Perspective: Integrating research into surgical residency education: lessons learned from orthopaedic surgery

Orthopaedic research has advanced tremendously in parallel with accelerated progress in medical science. Possession of a fundamental understanding of basic and clinical science has become more essential than previously for orthopaedic surgeons to be able to translate advances in research into clinical practice. The number of medical graduates with prior education in scientific research who choose to pursue careers in orthopaedic surgery is small. Therefore, it is important that a core of research education be included during residency training to ensure the continued advancement of the clinical practice of orthopaedics. The authors examine some of the challenges to a comprehensive research experience during residency, including deficient priority, inadequate institutional infrastructure, financial strain on residency budgets, restricted time, and an insufficient number of mentors to encourage and guide residents to become clinician-scientists. They also present some strategies to overcome these challenges, including development and expansion of residency programs with clinician-scientist pathways, promotion of financial sources, and enhancement of opportunities for residents to interact with mentors who can serve as role models. Successful integration of research education into residency programs will stimulate future orthopaedic surgeons to develop the critical skills to lead musculoskeletal research, comprehend related discoveries, and translate them into patient care. Lessons learned from incorporating research training within orthopaedic residency programs will have broad application across medical specialties-in both primary and subspecialty patient care.     

Evidence-Based Medicine: What Is It and How Does It Apply to Athletic Training?

OBJECTIVE: To introduce the concept of evidence-based medicine (EBM) to athletic trainers. This overview provides information on how EBM can affect the clinical practice of athletic training and enhance the care given to patients. DATA SOURCES: We searched the MEDLINE and CINHAL bibliographic databases using the terms evidence-based medicine and best practice and the online Index to Abstracts of Cochrane Reviews by group (injury, musculoskeletal injuries, and musculoskeletal) to identify reviews on topics pertinent to athletic training. DATA SYNTHESIS: Evidence-based medical practice has 5 components: defining a clinically relevant question, searching for the best evidence, appraising the quality of the evidence, applying the evidence to clinical practice, and evaluating the process. Evidence-based medicine integrates the research evidence, clinician's expertise, and patient's preferences to guide clinical decision making. Critical to this effort is the availability of quality research on the effectiveness of sports medicine techniques. Athletic training outcomes research is lagging behind that of other health care professions. RECOMMENDATIONS: Athletic trainers need to embrace the critical-thinking skills to assess the medical literature and incorporate it into their clinical practice. The profession should encourage more clinically related research and enhance the scientific foundation of athletic training. Evidence-based medicine provides an important next step in the growth of the athletic training profession.     

The Center for Clinical Epidemiology and Biostatistics of the Perelman School of Medicine at the University of Pennsylvania: an organizational model for clinical research in a school of medicine

A new model for the conduct of clinical research was established at the University of Pennsylvania (Penn) School of Medicine, now the Perelman School of Medicine, through the development of the interdepartmental Center for Clinical Epidemiology and Biostatistics in 1993 and the basic science Department of Biostatistics and Epidemiology in 1994. The authors describe the development and evolution of these novel structures.Five key objectives were achieved with these structures' creation: (1) Clinical faculty have the opportunity to be identified as both clinicians and epidemiologists, (2) nonclinical faculty have an academic "home," (3) clinical trainees are now educated in population medicine, which promotes its incorporation into their clinical practice, (4) population medicine and clinical medicine have become fully integrated, and (5) better epidemiologic research is conducted, informed by clinical insights.Today's center is the primary home for epidemiology and biostatistics at Penn, linking epidemiology, biostatistics, clinical medicine, and the health sciences. The center's core faculty manage their own research programs, conduct primary research in epidemiology and biostatistics, serve as members of collaborative research teams, manage cores and service centers that support research projects, and lead graduate training programs in epidemiology and biostatistics. The department provides an academic home and structure for faculty, provides primary research in epidemiology and biostatistics, supports the center's mission, and provides training in biostatistics. This organizational approach has wide applicability across schools of medicine in the United States and abroad and has been a model for many.     

Why technology matters as much as science in improving healthcare

ABSTRACT: BACKGROUND: More than half a million new items of biomedical research are generated every year and added to Medline. How successful are we at applying this steady accumulation of scientific knowledge and so improving the practice of medicine in the USA? DISCUSSION: The conventional wisdom is that the US healthcare system is plagued by serious cost, access, safety and quality weaknesses. A comprehensive solution must involve the better translation of an abundance of clinical research into improved clinical practice.Yet the application of knowledge (i.e. technology) remains far less well funded and less visible than the generation, synthesis and accumulation of knowledge (i.e. science), and the two are only weakly integrated. Worse, technology is often seen merely as an adjunct to practice, e.g. electronic health records.Several key changes are in order. A helpful first step lies in better understanding the distinction between science and technology, and their complementary strengths and limitations. The absolute level of funding for technology development must be increased as well as being more integrated with traditional science-based clinical research. In such a mission-oriented federal funding strategy, the ties between basic science research and applied research would be better emphasized and strengthened.     

Editorial: review and commentary section

Is this the era of empirically supported practice? If it isnot, it is up to us to make it so. Many of us were trained inthe scientist–practitioner framework of the Boulder model,now almost 60 years old, which emphasized training in both researchand practice for clinical psychologists, and which seems tomake the implicit assumption that the "science" training wouldhelp to make the "practice" activities more empirically-based.Almost 60 years later, we now have a greater appreciation forthe difficulties of translating research into practice. As complicatedas it may be to integrate science and practice into a singlecareer, it may be even more difficult to find ways to have scienceinfuse our clinical activities so that the knowledge base ofclinical psychology guides our clinical work whenever possible. Currently,     

Formación de especialistas en Latinoamérica: Argentina

In Argentina there are 36 schools of medicine, 13 of them public, with autonomy and freedom of teaching but that conform to the requirements of accreditation from the National Committee of Evaluation and Accreditation, that guarantees the quality of education through a minimum amount of training and practice. It is divided in 3 cycles: the biomedical cycle, the clinical cycle and the rotary annual boarding school. Around 4,600 and 5,500 medical students graduate annually. The degree from public and private schools of medicine enables graduates to work professionally in all the national territory. The specialty is obtained in different ways (internship, formal or informal supervised training practice, specialization degree, training in scientific societies) being internship the best system of medical training that was started in Argentina in 1946. In the last decade there has been an important increase in the number of vacancies for the internship system which were partially covered. Medical recertification is voluntary and require doctors to retest every 5 years. Different laws and ministry resolutions establish the legal framework for training undergraduates, certifying and recertifying specialists.     

How to use JSLM2009 guideline on the bedside teaching and learning in teaching hospitals

It is tremendously important to learn standard practice for residents especially of postgraduate year 1 and 2 grades. In teaching hospitals, residential training is usually "on the job" and management of patients is highly individualized. Thus, residents are always aware of how far their practice stands away from principles. To confirm principles of daily practice easily, JSLM2009 Guideline is an important tool in residential training. Attending physicians and supervisors should educate their residents about "clinical pearls" in addition to principles.     

Cleveland Clinic Lerner College of Medicine: an innovative approach to medical education and the training of physician investigators.

Cleveland Clinic Lerner College of Medicine (CCLCM) is an innovative, five-year medical education track within Case Western Reserve University School of Medicine (Case) with a focused mission to attract and educate a limited number of highly qualified persons who seek to become physician investigators. CCLCM curriculum governance, faculty appointments and promotions, and admissions committees are integrated with respective Case committees. The CCLCM curriculum is based on faculty-defined professional attributes that graduates are expected to develop. These attributes were used to create curricular and assessment principles that guided the development of an integrated basic science, clinical science, and research curriculum, conducted in an active learning environment. An organ-system approach is used to solidify an understanding of basic science discipline threads in the context of relevant clinical problems presented in PBL and case-based discussion formats. Clinical skills are introduced in the first year as part of the two-year longitudinal experience with a family practice or internal medicine physician. The research program provides all students with opportunities to learn and experience basic and translational research and clinical research before selecting a research topic for their 12- to 15-month master-level thesis project. All Case students participate in required and elective clinical curriculum after the second year, but CCLCM students return to the Cleveland Clinic on selected Friday afternoons for program-specific research and professionalism-learning activities. A unique portfolio-based assessment system is used to assess student achievements in nine competency areas, seven of which reflect the Accreditation Council for Graduate Medical Education competencies.     

The influence of physicians' demographic characteristics and their patients' demographic characteristics on physician practice: implications for education and research.

In recent years, interest in improving health care to diverse patient populations has stimulated the development of academic and clinical resources to improve physicians' cultural competence. These efforts have focused on increasing physicians' sensitivity to the roles patients' ethnicity and culture play in health care. However, the influence of physicians' own demographic characteristics on their practice of medicine is an important, yet relatively overlooked, consideration among efforts to improve cross-cultural care. There is a strong presumption in the medical literature that clinicians are neutral operators governed by objective science and are unaffected by personal variables. Yet, there is a body of research that finds physicians' practice patterns are influenced by their own demographic characteristics, and patient care is affected by the demographic concordance or discordance of the physician-patient dyad. The author discusses this existing literature to illustrate the presence and importance of the impact of physicians' demographic characteristics on the care they provide and discusses strategies to mitigate this influence. Greater attention to understanding the way in which physician demographic characteristics influence clinical care using multidisciplinary and multimodal approaches provides an opportunity to improve the quality of medical education and improve the quality and efficacy of medical care.     

Evidence-based dentistry: what's new?

The importance of evidence for every branch of medicine in teaching in order to orient the practitioners among the great amount of most actual scientific information's, and to support clinical decisions, is well established in health care, including dentistry. The practice of evidence-based medicine is a process of lifelong, self-directed, problem-based learning which leads to the need for clinically important information about diagnosis, prognosis, therapy and other clinical and health care issues. Nowadays the practice of dentistry is becoming more complex and challenging because of the continually changing in dental materials and equipments, an increasingly litigious society, an increase in the emphasis of continuing professional development, the information explosion and the consumer movement associated with advances on the Internet. The need for reliable information and the electronic revolution have come together to allow the "paradigm shift" towards evidence-based health care. Recent years have seen an increase in the importance of evidence-based dentistry, aiming to reduce to the maximum the gap between clinical research and real world dental practice. Aim of evidence-based practice is the systematic literature review, which synthesizes the best evidences and provides the basis for clinical practice guidelines. These practice guidelines give a brief review of what evidence-based dentistry is and how to use it.     

Research in Training Clinics and Practice Research Networks: A Route to the Integration of Science and Practice

The present commentary encourages the development of research infrastructures within the training clinics of clinical psychology programs, the use of such infrastructures for creating a true integration of science and practice in the earliest days of graduate student education, and the formation of collaborative practice research networks among clinics and across other mental health agencies. Such developments may contribute to more rapid creation of ways of integrating science and practice and to methods for creating large-scale, scientifically rigorous, and clinically meaningful research to answer the most pressing questions that our profession faces.     

The status and outlook of the training of pathologists in the RSFSR

Pathology service in the RSFSR suffers, at present, from the lack of pathologists: only 2393 (57.3%) of 4174 positions are occupied. Particularly difficult is the situation in Eastern Siberia and Moscow where only 47.7 and 48.6% positions, respectively, are covered. Lack of professional pathologists is aggravated by an artificial decrease of positions number as compared to real need, by the increase of proportion of persons retired or those having a preretirement age (30%), by a high percentage (over 30% of positions) of persons experiencing pathology as a second profession (65% of them do not have a sufficient knowledge and practice in pathology), by a low level of medical education in general and nonsufficient promotion of pathologists (only 39.3% pathologists have attestation categories). To solve the crisis the RSFSR Ministry of Health started in 1988/89 4-year training of pathologists at the pathology chairs of the RSFSR Medical Institutes: subinternship (1 year), internship (1 year), clinical internship (2 years). The realization of this program will result in turning out of 724 pathologists by 1994. The progress in pathologists training will require the improvement of technical basis of pathology chairs and departments and solution of certain organizational problems.     

Closing the Gaps: Developmental Psychopathology as aTraining Model for Clinical Child Psychology

Espouses developmental psychopathology as a framework for training our future leaders due to its emphasis on an ecological, transactional lifespan perspective, as well as interdisciplinary bridging and policy focus. This perspective, used as a framework for questioning and thinking about the complex interplay of psychological and social phenomena, provides a method for closing the gaps in training future psychologists as it allows for the development of niche expertise under an umbrella of the broader, ecological perspective. In an increasingly complex world of shrinking mental health dollars and growing severity of mental health problems for families and youth, clinical psychologists are needed more than ever to solve social problems. The current training paradigms in clinical child psychology programs need redirection and clarification for future psychologists to contribute meaningfully to science, practice, and policy. This article provides background in the history and influence of the developmental psychopathology perspective, as well as future implications for doctoral training programs in clinical psychology.     

Evidence-based practice in psychology: perceptions of graduate students in scientist-practitioner programs

The evidence-based practice movement in psychology (EBPP) is a relatively recent initiative to improve client care by integrating the best available research evidence with clinicians' expertise in the context of patient values and preferences. As this movement gains momentum in the field of psychology, training programs will likely need to modify their curricula to include training in the process of EBPP. An online survey was conducted of clinical psychology graduate students in programs that identified themselves as having a scientist-practitioner or clinical science model (N = 1,195). Understanding of, experiences with, attitudes towards, and training in EBPP was assessed. Students had a generally favorable view of psychology's move toward EBPP. Although students reported a moderate amount of exposure to and experiences with EBPP, misunderstandings about the principles of EBPP were prevalent. Compared to students planning primarily clinical practice careers, students planning primarily clinical research careers were more favorable towards EBPP, expected EBPP to be more influential in their future careers, and were more likely to use research, but less likely to use client preferences to guide treatment planning. Recommendations for modifying training programs to promote EBPP are discussed.     

The evolution of a required research program for medical students at the University of Washington School of Medicine.

The concepts and tools clinicians use to understand disease and treat patients are the direct product of basic and applied scientific inquiry. To prepare physicians to participate in this tradition of medical science, the University of Washington School of Medicine (UWSOM) created a research requirement in 1981. The objective was to provide students, during their clinical years of medical school, with first-hand experience in hypothesis-driven inquiry and an understanding of the philosophies and methods of science integral to the practice of medicine. A comprehensive curriculum review in 1998-2000 identified several limitations of this requirement. Although many students completed it successfully, others struggled to find mentors, funding, or time as coursework became more demanding. Other students found they had no interest in or aptitude for the research process itself. Accordingly, UWSOM has reaffirmed its commitment to independent inquiry but expanded the ways in which students can meet the requirement. Three research options are now available under the Independent Investigative Inquiry (III) program, generally completed the summer after students' first year of medical school. These are the hypothesis-driven inquiry, a critical review of the literature, or an experience-driven inquiry in community medicine. The goal of UWSOM is to shape new physicians who can manage rapidly changing medical science, information technology, and patient expectations in clinical practice and/or laboratories. The role of III is to teach students to develop personal methods of acquiring new knowledge and integrate it into their professional lives. Faculty support, program oversight, and funding have been increased.     

临床技能培训规范在妇科肿瘤学教学中的应用

临床技能培训是提高临床教学质量的重要内容,而建构针对性较强的临床技能培训规范则是提高妇科肿瘤学临床教学质量的关键环节。昆明医科大学第三附属医院妇瘤科,采用"知群体-建规范-重思路-提要求"的"四步走"策略进行培训,既有利于学生"三基"的融会贯通,激发学生学习妇科肿瘤学临床技能的主动性;又有利于任课教师在临床技能培训中拓展思维,调动带教的积极性。该方法为妇科肿瘤学临床技能规范培训提供了一种新途径。     

The status of the Beck inventories (BDI,BAI) in psychology training and practice: A major shift in clinical acceptance

While the Beck Depression Inventory I and II (hereon BDI) have been a mainstay in mental health assessment for many decades, a cursory review of survey‐based “test use” studies in the 1990s finds that the Beck Anxiety Inventory (BAI) was not initially a highly ranked test in the assessment of anxiety or psychopathology. To date, a review of the extant literature on the popularity of the Beck inventories in professional psychology training or practice settings has not been systematically analyzed, although Piotrowski and Gallant (Journal of Instructional Psychology, 36, 2009, 84) found the BAI the most visible anxiety scale in the research literature between 2000 and 2005. Yet, quite evident, the field of clinical assessment remains highly competitive with a proliferation of mental health scales and measures introduced, perennially, in both the professional and research literature. In addition, since the mid‐1990s, regulatory restrictions (i.e., managed care directives) on the feasibility of providing multimethod assessment services has also been a potent headwind in professional practice. Thus, historically, the professional acceptance of the BDI and BAI remains somewhat opaque, in terms of degree of usage in both training and practice settings compared to other assessment instruments. Hence, the aim of the current study is to address this gap in the literature. To that end, the author identified, through an extensive literature review, survey‐based studies with regard to personality assessment that reported on graduate‐level training in psychological testing and test usage patterns from 1989–2017. This systematic search yielded 45 articles (including 1 dissertation study) which served as the data pool for the current review (Training settings, n = 10; Practice settings, n = 35). The analysis found that the BDI has been relied upon to at least a moderate degree in 21 of the 35 (60%) of the surveys of practice settings and in 7 of the 10 (70%) of the studies of academic/internship training. Although the BAI has not been as popular as the BDI historically, this review clearly indicated that since 2010, the BAI has made a pivotal shift toward professional acceptance in practice, generated much enthusiasm in internship training, and been embraced by clinical faculty. Reflecting this emergent popularity of the Beck inventories, the current review indicated that, overall, 10 of the 14 studies (71%) since 2010 reported that both the BDI/BAI have been: (a) recognized and relied upon to a high degree in both assessment training and practice, (b) a valuable clinical tool for mental health clinicians, and (c) considered the instruments of choice amongst the myriad of brief, self‐report measures in the assessment of mood disorders. Potential competing factors, such as other established and newly introduced measures of anxiety and depression (e.g., GAD‐7, PROMIS, PHQ, DASS‐21) that may impact future trends regarding usage of the Beck inventories, were discussed. Furthermore, research efforts should investigate the common factor of negative affectivity reflected in the Beck inventories when differentiating depression and anxiety states in monitoring treatment outcomes.     

Informed evaluation of pathology residency programs

OBJECTIVES: To identify resources and summarize important issues in anatomic and clinical pathology training and to assist the pathology resident candidate in evaluating potential training programs. DATA SOURCES: Published guides for medical residency applicants, recent literature discussing pathology education, and World Wide Web sites. STUDY SELECTION: Resources perceived by the author as valuable for the pathology resident candidate. DATA EXTRACTION: Key issues in pathology education are identified. DATA SYNTHESIS: Issues are discussed from the perspective of a pathology resident candidate, and resources for further information are provided. CONCLUSIONS: The pathology residency candidate faces unique challenges in the residency search process because of the breadth of pathology training and the limited exposure to the practice of pathology in medical school. General guides for residency applicants include little discussion of pathology-specific issues. Recent literature discussing pathology education is fragmented but provides invaluable insights for resident candidates. This review seeks to identify a wide variety of issues and resources as a starting point for evaluating potential training programs.     

Focus on: Westchester County Medical Center Division of Biomedical Engineering

The Division of Biomedical Engineering (DBME), a vital element in the structure of any medical center, provides complete biomedical equipment services at Westchester County Medical Center (WCMC), through a Biomedical Instrumentation Program. Under this program, the DBME assumes direct responsibility for all diagnostic imaging equipment in radiology, radiation medicine and nuclear medicine; and patient care, surgical life support (respiratory care) equipment in critical care units, operating rooms, G.I. (gastro-intestinal) suites, renal center, burn center, emergency rooms, as well as clinical laboratories. In addition, the DBME provides academic and internship programs, research, design, database support, technology planning, and device inspection or evaluation. The DBME is "looking into the future" for a gradual migration of state-of-the-art technology into healthcare.     

A psychological re-analysis of the scientist–practitioner model

For decades, NHS clinical psychologists have struggled to implement the scientist–practitioner model of professional practice. The pressure for effectiveness and efficiency in health services internationally, and the advent of the NHS research and development (R & D) strategy in the UK make this a suitable moment to reframe this model, in favour of the more attainable, complementary and timely approaches of ‘empirical clinician’, ‘evaluative clinical scientist’ and ‘clinical scientist’. As well as being harmonious with the R & D programme, these more discrete models of professional practice can facilitate arrangements for basic training and continuing professional development. In this review paper, the R & D strategy is analysed from the standpoint of a ‘self-regulation’ model, as applied to clinical psychology. This psychologically reflexive approach focuses attention on the need for professions to observe their own research behaviour, to set appropriate improvement goals for themselves, and to alter their behaviour if they are to adapt successfully to the changed NHS. The literature concerned with modifying the behaviour of a range of professionals is used to highlight promising ways to self-manage effectively in the future. Copyright © 1998 John Wiley & Sons, Ltd.