Geropsychology post-doctoral training in public sector service delivery: the USF/Tampa VA fellowship model

There is a growing need for geropsychologists who are specialists in practice, research, education, and advocacy for older adults. The combined USF/Tampa VA geropsychology fellowship program focuses on the training of three post-doctoral Fellows each year in public sector service delivery across diverse long term care (LTC) and primary care settings. Addressing the bio-psycho-social needs of frail, poor, and minority older adults within an interdisciplinary framework exposes geropsychology Fellows to the complex nature of mental health problems of older adults and the need for collaborative efforts across professional lines. The program builds on prior geropsychology training at the graduate and internship levels by providing an integrated framework to achieve clinical, didactic, program evaluation, and advocacy goals: (1) delivery of state-of-the-art evidence-based psychological services to disadvantaged older adults in geriatric public sector primary care sites; (2) mastery of the knowledge base on diversity and interdisciplinary teamwork as they relate to providing services to older adults, including those residing in rural areas; (3) gaining competence in the evaluation of services to disadvantaged older adults; and (4) experience in public health advocacy for improvement of the LTC system.     

Doctoral Clinical Geropsychology Training in a Primary Care Setting

Abstract

Most older adults diagnosed with a mental disorder receive treatment in primary care settings that lack personnel skilled in geropsychological diagnosis and treatment. The Ferkauf Older Adult Program of Yeshiva University endeavors to bridge this gap by providing training in geriatric psychology, through coursework and diverse clinical practica, to clinical psychology doctoral students within a large urban professional psychology program. In an innovative effort to provide the most disadvantaged elderly with comprehensive mental health treatment and maximize trainee exposure to an interdisciplinary treatment model, the program also pairs selected doctoral psychology trainees with medical residents to optimize integrated mental health service delivery for primary care elderly. The program has the following core objectives: (1) Infuse the mental health and aging knowledge base into the regular graduate curriculum; (2) Provide interdisciplinary training in geropsychological diagnostic and consultative services within an urban primary care setting; (3) Provide interdisciplinary training in the practice of psychological and neuropsychological evaluation of elderly; (4) Provide training in geropsychological psychotherapeutic intervention, including individual, couples/family, and brief/psycho-educational therapies with outpatient older adults. These objectives are achieved by pooling the resources of a graduate school of psychology, a local public hospital, and an academic medical center to achieve educational and clinical service goals.     

Doctoral clinical geropsychology training in a primary care setting

Most older adults diagnosed with a mental disorder receive treatment in primary care settings that lack personnel skilled in geropsychological diagnosis and treatment. The Ferkauf Older Adult Program of Yeshiva University endeavors to bridge this gap by providing training in geriatric psychology, through coursework and diverse clinical practica, to clinical psychology doctoral students within a large urban professional psychology program. In an innovative effort to provide the most disadvantaged elderly with comprehensive mental health treatment and maximize trainee exposure to an interdisciplinary treatment model, the program also pairs selected doctoral psychology trainees with medical residents to optimize integrated mental health service delivery for primary care elderly. The program has the following core objectives: (1) Infuse the mental health and aging knowledge base into the regular graduate curriculum; (2) Provide interdisciplinary training in geropsychological diagnostic and consultative services within an urban primary care setting; (3) Provide interdisciplinary training in the practice of psychological and neuropsychological evaluation of elderly; (4) Provide training in geropsychological psychotherapeutic intervention, including individual, couples/family, and brief/psycho-educational therapies with outpatient older adults. These objectives are achieved by pooling the resources of a graduate school of psychology, a local public hospital, and an academic medical center to achieve educational and clinical service goals.     

Promoting the Development of Professional Identity of Gerontologists: An Academic/Experiential Learning Model

Graduate education in gerontology has an essential role in providing the foundational knowledge required to work with a diverse aging population. It can also play an essential role in promoting best-practice approaches for the development of professional identity as a gerontologist. The primary goal of this study was to determine what factors predict the professional identity and career path of gerontologists. In addition, the study explored how experiential learning influenced professional identity for newcomers to the field and for those experienced in an aging-related field (“professional incumbents”). Graduates (N = 146) of Association for Gerontology in Higher Education-affiliated graduate programs participated. Professional identity as a gerontologist was predicted by length of time in the field, age, satisfaction with coworkers, and satisfaction with opportunities for advancement. Experiential learning contributed to professional identity in important but different ways for newcomers to the field and for professional incumbents. The inclusion of an academic/experiential learning model within graduate gerontology programs promotes the development of professional identity and career path for all graduate students.     

Credentialing, diversity, and professional recognition-foundations for an Australian infection control career path.

BACKGROUND: There are no regulatory, legislative, or professional criteria stipulating minimum qualifications or experience that a health care worker must meet to be capable of coordinating an Australian infection control (IC) program. Measurement of IC competence is important to protect the public and for the ongoing credibility and growth of the profession. METHOD: Our study group was all 1078 nonmedical and nonindustry members of the Australian Infection Control Association in 1996. The survey examined perceived level of proficiency, level of education, and experience in health care and infection control. Almost three quarters (65%) of the members responded, and almost all (85%) of these respondents fulfilled the inclusion criterion of coordinating an IC program. RESULTS: Experience in IC ranged from less than 2 years (33.6%) to more than 20 years (10.0%). The majority (65.0%) of infection control professionals (ICPs) had between 8 years and 12 years IC experience. The respective proportions of respondents' self-ranked levels of proficiency on a 5-point scale were novice (3.6%), advanced beginner (21.2%), competent (33.8%), proficient (34.7%), and expert (6.8%). Almost half (47%) of the novices agreed that a registered nursing (RN) qualification was required, whereas a majority (41%) of advanced beginners considered both an RN and a basic IC course (BASIC) were required. Competent ICPs agreed less often than the other levels about their requirements. However, 27% of competents identified a BASIC and an undergraduate degree (UG) as the minimum requirements for a competent ICP. Proficient ICPs agreed that they required an RN, UG, BASIC, and a postbasic course in IC. Nearly all experts (80.0%) agreed that they required an RN, UG, BASIC, postbasic course, and a course in hospital epidemiology (EP). Two thirds of experts expected a master's degree as a requirement. CONCLUSION: The Australian IC profession is in an exciting period of development; however, the variation in ICP perception of the most appropriate qualifications and experience threatens the credibility and viability of the profession. This variation indicates the need for a clear-cut pathway that includes a system of credentialing, recognition of expertise, adoption of divergent roles, and improved networking. This pathway will lead to an increasingly credible and viable IC profession in Australia. Developing IC communities globally can benefit from the Australian experience.     

The effect of postgraduate education on COPD knowledge level of primary care physicians

Besides chest disease specialists, primary care physicians also have a great role in prevention and treatment of chronic obstructive pulmonary disease (COPD). The aim of this study was to evaluate the knowledge levels of primary care physicians about COPD before and after post graduate course. The level of knowledge was evaluated by a questionnaire including questions about COPD definition, prevalence, etiology, pathology, diagnostic methods, physical examination findings and treatment. Then a postgraduate course was performed about COPD and questionnaire forms were refilled. Ninety two physicians filled the questionnaire forms before and after seminar. Fifty of the physicians were female, 42 were male, mean age was 33.7 +/- 8.5 and duration of profession was 9.6 +/- 8 years. Thirty-six (39.2%) of physicians have attended a post graduate seminar on COPD previously. All physicians answered the questions about the most dominant sex that COPD was seen and etiologic agents correctly. Most of the physicians answered the questions about diseases that defined as COPD, pathology and physical examination findings incorrectly. There was no difference in number of correct answers between the physicians who have previously attended a post graduate seminar or not. Duration of profession was not correlated with correct answers. After the seminar, the number of correct answers increased significantly. Since most of the physicians answered the questions which are quite important in primary care such as COPD definition and physical examination findings incorrectly, it is thought that post graduate seminars about COPD should be performed more frequently. After the seminar, we observed significant increase in correct answers however long-term stability of this knowledge is needed to be determined in future studies.     

The master of public health graduate as infection preventionist:Navigating the changing landscape of infection prevention

Infection prevention is a rapidly changing field with regulatory requirements and emerging global public health threats. Infection preventionists (IPs) must use advanced epidemiologic skills for health care–associated infection investigation and prevention. A potential talent pool for IPs is the Master of Public Health graduate. Those hiring IPs should consider master of public health graduates as candidates who can help drive the future of this profession.     

Restructuring an internal medicine residency program to meet regional and national needs for general internists

The Department of Medicine at the University of Washington has reorganized its residency program to increase the emphasis on general internal medicine and primary care. New teaching services in community hospitals have been established, clinical training sites in Montana, Idaho and Eastern Washington opened, and primary care residency tracks begun. Current data indicate that a major shift in the career plans of our new residents also has occurred. Whereas a decade ago approximately two thirds of our residents were becoming subspecialists, almost two thirds of our 1979 and 1980 program graduates are headed toward careers as general internists. Many will practice in the region's smaller cities and towns. The program serves as a model for the development of a regional program for graduate training in internal medicine.     

Professionalism in the digital age

The increased use of social media by physicians, combined with the ease of finding information online, can blur personal and work identities, posing new considerations for physician professionalism in the information age. A professional approach is imperative in this digital age in order to maintain confidentiality, honesty, and trust in the medical profession. Although the ability of physicians to use online social networks, blogs, and media sites for personal and professional reasons should be preserved, a proactive approach is recommended that includes actively managing one's online presence and making informed choices about disclosure. The development of a "dual-citizenship" approach to online social media that separates public and private personae would allow physicians to both leverage networks for professional connections and maintain privacy in other aspects. Although social media posts by physicians enable direct communication with readers, all posts should be considered public and special consideration for patient privacy is necessary.     

Recertification in internal medicine: a program of continuous professional development. Task Force on Recertification

In 2000, the American Board of Internal Medicine (ABIM) introduced a second-generation recertification process that builds on the current knowledge-centered program by adding assessments of clinical and communication skills, clinical performance, and medical outcomes. The three-part process, called a program of continuous professional development, includes innovative self-evaluation exercises, documentation of essential knowledge, and confirmation of satisfactory qualifications and professional and community good standing. The program introduces the principles of continuous quality improvement; deemphasizes the summary nature of the traditional secure examination; and is designed to be a more continuous, less saltatory process for maintaining clinical competence. With the continuous professional development program, ABIM believes that it has taken a substantial step toward creating a recertification process that meets its goal of being valuable, doable, tolerable, and affordable" while maintaining the high standards expected of an accountable profession.     

Federal efforts to influence physician education, specialization distribution projections and options

I have tried to indicate the changes in the spectrum of medical education and practice, and have outlined in some detail the federal government's expanding role in this process.The deepening federal commitment to medical education is not the result of a drive for power or control. It is a response to public pressure as expressed through congressional legislation. Federal involvement represents the growing importance of the consumer in decision-making on matters of health.Growing cooperation between government and society is the pattern of the future in health matters. Changes will result more and more from decisions by all affected parties and less and less from random events and unilateral actions.Only through the participation of all significant interests can we achieve a health care system that will work as well for the medical profession as it does for the general public.     

Curriculum revision for a master's program in public health

The Master's degree program of the Escuela de Salud Pública de México (ESPM) has undergone a continuous process of evaluation and re-design since January 1988. An analysis of the program for 1985 showed problems of organization, sequence and integration of the curricular contents, as well as lack coherence with the stated objectives of the program and with the desired profile of the public health professional. Attention to environmental and population problems was almost absent. The Division of Academic Programs was created, and with the active participation of the academic staff a new design was developed, which resulted in the program to be applied in 1989. The next phase in this continuous process of evaluation and updating consists of the project Prospective Planning for Public Health Education in the Year 2005.     

Can a physician refuse to help a patient? American perspective

Refusal to help means for most people declining to accept the duty to treat. The reasons for refusing to help and how we think about these reasons from an ethical and professional viewpoint are outlined by considering ethical principles, an historical perspective, the law, societal contracts, medicine as a moral enterprise, professional codes, a physician's personal beliefs, reasons for refusing to help and physician discretion. Refusing to help a patient is not consistent with the ethical principle of beneficence, the concept of the primacy of patient welfare or the obligation of the profession to care for the sick. However duty to treat should not be exploited by institutions or place physicians in circumstances that they consider morally, psychologically or physically unacceptable. Following the principle of distributive justice, physicians are obligated to participate in the public debate to ensure that all patients have their needs met by developing or improving health care systems and addressing the new ethical questions that are likely to be generated.     

Erwartungen an die Ausbildung und den Beruf des Altenpflegers

Historically, the profession of geriatric nurse has arisen from the care of the sick and has developed very differently from region to region. A question as to the status of development of the profession of geriatric nurse cannot be answered by reference to the current status of legislation on professional law matters. If experts in that field focus too long on such matters, there is a danger that decisive developments in the profession of geriatric nurse take place outside their field of vision. This longitudinal survey involving trainees in their first year of training has revealed a series of interesting links and developments which had not been reckoned with. In the core training areas, for example, expected modes of behaviour with specific regard to age, education and gender were outlined which should result, in terms of the consequences for training, in measures to improve quality. Furthermore, there is a need for criteria to assure the quality of the training of geriatric nurses so as to guarantee a minimum quality standard. For example, there is currently a lack of any binding framework curriculum and provisions assuring the quality of the manpower and facilities available at training locations. Also questionable is the level of qualification of those who supervise the practical training of trainees at such locations and the whole area of further training of teaching staff.     

The Great Plains IDEA Gerontology Program: An Online,Interinstitutional Graduate Degree

The Great-Plains IDEA Gerontology Program is a graduate program developed and implemented by the Great Plains Interactive Distance Education Alliance (Great Plains IDEA). The Great Plains IDEA (Alliance) originated as a consortium of Colleges of Human Sciences ranging across the central United States. This Alliance's accomplishments have included faculty development in online distance education, development of cooperative approaches to graduate education among faculty and institutions, and development of quality graduate programming. In this article, the process of developing a national model for collaboration is discussed, the barriers that the program overcame are highlighted, and the lessons learned through implementing a graduate program in gerontology are presented. The outcomes of the assessment conducted across seven states to determine interest in an online gerontology graduate program and the findings from program evaluation efforts are presented.     

Training Clinical Psychology Students in Aging

Many conference reports have urged various strategies to increase the numbers of mental health service providers to the aged. The effectiveness of two strategies-specialized training and the infusion of gerontological content into regular professional curricula-were addressed in a program evaluation. Two groups of clinical psychology doctoral trainees were assessed on knowledge, attitudes, and akills. One group was in a special clinical-aging track; the other had different primary interests but-by virtue of being in the same graduate program-encountered gerontological content. The results support the suggestion that exposure to aging indirectly can contribute to increased knowledge and sophistication.     

The Great Plains IDEA Gerontology Program: an online, interinstitutional graduate degree

The Great-Plains IDEA Gerontology Program is a graduate program developed and implemented by the Great Plains Interactive Distance Education Alliance (Great Plains IDEA). The Great Plains IDEA (Alliance) originated as a consortium of Colleges of Human Sciences ranging across the central United States. This Alliance's accomplishments have included faculty development in online distance education, development of cooperative approaches to graduate education among faculty and institutions, and development of quality graduate programming. In this article, the process of developing a national model for collaboration is discussed, the barriers that the program overcame are highlighted, and the lessons learned through implementing a graduate program in gerontology are presented. The outcomes of the assessment conducted across seven states to determine interest in an online gerontology graduate program and the findings from program evaluation efforts are presented.     

Exciting new drugs on the horizon - eplerenone, a selective aldosterone receptor antagonist (SARA)

The morale of the medical professional is at an historic low in many countries. The recent case of a UK general practitioner being convicted of being a mass murderer, combined with increasing criticism of medical negligence and malpractice and an excessive influence of the large pharmaceutical companies has lead to the perception that the profession is under siege. Our professional leadership have not had sufficient public awareness to allay these concerns, and the resulting dip in morale is fast turning into a dangerous rout. We must review what has lead to this situation and what we should be doing now to put it right.Clinical research is under attack and the motives and ethics of large pharmaceutical company sponsorships of clinical trials is under increasing question. At this time there is a risk that medicine, and academic medicine in particular, will lose its attractiveness and the pace of achievements we have seen and benefited from in the last 2 decades may slow. The public debate should move on, it should move on to evaluate how much it would cost to reduce medical error rates to an acceptable level (to stop them altogether is impossible). It should move on to how we can get clinical trials designed and paid for by the public purse rather than merely grumbling that pharmaceutical companies take too much control of trials that they almost alone now appear to be sponsoring. And we should move on to debate about the role and status of the medical profession in the modern era. We can no longer do our best in secret and expect the public to trust us unquestioningly. The public wants and needs to be involved in our decision-making problems and errors. Only through informed debate will we improve health for the while population, now and in the future.     

Accelerating scientific publication in biology

Scientific publications enable results and ideas to be transmitted throughout the scientific community. The number and type of journal publications also have become the primary criteria used in evaluating career advancement. Our analysis suggests that publication practices have changed considerably in the life sciences over the past 30 years. More experimental data are now required for publication, and the average time required for graduate students to publish their first paper has increased and is approaching the desirable duration of PhD training. Because publication is generally a requirement for career progression, schemes to reduce the time of graduate student and postdoctoral training may be difficult to implement without also considering new mechanisms for accelerating communication of their work. The increasing time to publication also delays potential catalytic effects that ensue when many scientists have access to new information. The time has come for life scientists, funding agencies, and publishers to discuss how to communicate new findings in a way that best serves the interests of the public and the scientific community.     

Anatomy of the ward round

The ward round has been a central activity of hospital life for hundreds of years. It is hardly mentioned in textbooks. The ward round is a parade through the hospital of professionals where most decision making concerning patient care is made. However the traditional format may be intimidating for patients and inadequate for communication. The round provides an opportunity for the multi-disciplinary team to listen to the patient's narrative and jointly interpret his concerns. From this unfolds diagnosis, management plans, prognosis formation and the opportunity to explore social, psychological, rehabilitation and placement issues. Physical examination of the patient at the bedside still remains important. It has been a tradition to discuss the patient at the bedside but sensitive matters especially of uncertainty may better be discussed elsewhere. The senior doctor as round leader must seek the input of nursing whose observations may be under-appreciated due to traditional professional hierarchy. Reductions in the working hours of junior doctors and shortened length of stay have reduced continuity of patient care. This increases the importance of senior staff in ensuring continuity of care and the need for the joint round as the focus of optimal decision making. The traditional round incorporates teaching but patient's right to privacy and their preferences must be respected. The quality and form of the clinical note is underreported but the electronic record is slow to being accepted. The traditional multi-disciplinary round is disappearing in some centres. This may be regrettable. The anatomy and optimal functioning of the ward round deserves scientific scrutiny and experimentation.