A proposed managed-care curriculum for podiatric residencies

This article describes a curriculum that could be included in podiatric residencies to help residents function successfully in a managed-care environment. Various groups have identified and implemented the competencies necessary to function within such an environment. Podiatric residents, who are well trained in the clinical management of podiatric problems, can succeed in a managed-care environment if residency programs include training objectives and methods to address these competencies. This article describes the managed-care components of two primary-care residency programs and a podiatric program and proposes a managed-care curriculum for podiatric residencies. The author's goal is to educate residency directors and faculty members on possible objectives and methods that can enhance the podiatric resident's educational experience and knowledge of managed care.     

Specific clinical competencies for managing care: views of residency directors and managed care medical directors

CONTEXT: Although medical educators recognize the need to prepare physicians to work effectively in managed care environments, managed care is often perceived negatively by academic physicians. Curricular reform has been hampered by a failure to seek agreement about specific clinical competencies that are important to both managed care directors and medical educators. OBJECTIVES: To identify specific clinical competencies in the managed care setting and to assess agreement between residency directors and managed care medical directors on the importance of these competencies. DESIGN, SETTING, AND PARTICIPANTS: Surveys (1998-1999) of a national sample of 59 residency directors involved in managed care training programs (response rate, 94%); a sample of 186 residents in these programs and 258 matched control residents (response rate, 77%); and national samples of 147 managed care organization (MCO) medical directors (response rate, 67%) and 140 primary care residency program directors in areas of high MCO penetration (response rate, 73%). MAIN OUTCOME MEASURES: Specific clinical managed care tasks as defined by residency directors; self-reported confidence in performing these tasks by sample residents vs control residents; and importance of these tasks as rated by MCO medical directors and residency program directors. RESULTS: Twenty-six specific clinical managed care tasks were identified by the residency directors. Residents who participated in managed care training were significantly more confident than their counterparts in performing 20 of the 26 tasks (P<.01 for all). Residency directors and MCO medical directors viewed 65% of these tasks as important to patient care during the next 5 years. Of the 10 tasks most highly rated by residency directors and MCO medical directors, 9 were the same, addressing time management, ethics, case management, practice guidelines, cost-effective clinical decision making, referral management, disease management, patient satisfaction, and clinical epidemiology. CONCLUSIONS: Our data indicate that residency directors and managed care medical directors value mastery of many of the same specific clinical competencies in managed care. Previously documented negative attitudes toward managed care among academic physicians may obscure an underlying concordance about the skills essential to managing the health of populations. JAMA. 2000;284:1093-1098     

Significant attitude changes among residents associated with a pediatric nurse practitioner

In the study reported here, significant changes in attitudes occurred over a three-year period among pediatric residents who had close association with a pediatric nurse practitioner (PNP) in their residency program. Residents entering the training program had an overall uncertain attitude toward PNPs but did respond favorably to the PNP's participation in the care of well children, patient education, and follow-up care. The greatest number of attitude changes toward the PNP took place after the first year of interaction between the residents and the PNP. After the first year, the residents favored the PNP's participation in the care of minor illnesses and stable chronic illnesses and in management of telephone calls from parents with concerns. Second-year residents also felt that the PNP was accepted by patients and physicians, that the PNP contributed to the reduction of health care costs, and that the PNP should have an expanded role. Upper-level residents continued to express favorable attitudes. The findings support the authors' hypothesis that favorable attitudes on the part of physicians toward PNPs can be cultivated during residency training by exposing residents to a PNP role model. In addition, the findings suggest that subsequent years of exposure will reinforce these favorable opinions if favorable opinions are established early in residency training.     

A scheduling model for hospital residents

When medical students finish their school they must go through a horrendous apprenticeship known as hospital residency to be able to practice medicine. During residency, they work at least 16-hr a day, 5-days a week, with 2 or 3 nights on-call. These can turn into 36-hr shifts. This means that many patients are being treated by exhausted novices, who are therefore much more likely to make mistakes. It was one such mistake, leading to the death of a New York woman, which led to serious attempts to reforming working hours of residents. In this paper, we developed a decision model which attempts to schedule residents based on the requirements of the residency program as well as the desires of residents as to days-off, weekends, on-call nights, etc.     

An ambulatory medical education program for internal medicine residents

Teaching the fundamentals of ambulatory medicine has many well known difficulties. An education program with specific topics covered and modeled after continuing medical education programs for practicing physicians was instituted for residents in a university hospital clinic and was evaluated. The program was effective in improving the residents' knowledge, in enhancing their attitudes toward the clinic, and in improving their performance of influenza vaccinations. No adverse effects of the program were found. This approach, in which a curriculum is carefully defined and participation of the house staff is required, makes the ambulatory medical education process more accountable for what is taught.     

Factors affecting residents' decisions to moonlight

Moonlighting by residents has been a major concern of residency program administrators, since extensive moonlighting by residents in addition to their already demanding residency work schedule might jeopardize patient care. In this paper, the authors examine the influence of several factors on residents' decisions to moonlight. The results indicate that the main motivating factor behind their moonlighting is economic and that residents moonlight more frequently when they have the opportunity to do so. In addition, the residents with higher levels of medical school indebtedness were significantly more likely to moonlight than residents with less indebtedness. Personal characteristics of the residents and their specialties also influenced moonlighting but had a smaller impact than amounts of stipends and indebtedness and the number of off-duty hours. The results also suggest that residency administrators can influence their residents' decisions to moonlight.     

北京市某区属三级医院住院医师规范化培训多维评价体系的构建与应用研究

目的:北京市某区属三级医院为提高住院医师规范化培训质量,以岗位胜任力及职业素养为主体,建立多维度的评价体系。方法:通过第三方发放问卷调查的形式,从患者评价、同行评价、护士评价、上级评价和自我评价5个方面,对在院培训的住院医师进行评价。本文使用SPSS 24.0软件对多维评价测定量表进行信度和效度分析,对评价结果采用方差...     

The development of medical education on alcohol- and drug-related problems at the University of Toronto.

Medical education on alcohol- and drug-related problems at the University of Toronto covers undergraduate, residency and graduate programs, a result of collaboration since 1959 between the university and the Addiction Research Foundation of Ontario. An undergraduate core curriculum, developed in the early 1970s, is offered in year 2; it has been supplemented by electives, selectives and comprehensive clinics. The undergraduate program is rated highly by students; since 1978, 3024 have completed the core program. Residency training started in 1974 and is available through electives lasting from 1 to 12 months in internal medicine, psychiatry, and family and community medicine. To date, 370 residents have completed one of these electives; 129 have completed graduate programs in which their theses concerned alcohol- and drug-related topics, and there have been an additional 13 research and postdoctoral fellows. Despite the progress, there is still a need to improve and expand the undergraduate and residency programs and to develop an effective program of continuing medical education. The goals should be to ensure that, as far as possible, all medical graduates from the University of Toronto have the knowledge, attitudes, skills and behaviours needed to contribute effectively to the prevention and treatment of alcohol- and drug-related problems in their chosen field of practice and to avoid problems from their personal use of alcohol and other drugs.     

Effect of history of psychological counseling on selection of applicants for residencies

The stress of medical education and its consequences are widely recognized and acknowledged. However, many students may be reluctant to seek help for stress-related problems because they are concerned over the ramifications such a decision may have on their career opportunities. The purpose of the present study was to determine the extent to which an applicant's history of having received psychological counseling for stress-related problems influenced residency program directors' perceptions of such applicants seeking admission to residency programs. Five hundred twenty-three residency directors in six medical specialties (pediatrics, internal medicine, family medicine, psychiatry, obstetrics and gynecology, and surgery) rated a hypothetical residency applicant. The student's gender and history of psychological counseling were manipulated, but their basic qualifications remained constant. The directors rated the likelihood that they would invite the student for an interview and accept the applicant for the residency. Analysis of variance showed that the directors in pediatrics, family medicine, and psychiatry viewed the hypothetical applicant more favorably overall than directors in internal medicine, obstetrics and gynecology, and surgery. The program directors rated female applicants more favorably than their male counterparts and had a strong bias against inviting for an interview or accepting into their programs students who had a history of psychological counseling. Implications of these findings are discussed.     

Maximizing patient care services to improve funding in a family medicine residency

The authors discuss ways to increase the funding base of a family medicine residency program through the appropriate use of procedures related to patient care and the provisions of service. Following a commitment of cooperation by residents and faculty members, certain principles of a business practice management curriculum were expanded and applied to a residency program. A written procedure manual describing the intricacies of the fee-for-service system was prepared for interns. Mechanisms for the review of patient care productivity and educationally productive incentives were developed. All of these steps were helpful in achieving improvement in the funding base for the residency. Areas for potential expansion in training programs and financial and staffing strategies to increase revenues are discussed. Although administrative decisions regarding fees and collection mechanisms are mentioned, this discussion focuses on educational and patient care activities that also produce revenue.     

A curriculum for the times: an experiment in teaching health policy to residents in family medicine

The Department of Family Medicine at Queen's University in Kingston, Ont., recently undertook a pilot project to familiarize residents in family medicine with physician-related health policy issues. The objective of the project was to ease the residents' transition into practice and to equip them to participate effectively in future policy debates. All first-year residents assigned to a 4-month clinical rotation in the Department of Family Medicine took part in the program, which consisted of 5 weekly 1-hour lecture and discussion sessions. The program was offered as one component of the 130-hour core curriculum for first-year residents. Participants evaluated the program as highly informative and extremely relevant to their career plans. The authors conclude that health policy is a subject that can be incorporated into the core curriculum of residency training programs.     

以能力为本全科医学住院医师培训方案的初步评价研究

目的以能力为本的全科医学住院医师培训方案实施过程中开展了形成性评价研究,以进一步完善培训方案,提高培训质量。方法采用问卷调查、个别访谈、理论考试、客观结构化临床考试、360°评估等方法对全科医学住院医师培训实施方案进行中期评价研究。结果本研究对由9个培训模块构成的、以能力为本的全科医学住院医师培训方案进行了中期评价研究,结果表明,该方案实施后,住院医师的道德素质、人际交往与沟通能力、医疗、教学能力均有不同程度的提高,同时强化了全科医师的核心能力。结论以能力为本的全科医学住院医师培训方案有助于更好地为社区培养适宜的高素质全科医师。     

“讲者”培训对提高眼科住院医师核心胜任力的研究

培养住院医师的核心胜任力的教学能力和终身学习力是眼科住院医师培训课程设置的新热点。在中南大学湘雅医院眼科中心住院医师规范化培训基地,设计以住院医师为核心的分级“讲者”培训课程,以培养各级住院医师的主动学习、归纳总结及表达能力;并根据第一阶段住院医师所处的不同阶段提供不同培训任务,利用线上、线下多种平台提供展示机会,使其成长为不同级别的讲者。通过由易到难、循序渐进的“讲者”分级培训,进一步强化培养住院医师的核心胜任力,使其从思维模式上被培养成主动学习者,从教学能力上被培养成为带教学员或讲师,并更能胜任未来的学习和工作。     

北京大学医学部内科总住院医师培训现状分析

总住院医师培训是由住院医师成长为主治医师的重要阶段,总住院医师承担着医疗、教学和管理职责。随着内科专业化的不断增强、专科医师规范化培训的逐步开展,内科总住院医师培训受到一定的影响。本文通过调研北京大学医学部在培内科总住院医师和临床指导教师,了解了内科总住院医师的培训现状,发现了存在的问题,并提出了改进建议。     

Two combined residency programs in internal medicine and pediatrics

Combined residency training in internal medicine and pediatrics is becoming a popular postgraduate program among graduating medical students. The number of such programs has increased rapidly but with little interchange of ideas and without the benefit of a national data base. In this paper, the authors review the experience of two combined programs. Initially established because of the desire to provide broad-based training in primary care, the programs now offer a curriculum that prepares residents for primary care or education in the subspecialties. The difficulty for residents of achieving competence in two disciplines is compounded by a lack of faculty role models. The two programs offer special advantages to the residents and the departments involved. The career outcomes of program graduates have varied from primary care or subspecialty practice in one or both disciplines to faculty positions in teaching institutions. Whether the program remains successful will depend on the ability of its graduates to offer special talents to academic and clinical practice settings and on the availability of funding.     

基于混合研究方法对比两个全科培训基地全科住院医师对培训的态度和看法

背景　中国正在完善分级诊疗和家庭医生制度,全科医生人才培养是实现这一制度的核心因素,目前我国全科医生缺口40万,全科住院医师规范化培训是培养高质量全科医生的主要途径。目的　通过混合研究方法广而深地了解来自两个城市的两个医院全科住院医师对其接受的全科规范化培训看法的异同,探讨不同规范化培训模式下可能带来的益处。方法　应用混合研究方法进行横断面研究。于2019年4月,采用整群抽样法抽取北京大学第一医院和北京大学深圳医院全科住院医师作为研究对象。两个医院均是“5+3”全科住院医师规范化培训基地,其中北京大学第一医院为“四证合一”的试点基地。结果　北京大学第一医院共发放问卷39份,回收有效问卷35份,有效回收率89.7%;北京大学深圳医院共发放84份问卷,回收有效问卷70份,有效回收率为83.3%。总体上,全科住院医师感觉到由于选择了全科专业而受到歧视,感觉作为全科医师能力不足。许多住院医师提到教学医师的教学态度较差。北京的住院医师比深圳的住院医师对培训更满意（P=0.001）,并觉得全科教学医师有足够的知识（P<0.001）和更合适的教学态度（P=0.004）,并且北京大学第一医院住院医师5项工作愿景得分均低于北京大学深圳医院,差异具有统计学意义（P<0.05）。结论　这些中国全科住院医师了解培训中需要改进的内容及培训的长项。北京全科住院医师对教学及工作满意度更高,其可以获得高水平教学医师的培训,并可以获得相关证明,提示教育改革可以增强培训力度并促进住院医师有更好的工作愿景。这些发现提示中国的住院医师面临着和国际相类似的情况,同时,也提示规范化培训教学课程的改革可能会带来益处。     

导师制在麻醉科住院医师规范化培训中的实践研究

住院医师规范化培训是医师培养的必需环节,北京大学第三医院麻醉科探索在规培中引入导师制;探讨应用导师制培训麻醉科住院医师的具体办法,包括导师遴选,明确导师职责,细化对住院医师的要求、培训内容及方式等。初步实践显示,导师制的应用有助于加强教师责任感、住院医师归属感、提高培训质量。     

A program to teach house calls for the elderly to fourth-year medical students

The authors report on the development, implementation, and evaluation of a curriculum to teach house calls for the elderly to fourth-year medical students. A faculty committee drew up a statement of philosophy: developed attitude, knowledge, and skill objectives: and specified required educational experiences for the curriculum. which was incorporated into a required eight-week rotation in ambulatory medicine. In 1985 and 1986, 18 students completed the new curriculum at three different clinic sites and made a total of 167 documented house calls. Prerotation and postrotation measurement of the students' attitudes documented a significantly (p less than .003) more favorable attitude toward house calls after completion of the curriculum. The students further indicated that they were more likely after the curriculum than before it to provide house calls as part of their future medical practice. The students' evaluation of the curriculum provided information on the relative effectiveness of teaching strategies used in the curriculum and documented the success of the curriculum in transmitting knowledge about the homebound elderly.     

Graduate medical education in the United States

The annual surveys of residency programs on which this statistical report is based have had a 95% or higher rate of response for the past five years. The number of accredited programs increased in 1986, primarily as a result of the accreditation of subspecialty programs in internal medicine. The largest number of programs is found in general internal medicine, followed by family practice, general surgery, and obstetrics/gynecology. More than one fifth of the programs are located in the Middle Atlantic region of the United States, with the largest number in the state of New York. The number of positions offered by accredited programs has increased as a result of the increase in the number of specialties with accredited programs. The number of GY-1 positions projected in the fall to be offered the following July has not increased significantly over the past three years. The reader is cautioned that the "number of positions offered" is affected by many factors and is subject to frequent change throughout the year. The number of residents on duty in ACGME-accredited programs increased in 1986 as a result of the increase in number of programs. However, the number of GY-1 residents on duty has decreased by 7% since 1984. This decrease is largely accounted for by the number of FMGs in GY-1 positions, a 21% decrease since 1984. This is especially evident in number of US citizen FMGs in GY-1 positions, a 38% decrease in the same time period. The specific factors that have caused the decrease in number of GY-1 FMG residents are not known at this time. One explanation might be a hesitation on the part of program directors to appoint new FMGs. Another factor could be the lower pass rate of US citizen FMGs on the FMGEMS, one qualification for appointment to an ACGME-accredited program. The number and percentage of women in residency programs continues to increase as it has over the past several years. For example, in 1977 women accounted for only 15% of residents; in 1986 they were 27% of residents on duty. Although female residents are found in nearly all disciplines, two thirds of them are training in family practice, internal medicine, obstetrics/gynecology, pediatrics, or psychiatry.(ABSTRACT TRUNCATED AT 400 WORDS)     

Essential areas for behavioral science training: a needs assessment approach

The design of effective behavioral science curricula for graduate medical education is an important link in the delivery of high quality medical care. Despite the work that has gone into developing methods of teaching and evaluating behavioral science training, as shown by numerous published articles, practicing primary care physicians still show deficits in handling patients' psychosocial problems. In this study, the authors propose the use of a behavioral science needs assessment questionnaire to ascertain the needs of residents for content areas based on the residents' medical school backgrounds and preferences for training. The questionnaire can also be used to monitor the effectiveness of existing curricula. The questionnaire was administered to 40 family practice residents in four programs to determine essential content areas. It was then used for curriculum planning in one program with 19 residents. Results from this program identified areas not covered in medical school and reflected the resident's comfort/confidence in practice in areas emphasized in the residency curriculum.