Teaching behavioral science to family medicine residents: integrating training into the family practice unit

INTRODUCTION: Physicians need to be well trained in HIV risk assessment interview skills. Little has been written in the literature concerning training methods for this specialized interview. METHODS: One model to teach the HIV risk assessment interview has been developed and has been used to teach third-year medical students. We compared this interactive model, which uses simulated patients to teach HIV Risk Assessment, to a didactic one. Twelve medical residents were taken through either the interactive session or the didactic session. Pre-post changes from questionnaires were calculated to determine any differences in sessions. Also, Objective Structured Clinical Examinations (OSCEs) were used to grade all residents 2 weeks after their sessions. RESULTS: All pre-post changes were calculated and no statistically significant differences were seen (P > 0.50). OSCE interpersonal skills scores and content scores were calculated. The interactive group had statistically significantly higher scores (P < 0.05). CONCLUSION: The data supports the conclusion that an interactive method is more effective to use to train HIV risk assessment interview skills to medical residents when compared to the didactic method.     

Future of complementary medicine: training, status and the European perspective (Part 2)

In her second paper on developments within complementary medicine, Joanna Trevelyan takes a look at current approaches to training; issues surrounding the status of complementary medicine; and the influence Europe may have on the availability of therapies, natural medicines and supplements.     

The special training month for tutors and residents in family medicine in Valencia: evaluation of 3 cases]

Decompression and stabilization have been shown to improve neurologic outcome in cases of cervical spine trauma with proven compression of the spinal cord. This paper reviews experimental and clinical research to clarify the benefits of early surgery for cervical spinal cord injury. The direct clinical benefit of early surgery is a theoretic improvement in neurologic recovery over that of delayed surgery. Additional benefits of early surgery include the clinical advantages of a decreased length of hospitalization and its associated complications and a decreased time to rehabilitation and mobilization. Proper, timely surgical intervention can better the physiologic environment so as to allow for maximum neurologic improvement.     

A strategy for improving patient satisfaction by the intensive training of residents in psychosocial medicine: a controlled, randomized study

PURPOSE: To use a controlled, randomized design to assess the effect on patient satisfaction of an intensive psychosocial training program for residents. METHOD: Twenty-six first-year residents, in two internal medicine and family practice community-based programs affiliated with the Michigan State University College of Human Medicine, were randomly assigned during 1991 and 1992 to a control group or a one-month intensive training program. Experiential teaching focused on many psychosocial skills required in primary care. A 29-item questionnaire administered before and after the residents' training evaluated their patients' satisfaction regarding patient disclosure, physician empathy, confidence in physician, general satisfaction, and comparison of the physician with other physicians. Analyses of covariance with groups and gender as factors and pre-training patient satisfaction scores as the covariate evaluated the effect of the training. RESULTS: The patients of the trained residents expressed more confidence in their physicians (p = .01) and more general satisfaction (p = .02) than did the patients of controls. The effect of training on patient satisfaction with patient disclosure (p < .01) and physician empathy (p < .05) was greater for female than for male residents. CONCLUSION: The intensive psychosocial training program for residents improved their patients' satisfaction.     

Psychology training programs for direct services to the aging (status report: 1980).

Reports findings from a 1980 survey of all American Psychological Association-approved doctoral and internship programs in clinical and counseling psychology about their training opportunities for work with the elderly. Of the 127 programs that responded, 6 formal and 27 informal programs in the psychology of aging were reported. Among the internship programs, 56 (4%) had a formal part of training devoted to work with the elderly. Compared to data obtained in 1975, there has been only a moderate increase in involvement of training programs. Implications for the projected psychological needs of the elderly are discussed. (7 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Research secures the future of osteopathic medicine: Part 2: Readdressing the function and structure of colleges of osteopathic medicine

Many problems exist within the contemporary medical education process in general and the osteopathic medical profession in particular. Part 2 of this series suggests that the single greatest impediment to solving these problems is an institutional infrastructure that is not congruent with the institution's functions, as defined in its mission statement. (This mission statement generally entails two primary goals: education and research). Two major divisions within the core's infrastructure are suggested: medical education and medical research. By restructuring their infrastructure, colleges of osteopathic medicine can more effectively address and support their primary functions of education and research.     

A multicenter study to improve emergency medicine residents' recognition of intracranial emergencies on computed tomography

STUDY OBJECTIVE: Cranial computed tomography (CT) has assumed a critical role in the practice of emergency medicine for the evaluation of intracranial emergencies. Several recent studies have documented a deficiency in the emergency physician's ability to interpret these studies. The purpose of this study was to quantify the baseline ability of emergency medicine residents to interpret cranial CTs, and to test a novel method of cranial CT interpretation designed for the emergency physician in training. METHODS: A standardized pretest was administered to assess baseline ability to interpret CT scans. A standardized posttest was given 3 months after the course. Each test consisted of 12 CT scans with a short accompanying history. All scans were validated by 3 expert reviewers for difficulty and diagnosis. A 2-hour course based on the mnemonic "Blood Can Be Very Bad" was then administered. "Blood" reminds the examiner to search for blood, "Can" prompts the examiner to identify 4 key cisterns, "Be" denotes the need to examine the brain, "Very" prompts a review of the 4 ventricles, and finally "Bad" reminds the examiner to evaluate the bones of the cranium. RESULTS: Eighty-three residents at 5 institutions were initially examined. The mean percentage correct before the course was 60% (95% confidence interval [CI] 58%-64%) on the standardized pretest. At retesting 3 months after the course, the accuracy rate increased to 78% (n=61, 95% CI 75%-81%, P<.001 paired t test). CONCLUSION: Emergency medicine residents are deficient in their ability to interpret cranial CT scans. A novel educational course was demonstrated to significantly improve this ability.     

Detecting complications of direct arterial surgery: the role of intraoperative arteriography

Intraoperative arteriography was carried out using a specially constructed operating table and long x-ray film changer that permitted rapid serial exposure of the arterial reconstruction and the distal arteries. During a ten-year period, this method was applied in 1,810 arterial reconstructions, with technical problems being detected in 82 (4.6%) of these patients. The incidence of problems was highest in patients undergoing endarterectomy, where 16.7% of the patients were found to have either residual debris in the cleared segment or areas of stenosis. When bypass grafts were used, technical problems were found in 2.2% of patients and included embolism or thrombosis, graft torsion in vein grafts, stenosis of the distal anastomosis, and the creation of an intimal flap. In the entire series, five patients needed reoperation in the early postoperative period. In three of these, the operative arteriograms had been initially misread.     

A prospective survey of hospital ambulatory dental emergencies. Part 2: Follow-up to emergency treatment

Two hundred and fifty-three patients treated for dental emergencies at the University Hospital dental clinic over a three-month period were surveyed by telephone 24 to 48 hours and one year after treatment. The purpose was to investigate the success of treatment in resolving the chief complaint of pain and to determine the compliance with further dental care for the original dental problem. The results of the telephone survey showed that: patients available for questioning totaled 49.1% at 24 to 48 hours and 28.9% at one year; an 80.7% success rate was recorded in resolving pain within 24 to 48 hours; and the original emergency problem did not motivate a large number of these patients to seek further dental care.     

Implementation of a hypertext-based curriculum for emergency medicine on the World Wide Web

This project reports the publication of a variety of existing curricular resources for emergency medicine on the global Internet in a format that allows hypertext links between related material, timely updates, and end-user feedback. Curricular elements were converted to Hypertext Markup Language with extensive links between related content. The completed document contains instructions for curriculum development, specific curricula for subspecialty areas within a residency, reading lists for subspecialty curricula, banks of images, and board-type questions with answers. Users are provided with a mechanism to provide immediate feedback to section editors with suggestions for changes, including new references. Access to all or part of the document can be controlled via passwords, but is potentially available to anyone with an Internet connection and a World Wide Web browser. The document may by viewed on the World Wide Web at: http:@www.brown.edu@Administration@emergency_Medicine@ curr.html.     

Use of psychoactive substances in three medical specialties: anaesthesia, medicine and surgery

In order to determine the prevalence of psychoactive substance use in three specialty groupings, 1,624 questionnaires were sent to physicians in medicine, surgery and anaesthesia; all had trained at the same academic institution. A response rate of 57.8% was achieved. Comparison of prevalence of impairment rates showed no differences between Surgery (14.4%), Medicine (19.9%) and Anaesthesia (16.8%). Substance abuse was clearly associated with a family history of abuse; 32.1% of the abusers had a family history of such abuse compared with 11.7% of the non-abusers. Increased stress at various career stages did not appear to increase substance abuse; problem areas during medical life times were similar for each specialty. Substances most frequently used were marijuana (54.7%), amphetamines (32.9%); and benzodiazepines (25.1%). Seventy-three used psychoactive drugs which were non-prescribed. Drug counselling programmes were judged inadequate by most. Use of alcohol and drugs by faculty members was reported by a number of respondents.     

Mathematical modeling of a direct current electric arc: Part I. Analysis of the characteristics of a direct current arc

A mathematical model is used to describe fluid-flow, heat-transfer, and electromagnetic phenomena in the arc region of a direct current electric arc furnace (DC EAF). Based on those model results, a detailed physical analysis of the arc was performed, where the numerical computations help to explain the arc structure, its behavior, and the highly coupled relationship among their main physical variables. This analysis leads to the conclusion that the arc behaves in such a way that all the arc characteristics are controlled by the expansion of the arc, which is the main feature used to physically describe the arc behavior. The arc expansion is evident from the arc shape, which is defined as the region where conduction of electricity takes place. The arc shape is clearly seen in several contour fields presented in this work, such as the current density, the magnetic flux density, the electric conductivity, the electric potential, and the temperature fields. The results of this article focus on process analysis, to provide insight into the inter-relationship among the arc variables, and to establish physical grounds to subsequently explore dimensionless analytical representations to describe the arc behavior.     

Coping skills training for children: Effects on distress before, during, and after hospitalization for surgery.

Tested the hypothesis that coping skills (COS) intervention would help children adapt to hospitalization better than anxiety reduction (AR) or information interventions, using 33 parent–child dyads (children's mean age 7.2 yrs). All groups received the information procedure that described hospitalization and surgery experiences via a puppetry film. In the AR group, parents also learned procedures to help them reduce their own distress. Parents in the COS group learned how to help children use coping self-talk and related techniques. Results show that the AR and COS groups, compared to the information group, reduced children's self-reported fearfulness and parents' reported distress. The COS group, compared to the information group, exhibited fewer maladaptive behaviors during hospitalization and less problematic behavior in the preadmission week and 2nd postdischarge week. (PsycINFO Database Record (c) 2010 APA, all rights reserved)