, Emily J.; Taylor, Monica; Onore, Cynthia; Strom, Kathryn; Abrams, Linda
This paper describes an urban teacher residency program, the Newark Montclair Urban Teacher Residency, a collaborative endeavor between the Newark, New Jersey Public Schools and Montclair State University, built on a decades-long partnership. The authors see the conceptual work of developing this program as creating a "third space" in…
Jones, Tricia S.
Peace education embraces a wide range of programs and initiatives. Two of those subfields, human rights education and conflict resolution education, are often considered too different in goals, models and content to be seen as partners in the same educational effort. A review of recent literature confirms that few conflict resolution education…
Lin, Michelle; Joshi, Nikita; Grock, Andrew; Swaminathan, Anand; Morley, Eric J; Branzetti, Jeremy; Taira, Taku; Ankel, Felix; Yarris, Lalena M
Background Emergency medicine (EM) residency programs can provide up to 20% of their planned didactic experiences asynchronously through the Individualized Interactive Instruction (III) initiative. Although blogs and podcasts provide potential material for III content, programs often struggle with identifying quality online content. Objective To develop and implement a process to curate quality EM content on blogs and podcasts for resident education and III credit. Methods We developed the Approved Instructional Resources (AIR) Series on the Academic Life in Emergency Medicine website. Monthly, an editorial board identifies, peer reviews, and writes assessment questions for high-quality blog/podcast content. Eight educators rate each post using a standardized scoring instrument. Posts scoring ≥ 30 of 35 points are awarded an AIR badge and featured in the series. Enrolled residents can complete an assessment quiz for III credit. After 12 months of implementation, we report on program feasibility, enrollment rate, web analytics, and resident satisfaction scores. Results As of June 2015, 65 EM residency programs are enrolled in the AIR Series, and 2140 AIR quizzes have been completed. A total of 96% (2064 of 2140) of participants agree or strongly agree that the activity would improve their clinical competency, 98% (2098 of 2140) plan to use the AIR Series for III credit, and 97% (2077 of 2140) plan to use it again in the future. Conclusions The AIR Series is a national asynchronous EM curriculum featuring quality blogs and podcasts. It uses a national expert panel and novel scoring instrument to peer review web-based educational resources.
Full Text Available Background: The transformation of a surgical trainee into a surgeon is strongly influenced by the quality of teaching in the operating theater. This study investigates the perceptions of residents about the educational environment of the operating theater and identifies variables that may improve the operating theater education of our trainees. Materials and Methods: Residents in the department of surgery anonymously evaluated teaching in the operating room using the operating theater education environment measure. The residents evaluated 33 variables that might have an impact on their surgical skills within the operating theater. The variables were grouped into four subscales; teaching and training, learning opportunities, operating theater atmosphere and workload/supervision/support. Differences between male and female residents and junior and senior registrars were assessed using Mann-Whitney test. Statistical analysis was completed with the statistics package for the social sciences version 17. Results: A total of 33 residents were participated in this study. Twenty nine (88% males and 4 (12% females. 30 (90% were junior registrars. The mean total score was 67.5%. Operating theater atmosphere subscale had the highest score of 79.2% while workload/supervision/support subscale had the least score of 48.3%. There were significant differences between male and female resident′s perception of workload/supervision/support P 0.05. Conclusion: This study has shown a satisfactory teaching environment based on the existing local realities of means, resources and tools and highlighted the need for improvement in workload/supervision/support in our institution. An acceptable learning environment in the operating theatre will produce surgeons that are technically competent to bridge the gap in the enormous unmet need for surgical care in Nigeria.
Stoklosa, Hanni; Lyman, Michelle; Bohnert, Carrie; Mittel, Olivia
Healthcare providers have the potential to play a crucial role in human trafficking prevention, identification, and intervention. However, trafficked patients are often unidentified due to lack of education and preparation available to healthcare professionals at all levels of training and practice. To increase victim identification in healthcare settings, providers need to be educated about the issue of trafficking and its clinical presentations in an interactive format that maximizes learning and ultimately patient-centered outcomes. In 2014, University of Louisville School of Medicine created a simulation-based medical education (SBME) curriculum to prepare students to recognize victims and intervene on their behalf. The authors share the factors that influenced the session's development and incorporation into an already full third year medical curriculum and outline the development process. The process included a needs assessment for the education intervention, development of objectives and corresponding assessment, implementation of the curriculum, and finally the next steps of the module as it develops further. Additional alternatives are provided for other medical educators seeking to implement similar modules at their home institution. It is our hope that the description of this process will help others to create similar interactive educational programs and ultimately help trafficking survivors receive the care they need. HCP: Healthcare professional; M-SIGHT: Medical student instruction in global human trafficking; SBME: Simulation-based medical education; SP: Standardized patient; TIC: Trauma-informed care.
Oleksandr Yu. Burov
Full Text Available Networks play more and more important role for human life and activity, both in critical occupations (aviation, power industry, military missions etc., and in everyday life (home computers, education, leisure. Interaction between human and other elements of human-machine system have changed, because they coincide in the information habitat. Human-system integration has reached new level of defense needs. The paper will introduce features of information society in respect of a human and corresponding changes in HF/E: (1 information becomes a tool, goal, mean and environment of a human activity, (2 it becomes a part of the human nature and this makes him/her unprotected, (3 human psycho-physiological status becomes not only a basis of effective performance, but an object of control and support, and means of a human security and safety should be a part of information habitat, (4 networking environment becomes an independent actor in a human activity. Accompanying cyber-security challenges and tasks are discussed, as well as types of networking threats and Human View regarding the cyber security challenges.
Hansen, David T.
Music and philosophy travel together through time in human culture, and in this article, David Hansen responds to Randall Allsup's recent book, "Remixing the Classroom: Toward an Open Philosophy of Music Education." Hansen says that a singular feature of Randall's new book is how marvelously he demonstrates the organic union between…
Soomro, Shahzaib Habib; Ur Rehman, Syed Sheeraz; Hussain, Farhad
To evaluate the perception of operation theatre educational environment using surgical theatre educational environmental measure. This cross-sectional study was conducted at Liaquat National Hospital, Karachi, from August 2015 to February 2016, and comprised surgical and allied trainees. The reliability of the surgical theatre educational environmental measure questionnaire was assessed by Cronbach's alpha. The minimum score on the questionnaire was 40 and possible maximum score was 200. A score of at least 120 out of 200 was considered favourable. SPSS 22 was used for data analysis. Of the 103 participants who completed the questionnaire, 52(50.4%) were males and 51(49.5%) females. The results showed favourable operating theatre educational environment with the total score of 129. The overall reliability was calculated to be 0.97. Male residents perceived the educational environment more adequate than females (peducational environment.
Wilson Mark C; Mustafa Reem; Gunukula Sameer; Akl Elie A; Symons Andrew; Moheet Amir; Schünemann Holger J
Abstract Background The evidence supporting the effectiveness of educational games in graduate medical education is limited. Anecdotal reports suggest their popularity in that setting. The objective of this study was to explore the support for and the different aspects of use of educational games in family medicine and internal medicine residency programs in the United States. Methods We conducted a survey of family medicine and internal medicine residency program directors in the United Stat...
Takayama, Shin; Kobayashi, Seiichi; Kaneko, Soichiro; Tabata, Masao; Sato, Shinya; Ishikawa, Keiichi; Suzuki, Saya; Arita, Ryutaro; Saito, Natsumi; Kamiya, Tetsuharu; Nishikawa, Hitoshi; Ikeno, Yuka; Tanaka, Junichi; Ohsawa, Minoru; Kikuchi, Akiko; Numata, Takehiro; Kuroda, Hitoshi; Abe, Michiaki; Ishibashi, Satoru; Yaegashi, Nobuo; Ishii, Tadashi
Traditional Japanese (Kampo) medicine has been widely applied in general medicine in Japan. In 2001, the model core curriculum for Japanese medical education was revised to include Kampo medicine. Since 2007, all 80 Japanese medical schools have incorporated it within their programs. However, postgraduate training or instruction of Kampo medicine has not been recognized as a goal for the clinical training of junior residents by Japan's Ministry of Health, Labour and Welfare; little is known about postgraduate Kampo medicine education. This exploratory study investigated attitudes about Kampo medicine among junior residents in Japanese postgraduate training programs. A questionnaire survey was administered to junior residents at five institutions in the Tohoku area of Japan. Questions evaluated residents' experiences of prescribing Kampo medicines and their expectations for postgraduate Kampo education and training. As a result, 121 residents responded (response rate = 74%). About 96% of participants had previously received Kampo medicine education at their pre-graduate medical schools and 64% had prescribed Kampo medications. Specifically, daikenchuto was prescribed to prevent ileus and constipation after abdominal surgery and yokukansan was prescribed to treat delirium in the elderly. Residents received on-the-job instruction by attending doctors. Over 70% of participants indicated that there was a need for postgraduate Kampo medicine education opportunities and expected lectures and instruction on how to use it to treat common diseases. In conclusion, we have revealed that junior residents require Kampo medicine education in Japanese postgraduate training programs. The programs for comprehensive pre-graduate and postgraduate Kampo education are expected.
Petrović Aleksandar M.
Full Text Available Movement of enlightendness connected the riched knowledges with a statements of the human rights on a own education, because of destroying of prejudges who stopped the social progress, but they are also manifesting as a powerful tools for the changing the everyday life. Modern epoch proclaimed a right on a education as a basic part of a human rights (also by the documents of UN, but inserted in them also so many interesess in realization, making troubles to that rights alone. Paedagogical libertinism, as a some reflexion of a revolutionary attentions, in a claim of a critical thinking was relativisating programmes and goals of the schools in such measure, that it request a education of the people on the streets, as a hippycs who haven't borders in them arbitrariness. It starts on a some physical economistic cutting of a teaching programmes, with a minimum of knowledge in a own education and a maximum in a sale and managing of a nature and human resources. Did the management was also a biggest wisdom who needly must investigating on the Universities? It, what is useful directly, is not the durative and undestroyable. Because it may stay a object of troubles, it is valid to come back on a Classic education, who takes solutions for the growing appetites and greeds by the clearness of his theories.
Farley discusses progress US blacks have made in the areas of voting and citizenship rights, residency and housing, and education. A major goal of the civil rights movement was to permit blacks to influence the electoral process in the same manner as whites. Most important in this regard was the Voting Rights Act of 1965; the proportion of southern blacks casting ballots increased sharply since the early 1960s. The Civil Rights Act of 1875 outlawed racial segregation in public accommodations, but by the turn of the century, Jim Crow laws in southern states called for segregation in most public places. Common customs and government policy in the North resulted in similar segregation of blacks from whites. The Montgomery bus boycott and similar protests in dozens of other cities led to enactment of Title II of the Civil Rights Act of 1964, which proscribed such racial practices. By the late 1960s, blacks in all regions could use the same public accommodations as whites. In most metropolitan areas, de facto racial segregation persisted long after the laws were changed. Supreme Court decisions and local open-housing ordinances supported the right of blacks to live where they could afford. However the major change was the Fair Housing Act of 1968, which outlawed racial discrimination in the sale or rental of most housing units. The separation of blacks from whites did not end in the 1970s. Today, in areas which have large black populations, there are many central city neighborhoods and a few in the suburbs which are either all-black or are becoming exclusively black enclaves. Most other neighborhoods have no more than token black populations. Another major effort of civil rights organizations has been the upgrading of housing quality for blacks. By 1980, only 6% of the homes and apartments occupied by blacks lacked complete plumbing facilities (down from 50% in 1940). Unlike the modest changes in residential segregation, racial differences in housing quality have been
In the knowledge society, there is a conflict between "education for profit" and "education for humanity." Education for profit is needed for students' economic survival and success in the knowledge economy. Education for humanity is needed for their existential lives worthy of human beings. This paper deals with the…
Mojaverian, P.; Ferguson, R.K.; Vlasses, P.H.; Rocci, M.L. Jr.; Oren, A.; Fix, J.A.; Caldwell, L.J.; Gardner, C.
In animal and human studies, the gastric emptying of large (greater than 1 mm) indigestible solids is due to the activity of the interdigestive migrating myoelectric complex. The gastric residence time (GRT) of an orally administered, nondigestible, pH-sensitive, radiotelemetric device (Heidelberg capsule) was evaluated in three studies in healthy volunteers. In 6 subjects, the GRT of the Heidelberg capsule was compared with the half-emptying time (t1/2) of diethylenetriaminepentaacetic acid labeled with technetium 99m after a 4-ml/kg liquid fatty meal. The mean (+/-SD) GRT (4.3 +/- 1.4 h) was significantly (p less than 0.001) longer than the mean t1/2 (1.1 +/- 0.3 h); the GRT was prolonged compared with the t1/2 in each subject. In a randomized, crossover trial in 10 subjects, frequent feeding caused a dramatic prolongation in mean GRT of the capsule compared with the fasting state (greater than 14.5 vs. 0.5 h, p less than 0.005). In another crossover study in 6 subjects, the GRT of the capsule was evaluated after an overnight fast, a standard breakfast including solid food, and a liquid meal (i.e., 200 ml of diluted light cream). The mean GRT was 2.6 +/- 0.9 h after the liquid meal vs. 1.2 +/- 0.8 h after fasting (p less than 0.025). The mean GRT after the breakfast was 4.8 +/- 1.5 h, which was significantly greater than that after fasting (p less than 0.001) and after the liquid meal (p less than 0.01). These data suggest that the GRT of the Heidelberg capsule is a marker of the interdigestive migrating myoelectric complex in humans, the interdigestive migrating myoelectric complex can be markedly delayed by frequent feedings with solids, and the interdigestive migrating myoelectric complex is delayed by both liquid and solid meals
Mojaverian, P.; Ferguson, R.K.; Vlasses, P.H.; Rocci, M.L. Jr.; Oren, A.; Fix, J.A.; Caldwell, L.J.; Gardner, C.
In animal and human studies, the gastric emptying of large (greater than 1 mm) indigestible solids is due to the activity of the interdigestive migrating myoelectric complex. The gastric residence time (GRT) of an orally administered, nondigestible, pH-sensitive, radiotelemetric device (Heidelberg capsule) was evaluated in three studies in healthy volunteers. In 6 subjects, the GRT of the Heidelberg capsule was compared with the half-emptying time (t1/2) of diethylenetriaminepentaacetic acid labeled with technetium 99m after a 4-ml/kg liquid fatty meal. The mean (+/-SD) GRT (4.3 +/- 1.4 h) was significantly (p less than 0.001) longer than the mean t1/2 (1.1 +/- 0.3 h); the GRT was prolonged compared with the t1/2 in each subject. In a randomized, crossover trial in 10 subjects, frequent feeding caused a dramatic prolongation in mean GRT of the capsule compared with the fasting state (greater than 14.5 vs. 0.5 h, p less than 0.005). In another crossover study in 6 subjects, the GRT of the capsule was evaluated after an overnight fast, a standard breakfast including solid food, and a liquid meal (i.e., 200 ml of diluted light cream). The mean GRT was 2.6 +/- 0.9 h after the liquid meal vs. 1.2 +/- 0.8 h after fasting (p less than 0.025). The mean GRT after the breakfast was 4.8 +/- 1.5 h, which was significantly greater than that after fasting (p less than 0.001) and after the liquid meal (p less than 0.01). These data suggest that the GRT of the Heidelberg capsule is a marker of the interdigestive migrating myoelectric complex in humans, the interdigestive migrating myoelectric complex can be markedly delayed by frequent feedings with solids, and the interdigestive migrating myoelectric complex is delayed by both liquid and solid meals.
Gladding, Sophia; Zink, Therese; Howard, Cindy; Campagna, Ann; Slusher, Tina; John, Chandy
Globally competent pediatricians are in demand because of the increasing numbers of children from immigrant families living in the United States and the shortages of health care workers in low-income countries where the majority of the worlds' children live. This study sought to better understand the educational outcomes of international electives taken by pediatric residents training in global health. Thirty-two pediatric residents who participated in an international elective as part of a global health curriculum completed reflective essays which were analyzed for themes from 2006 to 2010. During the first-order analysis, the emergent themes mapped to the Accreditation Council for Graduate Medical Education (ACGME) competencies. In response, a second-order analysis re-examined the essays with an additional researcher to support categorization consistent with the ACGME competencies. More than 90% of essays described experiences related to medical knowledge, patient care and systems-based practice. More than 50% included reflections on practice-based learning and improvement, professionalism, and interpersonal and communication skills. Residents also described the impact on their personal and professional development. International electives can provide educational opportunities for residents to develop competency in each of the 6 ACGME domains and to reevaluate their life purpose and career goals. In addition to opportunities to increase their medical knowledge, patient care and communication skills, residents find international electives rich learning environments for systems-based practice, practice-based learning/improvement, and professionalism, domains that can be challenging to teach. These findings support the importance of international electives in global health in meeting core requirements in residency training. Copyright © 2012 Academic Pediatric Association. Published by Elsevier Inc. All rights reserved.
Wang, Ernest E; Beaumont, Jennifer; Kharasch, Morris; Vozenilek, John A
Utilization of simulation-based training has become increasingly prevalent in residency training. The authors compared emergency medicine (EM) resident feedback for simulation sessions to traditional lectures from an EM residency didactic program. The authors performed a retrospective review of all written EM conference evaluations over a 29-month period. Evaluation questions were scored on a 1-9 Likert scale. Lectures and simulation accounted for 77.6 and 22.4% of the conferences, respectively. Scored means (+/-standard deviations [SDs]) were as follows: overall, lecture 7.97 +/- 0.74 versus simulation 8.373 +/- 0.44 (p higher than traditional lectures. The scores over time suggest that this preference for simulation can be sustainable long term. Residents perceive simulation as more desirable teaching method compared to the traditional lecture format.
John F. Fisher
Full Text Available The training of physicians in the past century was based primarily on responsibility and the chain-of-command. Those with the bulk of that responsibility in the fields of pediatrics and internal medicine were residents. Residents trained the medical students and supervised them carefully in caring for patients. Most attending physicians supervised their teams at arm's length, primarily serving as teachers of the finer points of diagnosis and treatment during set periods of the day or week with a perfunctory signature on write-ups or progress notes. Residents endeavored to protect the attending physician from being heavily involved unless they were unsure about a clinical problem. Before contacting the attending physician, a more senior resident would be called. Responsibility was the ultimate teacher. The introduction of diagnosis-related groups by the federal government dramatically changed the health care delivery system, placing greater emphasis on attending physician visibility in the medical record, ultimately resulting in more attending physician involvement in day-to-day care of patients in academic institutions. Without specified content in attending notes, hospital revenues would decline. Although always in charge technically, attending physicians increasingly have assumed the role once dominated by the resident. Using biographical experiences of more than 40 years, the author acknowledges and praises the educational role of responsibility in his own training and laments its declining role in today's students and house staff.
Fisher, John F
The training of physicians in the past century was based primarily on responsibility and the chain-of-command. Those with the bulk of that responsibility in the fields of pediatrics and internal medicine were residents. Residents trained the medical students and supervised them carefully in caring for patients. Most attending physicians supervised their teams at arm's length, primarily serving as teachers of the finer points of diagnosis and treatment during set periods of the day or week with a perfunctory signature on write-ups or progress notes. Residents endeavored to protect the attending physician from being heavily involved unless they were unsure about a clinical problem. Before contacting the attending physician, a more senior resident would be called. Responsibility was the ultimate teacher. The introduction of diagnosis-related groups by the federal government dramatically changed the health care delivery system, placing greater emphasis on attending physician visibility in the medical record, ultimately resulting in more attending physician involvement in day-to-day care of patients in academic institutions. Without specified content in attending notes, hospital revenues would decline. Although always in charge technically, attending physicians increasingly have assumed the role once dominated by the resident. Using biographical experiences of more than 40 years, the author acknowledges and praises the educational role of responsibility in his own training and laments its declining role in today's students and house staff.
Laponis, Ryan; O'Sullivan, Patricia S; Hollander, Harry; Cornett, Patricia; Julian, Katherine
Fewer residents are choosing general internal medicine (GIM) careers, and their choice 5 be influenced by the continuity clinic experience during residency. We sought to explore the relationship between resident satisfaction with the continuity clinic experience and expressed interest in pursuing a GIM career. We surveyed internal medicine residents by using the Veterans Health Administration Office of Academic Affiliations Learners' Perceptions Survey-a 76-item instrument with established reliability and validity that measures satisfaction with faculty interactions, and learning, working, clinical, and physical environments, and personal experience. We identified 15 reliable subscales within the survey and asked participants whether their experience would prompt them to consider future employment opportunities in GIM. We examined the association between satisfaction measures and future GIM interest with 1-way analyses of variance followed by Student-Newman-Keuls post hoc tests. Of 217 residents, 90 (41%) completed the survey. Residents felt continuity clinic influenced career choice, with 22% more likely to choose a GIM career and 43% less likely. Those more likely to choose a GIM career had higher satisfaction with the learning (P = .001) and clinical (P = .002) environments and personal experience (P care (P = .009), workflow (P = .001), professional/personal satisfaction (P continuity clinic experience 5 influence residents' GIM career choice. Residents who indicate they are more likely to pursue GIM based on that clinical experience have higher levels of satisfaction. Further prospective data are needed to assess if changes in continuity clinic toward these particular factors can enhance career choice.
Heng Giap Woon; Asolina Braun; Jane Li; Corey Smith; Jarem Edwards; Frederic Sierro; Carl G Feng; Rajiv Khanna; Michael Elliot; Andrew Bell; Andrew D Hislop; Stuart G Tangye; Alan B Rickinson; Thomas Gebhardt; Warwick J Britton
Disruption of T cell memory during severe immune suppression results in reactivation of chronic viral infections, such as Epstein Barr virus (EBV) and Cytomegalovirus (CMV). How different subsets of memory T cells contribute to the protective immunity against these viruses remains poorly defined. In this study we examined the compartmentalization of virus-specific, tissue resident memory CD8+ T cells in human lymphoid organs. This revealed two distinct populations of memory CD8+ T cells, that...
Watling, Christopher J; Brown, Judith B
Despite the importance of communication skills for neurologists, specific training in this area at the residency level is often lacking. This study aimed to enhance learning of these skills and to encourage reflective practice around communication skills. A group of 12 neurology residents participated in a series of six case-based communication skills workshops. Each workshop focused on a particular clinical scenario, including breaking bad news, discussing do-not-resuscitate orders, communicating with "difficult" patients, disclosing medical errors, obtaining informed consent for neurologic tests and procedures, and discussing life-and-death decisions with families of critically ill patients. Residents also kept reflective portfolios in which real examples of these interactions were recorded. The program was well accepted, and residents rated the workshops as effective and relevant to their practice. Analysis of residents' portfolios revealed three themes relevant to patient-physician communication: 1) communication is more successful when adequate time is allowed, 2) the ability to empathize with patients and their families is essential to successful interactions, and 3) the development of specific approaches to challenging scenarios can facilitate effective interactions. The portfolios also demonstrated that residents would engage in reflective practice. Targeting of communication skills training around specific clinical scenarios using neurologic cases was well accepted and was deemed relevant to practice. The use of portfolios may promote lifelong learning in this area.
Full Text Available Abstract Background Work-hour limitations have been implemented by the Accreditation Council for Graduate Medical Education (ACGME in July 2003 in order to minimize fatigue related medical adverse events. The effects of this regulation are still under intense debate. In this literature review, data of effects of limited work-hours on the quality of life, surgical education, and patient care was summarized, focusing on surgical subspecialities. Methods Studies that assessed the effects of the work-hour regulation published following the implementation of ACGME guidelines (2003 were searched using PubMed database. The following search modules were selected: work-hours, 80-hour work week, quality of life, work satisfaction, surgical education, residency training, patient care, continuity of care. Publications were included if they were completed in the United States and covered the subject of our review. Manuscrips were analysed to identify authors, year of publication, type of study, number of participants, and the main outcomes. Review Findings Twenty-one articles met the inclusion criteria. Studies demonstrate that the residents quality of life has improved. The effects on surgical education are still unclear due to inconsistency in studies. Furthermore, according to several objective studies there were no changes in mortality and morbidity following the implementation. Conclusion Further studies are necessary addressing the effects of surgical education and studying the objective methods to assess the technical skill and procedural competence of surgeons. In addition, patient surveys analysing their satisfaction and concerns can contribute to recent discussion, as well.
Jaeger, M.; Adair, D.
Successful construction management depends primarily on the representatives of the involved construction project parties. In addition to effective application of construction management tools and concepts, human factors impact significantly on the processes of any construction management endeavour. How can human factors in construction management be taught effectively? Although simulations are applied in construction management education, they have not incorporated human factors sufficiently. The focus on human factors as part of the simulation of construction management situations increases students' learning effectiveness within a cross-cultural teaching setting. This paper shows the development of discrete-event human factors in construction management simulation. A description of the source code is given. Learning effectiveness in a cross-cultural education setting was analysed by evaluating data obtained through student questionnaire surveys. The mean score obtained by the students using the simulator was 32% better than those not exposed to the simulator. The spread of results was noticeably greater for the students not exposed to the simulator. The human factors simulation provides an effective means to teach students the complexities and dynamics of interpersonal relationships in construction management.
Shaverdian, Narek; Yoo, Sun Mi; Cook, Ryan; Chang, Eric M; Jiang, Naomi; Yuan, Ye; Sandler, Kiri; Steinberg, Michael; Lee, Percy
Internists and primary care providers play a growing role in cancer care. We therefore evaluated the awareness of radiation therapy in general and specifically the clinical utility of stereotactic body radiation therapy (SBRT) for early-stage non-small cell lung cancer (NSCLC) among current US internal medicine residents. A web-based institutional review board-approved multi-institutional survey was distributed to US internal medicine residency programs. The survey evaluated trainee demographic characteristics, baseline radiation oncology awareness, knowledge of the role of SBRT for early-stage NSCLC, and whether the survey successfully improved awareness. Thirty US internal medicine programs participated, with an overall participant response rate of 46% (1177 of 2551). Of the trainees, 93% (n=1076) reported no radiation oncology education in their residency, 39% (n=452) reported confidence in knowing when to consult radiation oncology in an oncologic emergency, and 26% (n=293) reported confidence in knowing when to consult radiation oncology in the setting of a newly diagnosed cancer. Of the participants, 76% (n=850) correctly identified that surgical resection is the standard treatment in operable early-stage NSCLC, but only 50% (n=559) of participants would recommend SBRT to a medically inoperable patient, followed by 31% of participants (n=347) who were unsure of the most appropriate treatment, and 10% (n=117) who recommended waiting to offer palliative therapy. Ninety percent of participants (n=1029) agreed that they would benefit from further training on when to consult radiation oncology. Overall, 96% (n=1072) indicated that the survey increased their knowledge and awareness of the role of SBRT. The majority of participating trainees received no education in radiation oncology in their residency, reported a lack of confidence regarding when to consult radiation oncology, and overwhelmingly agreed that they would benefit from further training. These findings
Maddry, Joseph K; Varney, Shawn M; Sessions, Daniel; Heard, Kennon; Thaxton, Robert E; Ganem, Victoria J; Zarzabal, Lee A; Bebarta, Vikhyat S
Simulation-based teaching (SIM) is a common method for medical education. SIM exposes residents to uncommon scenarios that require critical, timely actions. SIM may be a valuable training method for critically ill poisoned patients whose diagnosis and treatment depend on key clinical findings. Our objective was to compare medical simulation (SIM) to traditional lecture-based instruction (LEC) for training emergency medicine (EM) residents in the acute management of critically ill poisoned patients. EM residents completed two pre-intervention questionnaires: (1) a 24-item multiple-choice test of four toxicological emergencies and (2) a questionnaire using a five-point Likert scale to rate the residents' comfort level in diagnosing and treating patients with specific toxicological emergencies. After completing the pre-intervention questionnaires, residents were randomized to SIM or LEC instruction. Two toxicologists and three EM physicians presented four toxicology topics to both groups in four 20-min sessions. One group was in the simulation center, and the other in a lecture hall. Each group then repeated the multiple-choice test and questionnaire immediately after instruction and again at 3 months after training. Answers were not discussed. The primary outcome was comparison of immediate mean post-intervention test scores and final scores 3 months later between SIM and LEC groups. Test score outcomes between groups were compared at each time point (pre-test, post-instruction, 3-month follow-up) using Wilcoxon rank sum test. Data were summarized by descriptive statistics. Continuous variables were characterized by means (SD) and tested using t tests or Wilcoxon rank sum. Categorical variables were summarized by frequencies (%) and compared between training groups with chi-square or Fisher's exact test. Thirty-two EM residents completed pre- and post-intervention tests and comfort questionnaires on the study day. Both groups had higher post-intervention mean test
Although human rights education (HRE) has a long history, it has only recently begun to realize its transformative potential. A critical catalyst in this process is the emerging global ethos of accountability. Within this context, HRE can play a crucial role in the construction of a universal culture of human rights, inspired by a shared commitment to a humane order and a belief that human beings have both the capacity and the responsibility to make a difference. In such an effort, the training of professionals is vital, especially of those professionals who can influence public debate on accountability and governance. Innovative HRE initiatives, characterized by a commitment to experiential learning and to international and regional cooperation among state and non-state actors, constitute a step in the right direction.
Fernekes, William R.
Global citizenship education (GCE) and human rights education (HRE) offer substantive contributions to civic education. Interconnections between the fields exist in curricula from intergovernmental organizations (UNESCO), non-governmental organizations (Oxfam Great Britain) and national ministries (Learning and Teaching Scotland). This essay…
Tolchin, Benjamin; Willey, Joshua Z; Prager, Kenneth
In 2012, the American Academy of Neurology (AAN) updated and expanded its ethics curriculum into Practical Ethics in Clinical Neurology, a case-based ethics curriculum for neurologists. We piloted a case-based bioethics curriculum for neurology residents using the framework and topics recommended by the AAN, matched to clinical cases drawn from Columbia's neurologic services. Our primary outcome was residents' ability to analyze and manage ethically complex cases as measured on precurriculum and postcurriculum multiple-choice quizzes. Secondary outcomes included precurriculum and postcurriculum self-assessed comfort in discussing and managing ethically complex cases, as well as attendance at ethics discussion sessions as compared to attendance at other didactic sessions. Resident performance on quizzes improved from 75.8% to 86.7% (p = 0.02). Comfort in discussing ethically complex cases improved from 6.4 to 7.4 on a 10-point scale (p = 0.03). Comfort in managing such cases trended toward improvement but did not reach statistical significance. Attendance was significantly better at ethics discussions (73.5%) than at other didactic sessions (61.7%, p = 0.04). Our formal case-based ethics curriculum for neurology residents, based on core topics drawn from the AAN's published curricula, was successfully piloted. Our study showed a statistically significant improvement in residents' ability to analyze and manage ethically complex cases as measured by multiple-choice tests and self-assessments. © 2015 American Academy of Neurology.
Gonzalez, Jose L; Gilmer, Loise
Obesity is a highly burdensome public health issue associated with premature death, multiple comorbid disabilities and staggering healthcare costs. Between 1980-2000, the prevalence of obesity among children and adolescents nearly tripled. Obesity subjects youth to social stigmatization and discrimination. These economic and personal burdens mandate targeted prevention and detection educational programs for all individuals at risk. The most cost-effective method of approaching this obesity epidemic is through education of health professionals. As part of an "Obesity Prevention in Pediatrics" curriculum, postgraduate-year (PGY)-2 residents first observed and then participated in the dietary evaluation and counseling of pediatric patients and their families. Attitudinal questionnaires, multiple-choice knowledge examinations and a pre-established checklist of desired skills and behaviors provided evaluation of the curriculum's effect on the participants' ability and willingness to manage actually obese or at-risk pediatric patients and their families. Attitudinal survey and knowledge test scores from control PGY-3 residents generally confirmed that their knowledge and counseling skills on obesity prevention and management were well below expectation. Following participation in the curriculum, study residents' knowledge tended to improve, as did their level of comfort in counseling obese and at-risk children, adolescents and their parents. Implementation of an "Obesity Prevention in Pediatrics" curriculum appears to improve participants' knowledge base as well as their skills and level of personal comfort in the recognition, evaluation and management, including counseling, of both obese and at-risk pediatric patients and their families.
Rickert, Julie; Devlin, Kwanza; Krohn, Kimberly
Chronic non-cancer pain is a common condition associated with tremendous risk for morbidity and mortality. In many settings, the management of chronic non-cancer pain by primary care providers, although customary, can be difficult due to inadequate training and conflicts between patient expectations and best practices. Resident physicians, faculty, and staff of this family medicine residency program developed a comprehensive chronic pain management program to address these issues while improving patient outcomes. The program was aligned with evidence-based chronic non-cancer pain management strategies yet tailored to the needs of the providers and patients and the strengths of the clinic. In the end, the societal demand for improved chronic non-cancer pain management resulted in a massive curricular and clinical practice overhaul for this residency program. © The Author(s) 2016.
Full Text Available An overview of the global movement for human rights education (HRE, its impetus, challenges, and contrasting developments in different regions of the world, focusing especially on Latin America, the Philippines, South Africa, the Middle East, and Europe. Seeks to put HRE in the USA into an international perspective, as well as to show the variety of goals that inspire HRE and how methodologies have evolved to meet specific regional and political cultures and needs.
An overview of the global movement for human rights education (HRE), its impetus, challenges, and contrasting developments in different regions of the world, focusing especially on Latin America, the Philippines, South Africa, the Middle East, and Europe. Seeks to put HRE in the USA into an international perspective, as well as to show the variety of goals that inspire HRE and how methodologies have evolved to meet specific regional and political cultures and needs.
Boody, Barrett; Johnson, Patrick; Pugely, Andrew; Miller, Daniel; Geller, Jeffrey; Payne, William; Boegener, James; Schafer, Michael; Beal, Matthew
The Orthopedic In-Training Examination is an annual standardized examination with multiple-choice questions focused on application of orthopedic surgery core knowledge and principles. The outcome of this test can be used to both predict how residents are progressing in their orthopedic knowledge as well as assess their likelihood to pass the Orthopedic Board Examinations, that is the American Boards of Orthopedic Surgery Part 1, following completion of residency. Preparation for the examination can be difficult, as residents commonly have limited study time to review the vast amounts of available published literature. The objective of our study is to evaluate the effectiveness of the Orthopaedic In Training Examination (OITE) scores and the participants' perceived utility of the curriculum for OITE preparation. Residents from 5 US Orthopedic residencies (4 M.D. and 1 D.O.) were included in a pilot program of the Orthobullets PASS curriculum in the academic year 2013 to 2014. Only residents enrolled in the PASS curriculum who completed both the 2013 and 2014 OITEs were included in the final analysis (n = 71). We used the OITE 2013 and 2014 rank postgraduate year (RPGY) reported scores to assess for efficacy of the PASS curriculum, as the RPGY score provides postgraduate year-of-training matched analysis to control for expected increased levels of knowledge with subsequent retesting. While OITE scores incrementally increased for the group as a whole (n = 71, RPGY mean improvement = +2.5%, p = 0.406), the junior resident subgroup (postgraduate year 1-2) produced a statistically significant increase in scores (n = 28, RPGY mean increase = 10.1%, p = 0.0260). Nearly 90% (38/42) of curriculum participants surveyed reported a preference to complete a similar review curriculum for future OITE preparation. The participants completing greater than 150 PASS questions (n = 57) were analyzed for OITE predictive capacity of the PASS curriculum. Pearson analysis with PASS
Lin, Chi-Hung; Chik, Jenny H L; Packer, Nicolle H; Molloy, Mark P
Glycosylation results from the concerted action of glycosylation enzymes in the secretory pathway. In general, gene expression serves as the primary control mechanism, but post-translational fine-tuning of glycosylation enzyme functions is often necessary for efficient synthesis of specific glycan epitopes. While the field of glycomics has rapidly advanced, there lacks routine proteomic methods to measure expression of specific glycosylation enzymes needed to fill the gap between mRNA expression and the glycomic profile in a "reverse genomics" workflow. Toward developing this workflow we enriched Golgi membranes from two human colon cancer cell lines by sucrose density centrifugation and further mass-based fractionation by SDS-PAGE. We then applied mass spectrometry to demonstrate a doubling in the number of Golgi resident proteins identified, compared to the unenriched, low speed centrifuged supernatant of lysed cells. A total of 35 Golgi-resident glycosylation enzymes, of which 23 were glycosyltransferases, were identified making this the largest protein database so far of Golgi resident glycosylation enzymes experimentally identified in cultured human cells. We developed targeted mass spectrometry assays for specific quantitation of many of these glycosylation enzymes. Our results show that alterations in abundance of glycosylation enzymes at the protein level were generally consistent with the resultant glycomic profiles, but not necessarily with the corresponding glycosyltransferase mRNA expression as exemplified by the case of O-glycan core 1 T synthase.
Izard, Santiago González; Juanes Méndez, Juan A; Palomera, Pablo Ruisoto
Virtual Reality is becoming widespread in our society within very different areas, from industry to entertainment. It has many advantages in education as well, since it allows visualizing almost any object or going anywhere in a unique way. We will be focusing on medical education, and more specifically anatomy, where its use is especially interesting because it allows studying any structure of the human body by placing the user inside each one. By allowing virtual immersion in a body structure such as the interior of the cranium, stereoscopic vision goggles make these innovative teaching technologies a powerful tool for training in all areas of health sciences. The aim of this study is to illustrate the teaching potential of applying Virtual Reality in the field of human anatomy, where it can be used as a tool for education in medicine. A Virtual Reality Software was developed as an educational tool. This technological procedure is based entirely on software which will run in stereoscopic goggles to give users the sensation of being in a virtual environment, clearly showing the different bones and foramina which make up the cranium, and accompanied by audio explanations. Throughout the results the structure of the cranium is described in detailed from both inside and out. Importance of an exhaustive morphological knowledge of cranial fossae is further discussed. Application for the design of microsurgery is also commented.
Brauch, Rebecca Ann; Goliath, Cheryl; Patterson, Laurie; Sheers, Titus; Haller, Nairmeen
To better standardize the teaching of professionalism, the American Board of Internal Medicine and the Accreditation Council for Graduate Medical Education established competency-based training milestones for internal medicine residency programs. Accordingly, professionalism milestones served as the basis for a faculty development program centered on providing feedback to postgraduate year 1 residents (interns) on their own professionalism behaviors during preceptor-resident sessions in the internal medicine continuity clinic. To determine the level of faculty (n=8) understanding and comfort in providing feedback, surveys listing 12-month professionalism milestones were distributed to core internal medicine teaching faculty. Current interns (n=10) also rated their understanding of the same milestones. The faculty development program included interpersonal communication education, role-plays of difficult situations, and pocket resources, as well as direct feedback on videotaped sessions with residents. At the end of the intervention period, participating faculty completed a postdevelopment survey, and the current 6-month interns completed a follow-up assessment. Average ratings between the pre- and postintervention teaching faculty surveys fell approximately 0.25%-0.50% on all measures of understanding, but increased slightly on measures of comfort. Conversely, average ratings between the pre- and postintervention 6-month intern surveys generally increased 0.25%-0.50% for measures of comfort and understanding. The faculty perceived the intervention as helpful in teaching them to focus on behaviors that change the context of overall feedback delivery. However, the study results showed that the system in place was not conducive to implementing such a program without modification and the introduction of resources.
Knudson, Mark; Hosokawa, Michael
Preventive health practices known to benefit the general public include aerobic exercise, seat belt use, and self-examination for breast or testicular cancer. To assess whether residents would increase their promotion of these healthful behaviors, a controlled trial was conducted at the University of Missouri--Columbia Hospitals and Clinics.…
Li, Ina; Arenson, Christine; Warshaw, Gregg; Bragg, Elizabeth; Shaull, Ruth; Counsell, Steven R.
A survey of family practice residency directors found that 92 percent have a required geriatrics curriculum; nursing homes, assisted living facilities, and home care are the predominant training sites; the mean number of geriatrics faculty is 2.6 per program; and conflicting time demands with other curricula was ranked as the most significant…
Evans, Shari D.; Yi, Charlie; Baker, Blossom B.; Crowley, Eugene; King, Debbie S.; Korinek, Adam W.; Reinsch, N. Lamar
This article reports a discourse analysis of journals from adult learners during a 1-week residency in Cape Town, South Africa. The theoretical posture is a critical dialogic perspective, making use of a postcolonial understanding of intercultural interactions. The purpose of the study was exploratory. The analysis suggests that demographic…
Herrera-Añazco, Percy; Bonilla-Vargas, Luis; Hernandez, Adrian V; Silveira-Chau, Manuela
In Peru there are different hospitals and university programs for training of specialists in nephrology. To assess the perception of physicians who attend such programs. We carried out a descriptive cross-sectional national-level study in physicians who were in the last two years of nephrology training during February 2012 and who had graduated from it in 2010 and 2011. A self-applied questionnaire was developed along with the Peruvian Society of Nephrology based on international standards. The questionnaire evaluated: mentoring, clinical training, procedures, external rotations, research and global perception. Forty doctors were surveyed nationwide. 82.5% had tutors, 22.5% of them said their support was poor. A 27.5% described their theoretical formation as deficient. The practical training was perceived as acceptable globally; however, improvements in training on peritoneal dialysis and reading kidney transplant biopsies are necessary. A 90% have national external rotations and 65% reported to have an international rotation. In the assessment of research, 77.5% thought this is deficient. In addition, 82.5% believed that residency should last four years. However, 60% reported that their residency training was good. There is a decrease in the positive perception of the aspects studied among residents regarding graduates. The overall perception of nephrology residency training was considered good; however, areas of tutoring, and academic and research activities on average were deficient.
Wilson Mark C
Full Text Available Abstract Background The evidence supporting the effectiveness of educational games in graduate medical education is limited. Anecdotal reports suggest their popularity in that setting. The objective of this study was to explore the support for and the different aspects of use of educational games in family medicine and internal medicine residency programs in the United States. Methods We conducted a survey of family medicine and internal medicine residency program directors in the United States. The questionnaire asked the program directors whether they supported the use of educational games, their actual use of games, and the type of games being used and the purpose of that use. Results Of 434 responding program directors (52% response rate, 92% were in support of the use of games as an educational strategy, and 80% reported already using them in their programs. Jeopardy like games were the most frequently used games (78%. The use of games was equally popular in family medicine and internal medicine residency programs and popularity was inversely associated with more than 75% of residents in the program being International Medical Graduates. The percentage of program directors who reported using educational games as teaching tools, review tools, and evaluation tools were 62%, 47%, and 4% respectively. Conclusions Given a widespread use of educational games in the training of medical residents, in spite of limited evidence for efficacy, further evaluation of the best approaches to education games should be explored.
Akl, Elie A; Gunukula, Sameer; Mustafa, Reem; Wilson, Mark C; Symons, Andrew; Moheet, Amir; Schünemann, Holger J
The evidence supporting the effectiveness of educational games in graduate medical education is limited. Anecdotal reports suggest their popularity in that setting. The objective of this study was to explore the support for and the different aspects of use of educational games in family medicine and internal medicine residency programs in the United States. We conducted a survey of family medicine and internal medicine residency program directors in the United States. The questionnaire asked the program directors whether they supported the use of educational games, their actual use of games, and the type of games being used and the purpose of that use. Of 434 responding program directors (52% response rate), 92% were in support of the use of games as an educational strategy, and 80% reported already using them in their programs. Jeopardy like games were the most frequently used games (78%). The use of games was equally popular in family medicine and internal medicine residency programs and popularity was inversely associated with more than 75% of residents in the program being International Medical Graduates. The percentage of program directors who reported using educational games as teaching tools, review tools, and evaluation tools were 62%, 47%, and 4% respectively. Given a widespread use of educational games in the training of medical residents, in spite of limited evidence for efficacy, further evaluation of the best approaches to education games should be explored.
Jacobs, G. M.
Humane education has existed since at least the 18th century (Unti & DeRosa, 2003). This brief chapter begins with a brief definition of humane education and examples of how it can be incorporated in linguistics, cross cultural studies and foreign language education. Next, the chapter discusses why humane education constitutes an important…
Yoshimura, Seiichi; Fujimoto, Junzo; Sasou Kunihide; Hasegawa, Naoko
Education effectiveness in accordance with investment is required in the steam of electric power regulation alleviation. Therefore, evaluation methods for human factors education effectiveness which can observe human factors culture pervading process were investigated through research activities on education effectiveness in universities and actual in house education in industry companies. As a result, the contents of evaluation were found to be the change of feeling for human factors and some improving proposals in work places when considering the purpose of human factors education. And, questionnaire is found to be suitable for the style of evaluation. In addition, the timing of evaluation is desirable for both just after education and after some period in work places. Hereafter, data will be collected using these two kinds of questionnaires in human factors education courses in CRIEPI and some education courses in utilities. Thus, education effectiveness evaluation method which is suitable for human factors will be established. (author)
Rosenstein, Barry S.; Held, Kathryn D.; Rockwell, Sara; Williams, Jacqueline P.; Zeman, Elaine M.
Purpose: To obtain, in a survey-based study, detailed information on the faculty currently responsible for teaching radiation biology courses to radiation oncology residents in the United States and Canada. Methods and Materials: In March-December 2007 a survey questionnaire was sent to faculty having primary responsibility for teaching radiation biology to residents in 93 radiation oncology residency programs in the United States and Canada. Results: The responses to this survey document the aging of the faculty who have primary responsibility for teaching radiation biology to radiation oncology residents. The survey found a dramatic decline with time in the percentage of educators whose graduate training was in radiation biology. A significant number of the educators responsible for teaching radiation biology were not fully acquainted with the radiation sciences, either through training or practical application. In addition, many were unfamiliar with some of the organizations setting policies and requirements for resident education. Freely available tools, such as the American Society for Radiation Oncology (ASTRO) Radiation and Cancer Biology Practice Examination and Study Guides, were widely used by residents and educators. Consolidation of resident courses or use of a national radiation biology review course was viewed as unlikely by most programs. Conclusions: A high priority should be given to the development of comprehensive teaching tools to assist those individuals who have responsibility for teaching radiation biology courses but who do not have an extensive background in critical areas of radiobiology related to radiation oncology. These findings also suggest a need for new graduate programs in radiobiology.
Côté, Luc; Rocque, Rhéa; Audétat, Marie-Claude
Supervision of communication competency in clinical settings in medicine is an important component of professional training. The purpose of this study was to describe the content and rationale of psychology and social work preceptor feedback to family medicine residents who express educational needs during case-based written vignettes. We conducted a qualitative study with 25 psychology and social work preceptors from family medicine departments of the three French-speaking universities in the province of Quebec, Canada. During an individual interview, preceptors were asked to respond to three short case-based written vignettes depicting resident educational issues regarding communication and to explain their responses. Authors analyzed the content of responses and the conceptual frameworks reported. The three vignettes elicited 475 responses, including 58 distinct responses and 33 distinct conceptual frameworks. Therapeutic alliance and stages of grief were the two most reported conceptual frameworks. The vignettes stimulated a wealth of responses and conceptual frameworks among psychology and social work preceptors in family medicine. The complete list of responses could be useful for faculty development activities by stimulating preceptors' reflexive practice with regard to their responses, the educational goals of these responses and the conceptual frameworks underlying their feedback. Copyright © 2017 Elsevier B.V. All rights reserved.
Florek, Aleksandra G; Dellavalle, Robert P
A case report is a detailed narrative that usually illustrates a diagnostic or therapeutic problem experienced by one or several patients. Case reports commonly serve as the first line of evidence for new interventions or they function as alarms that an issue exists with an already established therapy. Case reports are of minor importance in evidence-based medicine; however, they make meaningful contributions to both the knowledge and education of medical students, residents, and fellows. Case reports are written with the goal of sharing information for medical, scientific, or educational purposes. They often serve as medical or even undergraduate students' first experience with medical writing and they provide a solid foundation for manuscript preparation and publication. In the last few decades, there has been an exponential increase in medical student research, specifically in the number of manuscripts published by medical students. It is important to foster this academic spirit among students by encouraging them to become involved in research. This editorial will focus on the value and educational benefits of writing case reports for medical students, university students, residents, and fellows.
Daley, Brian J; Cherry-Bukowiec, Jill; Van Way, Charles W; Collier, Bryan; Gramlich, Leah; McMahon, M Molly; McClave, Stephen A
Nutrition leaders surmised graduate medical nutrition education was not well addressed because most medical and surgical specialties have insufficient resources to teach current nutrition practice. A needs assessment survey was constructed to determine resources and commitment for nutrition education from U.S. graduate medical educators to address this problem. An online survey of 36 questions was sent to 495 Accreditation Council for Graduate Medical Education (ACGME) Program Directors in anesthesia, family medicine, internal medicine, pediatrics, obstetrics/gynecology, and general surgery. Demographics, resources, and open-ended questions were included. There was a 14% response rate (72 programs), consistent with similar studies on the topic. Most (80%) of the program directors responding were from primary care programs, the rest surgical (17%) or anesthesia (3%). Program directors themselves lacked knowledge of nutrition. While some form of nutrition education was provided at 78% of programs, only 26% had a formal curriculum and physicians served as faculty at only 53%. Sixteen programs had no identifiable expert in nutrition and 10 programs stated that no nutrition training was provided. Training was variable, ranging from an hour of lecture to a month-long rotation. Seventy-seven percent of program directors stated that the required educational goals in nutrition were not met. The majority felt an advanced course in clinical nutrition should be required of residents now or in the future. Nutrition education in current graduate medical education is poor. Most programs lack the expertise or time commitment to teach a formal course but recognize the need to meet educational requirements. A broad-based, diverse universal program is needed for training in nutrition during residency. © 2015 American Society for Parenteral and Enteral Nutrition.
This paper reviews national and cultural traditions that inform human rights consciousness in Slovakia and examines the role of constitutionalism in human rights protection and education on human rights. A prospering civil society is possible only in the context of a well-functioning civil state, making education in human rights and…
Full Text Available In recent years, higher medical education has witnessed major changes in the structure and content of postgraduate medical training. Seven professional competencies have been described that address the medical doctors′ ability to effectively communicate and transfer medical information, interact effectively and professionally, and demonstrate a good grasp of clinical knowledge and skills. Proficiency in didactic skills, however, is an important competency that has not received prominent attention. In the clinical setting, attending-physicians and medical residents are responsible for teaching. Consequently, several medical institutions have proposed the need for teacher training programs to improve the teaching skills of attending doctors and medical residents. The supporters of these programs believe that through teaching, medical doctors improve their individual professional and clinical problem-solving abilities. Hence, it is logical to assume that didactic skills′ training would contribute to the professional development of doctors. In this paper, we re-examine the underlying theory of the didactic proficiency, how it relates to the clinical setting, and why it may be beneficial for the professional training of medical residents.
Conclusion: Aiming to identify the challenges that orthopaedics and traumatology residents in Turkey face as regards their training, this survey stands as a pioneering study with a high participation rate. Analysis of survey data highlights the importance of several key factors such as the development of training programs and increasing the time spent with academicians as well as spreading and promotion of log book application.
Brandi, M C
"The OECD recently recognised that the Human Resources for Science and Technology (HRST) stock of any given country is sharply affected by migration flows of qualified people. We have thus undertaken a study of highly-qualified immigrants in Rome.... The conclusion is that the resident foreign population in Rome has a high mean level of instruction by no means lower than the mean level of Romans, at least up until the 1991 census. It also emerges, however, that among graduates differences in level of instruction vary according to geographical areas and, above all, the level of industrialisation of the country of origin." (EXCERPT)
Lam, Christopher Z; Nguyen, HaiThuy N; Ferguson, Emma C
Radiology residency education must evolve to meet the growing demands of radiology training. Resident opinions are a major resource to identify needs. However, few published data are available on a national level investigating the radiology resident perspective on factors that influence the resident experience. Our study investigates factors that affect residents' satisfaction with their residency experience and education. A 67-item survey was sent to all radiology residency program directors and coordinators in the United States to be distributed at their discretion. Questions were multiple choice, free-text answer, or 5-point Likert scale. Statistical significance (p teaching opportunities (OR, 6.5; 95% CI, 3.1-13.8), research opportunities (OR, 5.1; 95% CI, 2.6-10.6), personal study (OR, 2.1; 95% CI, 1.1-4.1), and compensation (OR, 1.9; 95% CI, 1.0-3.7). Our study provides incremental data to the existing literature that offers insight into factors that contribute to a successful radiology residency program.
Zarrabi, Bahar; Burce, Karen K; Seal, Stella M; Lifchez, Scott D; Redett, Richard J; Frick, Kevin D; Dorafshar, Amir H; Cooney, Carisa M
Rising health care costs, decreasing reimbursement rates, and changes in American health care are forcing physicians to become increasingly business-minded. Both academic and private plastic surgeons can benefit from being educated in business principles. The authors conducted a systematic review to identify existing business curricula and integrated a business principles curriculum into residency training. The authors anonymously surveyed their department regarding perceived importance of business principles and performed a systematic literature review from 1993 to 2013 using PubMed and Embase to identify residency training programs that had designed/implemented business curricula. Subsequently, the authors implemented a formal, quarterly business curriculum. Thirty-two of 36 physicians (88.9 percent; 76.6 percent response rate) stated business principles are either "pretty important" or "very important" to being a doctor. Only 36 percent of faculty and 41 percent of trainees had previous business instruction. The authors identified 434 articles in the systematic review: 29 documented formal business curricula. Twelve topics were addressed, with practice management/administration (n = 22) and systems-based practice (n = 6) being the most common. Four articles were from surgical specialties: otolaryngology (n = 1), general surgery (n = 2), and combined general surgery/plastic surgery (n = 1). Teaching formats included lectures and self-directed learning modules; outcomes and participant satisfaction were reported inconsistently. From August of 2013 to June of 2015, the authors held eight business principles sessions. Postsession surveys demonstrated moderately to extremely satisfied responses in 75 percent or more of resident/fellow respondents (n = 13; response rate, 48.1 percent) and faculty (n = 9; response rate, 45.0 percent). Business principles can be integrated into residency training programs. Having speakers familiar with the physician audience and a
Full Text Available La formación pregrado, posgrado y la formación continuada en medicina podemos encuadrarlas dentro de la educación para adultos. Si en la formación pregrado predomina la transmisión de conocimientos, la formación posgrado debería basarse en un asentamiento de esos conocimientos y en la adquisición de habilidades. Estas tareas, en el caso de la especialización médica vía MIR, se desarrollarán en un contexto concreto donde el residente se encontrará ante la necesidad de la resolución de problemas. Como adulto podrá responsabilizarse de su propia formación, pero necesita de la guía y orientación de un tutor, pieza clave en la educación y evaluación que no sólo mide los objetivos alcanzados, sino que permite mejorar las estrategias de aprendizaje. Tanto el tutor como los posibles profesionales sanitarios que participen en la formación son de vital importancia y merecen un reconocimiento, unos recursos y una formación acorde a su labor. En el presente artículo haremos un repaso del proceso formativo desde el pregrado hasta la residencia, y también destacaremos los aspectos evaluativos como indispensables en dicho proceso.Undergraduate, postgraduate and continuing medical education must be considered as adult education. If in undergraduate medical education dominates the transmission of knowledge, postgraduate education should be based on quantitative and qualitative increase of these knowledge and on acquisition of specific skills. These tasks, in medical specialization through residency programs will be developed in a concrete context where residents will face the need to solve real problems. As adult, he/she will be able to take responsibility on its own training but, at the same time, he/she will need guidance and orientation from the tutor. Tutorial methodology is a key piece in training and its evaluation; it doesn't only measures specific training achievements, but enhances the improving of individual learning strategies
King, Ashley B; Klausner, Adam P; Johnson, Corey M; Moore, Blake W; Wilson, Steven K; Grob, B Mayer
The challenge of resident education in urologic surgery programs is to overcome disparity imparted by diverse patient populations, limited training times, and inequalities in the availability of expert surgical educators. Specifically, in the area of prosthetic urology, only a small proportion of programs have full-time faculty available to train residents in this discipline. To examine whether a new model using yearly training sessions from a recognized expert can establish a successful penile prosthetics program and result in better outcomes, higher case volumes, and willingness to perform more complex surgeries. A recognized expert conducted one to two operative training sessions yearly to teach standardized technique for penile prosthetics to residents. Each session consisted of three to four operative cases performed under the direct supervision of the expert. Retrospective data were collected from all penile prosthetic operations before (February, 2000 to June, 2004: N = 44) and after (July, 2004 to October, 2007: N = 79) implementation of these sessions. Outcomes reviewed included patient age, race, medical comorbidities, operative time, estimated blood loss, type of prosthesis, operative approach, drain usage, length of stay, and complications including revision/explantation rates. Statistical analysis was performed using Student's t-tests, Fisher's tests, and survival curves using the Kaplan-Meier technique (P value ≤ 0.05 to define statistical significance). Patient characteristics were not significantly different pre- vs. post-training. Operative time and estimated blood loss significantly decreased. Inflatable implants increased from 19/44 (43.2%, pre-training) to 69/79 (87.3%, post-training) (P prosthetics surgery. © 2011 International Society for Sexual Medicine.
Yamamoto, Satoshi; Tanaka, Pedro; Madsen, Matias Vested
Our goal in this study was to examine Accreditation Council for Graduate Medical Education case logs for Stanford anesthesia residents graduating in 2013 (25 residents) and 2014 (26 residents). The resident with the fewest recorded patients in 2013 had 43% the number of patients compared with the...
Brahma V. Kumar
Full Text Available Tissue-resident memory T cells (TRMs in mice mediate optimal protective immunity to infection and vaccination, while in humans, the existence and properties of TRMs remain unclear. Here, we use a unique human tissue resource to determine whether human tissue memory T cells constitute a distinct subset in diverse mucosal and lymphoid tissues. We identify a core transcriptional profile within the CD69+ subset of memory CD4+ and CD8+ T cells in lung and spleen that is distinct from that of CD69− TEM cells in tissues and circulation and defines human TRMs based on homology to the transcriptional profile of mouse CD8+ TRMs. Human TRMs in diverse sites exhibit increased expression of adhesion and inhibitory molecules, produce both pro-inflammatory and regulatory cytokines, and have reduced turnover compared with circulating TEM, suggesting unique adaptations for in situ immunity. Together, our results provide a unifying signature for human TRM and a blueprint for designing tissue-targeted immunotherapies.
Riaz, Mahrukh; Palermo, Tia; Yen, Michael; Edelman, Norman H
To assess the projected responses of residency-sponsoring institutions to the proposed reduction in Medicare's indirect medical education (IME) payments. In 2012, the authors surveyed directors of graduate medical education (GME) programs, examining (1) overall responses to a reduction in IME reimbursement and (2) the value of individual residencies to the institution from the economic/operational and educational/public service points of view, to determine which programs may be at risk for downsizing. Responses from 192 of 555 institutions (35% response rate) varied by the size of the institution's GME program. Of large programs (six or more residencies), 33 (33%) would downsize at a 10% reduction in IME reimbursement, focusing cuts on specific programs. Small programs (five or fewer residencies) were more likely to retain their existing residencies with modest IME payment reductions and to make across-the-board cuts. The economic/operational value of specialties varied widely, with hospital-intensive residencies valued highest. Family medicine was valued highly from an economic/operational point of view only by small programs. Educational/public service value scores varied less and were higher for all specialties. Preventive medicine was not highly valued in either category. Even a modest decrease in IME reimbursement could trigger institutions to downsize their GME programs. Programs at the greatest risk for cuts may be those with modest economic/operational value but high societal value, like family medicine. The retention or expansion of training in family medicine may be most easily accomplished then at smaller institutions.
Education Commission of the States, Denver, CO.
On January 26, 1971 the Chairman of the Education Commission of the States issued a statement of principles and possible model legislation for the various states in the highly complex area of determination of student residency for tuition purposes at public institutions of higher education. The original model legislation was related to the…
Sriram, Rishi; McLevain, Melissa
The future of Christian higher education is not certain, and faith-based institutions will need to continue to convince prospective students that the experiences they offer are worth the investment. What is missing in the discussion of what makes Christian higher education special is the transformational experience provided outside of the…
Cheuk, Stanley; Schlums, Heinrich; Sérézal, Irène Gallais
Tissue-resident memory T (Trm) cells form a heterogeneous population that provides localized protection against pathogens. Here, we identify CD49a as a marker that differentiates CD8+ Trm cells on a compartmental and functional basis. In human skin epithelia, CD8+CD49a+ Trm cells produced...... interferon-γ, whereas CD8+CD49a− Trm cells produced interleukin-17 (IL-17). In addition, CD8+CD49a+ Trm cells from healthy skin rapidly induced the expression of the effector molecules perforin and granzyme B when stimulated with IL-15, thereby promoting a strong cytotoxic response. In skin from patients...... in this skin disease. Overall, CD49a expression delineates CD8+ Trm cell specialization in human epithelial barriers and correlates with the effector cell balance found in distinct inflammatory skin diseases....
Educational value of an intensive and structured interval practice laparoscopic training course for residents in obstetrics and gynecology: a four-year prospective, multi-institutional recruitment study.
Botchorishvili, Revaz; Rabischong, Benoit; Larraín, Demetrio; Khoo, Chong Kiat; Gaia, Georgia; Jardon, Kris; Pouly, Jean-Luc; Jaffeux, Patricia; Aublet-Cuvelier, Bruno; Canis, Michel; Mage, Gerard
To assess the educational value of an ongoing interval practice laparoscopy training program among obstetrics and gynecology residents. Prospective cohort, multi-institutional recruitment study. We conducted structured laparoscopic training sessions for residents, using both inanimate and porcine models. The 6-day course was separated into two 3-day long modules conducted 2 months apart. A prospective evaluation of standardized tasks was performed using validated scales. Resident's performance was compared using the Student t test and Wilcoxon signed-rank test when appropriate. International Center of Endoscopic Surgery (CICE), Clermont-Ferrand, France. 191 PGY2 or PGY3 residents from different institutions. Significant improvement in time and technical scores for both laparoscopic suturing and porcine nephrectomy was noted (p educational value of interval practice in laparoscopic performance, some acquired skills seem to deteriorate faster than anticipated. Copyright Â© 2012 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.
Schulz, Kristine; Puscas, Liana; Tucci, Debara; Woodard, Charles; Witsell, David; Esclamado, Ramon M.; Lee, Walter T.
Introduction Surgical Training and Education in Promoting Professionalism (STEPP) was developed in 2011 to train tomorrow's leaders during residency. It is based on virtue ethics and takes an approach similar to West Point military academy. The purpose of this research was: (i) to compare the virtue profiles of our residents with that of the military cohort using a standardized virtue assessment tool; and (ii) to assess the value of virtue education on residents. Methods As part of STEPP, otolaryngology residents participated in a virtue-based validated assessment tool called Virtue in Action (VIA) Inventory. This was completed at the initiation of STEPP in July 2011 as well as 1 year later in June 2012. Comparison of the VIA to a military cohort was performed. Leadership ‘Basic Training’ is a series of forums focused on virtues of initiative, integrity, responsibility, self-discipline, and accountability. A pre- and post-test was administered assessing resident perceptions of the value of this ‘Basic Training’. Results Virtues are shared between otolaryngology residents (n=9) and military personnel (n=2,433) as there were no significant differences in strength scores between two military comparison groups and otolaryngology-head and neck surgery (OHNS) residents. There was a significant improvement (p<0.001) in the understanding of components of the leadership vision and a significant improvement in the understanding of key leadership concepts based on ‘Basic Training’. All residents responded in the post-test that the STEPP program was valuable, up from 56%. Conclusions A virtue-based approach is valued by residents as a part of leadership training during residency. PMID:24172053
Mariê Luise Campos
Full Text Available In 2008, the Universal Declaration of Human Rights completed 60 years of existence. To commemorate this date, the Ministry of Education, the Special Secretariat for Human Rights of the Presidency, the Organization of Iberoamerican States with the sponsorship and implementation of the SM Foundation, created the National Award for Human Rights Education.
This paper examines the concept of human right to education as listed in Article 26 of the United Nations Declaration of Human Rights of December 1948. Human right is viewed as natural or moral law which has the force of conscience. The declaration is directed at the right to formal Western education in Nigeria, rather ...
Pastores, Stephen M; O'Connor, Michael F; Kleinpell, Ruth M; Napolitano, Lena; Ward, Nicholas; Bailey, Heatherlee; Mollenkopf, Fred P; Coopersmith, Craig M
The Accreditation Council for Graduate Medical Education recently released new standards for supervision and duty hours for residency programs. These new standards, which will affect over 100,000 residents, take effect in July 2011. In response to these new guidelines, the Society of Critical Care Medicine convened a task force to develop a white paper on the impact of changes in resident duty hours on the critical care workforce and staffing of intensive care units. A multidisciplinary group of professionals with expertise in critical care education and clinical practice. Relevant medical literature was accessed through a systematic MEDLINE search and by requesting references from all task force members. Material published by the Accreditation Council for Graduate Medical Education and other specialty organizations was also reviewed. Collaboratively and iteratively, the task force corresponded by electronic mail and held several conference calls to finalize this report. The new rules mandate that all first-year residents work no more than 16 hrs continuously, preserving the 80-hr limit on the resident workweek and 10-hr period between duty periods. More senior trainees may work a maximum of 24 hrs continuously, with an additional 4 hrs permitted for handoffs. Strategic napping is strongly suggested for trainees working longer shifts. Compliance with the new Accreditation Council for Graduate Medical Education duty-hour standards will compel workflow restructuring in intensive care units, which depend on residents to provide a substantial portion of care. Potential solutions include expanded utilization of nurse practitioners and physician assistants, telemedicine, offering critical care training positions to emergency medicine residents, and partnerships with hospitalists. Additional research will be necessary to evaluate the impact of the new standards on patient safety, continuity of care, resident learning, and staffing in the intensive care unit.
Creation and Dissemination of a Multispecialty Graduate Medical Education Curriculum in Pediatric and Adolescent Gynecology: The North American Society for Pediatric and Adolescent Gynecology Resident Education Committee Experiences.
Wheeler, Carol; Browner-Elhanan, Karen-Jill; Evans, Yolanda; Fleming, Nathalie; Huguelet, Patricia S; Karjane, Nicole W; Loveless, Meredith; Talib, Hina J; Kaul, Paritosh
The goal was to develop a multispecialty committee to address deficiencies in pediatric and adolescent gynecology (PAG) resident education through curricular development under the auspices of the North American Society for Pediatric and Adolescent Gynecology. DESIGN, SETTING, PARTICIPANTS, INTERVENTIONS, AND MAIN OUTCOME MEASURES: A multispecialty North American committee was organized to develop short as well as long curricula in PAG through a combination of conference calls and face-to-face meetings. Content was guided by objectives of national accrediting organizations. The curricula used print as well as interactive electronic resources. After publication of the short and long curricula, a dissemination strategy was developed to present the information at national meetings. A curricular study was performed after introduction of the curriculum to evaluate its efficacy. Long-term plans for further curricular components and expansion of educational tools are ongoing. We gathered a diverse multispecialty group of doctors to collaborate on a unified educational goal. This committee developed and disseminated resident PAG curricula using a variety of learning tools. This curricular development and implementation can occur with a minimal financial burden. Copyright © 2017 North American Society for Pediatric and Adolescent Gynecology. Published by Elsevier Inc. All rights reserved.
Geertzen, Jan H. B.; Rommers, G. M.; Dekker, Rienk
Background and Aim: Education programmes of the International Society for Prosthetics and Orthotics (ISPO) are directed primarily at prosthetists and orthotists. In a multidisciplinary setting, greater attention should be given to other professionals working in the field of amputation, prosthetics
Kátia Regina Barros RIBEIRO
Full Text Available The purpose of this article was to reflect on the practice of preceptorship as an educational practice in the training and qualifications of professional health information for the public health system. This is a theoretical reflection with support in the literature. The teacher addresses the teaching-learning process and transforms the activities in the work on educational moments. In this area arise questions about what is being preceptor and their role in health education. It is necessary to teach knowledge beyond the content of the discipline, and reflecting about preceptorship as an educational practice in the workplace, the preceptor needs pedagogical preparation. Herewith, being a preceptor means being a teacher? This reflection places us in front of a problem present in our daily exercise, which is the pedagogical training of those who teach for a transformation of practice in health.
Educational practices based on human capital theory are unlikely to alleviate social inequities because the theory views people as isolated materialists driven by desire for goods and security. It assumes an educational meritocracy in which socioeconomic status is limited only by educational investment, and more educated people are presumed to be…
Xie, Jiang; Guan, Fei; Wang, Jia-Hong; Hu, Da-Yi
The community medical center is the first barrier for lipid control. We aimed to survey the residents' cholesterol condition in the community, and pursue the reasons for the upsetting results from various aspects. Residents and physicians were recruited from four community centers. Residents completed questionnaires and a physical examination as well as biochemical analysis. Physicians were also asked to complete a questionnaire, some of which were about basic knowledge of lipids. About 37.0% male and 48.1% female had elevated cholesterol levels. Residents' blood pressure (BP), fasting glucose (FG), body mass index (BMI), and waist circumference (WC) were positively associated with their low-density lipoprotein cholesterol (LDL-C) and total cholesterol (TC). Framingham risk scoring (FRS) was strongly related to cholesterol (P education grade was positively related to a normal cholesterol condition (P education had a much higher lipid knowledge level themselves, the physicians' factors had almost no relationship with the residents' cholesterol levels. Management of hypercholesterolemia should be an important component of health strategy in Beijing. Education is imperative for residents as well as for physicians.
Transformational, transactional, and passive-avoidant leadership characteristics of a surgical resident cohort: analysis using the multifactor leadership questionnaire and implications for improving surgical education curriculums.
Horwitz, Irwin B; Horwitz, Sujin K; Daram, Pallavi; Brandt, Mary L; Brunicardi, F Charles; Awad, Samir S
The need for leadership training has become recognized as being highly important to improving medical care, and should be included in surgical resident education curriculums. Surgical residents (n = 65) completed the 5x-short version of the Multifactor Leadership Questionnaire as a means of identifying leadership areas most in need of training among medical residents. The leadership styles of the residents were measured on 12 leadership scales. Comparisons between gender and postgraduate year (PGY) and comparisons to national norms were conducted. Of 12 leadership scales, the residents as a whole had significantly higher management by exception active and passive scores than those of the national norm (t = 6.6, P leadership factors with eigenvalues over 1.0. Hierarchical regression found evidence of an augmentation effect for transformational leadership. Areas of resident leadership strengths and weaknesses were identified. The Multifactor Leadership Questionnaire was demonstrated to be a valuable tool for identifying specific areas where leadership training would be most beneficial in the educational curriculum. The future use of this instrument could prove valuable to surgical education training programs.
Full Text Available Abstract Background Little research has been conducted to examine the relationship between education level and functional limitations among Japanese community residents. We sought to examine the association between education level and physical functional limitations among Japanese men and women, and whether that association was modified by gender and history of stroke. Methods We examined prevalence of physical functional limitation by educational level using the data from a total of 29,134 Japanese men and women aged 50–69 years living in communities in 2000. The information of educational level (junior high school graduates, senior high school graduates, college and/or higher education and physical functional limitations (no need for assistance, need for assistance when going outdoors, and need for assistance to carry out indoor activities were obtained by self-administrated questionnaire. Results The proportions of the subjects reported their highest level of schooling were 48% for junior high school, 39% for high school, and 13% for college. Three hundred and twenty eight subjects (1% of total subjects reported having some physical functional limitations. Multinomial logistic regression analyses showed that the odds ratio of needing assistance to carry out indoor activities were 4.84(95%CI:3.61,6.50 for lowest education level group and 2.21(95%CI:1.00,4.86 for middle education level group compared to highest education level group. The corresponding odds ratios of needing assistance when going outdoors were 2.36(95%CI: 2.03,2.72 and 1.08(95%CI:0.73,1.60, respectively. Further, the significant excess prevalence of having functional limitations associated with the low education level was identified for men regardless of history of stroke and for women without history of stroke. Conclusion Low education level was associated with the higher prevalence of physical functional limitations for both genders. That association among persons with
Steckler, Taylor J; Brownlee, Michael J; Urick, Benjamin Y; Farley, Matthew J
Pharmacy informatics involves the customization and application of information technology to improve medication-related processes. It is a critical function given the recent expansion of technology and prevalence of medication use throughout healthcare. Despite the necessity for pharmacy involvement, many pharmacists and student pharmacists are unaware of how to get started in informatics. Ideally, training should start early with student pharmacists being enrolled in introductory courses taught by leaders in the field. Students especially interested in informatics can build upon their classroom experience with postgraduate year two (PGY2) residencies in several informatics-related areas. Additionally, current pharmacists can gather information from national pharmacy organizations and local information technology pharmacists to prepare for projects in the field. These approaches provide opportunities for all pharmacists to expand their knowledge and establish the basis for highly-motivated pharmacists to become experts in informatics. Copyright © 2017 Elsevier Inc. All rights reserved.
Full Text Available Anita Ghosh, Vidushi Pradhan Faculty of Medicine, Imperial College London, Kensington, London, UKWe read with great interest the article by Al Achkar et al highlighting the importance of residents-as-teachers (RaT programs.1 The increasing use of RaT instruction resonated with us from a medical student perspective, as a program that should be adapted and implemented as early as medical school to allow students to develop key teaching skills as well as enhance their own learning. The importance of teaching has been recognized by the UK General Medical Council (GMC for many years; however, it still only forms a small part of the current undergraduate curriculum with few medical schools in the UK integrating structured formal training.2 View the original paper by Al Achkar et al
Full Text Available Endocrinology is a relatively newer field in medicine but it has gained tremendous progress in the recent past and is currently one of the most cherished and sought after superspecialty subject. The journey is long and an average of 12 years is spent to complete a superspecialty training starting from Bachelor of Medicine, Bachelor of Surgery career. To get a seat in endocrinology in institutes like PGIMER, Chandigarh is difficult, the training is grueling and the final exit is tough but the vast clinical experience, research oriented teaching and the team work of the closely knit family of faculty members and resident colleagues had made these 3 years of our life as the most enjoyable years to be remembered forever.
In recent years, the internationalization of music education has become an important topic. Scholars of various research traditions try to find the best solutions for problems in music education theory and practice by taking a look at what other countries do. English as common language seems to facilitate this recent development. However, in spite…
Juárez, Sol; Revuelta-Eugercios, Bárbara A; Ramiro-Fariñas, Diego; Viciana-Fernández, Francisco
Evidence suggests that educational differences in perinatal outcomes have increased in some countries (Eastern Europe) while remained stable in others (Scandinavian countries). However, less is known about the experience of Southern Europe. This study aims to evaluate the association between maternal education and perinatal outcomes derived from birthweight (low birthweight and macrosomia) and gestational age (pre-term and post-term births) among Spaniards living in the Autonomous Community of Andalusia during the period 2001-2011 (around 19 % of births in Spain); and to evaluate whether the educational differences narrowed or widened during that period, which includes both an economic boom (2001-2008) and the global economic crisis (2009-2011). This study uses the Andalusian Population Longitudinal Database and the Vital Statistics Data provided by the Spanish National Statistics Institute. We study live and singleton births of Spanish mothers who lived in Andalusia at the time of delivery (n = 404,951). ORs with 95 % confidence intervals (crude and adjusted) were estimated using multinomial regression models. A negative educational gradient is observed in all perinatal outcomes studied (i.e., the higher the educational status, the lower the risk of negative perinatal outcomes). However, when disaggregating the sample in two periods, the gradient is only statistically significant for pre-term birth during 2001-2008, while a full gradient is observed in all perinatal indicators in the period 2009-2011 with an increase in the educational inequalities in macrosomia and post-term. Further studies are needed in order to confirm whether there is a causal association between the widening of the educational differences in perinatal outcomes and the onset of the economic crisis in Spain, or the widening can be explained by other factors, such as changes in childbearing patterns and the composition of women accessing motherhood.
Voelzke, Marcos Rincon; Rodrigues Ferreira, Orlando
The Distance Education [DE] presents significant growth in graduates and postgraduates programs. Regarding this fact, new challenges arise and others must be considered, as the generation gap between digital immigrants and digital natives, the establishment of a population increasingly accustomed to Information and Communication Technologies [ICT] and teaching methodologies that should be used and developed. Vygotsky’s model of social interaction related to mediation can and should be used in DE, and concerning historical, social and cultural approaches affecting Brazilian reality, Paulo Freire is still up-to-date, integrating humanization into the use of ICT. This work only proceeds with analyses of these elements, being an excerpt of the master’s dissertation of one of the authors [Ferreira], under the guidance of another [Voelzke].
Pride, David T; Salzman, Julia; Haynes, Matthew; Rohwer, Forest; Davis-Long, Clara; White, Richard A; Loomer, Peter; Armitage, Gary C; Relman, David A
Viruses are the most abundant known infectious agents on the planet and are significant drivers of diversity in a variety of ecosystems. Although there have been numerous studies of viral communities, few have focused on viruses within the indigenous human microbiota. We analyzed 2 267 695 virome reads from viral particles and compared them with 263 516 bacterial 16S rRNA gene sequences from the saliva of five healthy human subjects over a 2- to 3-month period, in order to improve our understanding of the role viruses have in the complex oral ecosystem. Our data reveal viral communities in human saliva dominated by bacteriophages whose constituents are temporally distinct. The preponderance of shared homologs between the salivary viral communities in two unrelated subjects in the same household suggests that environmental factors are determinants of community membership. When comparing salivary viromes to those from human stool and the respiratory tract, each group was distinct, further indicating that habitat is of substantial importance in shaping human viromes. Compared with coexisting bacteria, there was concordance among certain predicted host–virus pairings such as Veillonella and Streptococcus, whereas there was discordance among others such as Actinomyces. We identified 122 728 virulence factor homologs, suggesting that salivary viruses may serve as reservoirs for pathogenic gene function in the oral environment. That the vast majority of human oral viruses are bacteriophages whose putative gene function signifies some have a prominent role in lysogeny, suggests these viruses may have an important role in helping shape the microbial diversity in the human oral cavity. PMID:22158393
Dupaix, John; Chun, Maria BJ; Belcher, Gary F; Cheng, Yongjun; Atkinson, Robert
Use of mobile tablet computers (MTCs) in residency education has grown. The objective of this study was to investigate the impact of MTCs on multiple specialties' residency training and identify MTC adoption impediments. To our knowledge, this current project is one of the first multispecialty studies of MTC implementation. A prospective cohort study was formulated. In June 2012 iPad2s were issued to all residents after completion of privacy/confidentiality agreements and a mandatory hard-copy pre-survey regarding four domains of usage (general, self-directed learning, clinical duties, and patient education). Residents who received iPads previously were excluded. A voluntary post-survey was conducted online in June 2013. One-hundred eighty-five subjects completed pre-survey and 107 completed post-survey (58% overall response rate). Eighty-six pre- and post-surveys were linked (response rate of 46%). There was a significant increase in residents accessing patient information/records and charting electronically (26.9% to 79.1%; Peducation, clinical practice, and patient education. The survey tool may be useful in collecting data on MTC use by other graduate medical education programs. PMID:27437163
Maizels, Max; Yerkes, Elizabeth B; Macejko, Amanda; Hagerty, Jennifer; Chaviano, Antonio H; Cheng, Earl Y; Liu, Dennis; Sarwark, John P; Corcoran, Julia F; Meyer, Theresa; Kaplan, William E
Residency programs must continue to restructure teaching and assessment of surgical skills to improve the documentation of Accreditation Council for Graduate Medical Education competencies. To improve teaching and documenting resident performance we developed a computer enhanced visual learning method that includes a curriculum and administrative reports. The curriculum consists of 1) study of a step-by-step surgical tutorial of computer enhanced visuals that show specific surgical skills, 2) a checklist tool to objectively assess resident performance and 3) a log of postoperative feedback that is used to structure deliberate practice. All elements of the method are repeated with each case performed. We used the Accreditation Council for Graduate Medical Education index case of orchiopexy to pilot this project. All urology residents who trained at our institution from January 2006 to October 2007 performed orchiopexy using the computer enhanced visual learning method. The computer enhanced visual learning tutorial for orchiopexy consisted of customized computer visuals that demonstrate 11 steps or skills involved in routine inguinal orchiopexy, eg ligate hernia. The attending urologist rated resident competence with each skill using a 5-point Likert scale and provided specific feedback to the resident suggesting ways to improve performance. These ratings were weighted by case difficulty. The computer enhanced visual learning weighted score at entry into the clinical rotation was compared to the best performance during the rotation in each resident. Seven attending surgeons and 24 urology residents (resident training postgraduate years 1 to 8) performed a total of 166 orchiopexies. Overall the residents at each postgraduate year performed an average of 7 cases each with complexity ratings that were not significantly different among postgraduate year groups (average 2.4, 1-way ANOVA p not significant). The 7 attending surgeons did not differ significantly in
Pilar AZNAR MÍNGUET
Full Text Available Sustainable Human Development (hereafter SHD is taking shape as a proposal for progress in the face of a crisis in civilization so complex and far-reaching that it is considered quite difficult to solve. The aim of this article is to offer a reasoned justification of the evolution of the concept of development and of the need for an educational commitment to be able to make progress towards it. Although it is still polemical and the object of criticism, SHD has become consolidated as a strongly ethical proposal to lead the change in the course of development, transversally affecting its multiple dimensions and advocating interdisciplinary and intercultural cooperation and dialogue. The article analyses the challenges posed by SHD to today’s global society, as well as some ways to respond to them from the field of educational action and research. It concludes with a reasoned structuring of the contents of the monograph and an analytical description of the contents of the different contributions.
McCaffrey, Ruth; Hayes, Rose Marie; Cassell, Asenath; Miller-Reyes, Sharmin; Donaldson, Audeane; Ferrell, Cheryl
This article is a report of a study to determine the effect of an educational programme and to follow up weekly meetings on nurses and medical resident's attitudes towards positive communication and collaboration. Clear and appropriate communication and interdisciplinary collaboration is critical to the delivery of quality care. Collaborative practice among all healthcare professionals creates a positive work environment, decreases costs, improves job satisfaction among nurses and improves patient care, as well as decreasing patient morbidity and mortality. Poor communication and lack of teamwork or collaboration have been cited as persistent problems in healthcare. The study was conducted in 2008 - 2009 at a hospital where a new medical residency programme was beginning and nurses had no prior experience working with medical residents. A quasi-experimental pre test, post-test design was used. The Jefferson Scale of Attitudes towards Physician-Nurse Collaboration and the Communication, Collaboration and Critical Thinking for Quality Patient Outcomes Survey tool measured the attitudes of 68 nurses and 47 medical residents in the areas of positive communication and collaboration. The study demonstrates that a formal educational programme and follow-up discussions improved the attitudes of both nurses and medical residents on the Jefferson scale (medical residents t = 4·68, P = 0·001, nurses t = 4·37, P = 0·001) and on the communication scale (medical residents t = 4·23, P = 0·001, nurses t = 4·13, P = 0·001). Continuing education for nurses, medical residents and other healthcare providers may assist in developing positive communication styles and promote collegiality and team work. © 2011 Blackwell Publishing Ltd.
Denson, Steven; Simpson, Deborah; Denson, Kathryn; Brown, Diane; Manzi, Gabriel; Rehm, Judith; Wessel, Bambi; Duthie, Edmund H
Caring for the growing elderly population will require specialty and subspecialty physicians who have not completed geriatric medicine fellowship training to participate actively in patient care. To meet this workforce demand, a sustainable approach to integrating geriatrics into specialty and subspecialty graduate medical education training is needed. This article describes the use of a geriatrics education team (GET) model to develop, implement, and sustain specialty-specific geriatrics curricula using a systematic process of team formation and needs assessment through evaluation, with a unique focus on developing curricular interventions that are meaningful to each specialty and satisfy training, scholarship, and regulatory requirements. The GET model and associated results from 15 specialty residency and fellowship training programs over a 4-year period include 93% curriculum sustainability after initial implementation, more than half of the programs introducing additional geriatrics education, and more than 80% of specialty GETs fulfilling their scholarship requirements through their curriculum dissemination. Win-wins and barriers encountered in using the GET model, along with the model's efficacy in curriculum development, sustainability, and dissemination, are summarized. © 2016, Copyright the Authors Journal compilation © 2016, The American Geriatrics Society.
Kunzel, Carol; Kaur, Satvir; Ahluwalia, Kavita; Darlington, Tanya; Kularatne, Piyumika; Burkett, Sandra; Hou, Derek; Sanogo, Moussa; Murrman, Marita; Edelstein, Burton
Columbia University College of Dental Medicine, in partnership with the Harlem United Community AIDS Center, has developed a service-learning (SL) program for use in the training of Advanced Education in General Dentistry (AEGD) residents. This article presents basic tenets of SL, their applicability for dentistry, and our experience implementing SL in care of people living with HIV/AIDS. It proposes that social-behavioral theory, when incorporated into the basic components of SL, can play a useful role in resolving a number of challenges inherent in competency-based training programs. Although the article provides examples of how a particular theory, the Theory of Planned Behavior, might be applied in the SL context, opportunities for the application of other social-behavioral theories potentially exist.
Pride, David T; Salzman, Julia; Haynes, Matthew; Rohwer, Forest; Davis-Long, Clara; White, Richard A; Loomer, Peter; Armitage, Gary C; Relman, David A
Viruses are the most abundant known infectious agents on the planet and are significant drivers of diversity in a variety of ecosystems. Although there have been numerous studies of viral communities, few have focused on viruses within the indigenous human microbiota. We analyzed 2 267 695 virome reads from viral particles and compared them with 263 516 bacterial 16S rRNA gene sequences from the saliva of five healthy human subjects over a 2- to 3-month period, in order to improve our underst...
Minehart, Rebecca D; Rudolph, Jenny; Pian-Smith, May C M; Raemer, Daniel B
Although feedback conversations are an essential component of learning, three challenges make them difficult: the fear that direct task feedback will harm the relationship with the learner, overcoming faculty cognitive biases that interfere with their eliciting the frames that drive trainees' performances, and time pressure. Decades of research on developmental conversations suggest solutions to these challenges: hold generous inferences about learners, subject one's own thinking to test by making it public, and inquire directly about learners' cognitive frames. The authors conducted a randomized, controlled trial to determine whether a 1-h educational intervention for anesthesia faculty improved feedback quality in a simulated case. The primary outcome was an analysis of the feedback conversation between faculty and a simulated resident (actor) by using averages of six elements of a Behaviorally Anchored Rating Scale and an objective structured assessment of feedback. Seventy-one Harvard faculty anesthesiologists from five academic hospitals participated. The intervention group scored higher when averaging all ratings. Scores for individual elements showed that the intervention group performed better in maintaining a psychologically safe environment (4.3 ± 1.21 vs. 3.8 ± 1.16; P = 0.001), identifying and exploring performance gaps (4.1 ± 1.38 vs. 3.7 ± 1.34; P = 0.048), and they more frequently emphasized the professionalism error of failing to call for help over the clinical topic of anaphylaxis (66 vs. 41%; P = 0.008). Quality of faculty feedback to a simulated resident was improved in the interventional group in a number of areas after a 1-h educational intervention, and this short intervention allowed a group of faculty to overcome enough discomfort in addressing a professionalism lapse to discuss it directly.
Uymaz, Pelin E.; Nahcivan, Nursen O.
Falls are a major cause of morbidity and mortality among the elderly living in nursing homes. There is a need to implement and evaluate fall prevention programs in nursing homes to reduce the number of falls. The purpose of this research was to examine the effect of a nurse-led fall prevention education program in a sample of nursing home…
It is well known that the first years of teaching are a challenge for all beginning teachers. According to the National Commission on Teaching and America's Future's study (2010) first-year teacher attrition has been steadily increasing and many leave the profession even before they are proficient educators who know how to work with colleagues to…
Full Text Available Objectives: Aging is natural course of life which accompanied by changes of metabolism. The exchanges susceptible elderly to malnutrition in researched was do in this back ground about 3-13% of aged population involved to malnutrition that this rate increased to 30-60% in initialized elderly. In this study, we assessed the effects of medical care staff's education on nutritional situation of elderly livid in KAHRIZAK charity Foundation in TEHRAN during 4 months. Methods & Material: 192 elderlies which lived in KCF and equal or older than 65 satisfied in including to this study randomly. (50 males and 142 females although for inclusion they had not involved to an staged liver and renal disease and had not history of surgery during one months before initiated of study. We checked HB, HCT, LDL, HDL, FBS, CRP, ALB, although assessed MNA, MMSE, ADL, Norton sore before and after educational intervention. Educational workshop operated for medical and nursing staffs of KCF during 3 days. Clinical and Para clinical assessments did 4 months, again, after that, and collected data entered to EXEL and analyzed by SPSS soft wares. Results: Before educational intervention 35.9% of elderly had very sever or severe malnutrition that after intervention decreased to 18.3% mean of ALB, HB, HCT, LDL, F.B.S increased after intervention and significant (p<0/05. Nutritional situation correlated to age, mouth and swallowing disorders, poly pharmacy, cognitive condition, ADL score in eating and Norton scores significant. Conclusion: Base of this findings is concluded medical and nursing staffs nursing homes has significant effects on decrease of moderate and severe malnutrition in elderly. Education in this instated have to continues and not cross over like this study for significant Paraclinical improvements of nutritional indicators.
Derrien, M.M.N.; Collado, M.C.; Ben-Amor, K.; Salminen, S.; Vos, de W.M.
A 16S rRNA-targeted probe, MUC-1437, was designed and validated in order to determine the presence and numbers of cells of Akkermansia muciniphila, a mucin degrader, in the human intestinal tract. As determined by fluorescent in situ hybridization, A. muciniphila accounted more than 1% of the total
Ferro, Andrea R; Kopperud, Royal J; Hildemann, Lynn M
Continuous laser particle counters collocated with time-integrated filter samplers were used to measure personal, indoor, and outdoor particulate matter (PM) concentrations for a variety of prescribed human activities during a 5-day experimental period in a home in Redwood City, CA, USA. The mean daytime personal exposures to PM(2.5) and PM(5) during prescribed activities were 6 and 17 times, respectively, as high as the pre-activity indoor background concentration. Activities that resulted in the highest exposures of PM(2.5), PM(5), and PM(10) were those that disturbed dust reservoirs on furniture and textiles, such as dry dusting, folding clothes and blankets, and making a bed. The vigor of activity and type of flooring were also important factors for dust resuspension. Personal exposures to PM(2.5) and PM(5) were 1.4 and 1.6 times, respectively, as high as the indoor concentration as measured by a stationary monitor. The ratio of personal exposure to the indoor concentration was a function of both particle size and the distance of the human activity from the stationary indoor monitor. The results demonstrate that a wide variety of indoor human resuspension activities increase human exposure to PM and contribute to the "personal cloud" effect.
Castrechini, N. M.; Murthi, P.; Gude, N. M.; Erwich, J. J. H. M.; Gronthos, S.; Zannettino, A.; Brennecke, S. R.; Kalionis, B.; Brennecke, S.P.
The chorionic villi of human term placentae are a rich source of mesenchymal stem cells (PMSCs) The stem cell "niche" within the chorionic villi regulates how PMSCs participate in placental tissue generation, maintenance and repair, but the anatomic location of the niche has not been defined A
Al-Ahdal, Mohammed N; Al-Arnous, Walaa K; Bohol, Marie F; Abuzaid, Suhair M; Shoukri, Mohamed M; Elrady, Kamal S; Firdous, Nayyer; Aliyan, Rehab; Taseer, Rabia; Al-Hazzani, Amal A; Al-Qahtani, Ahmed A
Certain genotypes of human papillomavirus (HPV) are linked to cervical abnormalities. HPV DNA and genotype prevalence among women residing in Riyadh, Saudi Arabia is investigated in this hospital-based study. Cervical specimens were taken from 519 subjects along with consent and demographic data. DNA was extracted and PCR was performed on all specimens using general primers. Low- and high-risk HPV genotypes were determined by reverse blot hybridization assay using specific probes. SPSS version 17 was used for the data analysis. Of 519 cervical specimens, 164 (31.6%) were positive for HPV DNA. There was a significant association between HPV positivity and abnormal cytology (p women in Riyadh, Saudi Arabia, with a strong association between HPV infection and cytological changes. HPV-16 was the most frequent genotype but had a low prevalence of cervical cancer.
Kaup, Migette L.; Anderson, Barbara G.; Honey, Peggy
An education based in human ecology can greatly benefit interior designers as they work to understand and improve the human condition. Design programs housed in colleges focusing on human ecology can improve the interior design profession by taking advantage of their home base and emphasizing the human ecological framework in the design curricula.…
Full Text Available Theory of human capital views education as a specific production factor and as a specific sort of capital. Besides this theory, alternative concepts of education were developed. Philter theory which is interested in a selective function of education and created a different point of view of economic analysis phenomena in education. Signal equilibrium states for better or worse according to Pareto´s concept of efficiency and according to higher or lower difference between private and public educational returns.
Nicholson, Roscoe; O'Brien, Catherine
This random assignment waitlist control intervention study examined an implementation of the educational Boost Your Brain and Memory cognitive fitness intervention in 12 senior living organizations. Older adult participants ( n = 166) completed measures of brain health knowledge, use of memory techniques, physical and intellectual activity, and mindfulness, at baseline and after the intervention group's completion of the course. Changes in knowledge scores and in self-reported physical and intellectual activity increased significantly more for intervention participants than for waitlist controls at the conclusion of the course. There were no significant changes between the groups in mindfulness or use of memory techniques. This suggests that in senior living settings Boost Your Brain and Memory is effective in educating participants about brain healthy behaviors and in motivating behavioral change in the areas of physical and intellectual activity.
Chen, Luke Y C; McDonald, Julie A; Pratt, Daniel D; Wisener, Katherine M; Jarvis-Selinger, Sandra
To examine the role of classroom-based learning in graduate medical education through the lens of academic half days (AHDs) by exploring residents' perceptions of AHDs' purpose and relevance and the effectiveness of teaching and learning in AHDs. The authors invited a total of 186 residents in three programs (internal medicine, orthopedic surgery, and hematology) at the University of British Columbia Faculty of Medicine to participate in semistructured focus groups from October 2010 to February 2011. Verbatim transcripts of the interviews underwent inductive analysis. Twenty-seven residents across the three programs volunteered to participate. Two major findings emerged. Purpose and relevance of AHDs: Residents believed that AHDs are primarily for knowledge acquisition and should complement clinical learning. Classroom learning facilitated consolidation of clinical experiences with expert clinical reasoning. Social aspects of AHDs were highly valued as an important secondary purpose. Perceived effectiveness of teaching and learning: Case-based teaching engaged residents in critical thinking; active learning was valued. Knowledge retention was considered suboptimal. Perspectives on the concept of AHDs as "protected time" varied in the three programs. Findings suggest that (1) engagement in classroom learning occurs through participation in clinically oriented discussions that highlight expert reasoning processes; (2) formal classroom teaching, which focuses on knowledge acquisition, can enhance informal learning occurring during clinical activity; and (3) social aspects of AHDs, including their role in creating communities of practice in residency programs and in professional identity formation, are an important, underappreciated asset for residency programs.
Statler, Matt; Monthoux, Pierre Guillet de
An introduction is presented in which the editors discuss various reports within the issue on topics including business management education in Great Britain, liberal arts education, and business studios.......An introduction is presented in which the editors discuss various reports within the issue on topics including business management education in Great Britain, liberal arts education, and business studios....
Watkins, Karen E.; Marsick, Victoria J.
Adult education and human resource development as fields of practice and study share some roots in common but have grown in different directions in their histories. Adult education's roots focused initially on citizenship for a democratic society, whereas human resource development's roots are in performance at work. While they have…
In 2003, the International Baccalaureate Diploma Programme (IBDP)--a program implemented in thousands of schools globally--introduced a human rights course (Makivirta, 2003). This curriculum is the first of its kind to hold potential widespread influence on human rights education in the formal education sector. In this study, I analyze the…
Background/Context: Human rights education has proliferated in the past four decades and can be found in policy discussions, textbook reforms, and grassroots initiatives across the globe. This article specifically explores the role of creativity and imagination in human rights education (HRE) by focusing on a case study of one non-governmental…
In our global age, educational researchers and practitioners need tools that can be applied in a range of contexts and scales: local, national, and international. This article argues that human rights education (HRE) is a site of struggle in which human rights and democracy need to be constantly renewed. It contextualizes HRE within a critical,…
This study aims to obtain teacher perspectives on the civic and human rights education course included in the eighth grade curriculum in Turkish schools. The study group was selected with criterion sampling from among teachers who were teaching the eighth grade civic and human rights education at elementary schools in central Hatay. Using the…
To link a module in human resource management in education to knowledge management, a brief outline of the module and its three approaches are described. The article concludes with an application of knowledge management to the Human Resource Management in Education module. South African Journal of ...
In the "Poetics" of Aristotle there is a definition of the human being that perhaps has not yet been well considered in educational theory and practice. This definition calls into question a dynamism that according to Plato was unavoidable for an appropriate understanding of the educational process that turns a human being into a…
Flores-Crespo has written a timely paper, "Education, employment and human development: illustrations from Mexico". Flores-Crespo uses Amartya Sen's ideas to bring a fresh perspective to bear on the relationship between higher education and human development. Although there is growing interest in applying Sen's ideas in a range of…
The use of the familiar language of learners as medium of instruction (MoI) promotes quality education. However, sixty years after independence, Ghana is still ... Keywords: linguistic human rights, human rights, education, language policy, .... is not a treaty, it has had profound influence on the development of international.
Argues for moral context in nursing education. Discusses steps taken at the University of Colorado School of Nursing to emphasize human caregiving in the curriculum. Also argues that the preferred future for nursing education is a postbaccalaureate program in human caring, health, and healing that leads to the nursing doctorate. (CH)
Human resources in the field of education consists of students, teachers, administrative staff, university students, lecturers, structural employees, educational bureaucrats, stakeholders, parents, the society around the school, and the society around the campus. The existence of human resources need to be cultivated and developed towards the…
Chakraborti, Chayan; Boonyasai, Romsai T; Wright, Scott M; Kern, David E
Teamwork is important for improving care across transitions between providers and for increasing patient safety. This review's objective was to assess the characteristics and efficacy of published curricula designed to teach teamwork to medical students and house staff. The authors searched MEDLINE, Education Resources Information Center, Excerpta Medica Database, PsychInfo, Cumulative Index of Nursing and Allied Health Literature, and Scopus for original data articles published in English between January 1980 and July 2006 that reported descriptions of teamwork training and evaluation results. Two reviewers independently abstracted information about curricular content (using Baker's framework of teamwork competencies), educational methods, evaluation design, outcomes measured, and results. Thirteen studies met inclusion criteria. All curricula employed active learning methods; the majority (77%) included multidisciplinary training. Ten curricula (77%) used an uncontrolled pre/post design and 3 (23%) used controlled pre/post designs. Only 3 curricula (23%) reported outcomes beyond end of program, and only 1 (8%) >6 weeks after program completion. One program evaluated a clinical outcome (patient satisfaction), which was unchanged after the intervention. The median effect size was 0.40 (interquartile range (IQR) 0.29, 0.61) for knowledge, 0.38 (IQR 0.32, 0.41) for attitudes, 0.41 (IQR 0.35, 0.49) for skills and behavior. The relationship between the number of teamwork principles taught and effect size achieved a Spearman's correlation of .74 (p = .01) for overall effect size and .64 (p = .03) for median skills/behaviors effect size. Reported curricula employ some sound educational principles and appear to be modestly effective in the short term. Curricula may be more effective when they address more teamwork principles.
Full Text Available The Council of Emergency Medicine Residency Directors’ (CORD Academy for Scholarship in Education in Emergency Medicine was founded in 2010 to support emergency medicine educators, advance educational methods and scholarship in Emergency Medicine, and foster collaboration among members. As one of the first academies housed in a specialty organization, the CORD Academy concept has been successfully implemented, and has now grown to thirty members in the categories of Distinguished Educator, Academy Scholar, and Academy Member in four focus areas (Teaching and Evaluation; Enduring Educational Materials, Educational Leadership, and Education Research. In this update, the Academy leadership describes the revised academy structure, evolution of the application, and reports the activities of the three Academy pillars – membership/awards/recognition; faculty development and structured programs; and education research and scholarship – in the first five years of the Academy.
Sugar, William A.
This paper presents a potential solution to encourage technology adoption and integration within schools by proposing a human-centered technology "bill of rights" for educators. The intention of this bill of rights it to influence educators' beliefs towards technology and to enable educators to confront with confidence the seemingly…
Dalgaard, Carl-Johan Lars; Sørensen, Anders; Schultz, Esben
Is the wage gap between majors in human arts and other fields caused by the education? If the educational choice is endogenous, the wage gap may instead be caused by selection. We document that individuals' educational choice is correlated with that of older students and by the concentration o...
This paper argues for a mild perfectionism in applying Amartya Sen's capability approach for an education transformative of student agency and well-being. Key to the paper is the significance of education as a process of being and becoming in the future, and education's fundamental objective of a positively changed human being. The capability…
Bradley, Beverly J.; Mancuso, Patty; Cagginello, Joan B.; Board, Connie; Clark, Sandra; Harvel, Robin; Kelts, Susan
It is the position of the National Association of School Nurses (NASN) that age-appropriate health education about human sexuality should be included as part of a comprehensive school health education program and be accessible to all students in schools. NASN recognizes the role of parents and families as the primary source of education about…
Dalgaard, Carl-Johan; Schultz, Esben Anton; Sørensen, Anders
Is the wage gap between majors in human arts and other fields caused by their education per se? If the educational choice is endogenous, the gap may instead be caused by selection. We document that individuals’ educational choice is correlated with that of older students, and argue that it should...
Since the dawn a man has been taking numerous settlement actions in places even useless for this purpose, for example in areas water- or permafrost-stricken. A perfect example of this in European conditions have become households built in Friesland, on the Scandinavian Peninsula (Lapland) and in the western part of Jutland Peninsula. The scale of the building development, created within it neighbourly relations, as well as used on that occasion materials, techniques and technologies seem to be particularly interesting in the case of so-called negative evolution of the human environment and the disappearance of active-citizen attitudes. For these reasons, research undertakes aiming to assess the usefulness of construction and settlement solutions in the past should be regarded as reasonable.
Abdelsattar, Jad M; Pandian, T K; Finnesgard, Eric J; El Khatib, Moustafa M; Rowse, Phillip G; Buckarma, EeeL N H; Gas, Becca L; Heller, Stephanie F; Farley, David R
Preparation of learners for surgical operations varies by institution, surgeon staff, and the trainees themselves. Often the operative environment is overwhelming for surgical trainees and the educational experience is substandard due to inadequate preparation. We sought to develop a simple, quick, and interactive tool that might assess each individual trainee's knowledge baseline before participating in minimally invasive surgery (MIS). A 4-minute video with 5 separate muted clips from laparoscopic procedures (splenectomy, gastric band removal, cholecystectomy, adrenalectomy, and inguinal hernia repair) was created and shown to medical students (MS), general surgery residents, and staff surgeons. Participants were asked to watch the video and commentate (provide facts) on the operation, body region, instruments, anatomy, pathology, and surgical technique. Comments were scored using a 100-point grading scale (100 facts agreed upon by 8 surgical staff and trainees) with points deducted for incorrect answers. All participants were video recorded. Performance was scored by 2 separate raters. An academic medical center. MS = 10, interns (n = 8), postgraduate year 2 residents (PGY)2s (n = 11), PGY3s (n = 10), PGY4s (n = 9), PGY5s (n = 7), and general surgery staff surgeons (n = 5). Scores ranged from -5 to 76 total facts offered during the 4-minute video examination. MS scored the lowest (mean, range; 5, -5 to 8); interns were better (17, 4-29), followed by PGY2s (31, 21-34), PGY3s (33, 10-44), PGY4s (44, 19-47), PGY5s (48, 28-49), and staff (48, 17-76), p Surgery. Published by Elsevier Inc. All rights reserved.
Nicolaou, M.; van Dam, R. M.; Stronks, K.
BACKGROUND: To consider the changes in overall diet quality following migration we examined the associations of acculturation variables and education level with diet in Surinamese South Asian and Surinamese Afro-Caribbean origin on the one hand, and ethnic Dutch residents of the Netherlands on the
Helmes, Edward; van Gerven, Pascal W.M.
The construct of cognitive reserve has primarily been defined in terms of a single proxy measure, education. There may, however, be alternative, potentially additive, proxy measures of cognitive reserve, such as rural or urban residence. Using a large sample of 10,263 older Canadians, ranging in age
Wanderer, Jonathan P; Charnin, Jonathan; Driscoll, William D; Bailin, Michael T; Baker, Keith
Our goal in this study was to develop decision support systems for resident operating room (OR) assignments using anesthesia information management system (AIMS) records and Accreditation Council for Graduate Medical Education (ACGME) case logs and evaluate the implementations. We developed 2 Web-based systems: an ACGME case-log visualization tool, and Residents Helping in Navigating OR Scheduling (Rhinos), an interactive system that solicits OR assignment requests from residents and creates resident profiles. Resident profiles are snapshots of the cases and procedures each resident has done and were derived from AIMS records and ACGME case logs. A Rhinos pilot was performed for 6 weeks on 2 clinical services. One hundred sixty-five requests were entered and used in OR assignment decisions by a single attending anesthesiologist. Each request consisted of a rank ordered list of up to 3 ORs. Residents had access to detailed information about these cases including surgeon and patient name, age, procedure type, and admission status. Success rates at matching resident requests were determined by comparing requests with AIMS records. Of the 165 requests, 87 first-choice matches (52.7%), 27 second-choice matches (16.4%), and 8 third-choice matches (4.8%) were made. Forty-three requests were unmatched (26.1%). Thirty-nine first-choice requests overlapped (23.6%). Full implementation followed on 8 clinical services for 8 weeks. Seven hundred fifty-four requests were reviewed by 15 attending anesthesiologists, with 339 first-choice matches (45.0%), 122 second-choice matches (16.2%), 55 third-choice matches (7.3%), and 238 unmatched (31.5%). There were 279 overlapping first-choice requests (37.0%). The overall combined match success rate was 69.4%. Separately, we developed an ACGME case-log visualization tool that allows individual resident experiences to be compared against case minimums as well as resident peer groups. We conclude that it is feasible to use ACGME case
Heng Giap Woon
Full Text Available Disruption of T cell memory during severe immune suppression results in reactivation of chronic viral infections, such as Epstein Barr virus (EBV and Cytomegalovirus (CMV. How different subsets of memory T cells contribute to the protective immunity against these viruses remains poorly defined. In this study we examined the compartmentalization of virus-specific, tissue resident memory CD8+ T cells in human lymphoid organs. This revealed two distinct populations of memory CD8+ T cells, that were CD69+CD103+ and CD69+CD103-, and were retained within the spleen and tonsils in the absence of recent T cell stimulation. These two types of memory cells were distinct not only in their phenotype and transcriptional profile, but also in their anatomical localization within tonsils and spleen. The EBV-specific, but not CMV-specific, CD8+ memory T cells preferentially accumulated in the tonsils and acquired a phenotype that ensured their retention at the epithelial sites where EBV replicates. In vitro studies revealed that the cytokine IL-15 can potentiate the retention of circulating effector memory CD8+ T cells by down-regulating the expression of sphingosine-1-phosphate receptor, required for T cell exit from tissues, and its transcriptional activator, Kruppel-like factor 2 (KLF2. Within the tonsils the expression of IL-15 was detected in regions where CD8+ T cells localized, further supporting a role for this cytokine in T cell retention. Together this study provides evidence for the compartmentalization of distinct types of resident memory T cells that could contribute to the long-term protection against persisting viral infections.
This article explores some of the tensions that are created from the entanglement of religion and human rights and offers a possible response to these tensions in the context of religious education in conflict-troubled societies. It is suggested that a historicised and politicised approach in religious education in conjunction with human rights…
Burden, Amanda R; Pukenas, Erin W; Deal, Edward R; Coursin, Douglas B; Dodson, Gregory M; Staman, Gregory W; Gratz, Irwin; Torjman, Marc C
Cardiopulmonary arrests are rare, high-stakes events that benefit from using crisis resource management (CRM). Simulation-based education with deliberate practice can promote skill acquisition. We assessed whether using simulation-based education to teach CRM would lead to improved performance, compared to a lecture format. We tested third-year internal medicine residents in simulated code scenarios. Participants were randomly assigned to simulation-based education with deliberate practice (SIM) group or lecture (LEC) group. We created a checklist of CRM critical actions (which includes announcing the diagnosis, asking for help/suggestions, and assigning tasks), and reviewed videotaped performances, using a checklist of skills and communications patterns to identify CRM skills and communication efforts. Subjects were tested in simulated code scenarios 6 months after the initial assessment. At baseline, all 52 subjects recognized distress, and 92% (48 of 52) called for help. Seventy-eight percent (41 of 52) did not succeed in resuscitating the simulated patient or demonstrate the CRM skills. After intervention, both groups (n = 26 per group) improved. All SIM subjects announced the diagnosis compared to 65% LEC subjects (17 of 26, P = .01); 77% (20 of 26) SIM and 19% (5 of 26) LEC subjects asked for suggestions (P < .001); and 100% (26 of 26) SIM and 27% (7 of 26) LEC subjects assigned tasks (P < .001). The SIM intervention resulted in significantly improved team communication and cardiopulmonary arrest management. During debriefing, participants acknowledged the benefit of the SIM sessions.
Zhang, Lei; Liu, Yin-ping; Li, Jing-guang; Zhao, Yun-feng; Wu, Yong-ning
To investigate contamination levels of polychlorinated dibenzo-p-dioxins and dibenzofurans (PCDD/Fs) and dioxin-like polychlorinated biphenyls (dl-PCBs) in human breast milk from Beijing residents, and evaluate the human body burden of PCDD/Fs and dl-PCBs of general population. A total of 110 human milk samples were collected from 11 regions in Beijing in 2007. After 11 pooled samples were made, concentrations of PCDD/Fs and dl-PCBs in breast milk pooled samples were measured by a high resolution gas chromatography - high resolution mass spectrometry (HRCG-HRMS) with isotope dilution. For congeners of PCDD/Fs and dl-PCBs in human breast milk from Beijing, the highest content of congeners was octachlorodibenzo-p-dioxin (OCDD), polychlorinated biphenyl (PCB)-118, and PCB-105 with the median of 20.6 pg/g fat, 4.07 ng/g fat and 1.63 ng/g fat, respectively. The concentration median of total dioxins in 11 pooled human milk samples from Beijing was 7.4 pg TEQ/g fat. The highest was 13.5 pg TEQ/g fat from Tongzhou, and the lowest was 4.3 pg TEQ/g fat from Pinggu. The contamination level of PCDD/Fs and dl-PCBs in human milk from Beijing is relatively low. However, with the rapid industrialization in China, the human body burden of PCDD/Fs and dl-PCBs will be likely to rise. Thus, further studies should be conducted to continuously monitor the trend of contamination level.
Grace, Aimee M; Lippert, Suzanne; Collins, Kristin; Pineda, Noelle; Tolani, Alisha; Walker, Rebecca; Jeong, Monica; Trounce, Milana Boukhman; Graham-Lamberts, Caroline; Bersamin, Melina; Martinez, Jeremy; Dotzler, Jennifer; Vanek, John; Storfer-Isser, Amy; Chamberlain, Lisa J; Horwitz, Sarah M
The US Department of State estimates that there are between 4 and 27 million individuals worldwide in some form of modern slavery. Recent studies have demonstrated that 28% to 50% of trafficking victims in the United States encountered health care professionals while in captivity, but were not identified and recognized. This study aimed to determine whether an educational presentation increased emergency department (ED) providers' recognition of human trafficking (HT) victims and knowledge of resources to manage cases of HT. The 20 largest San Francisco Bay Area EDs were randomized into intervention (10 EDs) or delayed intervention comparison groups (10 EDs) to receive a standardized educational presentation containing the following: background about HT, relevance of HT to health care, clinical signs in potential victims, and referral options for potential victims. Participants in the delayed intervention group completed a pretest in the period the immediate intervention group received the educational presentation, and all participants were assessed immediately before (pretest) and after (posttest) the intervention. The intervention effect was tested by comparing the pre-post change in the intervention group to the change in 2 pretests in the delayed intervention group adjusted for the effect of clustering within EDs. The 4 primary outcomes were importance of knowledge of HT to the participant's profession (5-point Likert scale), self-rated knowledge of HT (5-point Likert scale), knowledge of who to call for potential HT victims (yes/no), and suspecting that a patient was a victim of HT (yes/no). There were 258 study participants from 14 EDs; 141 from 8 EDs in the intervention group and 117 from 7 EDs in the delayed intervention comparison group, of which 20 served as the delayed intervention comparison group. Participants in the intervention group reported greater increases in their level of knowledge about HT versus those in the delayed intervention comparison
Azarnert, Leonid V.
This paper analyzes the consequences of integration in public education. I show that the flight from the integrated multicultural public schools to private education increases private educational expenditures and, as a result, decreases fertility among more affluent parents whose children flee. In contrast, among less prosperous parents…
Strumwasser, Aaron; Grabo, Daniel; Inaba, Kenji; Matsushima, Kazuhide; Clark, Damon; Benjamin, Elizabeth; Lam, Lydia; Demetriades, Demetrios
Trauma training in general surgery residency is undergoing an evolution. Hour restrictions, the growth of subspecialty care, and the trend toward nonoperative management have altered resident exposure to operative trauma. We sought to identify trends in resident trauma training since the inception of the 80-hour workweek. The Accreditation Council for General Medical Education Case Log Statistical Reports for Surgery was abstracted for general surgery resident trauma operative volume for the years 1999-2014. Resident trauma experience (operative caseload [OC]) was compared before inception of the 80-hour workweek (1999-2002) to after the 80-hour workweek began (2003 to current). A trend toward decreased operative trauma for general surgery residents was observed (mean OC [before 80-hour workweek vs. 80-hour workweek], 39,252 ± 1,065.2 cases vs. 36,065 ± 1,291.8; p = 0.06). Trauma laparotomies increased (range, 5,446-9,364 cases) with corresponding decreases in vascular trauma (4,704 to 799 cases), neck explorations (1,876 to 1,370 cases), and thoracotomies (2,507 to 2,284 cases). By comparison, an increase in vascular/integrated cases was noted (mean OC [before 80-hour workweek vs. 80-hour workweek], 845 ± 44.2 vs. 1,465 ± 88.4 cases; p surgery (p surgery.
Steen, Julie A.; Mathiesen, Sally
This article presents a descriptive assessment of human rights education within schools of social work and law. A review of course titles and descriptions within MSW programs and law programs was conducted for identification of human rights content. The results suggest a dearth of human rights content in social work curricula and a great disparity…
Siddiqui, Jamila R.
The future viability of the humanities in higher education has been broadly debated. Yet, most of these debates are missing an important consideration. The humanities' object of study is the human, an object that some would argue has been replaced in our onto-epistemological systems by the posthuman. In her 2013 book, "The Posthuman,"…
Asserts that incorporating human rights issues into the curriculum causes tensions, especially in nations with histories of military dictatorships. Describes human rights education in Chile and other Latin American nations. Discusses whether human rights should be a separate curriculum subject or integrated into all courses. (CFR)
In human development, conscious efforts are made to enlarge ... decent living. Obviously, sustained improvement in African human development still falls short of those experienced in other regions. Progress in African human development is majorly driven ..... who missed formal education at certain stage in life that they can.
Winkler, Michael; Hobbs, Stephen; Charnigo, Richard; Embertson, Ryan; Daugherty, Michael; Hall, Michael; Brooks, Michael; Leung, Steve; Sorrell, Vince
Rationale and Objectives Coronary artery calcium (CAC) scoring is an excellent imaging tool for subclinical atherosclerosis detection and risk stratification. We hypothesize that although CAC has been underreported in the past on computed tomography (CT) scans of the abdomen, specialized resident educational intervention can improve on this underreporting. Materials and Methods Beginning July 2009, a dedicated radiology resident cardiac imaging rotation and curriculum was initiated. A retrospective review of the first 500 abdominal CT reports from January 2009, 2011 and 2013 was performed including studies originally interpreted by a resident as well as primary attending physician interpretations. Each scan was re-evaluated for presence or absence of CAC and coronary artery disease (CAD) by a cardiovascular CT expert reader. These data were then correlated to determine if the presence of CAC had been properly reported initially. The results of the three time periods were compared to assess for improved rates of CAC and CAD reporting after initiation of a resident cardiac imaging curriculum. Results Statistically significant improvements in the reporting of CAC and CAD on CT scans of the abdomen occurred following the initiation of formal resident cardiac imaging training which included two rotations (4 weeks each) of dedicated cardiac CT and cardiac MRI interpretation during the resident's 2nd, 3rd, or 4th radiology training years. The improvement was persistent and increased over time, improving from 1% to 72% after two years and to 90% after four years. Conclusion This single center retrospective analysis shows association between implementation of formal cardiac imaging training into radiology resident education and improved CAC detection and CAD reporting on abdominal CT scans. PMID:25579636
Taylor, Taryn S; Teunissen, Pim W; Dornan, Tim; Lingard, Lorelei
Although one proposed solution to the problem of fatigued medical trainees is the implementation of work hours regulations, concerns about the effectiveness of these regulations are growing. Canada remains one of the few Western jurisdictions without legislated regulation. Recent research suggests that fatigue is a complex social construct, rather than simply a lack of sleep; thus, the authors explored how regulations and fatigue are understood in countries with established work hours frameworks to better inform other jurisdictions looking to address trainee fatigue. Using constructivist grounded theory methodology, the authors conducted individual, semistructured interviews in 2015-2016 with 13 postgraduate medical trainees from four European countries with established work hours regulations. Data collection and analysis proceeded iteratively, and the authors used a constant comparative approach to analysis. Trainees reported that they were commonly fatigued and that they violated the work hours restrictions for various reasons, including educational pursuits. Although they understood the regulations were legislated specifically to ensure safe patient care and optimize trainee well-being, they also described implicit meanings (e.g., monitoring for trainee efficiency) and unintended consequences (e.g., losing a sense of vocation). Work hours regulations carry multiple, conflicting meanings for trainees that are captured by three predominant rhetorics: the rhetoric of patient safety, of well-being, and of efficiency. Tensions within each of those rhetorics reveal that managing fatigue within clinical training environments is complex. These findings suggest that straightforward solutions are unlikely to solve the problem of fatigue, assure patient safety, and improve trainee well-being.
Price, J L; Cleary, B
Clearly, faculty must work hard with residents to explore the nature of their resistance to a program's learning and growth opportunities. Initial steps to a deeper, more effective, and longer-lasting change process must be pursued. If resident resistance is mishandled or misunderstood, then learning and professional growth may be sidetracked and the purposes of residency training defeated. Listening to the whole person of the resident and avoiding the trap of getting caught up in merely responding to select resident behaviors that irritate us is critical. Every faculty member in the family practice residency program must recognize resistance as a form of defense that cannot immediately be torn down or taken away. Resident defenses have important purposes to play in stress reduction even if they are not always healthy. Residents, especially interns, use resistance to avoid a deeper and more truthful look at themselves as physicians. A family practice residency program that sees whole persons in their residents and that respects resident defenses will effectively manage the stress and disharmony inherent to the resistant resident.
Sherbino, Jonathan; Joshi, Nikita; Lin, Michelle
In health professionals' education, senior learners play a key role in the teaching of junior colleagues. We describe an online discussion about residents as teachers to highlight the topic and the online journal club medium. In January 2015, the Journal of Graduate Medical Education (JGME) and the Academic Life in Emergency Medicine blog facilitated an open-access, online, weeklong journal club on the JGME article "What Makes a Great Resident Teacher? A Multicenter Survey of Medical Students Attending an Internal Medicine Conference." Social media platforms used to promote asynchronous discussions included a blog, a video discussion via Google Hangouts on Air, and Twitter. We performed a thematic analysis of the discussion. Web analytics were captured as a measure of impact. The blog post garnered 1324 page views from 372 cities in 42 countries. Twitter was used to endorse discussion points, while blog comments provided opinions or responded to an issue. The discussion focused on why resident feedback was devalued by medical students. Proposed explanations included feedback not being labeled as such, the process of giving delivery, the source of feedback, discrepancies with self-assessment, and threats to medical student self-image. The blog post resulted in a crowd-sourced repository of resident teacher resources. An online journal club provides a novel discussion forum across multiple social media platforms to engage authors, content experts, and the education community. Crowd-sourced analysis of the resident teacher role suggests that resident feedback to medical students is important, and barriers to student acceptance of feedback can be overcome.
U.S. Department of Health & Human Services — The MDS Active Resident Report summarizes information for residents currently in nursing homes. The source of these counts is the residents MDS assessment record....
Kovalev, A V; Romanenko, G Kh; Makarov, I Yu; Vladimirov, V Yu; Bereznikov, A V
The objective of the present study was the development and implementation of the educational program for the training of the highly qualified specialists within the framework the clinical residency and internship in the speciality 31.08.10 'forensic medical expertise' aimed at the adherence to and the maintenance of the systemic approach to the training in compliance with the upgraded regulatory documents at the medical institutions of the Russian Federation authorized to carry out post-graduate educational activities. The residency program for the training of the highly qualified specialists in the speciality 31.08.10 'forensic medical expertise' has been developed and implemented based at the Russian Federal Centre of Forensic Medical Expertise with the extension of the elective part of the working residency program in order to provide the delivery of the lectures and holding seminars on the selected issues of forensic medicine and criminalistics. The ongoing modernization of the healthcare system in this country taking into consideration the public needs and the challenges for practical medicine, the necessity of formation of the integral educational medium, the development of the unique systemic approach to the effective training of the highly qualified specialists in forensic medical expertise, and further optimization of the educational process are intended to propel forensic medical education and the training of the forensic medical experts to the qualitatively new level.
... NATIONAL SCIENCE FOUNDATION Advisory Committee for Education and Human Resources; Notice of..., technology, engineering, and mathematics (STEM) education and human resources programming. Agenda May 6, 2013... Science Foundation announces the following meeting: Name: Advisory Committee for Education and Human...
Strkalj, Goran; Spocter, Muhammad A.; Wilkinson, A. Tracey
It is argued in this article that the human body both in health and disease cannot be fully understood without adequately accounting for the different levels of human variation. The article focuses on variation due to ancestry, arguing that the inclusion of information pertaining to ancestry in human anatomy teaching materials and courses should…
Garcia, Melissa N; O'Day, Sarah; Fisher-Hoch, Susan; Gorchakov, Rodion; Patino, Ramiro; Feria Arroyo, Teresa P; Laing, Susan T; Lopez, Job E; Ingber, Alexandra; Jones, Kathryn M; Murray, Kristy O
Chagas disease (Trypanosoma cruzi infection) is the leading cause of non-ischemic dilated cardiomyopathy in Latin America. Texas, particularly the southern region, has compounding factors that could contribute to T. cruzi transmission; however, epidemiologic studies are lacking. The aim of this study was to ascertain the prevalence of T. cruzi in three different mammalian species (coyotes, stray domestic dogs, and humans) and vectors (Triatoma species) to understand the burden of Chagas disease among sylvatic, peridomestic, and domestic cycles. To determine prevalence of infection, we tested sera from coyotes, stray domestic dogs housed in public shelters, and residents participating in related research studies and found 8%, 3.8%, and 0.36% positive for T. cruzi, respectively. PCR was used to determine the prevalence of T. cruzi DNA in vectors collected in peridomestic locations in the region, with 56.5% testing positive for the parasite, further confirming risk of transmission in the region. Our findings contribute to the growing body of evidence for autochthonous Chagas disease transmission in south Texas. Considering this region has a population of 1.3 million, and up to 30% of T. cruzi infected individuals developing severe cardiac disease, it is imperative that we identify high risk groups for surveillance and treatment purposes.
Kathleen F. Richards
Full Text Available Using a cell culture model where virus is bound to the extracellular matrix (ECM prior to cell surface binding, we determined that human papillomavirus type 16 (HPV16 utilizes ECM resident laminin (LN 332 as an attachment receptor for infectious entry. In presence of LN332, soluble heparin can function as ligand activator rather than competitive inhibitor of HPV16 infection. We also show that the ability to use LN332 binding as a productive attachment step for infectious entry is not conserved amongst HPV types. In the alpha genus, species 9 members (HPV16 attach to ECM via LN332, while members of species 7 (HPV18 are completely inhibited by heparin pre-incubation due to an inability to use LN332. Since HPV species 7 and 9 are preferentially associated with adenocarcinoma and squamous cell carcinoma of the cervix, respectively, our data provide first evidence that pre-entry events may contribute to the anatomical-site preference of HPV species.
Melissa N Garcia
Full Text Available Chagas disease (Trypanosoma cruzi infection is the leading cause of non-ischemic dilated cardiomyopathy in Latin America. Texas, particularly the southern region, has compounding factors that could contribute to T. cruzi transmission; however, epidemiologic studies are lacking. The aim of this study was to ascertain the prevalence of T. cruzi in three different mammalian species (coyotes, stray domestic dogs, and humans and vectors (Triatoma species to understand the burden of Chagas disease among sylvatic, peridomestic, and domestic cycles.To determine prevalence of infection, we tested sera from coyotes, stray domestic dogs housed in public shelters, and residents participating in related research studies and found 8%, 3.8%, and 0.36% positive for T. cruzi, respectively. PCR was used to determine the prevalence of T. cruzi DNA in vectors collected in peridomestic locations in the region, with 56.5% testing positive for the parasite, further confirming risk of transmission in the region.Our findings contribute to the growing body of evidence for autochthonous Chagas disease transmission in south Texas. Considering this region has a population of 1.3 million, and up to 30% of T. cruzi infected individuals developing severe cardiac disease, it is imperative that we identify high risk groups for surveillance and treatment purposes.
Wanderley Matos Reis Júnior
Full Text Available OBJECTIVE: to identify the prevalence of the factors associated with pre-frailty and frailty of elderly residents in a municipality with a low Human Development IndexMETHOD: Cross-sectional study with a populational and household framework conducted with 316 elderly people. Frailty was determined from the presence of three or more of the following factors: (i self-reported unintentional weight loss; (ii lack of strength and energy; (iii weakness; (iv slowness; (v low level of physical activity. The association between frailty and socio-demographic, behavioral and health factors was measured using the multinomial logistic regression technique.RESULTS: The prevalence of pre-frailty and frailty was 58.7% and 23.8%, respectively. The adjusted regression model showed that the state of pre-frailty was associated with gender, age group and BMI, and frailty was associated with gender, age group, hospitalization, functional capacity, and self-perceived health.CONCLUSION: The evidence presented in this study demonstrates more variables associated with the frailty condition, reinforcing the concept of a multifactorial clinical syndrome that may result in the loss of functionality.