Wanted: pediatric nephrologists! — why trainees are not choosing pediatric nephrology

A workforce crisis for many pediatric specialties, particularly nephrology, is due to growing retirement rates, attrition during training, and retention difficulties. To obtain specific information regarding pediatric nephrology trainee shortages, we administered two cross-sectional surveys to non-renal pediatric subspecialty fellows and pediatric nephrology program directors. We characterized the fellows' experiences with nephrology and the program directors' experiences with their fellows as well as their outcomes in the last 10 years. We analyzed responses from 531 non-renal fellows (14.4% response rate). Overall, 317 (60%) fellows rated nephrology as difficult, particularly women (65.4% vs. 49.5%, p?p?=?0.001). More men than women (24% vs. 8%, p?相似文献   

Loss of liver transplant surgeons into alternate career paths

In Germany, long‐term commitment of surgeons to transplantation is rare. Most surgeons leave transplant surgery after a short stint and follow careers in other surgical fields. This rapid turnover of liver transplant surgeons may result in poor resource utilization and potentially compromise patient safety. In this report, we have analyzed the caseload and the careers of 25 surgeons in liver transplantation over a period of 22 years. The median time in liver transplantation was short. Of all surgeons who engaged in liver transplantation, the median time was 3.5 years. Surgeons who completed their training remained in the field for 7 years. Surgeons who prematurely stopped their training remained for 2 years. Individual total caseloads of transplant surgeons were relatively low. The median number of procedures was 40 for all surgeons, 153 for currently active surgeons, 51 for surgeons who completed training, 27 for surgeons currently in training, and a median of four liver transplantations for surgeons who prematurely stopped liver transplantation. The vast majority (75%) of surgeons prematurely quit liver transplantation to follow alternate surgical careers. Structural changes in academic transplant surgery have to be made to facilitate long‐term commitments of interested surgeons and to avoid “futile” transplant careers.     

Repeated simulation-based training for performing general anesthesia for emergency cesarean delivery: long-term retention and recurring mistakes

BackgroundThe percentage of women undergoing cesarean delivery under general anesthesia has significantly decreased, which limits training opportunities for its safe administration. The purpose of this study was to evaluate how effective simulation-based training was in the learning and long-term retention of skills to perform general anesthesia for an emergent cesarean delivery.MethodsDuring an eight-week obstetric anesthesia rotation, 24 residents attended lectures and simulation-based training to perform general anesthesia for emergent cesarean delivery. Performance assessments using a validated weighted scaling system were made during the first (pre-test) and fifth weeks (post-test) of training, and eight months later (post-retention test). Resident’s competency level (weighted score) and errors were assessed at each testing session. Six obstetric anesthesia attending physicians, unfamiliar with the simulation scenario, generated a mean attendings’ performance score. The results were compared.ResultsAt one week of training, residents’ performance was significantly below mean attendings’ performance score (pre-test: 135 ± 22 vs. 159 ± 11, P = 0.013). At five weeks, residents’ performance was similar to mean attendings’ performance score (post-test: 159 ± 21) and remained at that level at eight months (post-retention test: 164 ± 16). Of the important obstetric-specific tasks, left uterine displacement was missed by 46% of residents at eight months.ConclusionFollowing lectures and simulation-enhanced training, anesthesia residents reached and retained for up to eight months a competency level in a simulator comparable to that of obstetric anesthesia attending physicians. Errors in performance and missed tasks may be used to improve residency training and continuing medical education.     

规范化培训与量化绩效考核对手术室感染率的影响

目的 探讨规范化培训与量化绩效考核对手术室感染率的影响.方法 2012年1-12月对我院手术室护理人员进行规范化培训并实施量化绩效考核,与201 1年1-12月感染率情况进行比较.结果 对手术室护理人员进行规范化培训,采取量化绩效考核之后,手术室感染率由1.46％下降到0.70％ （P=O.001）.结论 在护理管理中对护理人员进行规范化培训,并绩效考核量化其工作内容,能够调动其工作积极性,降低手术室感染率,提高护理服务质量.     

住院医师规范化培训临床教学查房的实践与体会

在国家住院医师规范化培训持续深入推进的背景下,以医院加强住院医师规范化培训临床教学查房为基础,分析了住院医师规范化培训临床教学查房的内涵及特点,提出了组织临床教学查房的实施方案,并就如何实现住院医师规范化培训临床与教学有机融合提出了意见、建议。     

社区全科医生课程建设的问题与对策研究

目的 探讨社区全科医生培训课程建设的问题及其解决办法.方法 通过访谈法、问卷调查法对全科医生理论培训课程进行整体评价.结果 经过调查发现,课程建设方面存在的问题主要包括三个方面：课程目标的制定缺乏学习者的参与、课程结构和内容不尽合理及遴选师资对社区工作了解不足.结论 加强课程建设、开展课程改革和整体优化课程结构是提高社区全科医生培训的重要措施,应进行教学目标、教学大纲、教材、教学模式和师资队伍等全方位改革,从而有效地提高社区全科医生培训的质量,为培养实用型全科人才奠定基础.     

2013年襄阳市城区健康知识知晓率、健康行为形成率和健康技能掌握率调查

目的 了解2013年襄阳市城区不同人群健康知识知晓、行为形成情况及社区居民健康技能掌握情况,为制定健康教育干预方案提供科学依据.方法 采用分层抽样和简单随机抽样方法,于2013年11月对本市城区内不同人群进行问卷调查.结果 健康知识总知晓率为86.3％,从高到低依次为中小学生（90.7％）、住院病人（90.1％）、行业职工（84.6％）及社区居民（82.5％）;健康行为总形成率为86.3％,从高到低依次为住院病人（88.6％）、中小学生（87.0％）、行业职工（79.5％）及社区居民（73.5％）,差异有统计学意义（P＜0.05）;社区居民健康技能掌握率为79.0％.结论 襄阳市城区健康知识知晓率、行为形成率及技能掌握率总体上达到国家卫生城市标准要求,但仍不客松懈,需进一步制定相应的健康教育干预措施.     

Therapist training in evidence‐based interventions for mental health: A systematic review of training approaches and outcomes

A lack of effective therapist training is a major barrier to evidence‐based intervention (EBI) delivery in the community. Systematic reviews published nearly a decade ago suggested that traditional EBI training leads to higher knowledge but not more EBI use, indicating that more work is needed to optimize EBI training and implementation. This systematic review synthesizes the training literature published since 2010 to evaluate how different training models (workshop, workshop with consultation, online training, train‐the‐trainer, and intensive training) affect therapists’ knowledge, beliefs, and behaviors. Results and limitations for each approach are discussed. Findings show that training has advanced beyond provision of manuals and brief workshops; more intensive training models show promise for changing therapist behavior. However, methodological issues persist, limiting conclusions and pointing to important areas for future research.     

早期运动训练对脑梗死后缺血半暗带GAP-43、Nogo-A及GFAP表达的影响*

目的： 探讨早期运动训练对脑梗死缺血半暗带区轴突生长相关蛋白43 （ GAP-43）、神经突起生长抑制因 子A（ Nogo-A）和神经胶质纤维酸性蛋白（ GFAP）表达的调控作用,及其对大鼠神经功能恢复的影响。方法 ： 健康成年雄性Wistar 大鼠,按随机数字表法分为假手术组、模型组、训练组。采用线栓法建立大脑中动脉闭塞 （ MCAO）大鼠模型,术后24 h 进行强度渐增的跑台运动训练14 d 和28 d。采用改良神经功能缺损评分（ mNSS） 评估神经功能;平衡木行走试验评估大鼠神经行为学改变;H-E 染色观察各组缺血半暗带区神经元病理形态学变 化;免疫印迹检测大鼠脑缺血半暗带GAP-43、Nogo-A 和GFAP蛋白表达变化;结果： 与假手术组相比,模型组 大鼠mNSS评分和平衡木试验评分均显著升高,脑缺血半暗带区GAP-43 和GFAP蛋白表达上调,而Nogo-A 的表 达下调。与模型组比较,跑台训练组大鼠mNSS评分与平衡木试验评分均显著降低,脑缺血半暗带区GAP-43 表 达上调,而Nogo-A 和GFAP表达下调。结论： 早期跑台训练可以促进轴突再生,抑制胶质瘢痕形成,最终改善 脑梗死大鼠神经功能障碍。     

Film as an educational tool to train psychotherapists

Starting with Freud who wrote about Dostoyevsky, Michelangelo, and da Vinci, therapists have acknowledged that the humanities and arts contain great sources of insight into human nature. In this paper, I argue for the need to incorporate insights acquired by artists into the training of psychotherapists. Specifically, I present and describe a graduate-level seminar I teach that uses cinema as a tool to train mental health practitioners. Films are used to expose students to a range of universal human issues; we discuss film characters' conflicts, motivations, sources of suffering, and attempts to cope. Further efforts should be devoted to search for ways to use art to inform and enrich the practice, training, and teaching of psychotherapDirected by Robert Redford and produced in the United Statesy.