Strengthening medical training programmes by focusing on professional transitions: a national bridging programme to prepare medical school graduates for their role as medical interns in Botswana

Background

The improvement of existing medical training programmes in resource-constrained settings is seen as key to addressing the challenge of retaining medical graduates trained at considerable cost both in-country and abroad. In Botswana, the establishment of the national Medical Internship Training Programme (MIT) in 2014 was a first step in efforts to promote retention through the expansion and standardization of internship training, but MIT faces a major challenge related to variability between incoming trainees due to factors such as their completion of undergraduate medical training in different settings. To address this challenge, in August 2016 we piloted a bridging programme for foreign and locally trained medical graduates that aimed to facilitate their transition into internship training. This study aimed to describe the programme and evaluate its impact on the participants’ self-rated perceptions of their knowledge, experience, clinical skills, and familiarity with Botswana’s healthcare system.

Methods

We conducted a national, intensive, two-week programme designed to facilitate the transition from medical student to intern and to prepare all incoming interns for their work in Botswana’s health system. Participants included all interns entering in August 2016. Formats included lectures, workshops, simulations, discussions, and reflection-oriented activities. The Kellogg Foundation Outcomes Logic Model was used to evaluate the programme, and participants self-rated their knowledge, skills, and attitudes across each of the programme objectives on paired questionnaires before and after participation.

Results

48/54 participants (89%) provided paired data. Participants reported a high degree of satisfaction with the programme (mean 4.2/5). Self-rated preparedness improved after participation (mean 3.2 versus 3.7, p?<?0.001), as did confidence across 18/19 knowledge/skill domains, suggesting that participants felt that the programme prepared them for their internship training. Exploratory analysis revealed that 20/25 participants (80%) reporting either no effect or a negative effect following participation had rated themselves “extremely” or “quite” prepared beforehand, suggesting the programme grounded expectations for interns who initially were overconfident. In contrast, no interns who had initially rated themselves “moderately” or “somewhat” prepared reported a decline in their self-rated sense of preparedness. Interns commented on the benefits of learning about roles/responsibilities, interacting with clinicians from Botswana’s healthcare sectors, and the sense of community the programme engendered.

Conclusions

This programme was feasible to implement and was well-received by participants. Overall, participants perceived an enhancement of their knowledge, skills, and expectations about their role in Botswana’s health system after completion of the programme. Our results are likely to be of interest to educators dedicated to training, professional transitions, and career pathways in similar settings in the region and beyond.

     

Training in Pediatric Psychology: Survey Results and Recommendations

Little specific information is available on the types of experiencesthat are important for training in pediatric psychology. Toaddress this need, the membership of the Society of PediatricPsychology (SPP) was surveyed regarding their views on the structureand content of training. A total of 160 completed forms werereceived, representing a return rate of approximately 32%. Surveyresults suggested that training in pediatric psychology should(a) encompass course work and applied experiences in developmentaland clinical child psychology, behavioral assessment and intervention,and child health psychology; (b) move from broad-based activitiesoccurring early in graduate training, to more specialized experienceslater on (internship and postdoc); (c) consider viewing postdoctoraltraining as a necessary step in the preparation of pediatricpsychologists. Distinctions between pediatric psychology andclinical-child and health psychology are discussed with respectto training needs.     

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.     

Graduate training in clinical psychology: A view from the consumer

Recent graduates from APA-approved doctoral programs in clinical psychology were asked to rate the adequacy of their training in a variety of skill areas (N = 316). For the most part, respondents were relatively satisfied with their training and were most satisfied with traditional skills in therapy and assessment. Comparisons of males and females, practitioners and academicians, and traditional clinical vs. community-oriented programs resulted in few significant differences. In light of other recent findings, the present results suggest that satisfaction with training and satisfaction with professional work role are not the same. Implications of these results and suggestions for future research are discussed.     

Internship placement data: is nonplacement the only concern?

Current discussion regarding securing internships often focuses on their availability. Thus, quantity is especially emphasized. However, quality is also an issue of importance. The number of intern applicants receiving slots at quality internship sites, as defined by the internship having been accredited by the American Psychological Association or having successfully been reviewed by the Association of Psychology and Postdoctoral Internship Centers, was assessed. Information regarding the number of unfunded internships also was gathered. Recommendations for increasing the availability of quality internships are provided.     

实习护生学习策略和学习动机及学习成效的质性研究

目的 归纳了解实习护生学习策略和学习动机及学习成效现况,明确三者之间的关系,以提出相应的教育对策,为提高实习效果提供参考。方法 采用质性研究的方法,便利抽取我院20名实习护生、10名带教老师作为访谈对象,对其进行一对一开放式深入访谈。结果 学习动机能通过影响实习护生的学习兴趣、态度、自觉性等方面,间接地影响学习效果;学习策略的深浅对学习动机的影响起着正相关的作用,并对学习成效产生一定的影响。结论 带教老师根据护生已有的学习动机、学习策略状态,使新的学习内容与已有的认知水平构成一个适当的跨度,帮助实习护生养成良好的学习习惯,培养慎独的工作作风,提高实习护生综合素质,培养出适应新形势的素质型、多向型、创新型的护理人才。     

The Places Rated Almanac and Training in Clinical Child Psychology

A recent chapter by Routh (1985) listed programs and rated the "quality" of graduates who were members of Section 1 of Division 12 (Section on Clinical Child Psychology). I question several assumptions and conclusions of this chapter. Particular issue is taken with the use of numbers of graduates as an indicator of who is training clinical child psychology Without examination of the training content. Additionally, the definitions of quality and excellence are not indisputable. Alternative procedures to find clinical child psychology training are outlined for the prospective students.     

Internship: Fact or Phantasy?

Many doctors have experienced their internship as a traumatic initiation into the medical profession. Rarely questioned, the process has resulted in a traditional cycle of distressed and unhappy interns. This article is an attempt to understand and clarify the institutional dynamics which are responsible for creating and maintaining these adverse patterns of behaviour. It concentrates on the interaction between the intern's inner phantasy world, the impact of the external hospital situation and the social defences which the hospital develops to protect its staff against the pain and anxiety inherent in their work. These collective social defence mechanisms often fail to protect the intern from intense anxiety and instead contribute to the hospital's increasing rigidity and resistance to change.     

Variation in lengths of training among residents enrolled in pediatrics and internal medicine training programs

Data were gathered in 1987 from 180 pediatrics and 302 internal medicine residency training programs about (1) the length of vacation provided their residents, (2) time allowed them for absence from work for reasons other than vacation, (3) how many of them during the previous three years had been required to extend their training to make up absences from work, and (4) whether a system was in place to cover their unexpected absences from work. All these variables affect the duration--but not necessarily the quality--of training that residents actually experience. The data show that these variables demonstrated wide ranges that depended on the postgraduate year of training, the discipline, the program size, and the program type (university, university-affiliated, freestanding, or military). The Accreditation Council for Graduate Medical Education, training program directors, and the American Board of Pediatrics and the American Board of Internal Medicine each need to consider these variables in making their respective decisions about accrediting training programs, verifying the clinical competence of trainees, and certifying program graduates.     

The tasks of pathological anatomy (pathology) in the medical college and the possible means for their resolution

The course of pathologic anatomy in medical students' training is unsatisfactory as it doesn't cover many aspects of present-day human pathology. The graduates lack necessary knowledge in general and special pathology. The existing system of pathologist training is deficient, it should last for at least 4 years (subinternship, internship, clinical internship). Coordinated plans of advanced training of both the teachers and the pathologists are necessary. The relationships between chairs and bureaus of pathology should be systematized and creation of educational-scientific-practical complexes validated.     

Internship and postdoctoral training in pediatric and clinical child psychology: a survey

A survey was designed to obtain data from pediatric psychology,clinical child psychology, and combined training centers. Sixtyprogram directors provided identifying characteristics aboutthe facility, application information for internship and postdoctoraltraining, information on clientele and case load of trainees,and specific training information. In addition, respondentsprovided definitions of the two areas and suggested differentiatingfeatures. It was concluded that the similarities are more numerousthan are the differences in training. Definitions suggest that(a) clinical child psychology has broader application than pediatricpsychology despite the latter's broader principles of application,and (b) pediatric psychologists rely heavily on the traditionalskills and techniques of clinical child psychology. The onlydifferentiating features identified were in terms of medicallyrelated populations of children served, collaboration with healthcare disciplines, and a specialized focus of viewing psychologicaldifficulties within the medical culture by pediatric psychologists.     

On the Origins of Clinical Psychology Faculty: Who Is Training the Trainers?

There exists little published research regarding the comparative performance of graduate programs in clinical psychology on relevant measures of program achievement. The present report thus aims to provide information about one such measure—program proficiency in training graduates to assume clinical psychology faculty positions. Degree-granting institution and year of degree completion were obtained for 1,529 individuals listed as core faculty at 150 university-based clinical psychology Ph.D. programs accredited by the American Psychological Association. On this basis, leading programs (i.e., those having trained numerous clinical faculty members) are identified. Proficiency in placing graduates in clinical faculty positions was moderately positively correlated with program reputational strength; it was not significantly associated with program size. A set of recommendations for the systematic investigation of factors germane to such proficiency, as well as to program achievement in other important (and heretofore unstudied) domains, is proffered. It is argued that no single measure is adequate as an overall gauge of program excellence.     

Career pathways and current practice patterns of clinical and counseling psychologists: A follow-up study of former interns

The present study examined career pathways and current work patterns for 110 graduates of an internship program. Results show that the group trained after 1980 went into private practice more rapidly than those trained prior to 1980. Both groups do extensive psychological testing. Implications are discussed.     

Differentiating roles of clinical and counseling psychology interns

Asked 60 clinical psychology interns and 54 counseling psychology interns from 18 APA approved university training programs to complete a survey form that involved rating the amount of emphasis placed upon various roles, functions and duties at internship and university training programs. Supervisors of the interns at the respective internship settings completed analogous forms, rating their perception of the degree of emphasis placed upon various roles, functions and duties. The data were analyzed via stepwise discriminant analysis to determine whether some roles would be more typical of one specialty. Finally, suggestions were offered for the improvement of university training programs and for the conduct of further research on roles of the two specialties.     

实习护士院外施救的意向及影响因素的调查

目的 研究实习护士院外目击意外事件时,采取施救措施的意向及影响因素。方法 采取方便抽样的方法,于2017年10月1日~12月1日对110名实习护士进行院外施救的意向及影响因素的问卷调查。结果 ①93.64%的实习护生在过去1年中参加过学校或医院组织的心肺复苏知识及技术培训,其中男生较女生参加急救知识培训较多,有CPR经历的护生相比无CPR经历护生参加急救知识培训也较多;②周围有防护用具对实习护士是否施救的影响最大,其次为有无目击者证明;③实习护士施救意愿平均得分（4.79±1.10）分,主要集中在3~6分,实习护士行为意愿评分较高,评分在5分以上达65.45%,不同性别、有无CPR经历的实习护士行为意愿评分比较,差异有统计学意义（P＜0.05）,不同学历、有无猝死高危亲属的实习护士行为意愿评分比较,差异无统计学意义（P＞0.05）。结论 实习护士参加急救知识、技术培训率较高,且院外施救行为意愿较高。施救行为受周围有防护用具、有无目击者证明等影响较大,应在加强心肺复苏理论知识培训的基础上,促进对实习护士施救能力的培养,使其树立良好的施救意识。     

Products of clinical-community-based training: National Asian American Psychology Training Center

The actual products of clinical-community-based training offered at the National Asian American Psychology Training Center (NAAPTC) internship are described. NAAPTC has responded to a need for comprehensive and specialized training which recognizes the multi-ethnic composition of American society and the diversity of the nation's mental health needs. The program has responded to the challenge by emphasizing a combination of broad based skill development, a community psychology model, and an interdisciplinary approach in its training experience. The many contrasting experiences offered are necessary to hone and refine diagnostic and therapeutic skills within a multi-ethnic community setting. These clinical, administrative, and community experiences are briefly reviewed to illustrate the comprehensive nature of the internship.     

Multicultural training in pediatric and clinical child psychology predoctoral internship programs

Surveyed directors of training of pediatric and clinical child psychology predoctoral internships regarding the extent of multicultural training within their programs. Respondents completed a brief survey assessing faculty and trainee ethnic composition, recruitment of minority trainees, content of training curricula, and perceptions of barriers to multicultural training. Ratings of the importance of multicultural training and the presence of minority interns were directly related to the presence of minority faculty. Recruitment of minority trainees appears to occur largely through program announcements. Didactic seminars on multiculturalism and informal resolution of intercultural conflicts predominate internship settings with less emphasis on formal structures for addressing multicultural conflicts. Implications for internship training are discussed.     

Predictors of doctoral student success in professional psychology: characteristics of students, programs, and universities

In the face of the rising number of doctoral recipients in professional psychology, many have voiced concerns about the quality of nontraditional training programs. Past research suggests that, on a variety of outcomes, graduates from clinical PhD programs outperform graduates from clinical PsyD and, to a lesser extent, counseling PhD programs. We examine an aggregate archival dataset to determine whether student or university characteristics account for the differences in outcomes among programs. The data show meaningful differences in the outcomes of clinical PhD, PsyD, and counseling PhD programs. Furthermore, graduates from research-intensive universities perform better on the psychology licensure exam and are more likely to become American Board of Professional Psychology diplomates. The available data support the notion that the ability to conduct research is an essential component of graduate education. In this light, PsyD programs represent a unique opportunity to train students in the types of evaluation and outcomes assessments used by practicing psychologists. We discuss implications for graduate-level training in professional psychology.     

Integrating research into clinical internship training bridging the science/practice gap in pediatric psychology

Existing literature highlights a critical gap between science and practice in clinical psychology. The internship year is a "capstone experience"; training in methods of scientific evaluation should be integrated with the development of advanced clinical competencies. We provide a rationale for continued exposure to research during the clinical internship year, including, (a) critical examination and integration of the literature regarding evidence-based treatment and assessment, (b) participation in faculty-based and independent research, and (c) orientation to the science and strategy of grantsmanship. Participation in research provides exposure to new empirical models and can foster the development of applied research questions. Orientation to grantsmanship can yield an initial sense of the "business of science." Internship provides an important opportunity to examine the challenges to integrating the clinical evidence base into professional practice; for that reason, providing research exposure on internship is an important strategy in training the next generation of pediatric psychologists.     

Responding to Clinical Psychology Practicum Competencies: An APPIC Perspective

This article offers a commentary by representatives of the Association of Psychology Postdoctoral and Internship Centers (APPIC) on the 2015 article written by Gonsalvez et al. related to the assessment of clinical competencies in clinical psychology practicum students. The four competency “super clusters” derived by Gonsalvez et al. result from a unique empirical hierarchical clustering approach and are sure to add important knowledge to the field. This commentary generalizes from clinical psychology education and training in Australia to the United States, expands from practica to internship and postdoctoral training, and reflects on some relevant APPIC issues and initiatives. Future research is also suggested.