Paediatricians�� validation of learning objectives in paediatric cardiology

BACKGROUND

The current objectives for teaching paediatric cardiology to paediatric residents have not been validated and may not be relevant to current paediatric practice.

OBJECTIVES

To validate the cardiology component of the Royal College of Physician and Surgeons of Canada’s objectives for training paediatricians.

METHODS

A questionnaire was sent to practising paediatricians in Atlantic Canada. The questions were based on the Royal College of Physician and Surgeons of Canada’s training objectives. The frequency of problems seen, confidence in assessment and management of problems, and reasons for referral were identified. Clinical vignettes were followed by short questions. The outpatient referrals were reviewed to validate the questionnaire responses.

RESULTS

One hundred fifty-one questionnaires were mailed and the response rate was 60%. Murmurs were the most common problem encountered (92%). Syncope (9%), Kawasaki disease (8%) and chest pain (6%) were less frequently encountered. Paediatricians were confident in assessing and managing problems despite the low frequency of encounters. Less confidence was expressed regarding physical examination skills and interpretation of electrocardiograms. Uncertainty of the diagnosis was the most common reason for patient referral, with parental anxiety and medicolegal concerns accounting for 24% and 7% of referrals, respectively. Syncope with exercise was relatively poorly recognized as a worrisome symptom.

CONCLUSIONS

Most cardiology objectives for general paediatric training remain relevant and appropriate to clinical practice. Physical examination skills, electrocardiogram interpretation and the assessment of syncope need to be emphasized.     

Required research by medical students and their choice of a women's health care residency

OBJECTIVE: This study searches for association between the subject of medical students' required research projects and subsequent choices of residency, focusing specifically on women's health fields. STUDY DESIGN: Students at our school graduating between 1997 and 2004 (n = 535) were required to undertake a research project beginning in the preclinical years. The subject of their required research project was related to their subsequent choice of residency. RESULTS: Ninety-nine of the 535 projects (18.5%) were women's health related. Although overall there was no significant relationship between the research project and residency choice, students who completed a women's health care project were nearly twice (1.8, 95% CI, 1.4-2.3) as likely to enter a women's health (obstetrics and gynecology or family medicine) residency than those who did not. CONCLUSION: An association exists between student participation in women's health research beginning during preclinical years and the subsequent choice of a women's health residency.     

浙江省以在职方式开展全科医师规范化培训状况分析及对策研究

目的研究对策来推动全省全科医师规范化培训工作。方法调研浙江省各地市开展全科医师规范化培训情况。结果主要存在宣传不到位，政策未落实，课程设置中全科医学特色不够突出，培训基地建设不够完善，师资队伍不足等问题。结论要加大宣传力度，严格执行有关政策规定，扩大培训范围；改进医学计划，并完善教材建设；严格审核培训基地准入条件；加强师资队伍建设。     

Inadequacy and indebtedness: no-fee psychotherapy in county training programs

The nature of the fee arrangement has significant influence on the psychotherapeutic process even when there is no fee. Given the large number of psychiatrists who receive at least some part of their training in the public system, understanding the no-fee arrangement is vital to the psychodynamic training of future psychiatrists. Following a brief overview of the meaning of money and the fee arrangement, various scenarios are considered under the headings of "inadequacy" and "indebtedness. "Although similar dynamics may be present in other public and private settings, attention is given to the county training program, with the intent to assist psychiatry residents and supervisors in their awareness and understanding of the psychodynamics of psychotherapy without fee.     

Resident job satisfaction: will 80 hours make a difference?

OBJECTIVE: This study was undertaken to assess job satisfaction and quality of life among obstetrics and gynecology residents before the 80-hour work week. STUDY DESIGN: We administered a job satisfaction survey to residents before July 1, 2003, assessing satisfaction with residency training, indicators of current quality of life, and predictions for the effect of reduced work hours. RESULTS: Residents were satisfied with training, with important outliers, including leisure time, ability to pursue educational reading, and surgical experience. We created job satisfaction facets that were generally reliable constructs and valid predictors for overall residency satisfaction. Residents predict more free time and a healthier lifestyle under the new requirements, but do not anticipate using additional time to study or teach. CONCLUSION: Job satisfaction facets for residents are proposed here and may be refined through further study. Lower scores for surgical experience are of concern in light of decreasing work hours. Educators must monitor self-directed learning efforts under new work hours.     

Attitudes of applicants for surgical residency toward work hour limitations

BACKGROUND: There is an ongoing debate regarding the merits of resident work-hour limitations. We postulated that this issue would be a factor in the decision-making process of applicants to surgical residency. METHODS: Candidates for surgical residency at a university-based program completed an anonymous survey during their visit. Data was analyzed by analysis of variance and the chi-square test. RESULTS: Most candidates viewed work-hour limitations as being favorable to their future training. Nevertheless, work-hour limitations ultimately were not a critical factor in the decision-making process compared with issues such as quality of training and program reputation. Candidates ranked "reading in surgery" the most likely way they would spend the leisure time afforded by work-hour limitations. CONCLUSIONS: Most applicants for surgical residency consider work hour-limitations as being favorable to their training and view the extra free time as an opportunity for furthering their education. However, other issues take precedence when choosing a residency.     

Meeting the Accreditation Council for Graduate Medical Education competencies using established residency training program assessment tools

BACKGROUND: Most existing residency evaluation tools were constructed to evaluate the Accreditation Council for Graduate Medical Education (ACGME) competencies. METHODS: Before ACGME's six competency based assessment requirements for resident performance were developed, we created a residency evaluation tool with 5 domains important to successful surgical resident performance. Reliability was determined after 6 months of use. Factor analysis assessed whether the evaluation tool was a construct-valid measure of the ACGME competencies. RESULTS: Three hundred forty-three evaluations for 36 surgical residents were tested. The original evaluation tool was highly reliable with an overall reliability of 0.97. Factor analysis defined 4 new combinations of questions analogous to 4 of the ACGME competencies: professionalism (reliability 0.95), patient care (reliability 0.93), medical knowledge (reliability 0.92), and communication (reliability 0.92). The new competency clusters were correlated with each other to a moderate degree. CONCLUSIONS: Our locally developed tool demonstrated high reliability and construct validity for 4 of 6 ACGME competencies. The correlation between factors suggests overlap between competencies.     

Hepatosplenic morbidity in two neighbouring communities in Uganda with high levels of Schistosoma mansoni infection but very different durations of residence

Peri-portal fibrosis can be a serious sequelae of Schistosoma mansoni infection. Age or duration of exposure have been identified as important risk factors, but their relative importance cannot be easily separated. Here, we have compared two cohorts, aged 6-50 years and resident for ten years or since birth, from two neighbouring villages (Booma and Bugoigo) on the eastern shore of Lake Albert, Uganda. Parasitological measurements were similar, whereas the prevalence of peri-portal fibrosis was 5-fold higher in Booma. Data from the cohorts were pooled to assess the relative contribution of age and duration of residency on the risk of disease. Amongst adults, duration of residency was the critical risk factor--individuals aged 17-31 years resident for more 22 years had an almost 12-fold increased risk of fibrosis than those resident for less than 15 years. Height-standardised Splenic Vein Diameter (SVD), Portal Vein Diameter (PVD), Para-sternal Liver Length (PLL) and Spleen Length (SL) values were all higher in Booma, and each organometric parameter except PLL increased with the severity of fibrosis. Our results clearly demonstrate that duration of exposure is a critical risk factor for the development of peri-portal fibrosis and its sequelae in adults. This parameter should therefore be a routine measurement during epidemiological surveys of S. mansoni.     

模拟教学联合心理暗示在耳鼻咽喉头颈外科住培模拟教学中的应用

目的 分析模拟教学联合心理暗示在耳鼻咽喉头颈外科住培模拟教学中的应用价值。方法 选取于清华大学附属北京清华长庚医院耳鼻咽喉头颈外科进行住培的36例住培医师,按不同教学模式将其分为研究组（n=20,模拟教学联合心理暗示）与对照组（n=16,传统教学）。比较两组住培医师考核成绩、综合能力、教学效果及教学满意度。采用SPSS 22.0进行t检验和卡方检验。结果 带教后,两组住培医师理论考试、技能考核成绩、学习兴趣、自学能力、沟通能力及临床诊疗水平评分均较带教前上升,且研究组上升程度明显优于对照组（P<0.05）。研究组兴趣程度、难易程度、可参与性、掌握程度评分均明显高于对照组（P<0.05）。研究组住培医师教学总满意度为95.00%,明显高于对照组的68.75%（P<0.05）。结论 模拟教学联合心理暗示在耳鼻咽喉头颈外科住培教学中可提高学员理论知识、技能操作水平、综合能力及教学水平,且学员对该教学方法满意度高。