Occupational medicine residency graduate survey: assessment of training programs and core competencies

OBJECTIVE: This study provides insight into Occupational Medicine (OM) residency graduates and how residency programs are meeting their education goals. METHODS: A survey of graduates from nine OM residency program was performed to evaluate the effectiveness of OM residency training in the United States and Canada. RESULTS: Eighty percent of the OM residency graduates were currently practicing OM. Three-quarters worked in clinical practice for a mean of 20 hr/wk. Other activities varied and included management, teaching and consulting. Ninety-five percent were satisfied with their OM residency training. The competencies acquired were mostly ranked highly as practice requisites, although preparation in clinical OM might be better emphasized in training. Recent OM residency graduates were more likely to be board-certified in OM than other American College of Occupational and Environmental Medicine physician members (73% vs 41%). CONCLUSIONS: OM residency graduates over the past 10 years were highly satisfied with OM residency training, with the training generally meeting practice needs.     

刍议临床住院医师规范化培训中责任导师的作用

本文通过全方位的剖析临床住院医师责任导师的工作内容探究责任导师在临床住院医师规范化培训中的作用。临床住院医师通过责任导师的培养和教育,不仅掌握了很巩固的专业知识还增强了职业素养和临床技能,积累了很多宝贵的工作经验,在遇到突发疾病时,不慌不乱,能够快速的展开救治工作。责任导师能够言传身教,使得临床住院医师掌握了良好的专业治疗技能,还使得临床住院医师的职业素质得以大大提高,有利于规范临床住院医师的医疗行为,适用于临床住院医师的规范化培训。     

Components of effective clinical-nutrition training: a national survey of graduate medical education (residency) programs

A national survey was conducted by The American Society for Clinical Nutrition's Committee on Medical/Dental School and Residency Nutrition Education to assess the context in which nutrition training is provided in medical residency programs. Accreditation guidelines for residency programs suggested eight nutrition components that were endorsed by content experts for inclusion in residency training. Directors and nutrition educators from all accredited residencies in the United States were surveyed to determine the perceived importance of the components and the extent to which the components were actually present. The eight components appear to be relevant for exemplary nutrition training at the residency level. An important identified need is to train and involve more clinical-nutrition faculty members in residency programs.     

Adolescent medicine in pediatric practice

Adolescents report important unmet health care needs. This study directly assesses pediatricians' current practices pertinent to the primary care of adolescents. An anonymous questionnaire survey of general pediatricians was conducted in two suburban counties in New York State. Of the 101 respondents, 51% were older than age 50 and 88% were in private practice. The “average” pediatrician saw 28 patients in a 7-hour office day. Approximately 1 in 10 regularly saw patients with a sexuality-related concern, substance abuse problem, or anorexia nervosa. Fewer than half provided anticipatory guidance regarding sexuality, and only 14% questioned teens about depression. Respondents perceived factors related to fees, lack of time, lack of knowledge, and their image as obstacles to an expanded care of adolescents. Those with some training in adolescent medicine during residency were significantly more likely to provide care and anticipatory guidance related to sexuality and substance abuse. Thirty percent reported an interest in increasing their involvement with adolescents. We conclude that most of these pediatricians played a small role in meeting the health needs of adolescents.     

Family medicine residency training--three or four years?

Opinions about a four-year family practice residency were elicited from a nationally representative sample of three groups of family physicians. Questionnaires were mailed to a random sample of 308 residency graduates aged 30 to 35 years, all 383 residency directors, and a random sample of 319 third-year residents. Two mailings produced an 82 percent response rate. A four-year residency was favored by 32 percent of recent graduates, 20 percent of program directors, and 34 percent of third-year residents. Over 60 percent of residents and recent graduates would have entered a family practice program had the residency been of four years' duration. Perceived barriers to a four-year residency included lack of resources, loss of appeal, and the additional time commitment. Respondents were most willing to complete a fourth year of residency to receive additional training in orthopedics, obstetrics, gynecology, and pediatrics. Many respondents believed that the additional year would be helpful in obtaining hospital privileges in obstetrics and in coronary care and intensive care units. This study provides information useful in discussions regarding extending residency training.     

Availability and characteristics of abortion training in US ob-gyn residency programs: a national survey

Objective

To assess the availability and characteristics of abortion training in US ob-gyn residency programs.

Methods

We surveyed fourth-year residents at US residency programs by email regarding availability and type of abortion training, procedural experience and self-assessed competence in abortion skills. We conducted multivariable, ordinal logistic regression with general estimating equations to determine individual-level and resident-reported, program-level correlates of quantity of uterine evacuation procedures done during residency.

Results

Three hundred sixty-two residents provided data, representing 161 of the 240 residency programs contacted. Access to training in elective abortion was available to most respondents: 54% reported routine training—where abortion training was routinely scheduled; 30% reported opt-in training—where training was available but not routinely integrated; and 16% reported that elective abortion training was not available. Residents in programs with routine elective abortion training and those who intended to do abortions before residency did a greater number of first-trimester manual uterine aspiration and second-trimester dilation and evacuation procedures than those without routine training. Similarly, routine, integrated training, even for indications other than elective abortion, correlated with more clinical experience (all p<.01, odds ratio and confidence interval shown below).

Conclusion

There is a strong independent relationship between routine training and greater clinical experience with uterine aspiration procedures.     

美国住院医师科研能力培训的经验与启示

住院医师规范化培训的目的在于提高住院医师的综合素质,培养高质量医学人才.具有科研能力及创新精神的青年医师是医院学科建设得以持续发展的必备条件.本文介绍了美国住院医师规范化培训中加强科研训练的一些实践和探索,为解决我国住院医师规范化培训中所面临的问题提出了建议,以期为国内正在开展住院医师规范化培训的医学院校加强青年医师创新意识和科研能力的培养提供新的思路.     

Teaching hospital costs: the effects of medical staff characteristics.

This article examines the effect of medical staff behavior on the cost of hospital-based care and graduate medical education, and shows its implications for estimation of hospital costs. The empirical work brings a unique new data source for these characteristics to the estimation process. Our results indicate that there are important economies of scale and scope in hospital production, both for inpatient stays and for residency training. Controlling for medical staff characteristics significantly reduces the estimated costs of residency training. Staff characteristics may be capturing aspects of the quality of inpatient care and residency training provided by the hospital.     

The University of Missouri Rural Obstetric Network: creating rural obstetric training sites for a university-based residency program

This paper describes a rural obstetric experience that was developed for a university-based family practice residency program and designed to increase the number of deliveries per resident, the number of graduates practicing in rural areas, and the number of graduates doing obstetrics. Rural hospitals can be a source of deliveries for residency training programs. This rural obstetric experience also offers more training months in a rural setting and more months training with family physicians.     

Community medicine in the training of family physicians.

Family practice residency programs are encouraged to include community medicine training in their curriculum, but there is little agreement as to what community medicine is or what would constitute appropriate training. Community medicine is most commonly defined as a discipline concerned with the identification and solution of health care problems of communities or other defined populations. The inclusion of training experiences in the identification and solution of health care problems of communities has two basic advantages for family practice residency programs: it fosters a contextual approach in the care of individual patients and it builds knowledge and skills for those who will work with communities in future practices. An example of curricular content is included. A survey was conducted in order to determine what residency programs teach in the field of community medicine. The results show that few of the responding programs include the areas which most clearly relate to community medicine. It is hoped that the report of these results, the rationale presented for including community medicine in the training of family physicians, and the suggested outline of curricular content will further encourage and assist family practice residency programs to incorporate such training in their curricula.     

Length and content of family practice residency training

BACKGROUND: Family practice residency programs are based largely on a model implemented more than 30 years ago. Substantial changes in medical practice, technology, and knowledge necessitate reassessment of how family physicians are prepared for practice. METHODS: We simultaneously surveyed samples of family practice residency directors, first-year residents, and family physicians due for their first board recertification examination to determine, using both quantitative and qualitative methods, their opinions about the length and content of family practice residencies in the United States. RESULTS: Twenty-seven percent of residency directors, 32% of residents, and 28% of family physicians favored extending family practice residency to 4 years; very few favored 2- or 5-year programs. There was dispersion of opinions about possible changes within each group and among the three groups. Most in all three groups would be willing to extend residency for more training in office-based procedures and sports medicine, but many were unwilling to extend residency for more training in surgery or hospital-based care. Residents expressed more willingness than program directors or family physicians to change training. Barriers to change included disagreement about the need to change; program financing and opportunity costs, such as loss of income and delay in debt repayment; and potential negative impact on student recruitment. CONCLUSION: Most respondents support the current 3-year model of training. There is considerable interest in changing both the length and content of family practice training. Lack of consensus suggests that a period of elective experimentation might be needed to assure family physicians are prepared to meet the needs and expectations of their patients.     

关于提高住院医师培训质量的思考

住院医师规范化培训的广泛开展为提高我国整体医疗质量、培养高层次医师起到至关重要的作用。然而,目前我国住院医师培训无论在内容、方法、形式及评估手段方面仍存在很多不足,亟待完善。本文结合我科多年来的临床教学体会及国内外培训机构的相关经验,探讨提高外科住院医师培训质量的一些新思路。     

Training in Firearm Safety Counseling in Family Practice Residency Programs

The purpose of this study was to establish a national baseline regarding the prevalence of training of family practice residents regarding firearm safety counseling. A national survey of the residency directors at the 420 accredited family practice residency programs in the coterminous United States was used to assess the prevalance of training in firearm safety counseling, perceived effectiveness of such training, and perceived barriers to such counseling in residency programs. Program directors were sent a two-page questionnaire on firearm safety counseling activity in their programs and 71% responded. Few residencies (16%) had formal training in firearm safety counseling. The most common perceived barriers were no trained personnel (31%), too many other important issues (31%), not enough time (30%), and lack of educational resources (28%). Patient education materials (57%), video training programs (49%), and a curriculum guide (46%) were identified as resources, that would be most helpful in implementing a firearm safety counseling program. The results showed that formal training in firearm safety counseling is virtually absent from family practice residency training programs. This finding is not surprising given that less than 14% of the directors perceived firearm safety counseling would be effective in reducing firearm-related injuries or deaths and that research on effectiveness of such counseling is very limited.     

A model for merging residency programmes during health care consolidations: a course for success

INTRODUCTION: As health care delivery systems experience economic and competitive challenges, institutional mergers have become a means for economic survival. Academic hospital mergers are well chronicled, yet little has been written about postgraduate, or residency, training programme mergers and their human and programmatic consequences. Mergers present opportunities to strengthen and redesign residency programmes, but risks include programme disruption, resident and faculty morale, and housestaff and faculty recruitment and retention. Mergers can cause a sense of disequilibrium, influencing resident and staff perceptions of job security, commitment to teaching, and even the viability of the residency programme. OBJECTIVE: We describe a process for the survival and successful merging of existing residency training programmes in the context of larger health care mergers. People, management, and communication skills are critical for leaders of the change process. We offer approaches and guidelines for leaders and others who are involved health care and residency training programme mergers. Awareness and understanding of systems issues and human factors improve the likelihood of success. Although our guidelines are intended primarily for residency programme mergers, they are equally applicable to mergers of health care institutions. CONCLUSION: Successful residency training programme mergers require a carefully planned and executed series of actions that minimise disruptions. Effective communication on all levels is key. Success is associated with effective leadership, good communication skills, an open process with physician input, attention to institutional cultures, and a relatively short timetable. Most important is the continuous involvement, input, and creation of the programme by those most affected.     

Teaching colposcopy and androscopy in family practice residencies

Addressing the widespread human papillomavirus and genital epithelial dysplasia epidemic requires mastery of colposcopy, androscopy, and cryotherapy. Implementing a family medicine residency training program for these skills requires identifying a faculty facilitator to consider the issues of time, cost, caseload, reimbursement, specialist support, personal training, and office impact related to this training. Experience with teaching these skills in a community-based family practice residency indicates that startup costs range from $10,000 to $20,000. Residents will initially require from 30 to 60 minutes to provide a complete examination. All procedures require precepting by trained faculty and adherence to established protocol. The most frequent indications for these procedures include evaluating the abnormal Papanicolaou smear, visible cervical abnormalities, or evidence of clinical papillomavirus infection in either sex. Experience suggests that over 90% of cervical dysplasia can be managed entirely in the residency outpatient setting. These procedures have become the most common outpatient procedures performed, surpassing all others combined. Referrals to the residency for these procedures are readily available. Strategies for developing curriculum, literature review, learning materials, and training workshops are presented. Colposcopy, androscopy, and cryotherapy are appropriate additions to the training curriculum of family practice residencies.     

Outpatient consultations from a family practice residency program: nine years' experience

Previous reports of consultation rates from family practice physicians have included small sample sizes and have suggested higher rates in residency training programs. This report summarizes 9 years of data involving 161 family practice physicians in a residency training program and shows an overall rate of 1.4 percent for outpatient consultations. Otolaryngology, orthopedics, obstetrics/gynecology, and general surgery were the most frequent disciplines consulted. These data are helpful in designing health care systems that include family practice residency programs.     

Abortion training in U.S. obstetrics and gynecology residency programs

The majority (72 percent) of U.S. residency programs in obstetrics and gynecology include first-trimester abortion techniques in their training. Programs affiliated with public hospitals or with private non-Catholic institutions are the most likely to provide such training, while Catholic-affiliated training programs and those at military hospitals are the least likely to do so. Approximately 23 percent of institutions include abortion training as a routine part of residency, and 50 percent offer it as optional training. The 28 percent of residency programs that offer no abortion training represents an almost fourfold increase since 1976. Although more of the large programs affiliated with public hospitals now include such training as a routine part of their residency programs, fewer of the private non-Catholic programs--where the largest proportion of residents are trained--do so. Consequently, the number of residents exposed to abortion training may have declined slightly over the past decade. Little difference exists between the proportion of programs that offer training in first-trimester techniques and the proportion that train in second-trimester techniques. Nine percent of programs report that all residents participate in first-trimester abortion training, and another 56 percent report that at least half of their residents do so. The participation rate is linked to the expectations of the program: Approximately 88 percent of programs that routinely incorporate abortion techniques in their training report that from one-half to all their residents participate, compared with about 55 percent of programs that offer the training as an option. Approximately 82 percent of programs teach abortion techniques up to at least 20 weeks' gestation.(ABSTRACT TRUNCATED AT 250 WORDS)     

临床型研究生培养与住院医师培训相结合可行性研究

目的研究临床型研究生培养与住院医师培训相结合的可能性。方法对上海某三级甲等医院临床型研究生和部分临床带教老师进行问卷调查。结果对于临床型研究生培养纳入住院医师培训,对其临床能力培养是否有帮助和对就业是否有帮助,带教老师和学生之间看法具有显著差异(P<0.05);临床型研究生医师资格被带教老师和学生认为是存在的障碍第一位;带教老师认为临床型研究生培养纳入住院医师规范化培训有必要的比例明显高于学生。结论从经济上、技术上、组织管理和社会影响进行分析,临床型研究生培养与住院医师培训相结合有其可行性,两条途径的临床能力培训并轨后,将利于统一的专科医师准入制度的建立。     

临床科室实施规范化住院医师培训的思考

随着我国规范化住院医师培训工作的推进,培训管理的重点从宏观的制度设计逐渐转移到了培训任务的具体落实。文章分析了国内医院临床科室实施规范化住院医师培训中存在的不足,并提出了相应的对策。     

临床专业学位研究生培养与住院/专科医师培训的比较研究

通过对临床专业学位研究生培养与住院/专科医师培训模式的比较研究,尝试对两者进行同一化管理,将利于量化临床型研究生临床能力培养情况,提高招生吸引力,利于挑选优秀临床型研究生,与住院医师规范化培训对象招录工作相衔接。